Meirav Eilon Shahar, Israel’s ambassador to the United Nations in Geneva, speaking to the WHO Executive Board.

For the second time in as many years, WHO member states have voted down a proposal by Israel to remove a standalone item from the agenda of the 74th World Health Assembly – devoted exclusively to a report on health conditions in the Occupied Palestinian territories – and consider it as part of WHO’s overall health emergencies agenda.  

Saying that the agenda item unfairly singles out just one country for criticism, as compared to every other nation in the world, Israel on Tuesday proposed to the WHO Executive Board, which fixes the WHA agenda, that the report be considered as part of the overall discussion on WHO’s work in health emergencies when WHO member states meet in May. 

In a lengthy and unusual voting process on the closing day of the 10-day EB session, the proposal was rejected in a vote of 15 to seven – with 9 abstentions and 3 countries absent. Those supporting Israel’s position included the United Kingdom, Germany and Austria, joined by the United States, Australia and Colombia. EB members that were opposed included Oman, China, Russia, and Tunisia. 

Israel’s delegation said the report was a “political” item that does not reflect reality and will not change the situation on the ground.

“Item 25 is a political item with only one purpose – to attack Israel and to politicize an otherwise professional organization [WHO]. This must be changed…What I’m asking you to do today is to ensure that the World Health Assembly maintains its focus on health and the truth,” said Israel’s ambassador to the United Nations, Meirav Eilon Shahar.

“Regardless of what takes place in Geneva, we, Israel, will continue to work with the Palestinians and with WHO and we’ll continue to work on any problem and assistance intended to improve the health conditions for the Palestinians,” she added. 

The Palestinian representative, Ibrahim Khraishi, Ambassador of the State of Palestine to the UN, which holds observer status in the World Health Assembly, retorted that: “The [health situation in the occupied territories] is catastrophic and dire…Israel is finding it easy to renege on its responsibility, for example, it is not meeting its requirement…when it comes to vaccination.

“When we look at the rate of vaccination for [Israeli] citizens, the figure exceeds two and a half million, whereas not one single Palestinian citizen has had the jab because of Israeli practices,” he said. 

Khraishi cited the WHO report from the 73rd WHA in November 2020, which he said shows that infant mortality of West Bank Palestinians is six times higher, and maternal mortality nine times higher than that of the 600,000 Israeli settlers living side by side with Palestinians in the Occupied West Bank. The report also describes barriers Palestinians from the West Bank and Gaza face in accessing more health services, such as the more specialized services in Jerusalem, which is directly under Israeli rule and to which access is tightly-controlled. 

Ibrahim Khraishi, Ambassador of the State of Palestine to the UN and Palestine’s representative to the Executive Board.

After the vote among member states, Israel disputed the vaccination claims, saying that Palestinian inmates have received vaccinations and the PA has been provided with emergency supplies for 100 essential health workers – but the overall responsibility to vaccinate the roughly 5 million Palestinians living in the West Bank and Gaza lies with the Palestinian Authority (PA), not Israel. 

“We are very happy to extend assistance in facilitation of those vaccines in entrance to Israel,” said Eilon Shahar, referring to the expected arrival of PA-purchased vaccine supplies from Russia. PA health officials have not, in fact, officially requested vaccines from Israel, but rather are awaiting the arrival of Russian Sputnik vaccines within the coming two weeks.  However, human rights groups have underlined that Israel still holds the ultimate responsibility for health under international law insofar as it still occupies the West Bank,

The largely technical issue of where on the WHA agenda the report on Palestinian health conditions should be reviewed, was subject to a lengthy and unusual voting process (most EB decisions are made by consensus).  The United States, Australia, and the United Kingdom explained their support of Israel’s proposal, saying that no other country in the world has been singled out in such a way by the WHO.

“We’re concerned that the World Health Assembly does not consider the many other difficult health situations around the world in the same way,” said the UK’s delegate. “This item remains the only country specific item at the WHA…We fail our duty to serve people around the world who have vitally important health concerns if we allow WHO to become politicized in this way.”

The UK’s delegate to the Executive Board.

Australia went a step further, expressing concerns about the introduction of political issues into the WHA through the existence of the stand alone item – and calling for negotiations to permanently remove the item, not only as a stand-alone item but altogether from the agenda. 

The delegations from Oman and the Syrian Arab Republic countered the arguments made by the UK and US, claiming that the agenda item does not single out Israel.

“This is not a country-specific item. This is an item which [reflects] a specific situation, a situation of people under occupation and addresses the legal obligations of the occupying power,” said Syria’s delegate. “The politicization is coming from attempts to go around these facts.”

The Palestinian representative concluded the discussion at the closing session of the Executive Board meeting on Tuesday by urging member states to encourage Israel to “shoulder her responsibilities and do her duty towards all citizens for which she is responsible, particularly those in the occupied Syrian Golan, the Gaza Strip, and the other occupied territories.”  The Gaza Strip has been under Israeli blockade as a result of repeated Israeli confrontations with the fundamentalist Hamas, which wrested control of the Strip from the PA-supported Fatah in 2007,  two years after Israel unilaterally uprooted its settlements and withdrew from the Strip. Israel captured the Golan Heights from Syria in the 1967 Six Day War, and extended Israeli citizenship to the predominantly Druse residents of the Heights who remained after the war.  

Image Credits: WHO.

Travel restrictions aiming to limit the importation of variants should be based upon a systematic testing policy and not geographic or national origins, Africa CDC Director Dr John Nkengasong has said.

IBADAN – Five African countries have now confirmed cases of the SARS-CoV-2 501Y.V2 variant, which first appeared in South Africa, and there is concern that the variant is circulating undetected elsewhere on the continent. The Gambia and Nigeria have seen cases of the variant B.1.1.7, first identified in the United Kingdom, said WHO’s African Regional Director today, Dr. Matshidiso Moeti, at a press briefing.

Meanwhile, Africa CDC Director, Dr John Nkengasong, called for a “common approach” to COVID testing to oil the wings of international air travel – and halt the wave of new travel restrictions that countries have been imposing based on people’s national origin or the origins of flights – including people and flights arriving to Europe and the United States from South Africa.

Researchers now believe the variants may be both more infectious but also more deadly than the COVID virus strains that were prevalent until just recently. Researchers also fear the variants could also elude COVID tests and be more resilient to vaccines just being rolled out now – although many unknowns remain.

The countries where 501Y.V2 is circulating include: Botswana, Ghana, Kenya and Zambia, as well as South Africa. Beyond Africa, the variant has been confirmed in 24 countries globally. And there’s concern, it is circulating undetected in other countries in Africa,” Moeti told the press briefing.

Dr. Matshidiso Moeti, WHO’s African Regional Director.

“We are seeing more and more cases of variants and 501Y.V2, which was first identified in South Africa now, cropping up in other countries,” Moeti said. “The evidence suggests that these variants are more transmissible and emerging evidence indicates that the UK variant may cause more severe illness than other common strains, although more research needs to be done.”

These variants in conjunction with “the aftermath of year-end gatherings”, Moeti said, “risk powering a perfect storm and driving up Africa’s second wave and overwhelming health facilities”.

The continent saw a 50% rise in infections between 29 December 2020 and 25 January 2021, when compared with the previous four weeks, while deaths doubled.  Last week, more than 6,200 deaths were reported across Africa, said the WHO.The past week saw a small dip in cases in South Africa, but 22 other countries continued to see numbers surge.

Existing COVID-19 vaccines remain effective against the variants, Moeti said. But Professor Tulio de Oliveira, of the University of KwaZuku-Natal, South Africa, noted that these or other emerging variants may likely require individuals receiving booster doses of the vaccine.

WHO’s African Region is meanwhile setting up a new surveillance network with Africa CDC to track the spread of the virus mutations and variants across Africa and beyond, Moeti added.

“The variant which was first detected in South Africa has spread quickly beyond Africa and so what’s keeping me awake at night right now is that it’s very likely circulating in a number of African countries,” said Moeti. “Africa is at a crossroads. We must stick to our guns and double down on the tactics we know work so well. That is mask wearing, handwashing and safe social distancing. Countless lives depend on it.”

WHO’s African CDC Calls for Common COVID Testing Approach For International Travel

Dr John Nkengasong issued his call for a rethink of travel policies after several foreign countries, including the United States, are considering or have already banned flights originating from South Africa. Travel restrictions aiming to limit the importation of variants should be based upon a systematic testing policy – and not geographic or national origins, said Nkengasong.

“We should not be banning people because of their geographical origin, but we should be encouraging people to travel with negative tests and facilitate the testing process so that people can travel with a negative test,” Nkengasong said.

“If I were to go to Kenya and I show up at the airport with a valid negative test, I pose no threat to the country of Kenya, and that way so you shouldn’t just ban me because I’m coming from a certain country. They should be looking at that test, is your test valid,” Nkengasong added.

Dr John Nkengasong, Director of the Africa CDC.

Up until now, the World Health Organization has resisted recommending pre-travel COVID testing, ostensibly due to fears that it would put an unnecessary onus on poor countries.

In fact, however, many of the poorest African and Asian countries have been requiring pre-flight COVID tests for all incoming passengers – which are paid for privately. Some counties, such as the Democratic Republic of Congo, also demand arrivals briefly quarantine until a post-flight test is completed as well, paid privately as well.

Paradoxically, it is wealthier European and American countries that first issued a rash of orders banning passengers of certain nationalities or flights from certain destinations as a result of variant scares – although more developed countries, most recently Switzerland on Wednesday, have adopted testing requirements.

Senegal’s Pasteur Institute – At Center Of New Genetic Surveillance Network

At the outset of the pandemic, most countries in Africa lacked adequate testing capacity for COVID-19 but this was gradually surmounted as new testing facilities were added.

Now, however, the identification of new variants of the virus will require more advanced capacities for gene sequencing that several countries in Africa have yet to obtain.

To address this vacuum, the Africa CDC, the WHO and member countries have created a network that enables existing labs with gene sequencing capabilities to collect samples from countries that lack such.

One of the labs in the network is the Dakar-based Institut Pasteur de Dakar in Senegal. Its CEO, Dr Amadou Sall, said in addition to providing gene sequencing services for Senegal, the institute is now supporting other countries, Cameroon and Equatorial Guinea notably. Others include Mali, Burkina Faso Guinea-Bissau, Côte d’Ivoire, Niger, Verde, and of course, Guinea.

“With the partnership we have with Africa CDC and WHO, we have the possibility of sequencing 500 genomes per week. And we’re trying to increase this capacity and to make these capacities available in different countries,” Sall said.

Key to the success of COVID-19 genomic surveillance in Africa, Sall said, will be the willingness and openness of African countries to share information.

“We need to be able to share information data and the Pasteur Institute is at the center of a global platform and we’re able to share information; to exchange information rapidly, if countries are willing to do so,” he said.

Knowing When to Raise the Alarm

While noting that identification of new variants is a significant feat, genomic experts warned that alarm should not be raised every time a new strain is identified.

Professor de Oliveira, who heads the KwaZulu-Natal Research and Innovation Sequencing Platform, said attention is raised when new strains are being confirmed in increasing numbers of cases with the new variant and not when just one case has been confirmed.

Describing the impacts that variants have on the epidemiology of the pandemic in South Africa, Oliveira said in some regions, the new variant has become the prominent type. But beyond this, he said South Africa is also worried about the variants from elsewhere getting into the country and circulating among its populations.

“Today, we just reported the first important case of the B.1.1.7, the variant of concern that is circulating in the UK. And it’s quite common that in addition to our main variant that is dominating, we’re going to still have introductions of new lineages,” Oliveira said.

“And in the case they begin to spread very fast, then we will communicate it and then highlight that could be a variant of concern.”

He said that while no one can know for sure about the possibility of third or fourth waves of the pandemic in Africa, the variants are highlighting the need for the entire world to globally control the transmission of  SARS-CoV-2 as a global community.

“We have to really decrease transmission to avoid the next waves and more worry that emergence of new variants of concern will transmit too fast or evade immune response,” he said.

“The appearance of these variants in the African continent, but also in South America and Europe really means that more than ever, it is the time that we don’t leave any continent behind, especially on vaccination,” Oliveira said.

Silver Lining In Cloud – Variants Also Impetus For Cooperation

But within Africa itself, Sall said the various SARS-CoV-2 variants constitute a new impetus for cooperation between countries, to be able to track and measure the circulation of the virus, and to enhance diagnostic capacities that he said will soon be available across Africa.

“The new variants are the object of a very thorough study, and the path of our countries is very clear: obtain maximum information and adapt the strategy to contain the transmission,” he said.

Moeti enjoined countries and individuals to strive to overcome COVID-19 fatigue and return to the fundamental actions that have been found to be effective against these variants. These measures, she said, need much more emphasis that news that the virus is much more transmissible.

“The vaccine is a tool that’s going to make a huge difference all over the world,” she said.

But she reminded that “having a corner of the world not protected, the way the world’s economies and peoples are connected, will have negative economic impact even in those countries that managed to vaccinate the entire population. We really are all in it together, and we have to work to support each other to overcome this global crisis.”

Image Credits: Paul Adepoju/HealthPolicyWatch, Africa CDC.

The Oxford/AstraZeneca vaccine is 2 months behind schedule due to an issue in manufacturing.

AstraZeneca has joined Pfizer in announcing delays in deliveries of COVID-19 vaccines to countries in Europe, leading furious EU officials to plan for a system of tighter monitoring of vaccine exports. 

The British-Swedish pharma company that developed its COVID-19 vaccine with researchers at Oxford University, informed the European Commission on Friday that there would be a 60% shortfall in vaccine deliveries this quarter due to a manufacturing issue at a production plant in Belgium. 

The company is reportedly two months behind schedule with regard to vaccines destined for European countries. Since vaccine deals with the United States and the United Kingdom were signed earlier on, and are based around manufacturing sites in those countries, the company has had a headstart in resolving “glitches” in those supply chains, pharma officials said.

But the Commission had its doubts over this given explanation.

Following an EU-requested investigation into AstraZeneca’s Belgian-based production facility on Wednesday, the European Commission has said it would establish a new mechanism that grants national regulators the power to refuse exports of vaccines.

The mechanism – the criteria for which is expected to be published on Friday – could throw the security of the UK’s 40m-dose deal with Pfizer/BioNTech.

The investigation, a spokesperson for the Belgian health ministry said, was to “make sure that the delivery delay is indeed due to a production problem on the Belgian site”.

AstraZeneca ‘Scaling Up’ Doses, As EU Leaders Question Pharma Company
Pascal Soriot, CEO of AstraZeneca

“We are scaling up to hundreds of millions, billions of doses of vaccines at a very high speed. A year ago we didn’t have a vaccine. When you do that, you have glitches, you have scale-up problems. Therefore, the yield varies,” said Pascal Soriot, CEO of AstraZeneca, in an interview with la Repubblica, an Italian newspaper, on Tuesday. 

News of the delays was met with frustration by EU officials and leaders, who were expecting to receive 80 million doses by the end of March. 

“This new schedule is not acceptable to the European Union,” said Stella Kyriakides, European Commissioner for Health and Food Safety, in a statement released on Monday. “The European Union wants to know exactly which doses have been produced by AstraZeneca and where exactly so far, and if, or to whom, they have been delivered.”

Stella Kyriakides, European Commissioner for Health and Food Safety, at a press briefing on Wednesday.

Soriot disputed suggestions that the company sold the doses elsewhere for a higher price, claiming that “there is a lot of silly talk going on right now about all sorts of things,” and the response from the European Commission and EU member states is because “there are a lot of emotions running in this process right now.”

“The suggestion [that] we sell to other countries to make more money is not right because we make no profit everywhere…That’s the agreement we have with Oxford University,” said Soriot. 

“Governments are under pressure. Everybody is getting kind of…aggravated or emotional about those things. But I understand because the Commission is managing the process for the whole of Europe,” he added. 

In late August, the EU made an upfront payment of €336 million to the company to secure 300 million doses of the vaccine. EU officials have disputed AstraZeneca’s explanation of production issues, claiming there are no excuses for the delay. 

“The flimsy justification that there are difficulties in the EU supply chain but not anywhere else does not hold water, as it is of course no problem to get the vaccine from the UK to the continent,” said Peter Liese, an EU parliamentarian from Germany’s Christian Democratic Union.

Currently AstraZeneca is producing 17 million doses per month. That number will reach 100 million doses from February onwards, according to Soriot, meaning 1.2 billion doses per year. And Europe will receive 17% of the global production in February for a population that represents 5% of the world’s population. 

The Oxford/AstraZeneca vaccine is in the final stages of the approval process with the European Medicines Agency (EMA) and is expected to receive the recommendation for market authorization on Friday. After being approved, the company plans to deliver three million doses immediately. 

Meetings between EU officials and AstraZeneca have done little to resolve the issue, with Kyriakides announcing on Twitter: “Discussions with @AstraZeneca today resulted in dissatisfaction with the lack of clarity and insufficient explanations. EU Member States are united: vaccine developers have societal and contractual responsibilities they need to uphold.”

The EU Steering Board, the body that oversees vaccine deals, plans to meet with AstraZeneca again on Wednesday at 6:30pm CET and hopes to “resolve this in a spirit of collaboration and responsibility,” according to Kyriakides. 

The Italian government plans to take legal action against Pfizer and AstraZeneca over their delays in deliveries, according to an announcement made by Foreign Minister Luigi Di Maio on Sunday. 

“This is a European contract that Pfizer and AstraZeneca are not respecting and so for this reason we will take legal action,” Di Maio said on RAI state television. “We are activating all channels so that the EU Commission does all it can to make these gentlemen respect their contracts.”

According to Soriot, however, the vaccine deal signed with the EU was not a contractual commitment but a best effort, so there is no feasible basis for legal action. 

EU to Establish a Vaccine Export Transparency Mechanism

The Oxford/AstraZeneca vaccine is also considered one with global potential – due to its ability to be stored at refrigerator temperatures. Amidst some countries’ suspicions that countries outside Europe are receiving priority for vaccines produced at the Belgium plant, the European Commission announced plans to establish an export transparency mechanism for vaccines to ensure clarity on transactions and to protect its investments in the R&D that led to development of vaccines like AstraZeneca’s.

AstraZeneca is also a major supplier of the WHO COVAX global distribution initiative – which has pledged to begin distributing vaccine doses to the 92 lowest-income countries in the world within the next two months. Although most of the COVAX supplies were reportedly to be produced by India’s Serum Institute or in the Republic of Korea, the exact supply lines remain unclear. 

“Europe invested billions to help develop the world’s first COVID-19 vaccines…And now, the companies must deliver,” said Ursula von der Leyen, President of the European Commission, at the World Economic Forum on Tuesday. “They must honor their obligations. This is why we will set up a vaccine export transparency mechanism. Europe is determined to contribute to this global common good. But it also means business.”

Ursula von der Leyen, President of the European Commission, speaking at the World Economic Forum on Tuesday.

“In the future, all companies producing vaccines against COVID-19 in the EU will have to provide early notification whenever they want to export vaccines to third countries,” said Commissioner Kyriakides. 

The aim of the proposed system will be to monitor, but not block, exports, officials said. And humanitarian deliveries would be anyway exempt from this oversight mechanism. 

EMA Yet To Issue Final Approval – Insufficient Data on Vaccine in Older People

Meanwhile, the EMA has yet to issue its final regulatory approval for the two-dose Oxford/AstraZeneca vaccine, and is reportedly considering limiting the age range to people under the age of 65 – due to a lack of data on effectiveness in older people. Unlike mRNA counterparts produced by Moderna and Pfizer, the AstraZeneca/Oxford vaccine uses a disabled, modified version of a chimpanzee adenovirus that can enter human cells but cannot replicate or cause the disease, as a vector to deliver a fragment of SARS-CoV2 spike protein, stimulating COVID-19 immunity. 

According to data shared by the company, only 10% of participants in the vaccine clinical trials were over the age of 65 because it was first waiting for sufficient safety data in the 18 to 55 age group before vaccinating older individuals. 

“We don’t have a huge number of older people who have been vaccinated,” said Soriot. “But we have strong data showing very strong antibody production against the virus in the elderly, similar to what we see in younger people.”

The results of an ongoing, larger Phase 3 clinical trial with 30,000 participants being conducted in the United States are expected to provide insight into the protection the vaccine provides to older individuals and ethnic minorities populations –  groups that were not very well represented in previous trials. 

In addition, scientists are exploring whether a half-dose of the first vaccine would reliably yield a higher efficacy rating of 90% that was seen in initial trials. The other regime, involving two full doses was only 62% effective, according to the results released by the company in late November and reviewed by an independent Data and Safety Monitoring Board. That still meets key global benchmarks for efficacy, but is significantly lower than the 94-95% efficacy results for the Moderna and Pfizer mRNA vaccines.

The AstraZeneca vaccine has, however, already been authorized in the UK, is already being used in British vaccination campaigns, including for people over 70 years old.

Image Credits: AstraZeneca, AstraZeneca, Twitter, Twitter.

Member States and non-state actors alike have expressed dissatisfaction with the current system, albeit for different reasons, according to WHO.

The World Health Organization (WHO) aims to make its engagement with non-state actors (non-state actors) more meaningful and efficient with a new proposal to establish a number of NSA fora that would allow exchange with WHO and member state representatives outside of official meetings.

The new proposal — which will be tested during the 74th World Health Assembly (WHA), 24 May to 1 June — would offer multiple side events in which non-state (NSA) actors could engage more informally with member state representatives as well as a forum for exchange between NSAs and WHO regional and technical staff.

But at the same time, non-state actors will be allotted a more limited number of constituency statements in formal governing body meetings – and like-minded groups of actors will be asked to combine their official statements together.

Non-state actors include civil society groups such as non-governmental organizations, international business and professional associations, and philanthropic foundations. More than 70 non-state actors are recognized as being “in official relations” with WHO, and thus contribute in formal meetings such as the EB and the WHA.

However, EB and WHA members have complained that the civil society interventions have become bogged down by too many lengthy, individual statements – and NSAs acknowledge that the statements often had limited impact in member state debates.

More informal meetings ahead of the formal meeting dates would help engender more meaningful interaction, WHO said in its proposal for the reform, which was reviewed by the WHO Executive Board on Saturday. Informal meetings will also allow non-state actors to organize themselves into constituencies, consolidating their positions into joint statements to be presented at official events.

The new arrangements to be tested in May, will “serve as a trial for potential future virtual informal meetings between non-state actors, Member States and the Secretariat, as a means of enabling more in-depth technical exchanges, as well as discussions on the Health Assembly agenda items,” said the WHO Secretariat, in its presentation to the EB on Saturday.

The COVID-19 pandemic has provided added impetus for reforms that have long been in the making – insofar as the limitations of virtual meetings have also curtailed the interactions between member states and non-state actors.

According to the new proposal, the informal series of meetings with non-state actors will be held just ahead of the WHA, and thus prepare the groundwork for the formal meeting.

Role of Non-State Actors Has Evolved – But Increasing Number of Statements Detracted from Impact

In the discussion over the proposal, WHO officials stressed that the Organization “is and remains a Member State Organisation” — engaging with 77 non-state actors, at global, regional and country levels, who also support the development and implementation of the Organization’s policies and recommendations, technical norms and standards.

But while non-state actors have “served the Organization well for several decades”, the increasing number of non-governmental organizations and other non-state actors participating — often with a greater number of requests to speak — has “not resulted in a more meaningful involvement”.

For example, when civil society representatives speak one-by-one at the end of a discussion, their interventions have little impact on the content or direction of the debate, WHO contends.

Member States and non-state actors alike have expressed dissatisfaction with the current system, albeit for different reasons, says the WHO.

A virtual consultation by WHO further confirmed that non-state actors’ primary interests in attending governing body meetings are to participate in technical exchanges with the Secretariat and the Member States and to attend consultative hearings that feed into decision-making processes.

Meaningful Participation From NGOs Critical, Member States Say

The UK delegate said that it would allow NSAs to exert even more credible influence on member states attitudes and positions. The EB representative from the United States flagged that it is critical to ensure and enhance meaningful participation of non-state actors in WHO governing bodies, while also creating greater efficiency in the governance process.

“Non-State actor participation must be allowed in a transparent and accountable manner with an open door to input from all stakeholders including the private sector,” the delegate noted.

Austria pressed for the Secretariat to provide some more detailed information on the procedure for these meetings.

Other states, like Australia, flagged that the trial is very ambitious given the agenda for the 2021 assembly is already very crowded.

“We suggest that before agreeing to a trial, the number of meetings proposed to be repeated and streamlined,” the representative said.This would “provide reflections to technical areas in advance of the governing body meetings”.

Civil Society Groups Request Clarity and Procedure Details

Bodies like Health Action International asked for details as to how NGOs would participate, and for clarity on the processes governing such meetings.

“It is a remaining concern to those who have witnessed creeping capacity shrinking of NGO space and poor consultation in recent years,” said an HAI statement. The HAI delegate requested that similar procedures be implemented for WHO regional meetings with member states, also asking that  “these informal meetings compliment, but do not replace comprehensive consultations with non-state actors.”

Meanwhile, the European Society for Medical Oncology said the views and expertise of non-state actors should be introduced earlier in the WHO decision-making process; it would be of greater value if delivered at the onset of projects, and when member states are drafting zero draft decisions and resolutions.

“Direct interaction and discussion between member states, WHO offices, and Non-State actors would provide the opportunity for more in-depth exchanges, and partnerships, as the Member States, develop policies and implement actions to fulfill their WHO commitments,” said the ESMO spokesperson.

Silberschmidt stressed that the virtual informal meetings will not replace other channels, but become an additional avenue for interaction – highlighting the fact that Dr Tedros Adhanom Ghebreyesus, WHO Director General, has already established a regular dialogue with civil society groups, to be held every six weeks.

 

Image Credits: WHO / Christopher Black.

While very low-income countries have experienced relatively low mortality rates from COVID-19, they can expect higher mortality caused by the knock-on effects of the pandemic on their fragile health systems, according to the Executive Director of the Global Fund to Fight AIDS, TB and Malaria.

Since the pandemic first overwhelmed health systems in early 2020, countries across the globe have reported a reduction in referrals and diagnoses for various diseases.

Peter Sands, Executive Director of Global Fund

“It’s a perfect storm of concurrent social crises which are disrupting health interventions: programmes to fight diseases like HIV, tuberculosis (TB) and malaria,” Peter Sands, Executive Director of the Global Fund, said during a session of the  World Economic Forum in Davos today.

Last year, India, Indonesia, the Philippines — three high-burden countries for TB — reported a 25-30% drop in its case notifications. A Lancet study predicted a 25% reduction in antimalarial drug coverage in 2020 in malaria-endemic African countries, potentially doubling mortality.

And although the pandemic has affected health systems in low- and high-income countries alike, poorer countries with weaker health infrastructure, greater disease burdens, and generally worse access to COVID-19 treatments and vaccines will have the hardest time recovering.

“Particularly, the lowest income countries have very young populations. This kind of demographic means that the mortality rate from COVID is relatively low,” he said. In the poorest countries, the life expectancy is about 18 years lower than the richest.

But these countries could be more vulnerable to the “collateral damage” of the SARS-CoV-2 pandemic, rather than the direct impact of the virus. 

“You’re going to see relatively low mortality from COVID itself, and relatively high mortality from these knock-on consequences,” added Sands.

Diagnosis Deficit: Lower Diagnoses Globally

The COVID-19 pandemic risks shattering countless disease elimination targets, many of which have been set by the World Health Organization (WHO).

Diagnoses and interventions for communicable and non-communicable diseases (NCDs) have both been impacted in 2020, with COVID-19 and related lockdowns affecting patients’ ability to get access to treatment.

The World Hepatitis Alliance found that last year 94% of respondents in its 32-country survey had had their hepatitis services closed. In addition, half of respondents in lower- and middle-income countries (LMICs) could not get their medication, with respondents in India and Nigeria citing pandemic-related travel restrictions as the cause.

“The Task Force for Global Health and the World Hepatitis Alliance [have] all come up with the same figures,” said Charles Gore, Executive Director of the Medicines Patent Pool.

“Diagnosis and treatment are the key areas in [WHO’s] Global Strategy where the world is lacking,” he added. “And unfortunately, the hit is even bigger in LMICs.”

Where access to treatment for a given disease might have been reduced by 40-60% in a high-income country, “we’re talking 60-90% in LMICs”.

“There’s an estimate that a one-year hiatus in [a country’s] national programs from hepatitis elimination will lead to an extra 45,000 liver cancers and 72,000 deaths by 2030,” he said.

The reduction in access to treatments is similarly stark for NCDs.In the UK, lung cancer referrals in August 2020 were down by 26% from the previous year. During the April lockdown — when much of the Western world experienced its first COVID wave — referrals for lung cancer from doctors’ surgeries dropped by 72%.

“Even if they are referred, it’s very difficult to get patients through the system, and get respiratory symptoms investigated so they can start treatments quickly,” said Michelle Mitchell, chief executive of Cancer Research UK.

“This is a time of great worry for patients with lung cancer or other types of cancer.”

Patients will have a much better prognosis if they are diagnosed early. Data observed by Cancer Research UK indicates that nearly 90% of patients diagnosed at Stage 1 survived the disease for at least one year, compared to just 19% for those diagnosed at Stage 4.

“It’s too early to know the impact yet,” she said. “But we do expect there to be a huge impact.”

Build Back Better: ‘Not Ambitious Enough’

The process of ‘building back better’ does not go far enough, Harvard T.H. Chan School of Public Health’s Dean, Michelle Williams, said.

Building back better refers to a process of economic recovery from COVID-19 that avoids destructive investment patterns: namely, investments that endanger biodiversity, which is linked to zoonotic diseases jumping species.

“What COVID has done is really show how weak global public health infrastructure can bring us to our knees,” she said.

“To build back better is [to] first recognise the importance and value of public health and invest accordingly. That means properly investing in global governance of public health leadership [and] making the structure nimble and equipped.”

An interim report by the Independent Panel on Pandemic Preparedness and Response, published last week, determined that WHO’s COVID-19 response was too slow, and was hampered by a lack of resources and a damning lack of authority among its member states.

“We’re not being remotely ambitious enough,” Sands said. “This year we are deploying about US$4.7 billion on HIV, TB and malaria to mitigate the collateral damage … we need another $5 billion. And that’s the Global Fund alone.”

And the global ambition for economic recovery, which is “currently shaped as getting back to [a] pre-pandemic” scenario, is “not good enough”, Mitchell added. “Because we weren’t doing well enough before COVID.”

Image Credits: The Global Fund.

WHO is yet to grant the Moderna vaccine Emergency Use Listing (EUL), but its advice for use is still significant as many member states rely upon these vaccine recommendations as a global reference point.

The Moderna COVID-19 vaccine is safe for most people including those with a wide range of underlying medical conditions, according to the World Health Organization’s Strategic Advisory Group of Experts (SAGE) on immunizations.

However, the vaccine is not recommended for pregnant women or children as it has not been tested on these groups, according to interim recommendations published today by WHO.  The issue of the vaccine in pregnancy is emerging as a bigger issue in light of recent evidence, including from the US Centers for Disease Control, that pregnant women are at higher risk of serious COVID-19, and as new variants of the SARS-CoV2 virus infect more young people, including those of childbearing age.

The WHO approval may also pave the way for Moderna to contribute vaccines to the global COVAX facility, following a final WHO “Emergency Use Listing” approval for the vaccine.

Last Friday, Pfizer announced it was contributing 40 million doses of its vaccine to the WHO co-sponsored COVAX, weeks after WHO approved the vaccine.

People who have severe allergic reactions to any of the vaccine’s components should not receive it, and it should also not be used in countries that do not have the capacity to treat anaphylactic shock, according to SAGE. It also advises caution about administering the vaccine to frail, elderly people near the end of their lives.

The vaccine needs to be administered in two doses 28 days apart, although “the interval between the doses may be extended to 42 days”, SAGE said. All those vaccinated should be observed for “at least 15 minutes after vaccination”, and anyone experiencing an immediate severe allergic reaction should not receive the additional dose.

No Word On Emergency Authorization From WHO

The WHO has not yet issued an Emergency Use Listing (EUL) for the Moderna vaccine, but it has undergone review by the European Medical Agency (EMA), which has authorized its use in the European Union. It has also been approved in the United States, Canada, the United Kingdom and Swissmedic.

Regardless, the WHO advice is significant as many member states – especially low- and middle-income countries (LMICs) – also rely upon WHO for vaccine recommendations as a global reference point.

Dr Kate O’Brien, WHO’s Director of Vaccines, told a media briefing today that the global body was still in discussions with Moderna about the information it needed to issue an EUL, and so did not comment about if or when this would be issued.

O’Brien did add, however, that SAGE’s advice was important as some member states had already made arrangements to procure the vaccine from Moderna.

Dr Kate O’Brien, WHO’s Director of Vaccines.

Moderna and Pfizer/BioNTech are both mRNA-based vaccines, but the Moderna vaccine does not need to be stored at the extremely cold temperatures required by the BioNTech-Pfizer vaccine, which makes it more suitable for LMICs.

In trials, the Moderna vaccine showed an efficacy of approximately 92% in protecting against COVID-19, starting 14 days after the first dose.

Moderna claimed yesterday that its candidate appears to retain its efficacy against the B.1.1.7 and South Africa-identified (B.1.351) variants. In the study, which is yet to be peer-reviewed, researchers looked at blood samples from eight participants who had previously received the recommended two doses during Phase 1 trials.

In the case of the B.1.1.7 variant, they reported the mutated virus posed no significant impact on titers: a means for measuring the amount of antibodies in a blood sample. Tests on B.1.351 showed a “six-fold reduction in neutralizing titers” although “neutralizing titer levels with B.1.351 remain above levels that are expected to be protective”, according to the company media release.

Meanwhile, Moderna also announced that it will “test an additional booster dose of its COVID-19 Vaccine (mRNA-1273)” to see whether it can further increase neutralizing antibodies against emerging strains “beyond the existing primary vaccination series”.

Despite this, O’Brien said that clinical evidence was needed to support this report, and that the blood sera of people who have antibodies against COVID-19 was currently being tested against these variants.

She welcomed how prepared vaccine manufacturers were to “potentially make modifications to the vaccines that they are continuing to develop”.

“The preponderance of evidence at hand, albeit small, is that the vaccines in hand are extremely valuable as part of the toolbox for fighting the pandemic and really crushing this virus, but we will continue to respond to as new scientific evidence comes in,” concluded O’Brien.

Image Credits: Moderna.

Björn Kümmel, Vice Chair, WHO Executive Board.

Discussions on WHO’s state of financing were addressed by member states during the on-going Executive Board meeting. As we reported last week, WHO is keen on defining independence and sustainability of its financing to be better prepared to address emergencies in the future.

We spoke to Björn Kümmel, Deputy Head of Unit, Global Health, German Federal Ministry of Health and Vice Chair of the WHO Executive Board, who has been actively involved consistently in raising these issues on the organization’s finances. He was also a part of the consultations on the Open-ended Intergovernmental Working Group on Sustainable Financing at the EB last week.

Geneva Health Files: Germany has emphasized the importance of assessed contributions for improving the finances of WHO. Can you please share your reasoning behind an increase in assessed contributions for all member states?

Björn Kümmel: Strengthening of the World Health Organization (WHO) is a key priority for the German Federal Government. In the new Global Health Strategy of the German Federal Government, which has been adopted by the Cabinet of Ministers last October, there is a clear focus on enabling WHO to play its mandated role as the leading and coordinating authority in global health.

The WHO’s budget has grown over the past decades. However, the assessed contributions have remained practically stable since the year 2000. Today, WHO’s overall budget volume foresees roughly 5 billion USD for two years. While in past history, the entirety of the membership fee, the assessed contributions was the main part of WHO’s budget, since 2000, the voluntary contributions have outgrown the assessed contributions.

It is essential to realize, that today, the vast majority of  financial resources (currently roughly 83 %) are contributed on a voluntary and largely unpredictable basis. These funds are provided and steered by a very limited number of generous individual donors on a purely voluntary basis. These donors decide, for which concrete goals WHO may use the funding, and they are free to withdraw the funding as they please. This financial dependency on a very limited number of key donors is seen as one of the key risks for WHO as this leads also to political dependency. Some argue that WHO is often used by donors like an implementing agency, implementing the goals that are a priority for the generous donors.

With only 17 % purely predictable and flexible sustainable finances (assessed contributions), it is practically impossible for WHO to play its envisaged role as a guardian of global health. Through the COVID-19 pandemic it has become obvious: The expectations of the 194 Member States vis-à-vis WHO by far outweigh WHO’s de facto abilities. And while in the WHO governing bodies, Member States keep on adding concrete tasks for WHO, not only but including through adopting World Health Assembly Resolutions that have wide financial implications, within the past decades, the WHO Member States have failed to properly address the key challenge of sustainable financing for WHO. One lesson that will most likely be pointed out in the current lessons-learnt-processes that assess the reaction towards the COVID-19 pandemic will be: This financing challenge needs to be tackled if  WHO should in the future continue to be expected to lead and coordinate the international prevention, detection and response to pandemics.

GHF: Based on the deliberations at the EB, what is your assessment of WHO’s proposal for sustainable financing?

Björn Kümmel: Through its resumed session in November 2020, the World Health Assembly has asked the WHO Secretariat to prepare a paper on sustainable financing for discussion at the Board`s meeting in January. The Secretariat’s report (EB148/26) provides a clear picture about the different sources of financing for WHO with regards to the question whether this financing is sustainable or not. The Secretariat proposed to set up a Member State working group to assess the situation with regards to the sustainability of financing for WHO. Based on this assessment, the working group is supposed to discuss and explore options in order to address this challenge. However, it is clear, that it is not the role of the working group to take final decisions. These would have to be taken by the entire membership of WHO, all 194 Member States together.

The proposed process is promising as it may help to address one of the key structural challenges that has been hindering WHO to fulfil its mandate. During the yearly meetings of the Executive Board in January, the implementation of the current Programme Budget is being discussed. In the relevant discussions, all Member States complain about the fact, that the different programme areas of the WHO are unevenly financed with many so called “pockets of poverty”. These are predominant throughout all WHO’s programme areas and have severe implications for WHO’s day to day work.

It is important to understand: When WHO’s programme budget is being approved by the 194 Member States, it is a largely unfunded budget. The only financing source that is purely certain is the 17 % share of the assessed contributions and some already secured grant agreements by voluntary donors. Therefore, WHO has to raise the vast majority of the needed finances after the approval of the programme budget.

This has led to the fact, that many departments need to spend major parts of their work on fund-raising efforts to make sure that envisaged activities are enabled and staff positions can be paid for. Since the vast majority of WHO’s funding is unpredictable and non-sustainable, many WHO staff members do not work on a long-term basis but even based on contracts covering shorter periods than half a year. In addition, this situation has led to a major increase of the use of “non-staff” contracts, in particular consultants and other agreements that are perceived to be more flexible and cover shorter periods of time. Obviously, this financial reality is hardly reconcilable with the need to ensure the best talent in public and global health in order to be able to lead global health by excellence. Attracting and retaining the needed talents will be a growing challenge due to the human resources consequences of the current financing model of WHO.

The discussion that will evolve based on the Secretariat’s report on sustainable financing and the future work of the working group is of highest importance to make all WHO Member States and the broader public health community aware of this financing challenge. We hope that the different ways that have been tried in the past years to ease this challenge will be assessed including why these options have failed to properly address the given challenge. It would be a great step forward, if, through this process, the WHO’s governing bodies would devote adequate focus on potential future options for long-term solutions.

It is clear, that this will be a lengthy and very complex endeavour. However, the COVID-19 crisis may serve for a new political understanding among the entire membership of WHO, that more sustainable investments are needed to enable WHO to fulfil its mandated role.

GHF: What steps have been taken, or will be taken, in the near future to revitalise the role of the governing bodies?

Björn Kümmel: Germany has been a member of the Executive Board for the past three years. From the start, we shared the view that the role of the governing bodies and in particular the Executive Board indeed needs to be revitalized. The Executive Board has been criticized not to allow for adequate interaction between its members and sometimes not being able to more flexibly shift the focus of its deliberations on the most pressing and decisive questions. It is a fact, that the Executive Board has become to some extent a small World Health Assembly.

While this transparency is a great merit as it allows for full inclusiveness and at least theoretically ensures that the Assembly is well prepared through a consensual process, some argue that this setting sometimes limits the interaction in between the original members of the Executive Board. This leads to reading out only prepared statements and thus reduces the role of the Executive Board to serve as an exclusive steering board.

During the COVID-19 pandemic, some EB members have raised their concern, that the EB has not played its mandated role to provide oversight and guide the work of the Secretariat throughout the pandemic. In order to reflect on this and more generally the role that the Executive Board sees for itself, a retreat of the Executive Board has been proposed. Taking into account the limitations for such a retreat during the ongoing pandemic, members of the Executive Board have called for such a retreat at the earliest possible timing.

Priti Patnaik is the founding editor of Geneva Health Files – a reporting initiative that tracks power and politics in global health.

This interview is a part of a series under a new collaboration arrangement between Geneva Health Files and Health Policy Watch.  

Image Credits: C Black, WHO.

Michael Osterholm – a leading member of the United States President’s coronavirus transition team – has said he is “convinced” by data indicating the UK COVID-19 variant is more deadly, even as United Kingdom officials downplay the limited and “uncertain” evidence.

Meanwhile, Moderna announced today that it will “test an additional booster dose of its COVID-19 Vaccine (mRNA-1273)” to see whether it can further increase neutralizing antibodies against emerging strains “beyond the existing primary vaccination series”.

Late on Friday evening, UK Prime Minister Boris Johnson announced that the SARS-CoV-2 variant, also known as B.1.1.7, “may be associated with a higher degree of mortality”: potentially by up to 30%.

But the government’s chief scientific adviser, Sir Patrick Vallance, was quick to flag that the current data available – published by Nervtag, a government advisory committee – was “not yet strong”.

The report concluded there was “a realistic possibility” that infection with B.1.1.7 “is associated with an increased risk of death”.

Vallance noted: “There’s a lot of uncertainty around these numbers and we need more work to get a precise handle on it, but it obviously is a concern that this has an increase in mortality as well as an increase in transmissibility.”

The variant, which was first detected in September 2020, was previously understood to be around 30-70% more transmissible than the Wuhan strain.

Vallance explained that around 10 in 1,000 men in their 60s infected with the Wuhan strain would be expected to die with the virus. “With the new variant,” he said, “for 1,000 people infected, roughly 13 or 14 people might be expected to die.”

Despite this, Michael Osterholm – epidemiologist and a member of President Joe Biden’s coronavirus transition team – has said he is “convinced” that B.1.1.7 is deadlier after reviewing the UK report.

Osterholm, who has also reviewed other unpublished data, said: “The data is mounting — and some of it I can’t share — that clearly supports that B.1.1.7 is causing more severe illness and increased death.”

The US Centers for Disease Control and Prevention (CDC) has begun reviewing the data, it confirmed to CNN on Saturday: “The CDC has reached out to UK officials and is reviewing their new mortality data associated with variant B.1.1.7.”

The Nervtag report collected data from three independent analyses, led by University of Exeter, Imperial College London, and London School of Hygiene & Tropical Medicine.

Moderna Latest To Claim Vaccine Effective Against Key Variants

Moderna’s clinical development manufacturing facility in MA, USA.

Given this uncertainty, questions have naturally been directed toward those organizations developing COVID-19 vaccines, notably as to whether these candidates can protect against these variants.

As of Monday morning, Moderna — whose mRNA vaccine has so far been approved for emergency use in at least 10 blocs including the UK, the US and the European Union — has claimed its candidate appears to retain its efficacy against the B.1.1.7 and South Africa-identified (B.1.351) variants.

In the study, which is yet to be peer-reviewed, researchers looked at blood samples from eight participants who had previously received the recommended two doses during Phase 1 trials.

In the case of the B.1.1.7 variant, they reported the mutated virus posed no significant impact on titers: a means for measuring the amount of antibodies in a blood sample.

Tests on B.1.351 showed a “six-fold reduction in neutralizing titers” although “neutralizing titer levels with B.1.351 remain above levels that are expected to be protective”, according to the company media release. But the sample size is surprisingly low, with only eight participants and the study is based on an in-house, un-peer reviewed study,

Last week, Pfizer made a similar claim after testing only 16 blood samples: a startlingly low number given the number of participants involved in their clinical trials. Critics had said Pfizer had been overly optimistic in its interpretation of the data.

Meanwhile, Moderna is also “advancing an emerging variant booster candidate (mRNA-1273.351) against the B.1.351 variant first identified in South Africa”.

It aims to test the candidate in preclinical studies and a Phase 1 study in the US “to evaluate the immunological benefit of boosting with strain-specific spike proteins” and “expects that its mRNA-based booster vaccine will be able to further boost neutralizing titers in combination with all of the leading vaccine candidates”.

Image Credits: Moderna.

Vaccine
The economic cost to the world’s advanced economies in the absence of global vaccine access could be up to US$5 trillion, a report has found, compared to the $38 billion cost of funding WHO’s ACT Accelerator.

Wealthy countries that pursue ‘vaccine nationalism’ when their trading partners don’t have access to the COVID-19 vaccine will pay a far higher economic price than if they invest in ensuring all countries have access to vaccines, according to a comprehensive economic modelling study released today by the World Health Organization (WHO).

The study, commissioned by the International Chamber of Commerce (ICC) Research Foundation, projects that the economic cost to the world’s advanced economies in the absence of global vaccine access could be up to US$5 trillion.

In contrast, the entire cost of funding the Access to COVID-19 Tools (ACT) Accelerator, the WHO-led global platform to ensure equitable access to COVID-19 vaccines, tests and treatments, is $38 billion.

“Strikingly, a $27.2 billion investment on the part of advanced economies – the current funding shortfall to fully capitalize the ACT Accelerator and its vaccine pillar COVAX – is capable of generating returns as high as 166x the investment,” according to the ICC.

The researchers looked at the production and trade networks of 65 countries across 35 sectors, modelling three different vaccine access and lockdown scenarios. They concluded that the global loss to GDP if vaccines are not widely available “is higher than the cost of manufacturing and distributing vaccines globally”.

“Our estimates suggest that up to 49 percent of the global economic costs of the pandemic in 2021 are borne by the advanced economies even if they achieve universal vaccination in their own countries,” states the report, which was produced by the Centre for Economic Policy Research.

The study explains that the advanced economies are “tightly connected to unvaccinated trading partners which consist of a large number of emerging markets and developing economies”.

“Thus, the devastating economic conditions in these countries under the ongoing pandemic can cause a non-negligible drag on the advanced economies as well,” according to the study.

Demand for goods would fall in countries badly affected, and their production capacity would be weakened, thus affecting their ability to supply goods and materials needed by advanced economies.

Ṣebnem Kalemli-Özcan, Professor of Economics and Finance at the University of Maryland and an author of the report, said: “No economy can fully recover until we have global equitable access to vaccines, therapeutics and diagnostics. The path we are on leads to less growth, more deaths, and a longer economic recovery.”

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus said that “this research shows a potentially catastrophic economic failure”.

“The progress made by the ACT Accelerator shows solidarity in beating this virus. The longer we wait to provide vaccines, tests, and treatments to all countries, the faster the virus will take hold, the potential for more variants will emerge, the greater the chance today’s vaccines could become ineffective, and the harder it will be for all countries to recover. Truly, no-one is safe until everyone is safe.”

ICC Secretary General John WH Denton added that the research shows that  “ensuring equitable access to COVID-19 tests, treatments and vaccines is not only the right thing to do – to do otherwise is economically irresponsible. International business needs a fully funded ACT Accelerator”.

“This is not an act of charity. This is economic common sense,” said Denton. “If you want to ensure a durable recovery in your economies, you need to step up and actually pay up.”

Countries with open economies stand to lose the most, particularly Belgium, France, Germany, the Netherlands, Norway, Switzerland, the United Kingdom and the US, “who might lose up to 3.9% of their GDPs”.

“No economy is an island,” the report concluded, paraphrasing the John Donne poem. “The economic losses of the pandemic can only be mitigated through a multilateral coordination ensuring the equitable access of vaccines, tests and therapeutics.”

COVAX Deal With Pfizer Is Small But ‘Opens the Door’

Meanwhile, WHO Special Advisor Dr Bruce Aylward defended a small 40 million COVAX deal reached with Pfizer, which had been announced on Friday. The European Union has reserved 600 million doses, with the US securing 200 million.

Alyward said the small number was “a start”, but that the Pfizer vaccine was already recommended by WHO “so this could be launched very, very rapidly and earlier possibly than some of the other products”.

45 out of 50 of the countries rolling out COVID-19 vaccines are using the Pfizer vaccine.

“45 out of 50 of the countries rolling out vaccines are using the Pfizer vaccine,” said Aylward. “Even with a relatively small number of doses …  it was clear that we could make a real difference in protecting some of the most highly exposed, highly at risk health care workers, particularly in some of the [low- and middle-income countries (LMICs)] that the facility serves.

“The other big advantage by putting the framework agreement in place, is that we can then open the door to donations in a much more potentially seamless manner with other countries that currently have contracts with and substantial quantities of the Pfizer vaccine.”

Rapid COVID Tests Ensured For LMICs As Costs Halved

Fragile health systems, remote or decentralised populations, and reliance on global provision in LMICs have created obtrusive barriers to achieving mass rapid testing for SARS-CoV-2.

However, more than 250 million antigen-detecting rapid diagnostic tests (Ag RDTs) will be made available to LMICs for approximately US$2.50 each following a July 2020 call for interest.

The open call for Expressions of Interest (EOI) was launched by Unitaid — a WHO partner — and global nonprofit Foundation for Innovative New Diagnostics (FIND), on behalf of the ACT-Accelerator: WHO’s platform for providing equitable COVID medicines and treatments

Up to 120 million tests will be produced by Premier Medical Corporation, India, in 2021, with a further 130 million tests secured through other, unannounced agreements.

The ACT-Accelerator has estimated that 500 million COVID tests will be needed in LMICs over the next 12 months, with three-quarters necessarily deployed via primary health care.

Image Credits: WHO Afro region, WHO, Pfizer.

Activism against Gender-Based Violence at the National University of Lao, Dong Dok campus. During the pandemic, violence against women had increased by 25% as early as April in countries with formal reporting systems in place.

WHO needs to focus more work on limiting gender-based violence, increase its programmatic emphasis on healthy diets and lifestyles, and contribute to renewed momentum on climate action, said WHO member states at Friday’s Executive Board session.

The member states were reviewing the WHO Director General’s report on “social determinants of health” – in light of the added health impacts of the ongoing global COVID-19 pandemic.

Social determinants of health is a broad umbrella term referring to a range of socio-economic and environmental drivers that can help prevent diseases from ever occurring – or conversely accelerate more disease if neglected. They range from poverty, which can foster more communal violence and addictions, to unhealthy diets leading to malnutrition and obesity, or air pollution that contributes to the development of cardiovascular and respiratory diseases as well as cancers.

COVID-19’s Gender Gap

Amid mounting evidence that the social and economic toll of the COVID-19 pandemic is to being disproportionately paid by women, member states flagged WHO’s need to do more to assist countries’ attempts to limit gender-based violence and discrimination, WHO member states suggested.

A delegate from Kenya highlighted “increased teenage pregnancies, gender-based violence and substance abuse” as results of pandemic related lock-downs and economic stagnation. He called on WHO for an inter-agency plan to support its Member States, as they struggle to mitigate the “severe social shocks of the pandemic”.

A United Nations report, published as early in the pandemic, highlighted that “many women are being forced to ‘lock down’ at home with their abusers” even as support services typically available for victims continue to be “disrupted or made inaccessible”.

That same report flagged that violence against women had increased by 25% in countries with formal reporting systems in place.

Beyond gender-based abuse, the pandemic-related gender impacts also are evident in the greater difficulties when have had accessing healthcare. And the pandemic has exacerbated pre-existing employment inequalities, member states reflected.

“Gender is a key social determinant of health given the impact of gender roles, norms and behaviours, on how people access health services and information,” a delegate from the United Kingdom said. Similarly, gender also determines how health systems respond to individual patients.

With regards to the pandemic, as such, the WHO report staed that the Organization is developing advocacy and engaging with other UN agencies and actors on “on human rights-based approaches” to gender and COVID-19- although it didn’t provide further details.

The report also notes that internally at WHO: “The Gender, Equity and Human Rights team at headquarters and the regional office network are spearheading efforts to mainstream gender issues across the Organization.” In other comments this past week to the EB, Dr Tedros Adhanom Ghebreyesus has noted that while WHO has gender parity among the ranks os its senior management – but male professionals still well outnumber women in certain WHO regional  and country offices – with the most imbalance in the African region.

Diet and Nutrition

During the board meeting, the UK also flagged diet and nutrition as key social determinants: topics scarcely mentioned in the WHO report.

“Healthy diets and malnutrition are an important element of determinants of health,” the delegate said.  “Action is needed to address unhealthy diets and malnutrition in all its forms.”

The WHO report refers to nutrition only vaguely, listing “food insecurity” alongside “poor-quality housing … insecure employment, and poorly regulated care for the elderly” as “examples of social determinants with devastating impacts on individuals and communities affected by COVID-19”.  However, a growing body of evidence, including other recent WHO reports, point to the double burden many low-and middle-income countries are now seeing from undernutrition and malnutrition- the latter related to an over reliance of fast-urbanizing communities on fast or processed foods, cheap starches, and sugar-  and fat-heavy diets.

Despite arguments that addressing diet would help to improve health outcomes and prevent future pandemics, the WHO report on social determinants of health scarcely mentioned nutrition.

Those forms of malnutrition – leading to micronutrient deficiencies as well as to obesity –  are responsible for a significant portion of the Global Burden of Disease, the UK delegate said.  He reminded the EB that “obesity has shown to significantly increase the severity of COVID-19”.

Meaningfully addressing poor diet, the UK argued, would help to improve health outcomes and enter future pandemics better prepared.

The Climate Crisis & Biodiversity

In the decade before the pandemic, awareness of the health impacts of climate change and loss of biological diversity were growing global health concerns, including at WHO. But the sudden and overwhelming emergence of SARS-CoV-2, however, has meant climate-related health policy has mostly been left to stagnate, some delegates observed.

Pedestrians in Bangladesh cover their faces to keep from breathing in dust and smog. Despite significant advancements before the pandemic, environmental health has largely taken a back seat in policymaking.

While there have been a few significant steps made since the first COVID-19 death — such as the UN including climate measures on its Human Development Report, or the UK registering the first death due to air pollution — there is evidence that the pandemic has led national health ministers to push  environmental health risks to the background of their agendas.

This is despite the fact that environmental risks, notably from air pollution, also contribute directly to more chronic cardiovascular and respiratory health conditions, and thus more COVID-related deaths.

The WHO report acknowledges this, indirectly, stating that “increasing urbanization and climate change risk [as] entrenching existing inequalities and further widening the gap in health outcomes”.

However, delegates noted that more attention needs to be given to the routes by which climate change, biodiversity loss and urbanization are contributing to ill health during the pandemic – as well as increasing future pandemic risks.

In the case of SARS-CoV2, for instance, while the exact route by which the virus reached Wuhan and its seafood market where the first human clusters of infection appeared, most scientists agree that the virus hails from a bat coronavirus that leaped the species barrier. In the past, that has happened when wild animals are hunted, captured, caged, transported and sold alive in crowded urban food markets across Asia.

Similar leaps of animal diseases to humans have led to the rise of Ebola and HIV in Africa, where the capture and consumption of  wild animals as “bushmeat” is a traditional practice that became even more common in conditions of conflict and food insecurity, where wildlife areas also are more vulnerable to poaching and plunder by black marketeers.

“The [COVID-19] crisis we are facing is not only a health crisis, but also a social and economic crisis,” the Austrian delegate told the board. But, vitally, she added that “it cannot be fully understood without considering the ongoing ecological crisis.”

“The poorest and most vulnerable have been disproportionately hit,” she said, “and further action to foster health equity and moving beyond the health sector is urgently needed.”

This was also underlined by the UK delegate, who stated it “will also welcome more attention on to the impact of climate change both on people’s health and on national health systems”.

Image Credits: DANHO/Daniel Hodgso, Sven Petersen/Flickr, Rashed Shumon.