WHO Director-General Dr Tedros Adhanom Ghebreyesus unveiled a bold new WHO Healthy Recovery Manifesto – including an unprecedented call to governments to stop subsidizing the fossil fuel industry to the tune of US$ 400 bilion annually – driving both climate change, air pollution, and an epidemic of chronic diseases that also sharply increased mortality risks for people infected with COVID-19.

The move coincided with the European Union;s unveiling of a much anticipated Covid-19 recovery plan with a green investment edge. Named Next Generation EU the €750 billion package aims to address the economic and social fallout of the coronavirus pandemic with direct investments in renewable energy technologies and support to countries to shift to low-carbon economies. 

The six WHO-endorsed manifesto principles include oft-repeated calls for healthier cities, food systems, and clean water.  However, WHO’s blunt call to governments to “stop using taxpayers money to fund pollution” steps out of the Organization’s traditional comfort zone. The manifesto also calls for an end to biodiversity destruction and the “unsafe management and consumption of wildlife”, noting that it is these activities that lead to the transmission of deadly animal pathogens such as COVID-19 to humans, and “increase the risk of emerging infectious diseases.”  

These steps, WHO says, will lead towards healthier societies, more resilient to future outbreaks and epidemics. 

“The human cost of COVID-19 has been devastating, & the so-called lockdown measures have turned lives upside down,” said Dr Tedros in a press briefing. “But the pandemic has given us a glimpse of what our world could look like if we took the bold steps that are needed to curb climate change and air pollution. Our air and water can be clearer, our streets can be quieter and safer, and many of us have found new ways to work while spending more time with our families.”

Both the WHO and EU proposals were unveiled just a day after over 40 million healthcare workers issued a call to place climate-friendly initiatives at the heart of COVID-19 economic recovery. 

Turn “Immense Challenge into Opportunity”

“The recovery plan turns the immense challenge we face into an opportunity, not only by supporting the recovery but also by investing in our future: the European Green Deal and digitalization will boost jobs and growth, the resilience of our societies and the health of our environment,” European Commission President Ursula von der Leyen said in launching the plan. 

The plan would require all 27 EU member states to back it up with concrete investments. It comes as the bloc faces the prospects of a EU-wide recession. However, Member States have remained divided on whether the plan represents the best way forward.

France, Germany, Spain and Italy have welcomed the package, with French President Emmanuel Macron hailing it “a crucial step”.  But Austria, Denmark, the Netherlands, and Sweden — known as the “frugal four” — have protested the proposal, saying the aid should instead come in the form of low-interest loans. As such, the plan in its current form is unlikely to pass in its current form, given that it does not have unanimous support. 

Climate-Friendly Initiatives Core to in the European Union Plan
Urban pedestrian & green space (Photo: CCAC)

One key pillar of the EU plan is “supporting the green transition to a climate-neutral economy.”  A new “Recovery and Resilience Facility” of €560 billion would offer financial support for investments and reforms focusing on green and digital transitions.

The plan also earmarks €91 billion per year in EU grants and loan guarantees to businesses and households that install green technologies such as rooftop solar panels, building insulation and  heating systems based on renewable energy.

The facility also sets aside €5 billion in guarantees for “green mortgages”, tying low-carbon renovations into property sales, giving schools, hospitals, and social housing the priority.

Other climate-friendly instruments include a proposal to strengthen an EU Just Transition Fund, with up to €40 billion to assist economically weaker Member States in accelerating the transition towards climate neutrality, and a €15 billion injection of funds into the European Agricultural Fund for Rural Development, to support a trajectory for rural areas to reach climate neutrality.

The plan has been largely praised for centering on climate-friendly initiatives. However, some advocates have criticised the plan for leaving out ocean health initiatives, and other climate NGOs blasted leaked drafts of the plan for being too lenient towards polluting industries such as automakers and fossil fuel.

“The European Commission’s €1.85 trillion recovery plan is contradictory at best and damaging at worst,” said Greenpeace in a statement. “It does not solve the problem of existing support for gas, oil, coal, and industrial farming – some of the main drivers of a mounting climate and environmental emergency. The plan also fails to set strict social or green conditions on access to funding for polluters like airlines or carmakers,” the NGO added.

WHO Manifesto For Green COVID-19 Recovery

The bold new WHO manifesto begins with a comment by Dr Tedros on the intimate links that have been laid bare between viral threats and other emergencies, pollution and climate change and wildlife and biodiversity destruction:

“The pandemic is a reminder of the intimate and delicate relationship between people and planet. Any efforts to make our world safer are doomed to fail unless they address the critical interface between people and pathogens, and the existential threat of climate change, that is making our Earth less habitable,”

The  WHO Healthy Recovery Manifesto includes six key principles, described as “prescriptions” for a healthy and green recovery from COVID-19, which include the following key messages:

1) Protect and preserve the source of human health: Nature

“Human pressures, from deforestation, to intensive and polluting agricultural practices, to unsafe management and consumption of wildlife, undermine these services. They also increase the risk of emerging infectious diseases in humans  – over 60% of which originate from animals, mainly from wildlife. Overall plans for post-COVID-19 recovery, and specifically plans to reduce the risk of future epidemics, need to go further upstream than early detection and control of disease outbreaks. They also need to lessen our impact on the environment, so as to reduce the risk at source.”

Pangolin, Manis javanica – harbors coronavirus infections, and is hunted for its meat and scales

2) Invest in essential services, from water and sanitation to clean energy in healthcare facilities

“Around the world, billions of people lack access to the most basic services that are required to protect their health, whether from COVID-19, or any other risk. Handwashing facilities are essential for the prevention of infectious disease transmission, but are lacking in 40 % of households. Antimicrobial-resistant pathogens are widespread in water and waste and their sound management is needed to prevent the spread back to humans. In particular it is essential that health care facilities be equipped with water and sanitation services, including the soap and water that constitutes the most basic intervention to cut transmission of SARS-CoV-2 and other infections, access to reliable energy that is necessary to safely carry out most medical procedures, and occupational protection for health workers.”

3) Ensure a quick, healthy energy transition

“Currently, over seven million people a year die from exposure to air pollution – 1 in 8 of all deaths. Over 90% of people breathe outdoor air with pollution levels exceeding WHO air quality guideline values.  Two-thirds of this exposure to outdoor pollution results from the burning of the same fossil fuels that are driving climate change. Energy infrastructure decisions taken now will be locked in for decades to come. Factoring in the full economic and social consequences, and taking decisions in the public health interest, will tend to favour renewable energy sources, leading to cleaner environments and healthier people. Several of the countries that were earliest and hardest hit by COVID-19, such as Italy and Spain, and those that were most successful in controlling the disease, such as South Korea and New Zealand, have put green development alongside health at the heart of their COVID-19 recovery strategies.”

Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm

4) Promote healthy, sustainable food systems

Diseases caused by either lack of access to food, or consumption of unhealthy, high calorie diets, are now the single largest cause of global ill health. They also increase vulnerability to other risks – conditions such as obesity and diabetes are among the largest risk factors for illness and death from COVID-19. Agriculture, particularly clearing of land to rear livestock, contributes about ¼ of global greenhouse gas emissions, and land use change is the single biggest environmental driver of new disease outbreaks. There is a need for a rapid transition to healthy, nutritious and sustainable diets. If the world were able to meet WHO’s dietary guidelines, this would save millions of lives, reduce disease risks, and bring major reductions in global greenhouse gas emissions.

5) Build healthy, liveable cities

Cycling in Fortaleza, Brazil – the city strengthened its active transport plans as part of the Healthy Cities Partnership

“As cities have relatively high population densities and are traffic-saturated, many trips can be taken more efficiently by public transport, walking and cycling, than by private cars. This also brings major health benefits through reducing air pollution, road traffic injuries – and the over three million annual deaths from physical inactivity. Many of the largest and most dynamic cities in the world, such as Milan, Paris, and London, have reacted to the COVID-19 crisis by pedestrianizing streets and massively expanding cycle lanes – enabling “physically distant” transport during the crisis, and enhancing economic activity and quality of life afterwards.”

6) Stop using taxpayers’ money to fund pollution – halt US$ 400 billion in fossil fuel industry subsidies

“Financial reform will be unavoidable in recovering from COVID-19, and a good place to start is with fossil fuel subsidies.

Globally, about US$400 billion every year of taxpayers money is spent directly subsidizing the fossil fuels that are driving climate change and causing air pollution. Furthermore, private and social costs generated by health and other impacts from such pollution are generally not built into the price of fuels and energy. Including the damage to health and the environment that they cause, brings the real value of the subsidy to over US$5 trillion per year-  more than all governments around the world spend on healthcare – and about 2,000 times the budget of WHO.

Placing a price on polluting fuels in line with the damage they cause would approximately halve outdoor air pollution deaths, cut greenhouse gas emissions by over a quarter, and raise about 4% of global GDP in revenue. We should stop paying the pollution bill, both through our pockets and our lungs.”

New ‘WHO Foundation’ Aims To Raise More Flexible Funding For The World Health Organization
Dr Tedros (left) and Thomas Zeltner (right) sign an MOU between the WHO and the newly established WHO Foundation

Meanwhile, WHO also unveiled a new initiative Wednesday to address some of its own pressing financial problems – triggered by the temporary suspension of funding from the United States as well as by a longer term decline in “assessed contributions” by WHO member states to the Organization. 

The WHO Foundation was launched today to raise funding from the general public and other  “non-traditional sources” for the Organization. The new foundation will give the agency a source of unearmarked income, providing more flexibility in financing WHO’s General Programme of Work. 

“The creation of the foundation represents a truly innovative approach to diversify WHO’s resource mobilization strategy. This new approach is clearly an urgent need,” said WHO Foundation founder and former Swiss Secretary of State for Health Thomas Zeltner.

“One of the greatest threats to WHO success is the fact that less than 20% of our budget comes in the form of flexible assets contributions from Member States,” said Dr Tedros at the press briefing. “For WHO to fulfill its mission and mandate, there is a clear need to broaden our donor base, and to improve both the quantity and quality of funding we receive – meaning more flexibility.”

WHO is one of the few international organizations that, up until now, has no legal channel for receiving donations from the general public, he noted. 

The success of the COVID-19 Solidarity Fund, which has raised more than US $241 million in a few short months, served as a good proof-of-concept for the WHO Foundation, which aims to raise money for a broader, more flexible and more long-term portfolio encompassing all of WHO health programmes.

Currently, almost 80% of the funding that WHO receives comes in the form of voluntary contributions earmarked for specific programmes, according to Dr Tedros. 

“This means that WHO has little discretion over the way it spends almost 80% of its funds,” he explained.

More flexible funding, channeled through the new WHO Foundation, will allow the organization to address some underfunded programmes that have not caught the eye of other large donors. attention. 

“All funding of the WHO Foundation will help implement WHO’s General Programme of Work. On average, between 70-80% of the funds we raise will go directly to the WHO Secretariat. The remaining 20-30% will be used to strengthen public health globally by working with implementing partners of WHO,” said Zeltner.

Still, money raised by the new Foundation is meant to “complement, not supplement” existing resources available to the agency, clarified Zeltner.

The WHO Foundation will be set up as an independent, non-profit organization under Swiss law. A Memorandum of Understanding between the WHO and the WHO Foundation was signed Wednesday by Zeltner and Dr Tedros to set the framework for how the Foundation will collaborate with the agency.

Image Credits: Twitter: @WHO, Wikimedia Commons, Piekfrosch/wikipedia, Health Care Without Harm, FAO/Shutterstock, City of Fortaleza.

WHO Regional Director for the Americas Carissa Etienne at a regular press conference

As global COVID-19 cases topped 5 million this past week, Latin America has surpassed Europe and the United States in terms of new cases being reported everyday, said WHO Regional Director for the Americas, Carissa Etienne, at a Pan American Health Organization press conference on Tuesday.

There have been almost 32,000 new cases of COVID-19 in Latin America and the Caribbean over the past 24 hours, as compared to 24,000 in the United States and 18,000 in WHO’s European Region – which includes the recently hard-hit Russian Federation and Turkey as well as western European states, such as Italy, Spain and the United Kingdom, which saw a major wave of infections in March and April.

However, the United States and Brazil are now the two countries with the highest cumulative number of reported cases worldwide, added Etienne.  And the Americas region as a whole has seen 2.4 million of the world’s 5.5 million reported cases, as well as 143,000 of the 350,000 deaths. As of Tuesday evening, the United States reached the 100,000 mark for deaths from the novel virus.

The latest data is ‘truly alarming’, Etienne said in light of the fact that non-communicable diseases (NCDs) like diabetes, cancers or other respiratory diseases are “pervasive” throughout the “Americas” region – and those diseases make people more vulnerable to serious illness from Covid-19. 

“We have Never Seen Such a Deadly Relationship”

Prior to COVID-19, about 80% of all deaths in the Americas were already due to such non-communicable diseases and almost 40% of these deaths were premature, as they occurred before 70 years of age, said Etienne. The Americas Region, according to World Health Organization’s definitions, includes Latin America and the Caribbean as well as the United States and Canada.

That means one in four people in the Americas is at an increased risk of poor outcomes if they become infected with COVID-19, said Etienne.

“We have never seen such a deadly relationship between an infectious disease and NCDs”, said Etienne. “One of the most concerning aspects of the COVID-19 pandemic in PAHO is the disproportionate impact of the virus on people suffering from non-communicable diseases.”

Latin America has 62 million people living with diabetes and 1.2 million people living with cancer, and these populations are much more vulnerable to COVID-19.

Diabetics are twice as likely to have severe COVID-19 disease, according to a recent review of 16,000 patients with COVID-19. And in one Chinese study, almost 30% of cancer patients died from the virus, as compared to only 2% on average, said Etienne. 

Smoking increases vulnerability to COVID-19

Smoking prevalence is another risk factor in the Americas that is exacerbating the current crisis. About 15% of adults in the region still smoke, increasing the likelihood of developing severe illness from COVID-19, as smoking reduces respiratory capacity and promotes cancers, heart and lung disease.

For all of these reasons, she said, health systems need to prioritize prevention and control of non-communicable diseases along with supporting the pandemic response –  as treating NCDs can prevent COVID-19 from becoming life-threatening. 

“As cases continue to rise in our region, our efforts to protect those with underlying conditions must intensify,” she said. “We must ensure timely access to care for chronic diseases to prevent them from becoming life-threatening.”

“Fighting non-communicable diseases now is integral to our response to COVID-19. We need aggressive preventive measures to protect people with diabetes, respiratory and cardiovascular diseases from the new coronavirus.”

If measures are not taken now to help people with NCDs, health systems will be faced with a “parallel epidemic” of preventable deaths in persons with those conditions.

The New Epicentre Of Infection – Latin America

There can be ‘no doubt’ that Latin America has become the epicenter of the COVID-19 pandemic, said Etienne at Tuesday’s press conference.

And over the past day, the ‘highest increase’ in cases was seen in Latin American countries like Chile, Brazil and Peru.

While Chile has reported almost 5000 new cases in the past day, a 7% increase, Brazil has seen almost 16000 new cases over the past 24 hours, a 5% increase. Meanwhile, Peru and Mexico have each witnessed a 4% increase in cases over the past day, said Etienne.

Some countries in the region have successfully ramped up testing; Chile, for instance, has reached the milestone of 25,000 tests per million people, comparable with the highest range of testing rates in Europe at the height of the pandemic wave there. But testing is still ‘not sufficient’ in most other countries, said Director of PAHO’s Department of Communicable Diseases Marcos Espinal – The majority of South American nations are still only managing to test less than 5000-6000 people per 1 million, a figure that is much lower than most European countries.

The Americas has 40% of the world’s cases and 40% of total deaths

Image Credits: WHO, WHO.

COVID-19 responders learn how to properly don and doff protective gowns in Kenya

In contrast to Europe and the Americas, Africa has just 1.5 percent of the world’s reported cases of COVID-19, and less than 0.1 percent of the world’s deaths, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus noted on Africa Day 2020.

“Africa appears to have so far been spared the scale of outbreaks we have seen in other regions,” said Dr Tedros. “Of course, these numbers don’t paint the full picture. Testing capacity in Africa is still being ramped up, and there is a likelihood that some cases may be missed.”

Still, African countries’ histories of facing outbreaks of infectious disease have played in their favor, said the WHO Director-General.

“Africa’s knowledge and experience of suppressing infectious diseases has been critical to rapidly scaling up an agile response to COVID-19,” he said.

For example, a coalition of African leaders, organized through the African Union chaired by South African President Cyril Ramaphosa, was set up early in the global pandemic to coordinate cross-country preparedness efforts. Infrastructure and knowledge from battling previous outbreaks was used to rapidly scale COVID-19 interventions, as seen in South Africa’s rapid deployment of mobile diagnostic teams, and the Democratic Republic of the Congo’s use of Ebola screening infrastructure for COVID-19 temperature screening.

Additionally, citizens across the continent have largely understood the need for strong lockdown measures, taken early by many African nations. WHO Regional Director for Africa Dr Matshidiso Moeti on Monday thanked citizens for abiding by stay-at-home orders where possible, acknowledging the hardships that many were facing.

“I’d like to very much commend and thank [the citizens]… because we think that it’s thanks to these measures that we have not started to see the kind of evolution of the pandemic in Africa that we were projecting,” said Moeti. “They accepted the need for some of these measures, although many of them recognize that it would be very tough on them in the households, particularly if you take into account the proportion of African people that are in a sector where you need to be out, earning your money in order to be able to put food food on the table.”

Japan Lifts State Of Emergency As Other Asian Countries Seesaw On COVID-19 Control

On Monday, Japan officially lifted its state of emergency in all its provinces ahead of the May 31st deadline, regarding the emergency situation as “no longer necessary” according to the Ministry of Health. The country has been largely praised for its efficient coronavirus response, relying almost solely on quick contact tracing, testing, and isolation of cases.

India also lifted its restriction on domestic air travel effective Monday, although there were mixed opinions on the move. Meanwhile, Philippines President Rodrigo Roa Duterte commanded its government agencies to expedite the repatriation of more than 24,000 overseas Filipino workers (OFW) within the week.

In China, clusters of cases in Jilin province in the northeast have led to officials to lockdown cities only a couple weeks after the original pandemic epicentre Wuhan began relaxing lockdown measures.

Tensions between China and the US remain high. China’s Foreign Minister Wang Yi remarked that a “political virus is spreading in the US, with some politicians ignoring facts and promoting conspiracy” at a video press conference on Sunday. Still, Wang expressed hope that there could be future collaboration between China and the U.S. for addressing global challenges. 

Park rules in Paterson, New Jersey, USA.
New Death Projections in US Cast Somber Outlook If States Are Too Eager To Reopen

In stark contrast to the Chinese approach, states across the US have begun relaxing social distancing guidance even as new cases continue to appear.

And health experts warn that relaxing COVID-19 measures early could lead to a fresh wave of coronavirus deaths. Some 23,000 more people could die if states failed to reimplement social distancing measures, according to a new analysis by epidemiologists at the Columbia Mailman School of Public Health. 

And enacting federal social distancing measures just two weeks earlier could have prevented 83% of the US’ nearly 100,000 coronavirus deaths, according to the same study. 

But experts fear that social fatigue from complying with the stringent measures mean that citizens will be loathe to comply with any renewed measures. As such, the importance of scaling up public health measures to rapidly detect and contain the virus, as well as improve health education, is even more important in the next phase of the fight.

“Our results also indicate that without sufficient broader testing and contact tracing capacity, the long lag between infection acquisition and case confirmation will mask the rebound and exponential growth of COVID-19 until it is well underway,” says lead researcher Jeffrey Shaman, professor of environmental health sciences at the Columbia Mailman School of Public Health in a press release. “Efforts raising public awareness of the ongoing high transmissibility and explosive growth potential of COVID-19 are still needed at this critical time.”

A COVID-19 triage tent in Italy
High COVID-19 Death Rates in Italy & Sweden  

Sweden had a seven-day rolling average of  6.08 deaths per million between 13 May and 20 May, overtaking the UK, Italy and Belgium to have the highest coronavirus per capita death rate in the world regardless of its low population densities and limits in international travel.

In contrast to countries like France and Germany, social distancing implemented in Sweden depending largely on the discretion of individual Swedes, without harsh controls, fines, or policemen.

However,  the high mortality rate has thrown the government’s decision to avoid strict lockdown into further doubt- especially as its neighboring countries such as Norway, Denmark and Finland, where much tighter restrictions are put in place, have seen dramatically lower numbers of deaths over the past month.

Sweden’s decision to keep open schools, bars and restaurants and to continue to allow gatherings of up to 50 people has been praised by many who believe that the country will be better equipped for a “second wave” with certain degree of herd immunity through the relatively relaxed measures. However, WHO experts have repeatedly warned that early antibody surveys are showing that a far higher proportion of the population will remain susceptible to a second wave, casting strong doubt on the ‘herd immunity’ approach.

Meanwhile, a recent analysis of death registry data by two Italian economists shows that Italy had a 40% higher death rate from February to March 2020, as compared to the same time the previous year.

The economists estimated that the virus may have killed 0.1% of the local population in less than 40 days and that its mortality is vastly underreported in official statistics.

But on the bright side, the analysis shows that stringent containment measures were significantly lower in the Veneto region, which has “embraced mass testing, contact tracing and at-home care provision.” Neighboring Emilia-Romagna and Lombardia did not fare as well.

The economists also found that closure of service activities is effective in reducing COVID-19 mortality – a 10% increase in proportion of the service industry closed correlated with a 15% lower death rate in municipalities. In this second paper, the economists draw from daily death registry data on 4,000 Italian municipalities to investigate two policies, namely the shutdown of non-essential businesses and the management of the emergency care system. However, shutting down factories is much less effective. In addition, results also show that morality strongly increases with distance from the intensive care unit (ICU).

Svet Lustig Vijay contributed to this story

Image Credits: Twitter: WHOAFRO, Paterson Great Falls, Servizio Nazionale della Protezione Civile.

This story was updated 4 June to reflect the Lancet study’s retraction.

WHO Chief Scientist Soumya Swaminathan provides reasoning behind pausing hydroxychloroquine arm of the Solidarity Trial.

Enrollment of new patients in the hydroxychloroquine (HCQ) arm of the World Health Organization’s Global COVID-19 Solidarity Trial will be put on pause, as the trial’s oversight committee reviews all available data on COVID-19 and hydroxychloroquine, WHO Director-General Dr. Tedros Adhanom Ghebreyesus said on Monday.

The WHO decision on Saturday came just a day after a major observational study published in The Lancet found a higher mortality rate in COVID-19 patients who have received hydroxochloroquine, chloroquine, or a combination of either drug and azithromycin, as compared to COVID-19 patients who did not receive any treatments.

The Lancet paper was later retracted on 4 June by three of the authors due to concerns about the “veracity of the primary data sources.”

“The executive group [composed of experts from 10 countries involved in the trial] has implemented a temporary pause of the hydroxychloroquine arm within the Solidarity trial,” said Dr Tedros speaking at a WHO press conference. “The group has agreed to review a comprehensive analysis and critical reappraisal of all evidence available globally. The review will consider data collected so far in the Solidarity trial, and important, robust randomized available data to evaluate the potential benefits and harms from this drug.”

WHO Experts Clarify Reasoning Behind Hydroxycholoroquine Arm Suspension

Still, WHO experts said that mortality conclusions could not be definitively drawn from an observational study, such as the one reported by The Lancet. WHO’s Chief scientist Soumya Swaminathan acknowledged that unlike randomized controlled trials such as the one WHO is conducting observational studies can yield misleading results.

“We know that the evidence from observational studies, however large they may be, is still subject to inherent bias. What’s really important is to have well-conducted randomised control studies, done in large numbers,” said WHO Chief Scientist Soumya Swaminathan, also speaking at the press briefing.

WHO Emergencies head Mike Ryan also underlined that WHO’s decision to suspend the hydroxychloroquine arm of the WHO Solidarity Trial was not due to any negative preliminary results that had already been flagged in the ongoing WHO study.

Rather, the decision was a “proactive” one made to “err on the side of caution,” said Swaminathan.

“There were also a lot of questions coming from our own principal investigators in countries, and we knew that the regulatory agencies in many countries were also discussing these data…So the steering committee decided that in the light of this uncertainty that we should be proactive, err on the side of caution and suspend enrollment temporarily into the hydroxychloroquine arm,” she told reporters.

As one part of the review, the trial’s independent data safety monitoring board will be analyzing data collected so far to see if there are any “signals” that the drug is failing, and send them to the trial’s advisory committee for further review, said WHO Health Emergencies Executive Director Mike Ryan.

“We will expect that if there is no signal of failing, and we don’t have any problems, we will try to use the drug,” said Ryan.

Dr Tedros highlighted that hydroxychloroquine, which has been widely approved for use for malaria and the autoimmune disease Lupus, is still safe to use in patients with those diseases.

Researchers Criticise The Lancet Study Design
Analysis of HCQ studies finds that randomised control studies (green) are more likely to find the drug has a positive effect on COVID-19, compared to observational studies (red)
(Credit: Didier Raoult et al.)

Other researchers have also criticised The Lancet study’s design. While the study had analyzed a large body of data from 671 hospitals in 6 continents, there could still be bias in the analysis that is obscuring the true effects of the drug.

In smaller RCTs for example, positive results for hydroxychloroquine had been found. Treatment failure had so far mainly been identified only in observational studies, according to an analysis by Didier Raoult, director of the Marseille University Hospital Institute for Infectious Diseases ( IHU Méditerranée Infection).

One major critique is that The Lancet study does not adequately adjust for the fact that many of the patients in the study are more likely to be severely ill, and are already at increased risk of death.

Critics contend that The Lancet study primarily observes patients experiencing more severe disease who began receiving HCQ later in disease progression, while the drug has shown promise when given earlier or used as a preventative treatment. For example, India now recommends the prophylactic use of hydroxycholoroquine to protect against COVID-19 infection in all healthcare and frontline workers, following results from a small observation trial that found the likelihood of infection was lower in those who took the drug.

“Another poorly designed interpretation of a hydroxychloroquine data set for COVID-19. A larger poorly designed “trial” only leads to larger erroneous conclusions,” tweeted Steven Phillips, a Yale-educated internal medicine doctor who specializes in zoonotic infectious diseases.

About two-thirds of the patients in The Lancet study were from North America, where delays in testing mean that patients aren’t identified until 5 to 7 days after they begin showing symptoms, says Phillips.

“HCQ early COVID-19 treatment isn’t embraced in the US. It’s given only to the sickest patients, without contrary evidence in this study. To state that the baseline disease severity between treatment & control is equal was incorrect,” he added.

For example, one measure used in The Lancet study to determine baseline disease severity is the “quick sequential organ failure assessment”(qSOFA) score. There is little difference between qSOFA scores across different disease severities, so the score is “proving a bad stratifier for COVID,” tweeted antimalarial pharmacology researcher James Watson, a lead scientist at the Mahidol Oxford Tropical Medicine Research Unit (MORU).

“So a quick conclusion is that they have just inadequately adjusted for disease severity, which is driving the treatment allocation [of HCQ or no HCQ],” added Watson.

“I agree with one thing the authors said: ‘Randomized clinical trials will be required before any conclusion can be reached regarding benefit or harm of these agents in COVID-19 patients,'” Phillips tweeted in conclusion.

Image Credits: Matthieu Million, Yanis Roussel, Didier Raoult.

Scientist conducting coronavirus vaccine research at NIAID’s Vaccine Research Centre, Moderna’s original collaborator on the SARS-CoV-2 vaccine.

A COVID-19 vaccine candidate made by Chinese researchers successfully induced the development of neutralizing and binding antibodies against SARS-CoV-2, the virus that causes COVID-19, according to early results from a non-randomized phase I clinical trial published Friday in The Lancet. 

The trial results follow on to results announced by Moderna earlier this week, which found that their vaccine candidate was able to induce neutralizing antibodies in 8 healthy volunteers. In vaccine trials, the development of neutralizing antibodies is the most sought-after immune response because these antibodies bind to viral particles in a way that immediately blocks infection.

The non-randomized Chinese study, which was published in The Lancet, reported preliminary safety and efficacy results for a vaccine in 108 healthy middle-aged adults at low, medium, and high doses; with 36 participants enrolled in each dosage level. At low dose and middle-doses, about a half of the individuals produced neutralizing antibodies after 28 days. At high doses, some three-quarters (27/36) of volunteers produced neutralizing antibodies. Regardless of vaccine dosage, over 90% of participants showed a four-fold increase in binding antibodies. 

“These results represent an important milestone,” said Wei Chen from the Beijing Institute of Biotechnology, who was responsible for the study. “The trial demonstrates that a single dose of the new adenovirus type 5 vectored vaccine produces virus-specific antibodies and T cells in 14 days, making it a potential candidate for further investigation.”

The Ad5-nCoV vaccine also stimulated a rapid T cell response in 83.3% of individuals that received a low dose – and in the medium and high- dose groups,  97% (35/36) of individuals exhibited rapid T cell responses. Certain types of T cells develop responses when exposed to specific antigens, or parts of disease-causing pathogens, and “remember” to attack the same pathogen once exposed to it again. Vaccines, which contain un-infective pieces of viruses or weakened viruses, help activate this immune memory by inducting a T-cell mediated response.

The most common adverse reactions to the vaccine persisted for less than 48 hours, which is usually considered acceptable for a vaccine. Side effects ranged from mild pain at the injection site reported in over half (54%, 58/108) of vaccine recipients, as well as fever (46%, 50/108), fatigue (44%, 47/108), headache (39%, 42/108), and muscle pain (17%, 18/108). 

Many Limitations to Chinese Vaccine Study & Concerns with the Adenovirus 5 Vector

Still, “the challenges in the development of a COVD-19 vaccine are unprecedented, and the ability to trigger these immune responses does not necessarily indicate that the vaccine will protect humans from COVID-19,” warned Chen.

Further, randomized trials are needed to tell whether the immune response the vaccine candidate elicits effectively protects against SARS-CoV-2 infection, he added.

And health experts have brought up concerns around the vector used to carry the vaccine, a weakened common cold-causing virus, adenovirus type 5 or Ad5.

“There has been a shadow with the Ad5 as a vaccine vector over the last decade, not seen with other Ad vectors for vaccines. Have these concerns been allayed?” tweeted Jeremy Farrar, director of the research foundation Wellcome Trust, in response to the study.

Farrar referred to a previous case where an HIV-vaccine candidate using the Ad5 vector was found to put study participants who received the vaccine at a higher risk of HIV infection – and further exploration of that vaccine candidate was promptly discontinued. It’s been posited that the T-cells activated by the Ad5-vector HIV vaccine candidate made the cells more vulnerable to infection by HIV-1, which attacks immune cells.

Of the concerns, the study authors write, “although the association between HIV-1 acquisition risk and Ad5 vectored vaccine is controversial and its mechanism is unclear, the potential risks should be taken into account in studies with this viral vector delivery platform.

“We plan to monitor the participants in our upcoming phase 2 and phase 3 studies to assess the indication for any such acquisition.” At least two other vaccine candidates using the Ad5 vector are listed in the World Health Organization’s draft registry of SARS-CoV-2 vaccine candidates, the study authors say.

However, another concern is that half of the participants in the COVID-19 vaccine trial also already had immunity to the Ad5 virus, and these participants showed weaker immune responses to the COVID-19 vaccine. 

“Our study found that pre-existing Ad5 immunity could slow down the rapid immune responses to SARS-CoV-2 and also lower the peaking level of the responses,” said Feng-Cai Zhu from Jiangsu Provincial Center for Disease Control and Prevention in China, part of the group that led the study. “Moreover, high pre-existing Ad5 immunity may also have a negative impact on the persistence of the vaccine-elicited immune responses.”

The authors note that the other limitations of the trial are its small sample size, relatively short duration, and most importantly, lack of a randomised control group – which may have biased their results.

To address these limitations, a randomised, double-blinded, placebo-controlled phase 2 trial in 500 healthy adults has been initiated in Wuhan to determine whether the results can be replicated, and if there are any adverse events up to 6 months after vaccination. For the first time, this will include participants over 60 years old, an important target population for the vaccine.

Moderna Vaccine Induces Immune Response In Limited Number Of Healthy Volunteers

In a parallel development, eight people injected with Moderna’s experimental COVID-19 vaccine, mRNA-1273, developed neutralizing antibodies against the virus, announced the US-based pharmaceutical firm on Monday.

Neutralizing antibodies were detected in 4 participants that were given a low vaccine dose of 25 micrograms, and in 4 others that received a higher dose of 100 micrograms, 43 days after receiving the vaccine. At these doses, the vaccine was generally safe and well tolerated, said Moderna in a statement.

Neutralizing antibody titers for the remaining study participants were not yet available. The data were from a Phase I clinical trial conducted in collaboration with the US National Institute for Allergies and Infectious Diseases (NIAID). 

“These interim Phase 1 data, while early, demonstrate that vaccination with mRNA-1273 elicits an immune response of the magnitude caused by natural infection starting with a dose as low as 25 micrograms,” said Tal Zaks, M.D., Ph.D., Chief Medical Officer at Moderna.

“When combined with the success in preventing viral replication in the lungs of a pre-clinical challenge model at a dose that elicited similar levels of neutralizing antibodies, these data substantiate our belief that mRNA-1273 has the potential to prevent COVID-19 disease and advance our ability to select a dose for pivotal trials,” added Zaks.

Based on these early results, Phase 2 trials for the Moderna vaccine were amended to include a 50 ug dosage and a 100ug dosage in order to finalize a dosage for Phase 3 studies. A 50ug dosage arm was added to the Phase 1  – NIAID study.

Phase 3 clinical trials could be initiated as soon as July 2020, an unprecedented speedy timeline for vaccine development.

However, similar to the Chinese vaccine study, the initial results don’t necessarily show that the vaccine induces an immune response strong enough to protect against COVID-19, nor do they show how long protection might last.

The concentration of neutralizing antibodies in the 8 participants was similar to the concentration found to be protective against COVID-19 in mouse models, although the results from animal models do not necessarily always correlate directly with humans. The 8 participants with neutralizing antibodies were sampled only two weeks after receiving the second dose of vaccine, and must be followed further in order to determine whether and for how long the neutralizing antibodies could protect against SARS-CoV-2 infection. 

Some 45 participants also developed ‘binding antibodies’, which can bind to a virus but do not make it less infectious.

Though Moderna’s vaccine study was led by the US National Institute of Allergy and Infectious Diseases (NIAID), the NIAID did not publish a press release, and declined to comment on Moderna’s announcement. If successful, this would be the first vaccine candidate that Moderna, a company that is experimenting with new, mRNA vectors for carrying vaccines, will bring to market. 

In recent months, health experts and government leaders are more and more pinning their hopes to quash the pandemic for good on a successful COVID-19 vaccine, as serological studies are beginning to show that a large proportion of countries’ populations will remain susceptible to the virus after the first wave.

Not everyone that gets infected with COVID-19 develops antibodies, suggest recent European serological surveys. In Switzerland, one of the hardest-hit countries in Europe, only 1 in every 10 people had antibodies against COVID-19 – and older people had about half as many antibodies as young and middle-aged individuals. 

Surveys in Spain and France also paint a solemn picture of immunity, as only about 4-5% of the population has detectable antibody levels. Though the number of people with antibodies is growing rapidly as infections increase, herd immunity is far away.

The creation of an effective vaccine is seen as the long-term solution to controlling the COVID-19 pandemic. Currently, there are more than 100 candidate COVID-19 vaccines in development worldwide.

Image Credits: NIAID.

This story was updated 4 June to reflect the paper’s retraction.

Colorized scanning electron micrograph of a dying cell (blue) heavily infected with SARS-COV-2 (yellow), the virus that causes COVID-19

New research published in The Lancet on Friday found that hydroxychloroquine and chloroquine has ‘no benefit’ for coronavirus patients, and could even increase the risk of heart arrhythmias and mortality. 

The study was retracted by three of its authors on June 4, due to the authors own concerns about the “veracity of primary data sources.”

“This is the first large scale study to find statistically robust evidence that treatment with chloroquine or hydroxychloroquine does not benefit patients with COVID-19,” said lead author of the study and Executive Director of the Brigham and Women’s Hospital Center in Boston Mandeep R. Mehra. “Instead, our findings suggest it may be associated with an increased risk of serious heart problems and increased risk of death.”

In the worst-case scenario, some 8% of patients in The Lancet study who were given hydroxychloroquine combined with azithromycin developed a heart arrhythmia (502/6,221), compared with 0.3% patients in the control group (226/81144).

Hydroxychloroquine and chloroquine use predicts in-hospital mortality

Treatment with hydroxychloroquine, chloroquine, or either drug in combination with azithromycin was also associated with higher odds of death, even after accounting for age, race, body mass index, and preexisting conditions.

While not a randomized control study, The Lancet article is the largest study to date on the hyped drugs, analyzing data from nearly 15,000 COVID-19 patients who received hydroxychloroquine, chloroquine, or a combination of either drug with a macrolide antibiotic such as azithromycin, and 81,000 COVID-19 patients who did not receive any of those treatments. The data came from 671 hospitals across 6 continents.

In light of mounting evidence that hydroxychloroquine provides little benefit to coronavirus patients, health experts are again repeating calls to take caution in rolling out emergency approval for unproven treatments, even as countries all over the map cautiously begin to authorize the use of hydroxychloroquine for COVID-19. India even issued a revised advisory on Friday expanding the use of hydroxychloroquine as a prophylactic treatment in healthcare workers and contacts of lab-confirmed coronavirus patients.

Experts from the World Health Organization have also been cautioning against widespread, unmonitored use of the drug. 

“We do point to the fact that… the current clinical evidence does not support the widespread use of hydroxychloroquine for the treatment of COVID-19, not until the trials are completed and we have clear results,” said WHO’s Executive Director of Emergencies Programme Mike Ryan, at WHO’s press conference on Friday, referring to evidence from clinical and systematic reviews carried out by the WHO Pan American Health Organization (PAHO).

Hydroxychloroquine, and hydroxychloroquine plus azithromycin are two of the drug regimens being tested for COVID-19 patients in WHO’s giant, multicountry Solidarity Trial.

The Lancet results support previous findings from a widely disseminated Brazilian study that found an increased risk of heart arrhythmias in COVID-19 patients receiving high doses of the drug. The study was discontinued shortly after, as subjecting patients to increased risk of death in the trial was deemed unethical by study coordinators.

The Lancet study however, does not explore another use for hydroxychloroquine – taking the drug to prevent onset of COVID-19.

India Revises Hydroxychloroquine Recommendations To Promote Prophylactic Use
Indian Ministry of Health recommends prophylactic use of hydroxychloroquine in revised advisory

On Friday, India’s National Task force (NTF) for COVID-19 issued a revised advisory on prophylactic use of hydroxychloroquine – expanding the recommendation to include all asymptomatic healthcare workers in COVID-19 positive and non-COVID-19 settings, all asymptomatic frontline workers in the COVID-19 response including contact tracers, and all asymptomatic household contacts of laboratory confirmed cases. 

The previous advisory, issued on 23 March, restricted the recommendation to healthcare workers who worked directly with confirmed and suspected COVID-19 patients, and asymptomatic household contacts of laboratory confirmed cases. 

The revised recommendation was based on a small prospective observational study of 334 healthcare workers. According to the advisory, the incidence of COVID-19 infection in the 248 healthcare workers who took HCQ prophylaxis in New Delhi was lower than the incidence of infection in those who did not take it after following up with the study subjects for a median of 6 weeks, however the exact reduction was not listed.

Still, the revised advisory recommends that the drug has to be given under ‘strict medical supervision with informed consent’ and ‘only on the prescription of a registered medical practitioner’ – noting a number of preexisting conditions that make taking the drug risky. 

The advisory also notes that only under ‘rare’ circumstances does hydroxychloroquine lead to the dangerous cardiovascular side effects. Among 1323 healthcare workers who took HCQ prophylaxis, serious side effects were reported in 7. Among those 7, three healthcare workers had a serious cardiac side effect – prolongation of QT interval on ECG.

“Rarely the drug causes cardiovascular side effects such as cardiomyopathy and rhythm (heart rate) disorders. In that situation the drug needs to be discontinued,” said the advisory. 

China, Spain, Brazil, and the United States have also issued recommendations for use of hydroxychloroquine in limited populations, largely restricting them to use in clinical trial settings in light of the new reports of serious cardiac side effects.

But the authors of The Lancet study still warn that the overall likelihood that these drugs improve clinical outcomes in COVID-19 patients is quite low, and underline that the medicines should not be recommended by countries for widespread treatment of COVID-19.

 “Several countries have advocated use of chloroquine and hydroxychloroquine, either alone or in combination, as potential treatments for COVID-19. Justification for repurposing these medicines in this way is based on a small number of anecdotal experiences that suggest they may have beneficial effects for people infected with the SARS-CoV-2 virus,”  said Director of the Heart Center at University Hospital Zurich Frank Ruschitzka, who also co-authored The Lancet study.

Image Credits: NIAID, The Lancet, India Ministry of Health.

New technical guidance for national governments was released to support the enhanced measurement of two key indicators for the COVID-19 response; the number of cases and the number of deaths, as reported on national and global dashboards. The package was launched by global health NGO Vital Strategies.

Limited COVID-19 testing capacity in low- and middle-income countries makes it especially challenging to use confirmed cases as a measure of epidemic impact and burden.

“In the absence of adequate global testing capacity, measuring cases and deaths specifically due to COVID-19 is not straightforward,” said Dr. Philip Setel, vice president of the Civil Registration and Vital Statistics Program at Vital Strategies in a press release. “Rapid surveillance of total mortality can provide critical data to national leaders and health authorities as they work to temper and control the pandemic within their borders.”

 The new guidance, Revealing the Toll of COVID-19: A Technical Package for Rapid Mortality Surveillance, offers a step-by-step manual on ‘rapid mortality surveillance,’ which relies on the key concept of estimating excess deaths due to COVID-19. The technique allows countries to rapidly determine the extent of the epidemic and accordingly plan outbreak responses.

By comparing year-on-year all-cause mortality data from national civil registration and vital statistics (CRVS) systems, countries can see how many more deaths occurred in 2020 compared to previous years, and get a snapshot of how many excess deaths may have been caused by COVID-19, according to the new guidance. The data can then be visualized separately by age group, sex, and location to further identify trends in deaths.

Brazil, Colombia and Peru already began using existing civil registration and vital statistics systems for rapid mortality surveillance through the Bloomberg Philanthropies Data for Health Initiative. Analysis of vital registration data helped identify a sharp increase in total mortality in April 2020 compared to the same time in 2019 in Manaus, Brazil, illustrating the enormous impact the pandemic has had on the city’s death rate.

“All countries need timely and reliable data to inform health planning. This need becomes particularly acute at times like now when they face a swiftly evolving pandemic,” said Dr. Samira Asma, Assistant Director General for Data, Analytics, and Delivery for Impact at the World Health Organization

Rapid mortality surveillance generates daily or weekly counts of total mortality by age, sex, date of death, place of death and place of usual residence, helping to provide a fuller picture of the scale and direction of the pandemic, including estimates of deaths due to COVID-19 that may have been missed by the traditional testing and surveillance system. Data is collected through facility- and community-based surveillance, which helps capture deaths that are also occurring in homes.

The technique also estimates indirect mortality caused by disruptions to health services, and the interaction of the virus with pre-existing conditions such as noncommunicable diseases.

“Governments need timely, reliable data to inform decisions that will ultimately save lives, now more than ever,” said Dr. Kelly Henning, head of Bloomberg Philanthropies’ public health programs. “This new technical package will empower leaders around the world with a faster, more accurate understanding of potential COVID-19 deaths, and allow them to take action to slow the spread of this pandemic.”

The technical package was developed with experts from Vital Strategies and partner organizations that helped shape the package, ensuring clarity, rigor and ease of use: Africa Centers for Disease Control and Prevention, Bloomberg Philanthropies Data for Health Initiative, CDC Foundation, Pan American Health Organization, UN Economic Commission for Africa, UN Economic and Social Commission for Asia and the Pacific, US Centers for Disease Control and Prevention, and the World Health Organization.

Image Credits: Twitter: @WHOKenya.

Western Uganda was hit by a wave of flash floods in May after days of heavy rain caused major rivers to burst their banks.

East Africa and the Horn of Africa are facing a series of unprecedented overlapping disasters – widespread displacement and food insecurity caused by a record season of flooding and locusts, along with the COVID-19 pandemic, according to a new report released Thursday by the International Federation of the Red Cross (IFRC).

Meanwhile, the United Nations High Commissioner for Refugees (UNHCR) and the World Health Organization (WHO) signed a new collaboration agreement on Thursday, with the aim to support efforts to protect the 71 million forcibly displaced people around the world from COVID-19.

Widespread flooding in Ethiopia, Kenya, Somalia, South Sudan, Tanzania, Rwanda and Uganda during this year’s record wet season has displaced around 500,000 people and killed nearly 300. The flooding has also set back key interventions against the worst locust crisis the area has faced in decades, and created conditions ripe for COVID-19 transmission. 

Food insecurity, already exacerbated by the locust crisis and economic devastation due to the coronavirus, will likely be amplified. Nearly 18 million people across the region are already facing an acute food crisis. 

“The ongoing flooding crisis is exacerbating other threats caused by COVID-19 and the invasion of locusts,” said IFRC Africa Director Simon Missiri in a press release. “Travel and movement restrictions meant to slow down the spread of COVID-19 are hampering efforts to combat swarms of locusts that are ravaging crops. Flooding is also a ‘threat amplifier’ with regards to the spread of COVID-19 as it makes it hard to implement preventive measures.” 

Many of the displaced people are being housed in crowded temporary shelters or internal displacement camps, where physical distancing to prevent the spread of COVID-19 is nearly impossible. 

As of Wednesday, two cases have already been confirmed in Dadaab camp in Kenya, the third largest refugee camp in the world, according to UNHCR and the Kenya Ministry of Health. As of Thursday night, there are 4,458 cases and 120 deaths across Ethiopia, Kenya, Somalia, South Sudan, Tanzania, Rwanda and Uganda, although the true numbers may be much higher due to limited testing capacities, according to IFRC.

Woman receives IFRC assistance after widespread flooding the Horn of Africa and East Africa
Increase In Food Insecurity Due To The Triple Threat

Additionally, the record wet season has hampered efforts to control the second wave of a deadly locust infestation, already estimated to be 20 times larger than the first invasion that began in late 2019. Nearly 18 million people in the region were already experiencing an “acute food and livelihood crisis” due to the locust invasion, according to the IFRC report, which classifies regions facing food insecurity using the Integrated Food Security Phase Classification (IPC) scale.

The increased rainfall in fact promotes locust breeding and growth of wild vegetation that acts as locust food, according to Euloge Ishimwe, spokesperson for IFRC Africa.

“The heavy rains rainfall recently experienced have caused a slowdown in locust control operations due to poor visibility during aerial spraying, and affected the movement of the spraying teams. This could have allowed continued locust destruction of crop and vegetation , further undermining the food security and livelihoods in the affected areas,”  said Ishimwe in an interview with Health Policy Watch. 

Why the Locust Problem Particularly Acute This Year?
(Photo: UN News)

Locusts typically breed and die in arid desert regions of the Sahara and the Arabian Peninsula. But unusually heavy regional rains over the past two years have greatly expanded the fertility of those remote breeding grounds – prompting locust swarms’ expansion and migration towards Yemen and Somalia. Those, in turn, are conflict zones where control activities are all the more difficult to carry out.

From there, the swarms have migrated even further across Ethiopia, South Sudan, Kenya, Uganda and Tanzania, where heavy rains gave them yet more sites to multiply.

“This crisis is both natural and man-made,” Baldwyn Torto, a scientist specializing in locusts at the International Centre of Insect Physiology and Ecology in Nairobi, Kenya, told the Christian Science Monitor. “There is a natural cycle of cyclones in this region, but there’s also so much insecurity in some parts of the region that the surveillance systems for locusts and other pests have broken down.”

Climate change is also contributing to the wet weather in normally arid areas, upon which locusts thrive, said Richard Munang, United Nations Environment Programme expert, in an interview with Reliefweb.int.  According to the World Metereological Organization, the last five years, hotter than any other since the industrial revolution, led to particularly web weather in Africa, which favours multiplication of locusts. Rains around the Horn of Africa from October to December 2019 were up to 400 per cent above normal rainfall amount. This abnormal rains were caused by the Indian Ocean dipole, a phenomenon accentuated by climate change.

Food insecurity – 100% Crop Loss in Worst Case Scenarios
Locusts swarming near a farm (Photo: UN News)

While the rains promote the growth of vegetation as locust food, African farmers displaced by flooding have also lost access to vital farmland, and are unable to harvest or replant crops during the most important planting season of the year, added Ishimwe.

“Harsh weather conditions are having a multiplier effect on an already difficult situation and this could potentially lead to worrying levels of food insecurity in the region,” said Missiri.

Loss of crops due to flooding and locusts, along with increased food prices due to supply chain disruptions caused by COVID-19, form a deadly combination that will exacerbate food insecurity in the East Africa and Horn of Africa region, said Ishimwe.

In a worst case scenario, there could be a nearly 100% loss of crops that the locusts feed upon, which include leaves and tender tissues of most food-producting plants, the IFRC report warns.

The IFRC has launched an emergency appeal for 1.8 million Swiss francs to help prevent 75,000 people from falling into deeper crises. Currently, the organisation has released over 7 million Swiss francs to local Red Cross and Red Crescent National Societies in East and Horn of Africa in order to provide food and non-food support to displaced populations. 

In Kenya, the Red Cross is conducting drone and satellite image assessments in 16 counties to observe the extent of damage caused by the overlapping disasters. Red Cross teams are also airlifting household items to families that have been marooned by floods, and UNHCR has doubled the amount of food rations distributed in Dadaab camp in an effort to cut down on crowding at distribution centers.

Filippo Grandi (left) and Dr Tedros (right) at the signing of a new agreement between WHO and UNHCR

WHO and UNHCR Sign Agreement To Protect Refugees Against COVID-19

WHO Director-General Dr Tedros Adhanom Ghebreyesus and UNHCR High Commissioner Filippo Grandi signed an agreement Thursday to collaborate on protecting refugees in the COVID-19 pandemic. The agreement renews a partnership that WHO and UNHCR have sustained since 1997.

The UNHCR also joined the UN COVID-19 Solidarity Fund on Thursday, allowing it to access US$10 million to finance the COVID-19 response in five countries hosting the largest populations of refugees; Jordan, Kenya, Lebanon, South Sudan and Uganda. The emergency funding will go towards financing community mobilization, procurement of hygiene and medical equipment, and the construction of isolation units for COVID-19 patients.

“UNHCR’s long-term partnership with WHO is critical to curb the coronavirus pandemic and other emergencies – day in, day out, it is improving and saving lives of millions of people forced to flee their homes,” said Filippo Grandi in a press release.

Dr Tedros added that the signing of the agreement represents the “principle of solidarity and goal of serving vulnerable peoples” carried by both agencies.

“We stand side by side in our commitment to protect the health of all people who have been forced to leave their homes and to ensure that they can obtain health services when and where they need them. The ongoing pandemic only highlights the vital importance of working together so we can achieve more,”  said Dr Tedros.

Elaine Ruth Fletcher contributed to this story

Image Credits: IFRC, UN News , UN News, Twitter: @WHO.

Seventy-Second World Health Assembly, Geneva, Switzerland, 20–28 May 2019

Although a proposal to include Taiwan as a World Health Assembly (WHA) observer was delayed until the WHA 73 session resumes again later this year, that didn’t prevent WHO member states from locking horns over the issue in statements on the second day of this week’s virtual WHA session. 

The charge was led by a handful of states, small and large, from the USA to the Caribbean islands of St Kitts and Nevis, Haiti and Belize; the Marshall Islands and Tuvalu in the Pacific; and Eswatini in Africa.

The People’s Republic of China countered with their own arguments:

“There are a few countries determined to plead for the [inclusion of Taiwan], seriously violating the relevant UN resolutions…This video conference decided not to examine the issue of Taiwan to guarantee the smooth running of the meeting. However, just now, the US delegate is still [politicizing this]. That is not acceptable.”

But only a few states, including Syria and Pakistan, openly endorsed China’s stance on Taiwan, reaffirming that ‘there is only one true representative of China,’ in the words of Pakistan.

Most of the world’s other conflicts and regional fault lines were also plainly evident at the Assembly; including member state protests over the plight of migrant populations and refugees in conflict zones such as Yemen and the Sahel, as well as the health status of people in  territories such as Russian Federation-occupied Ukraine and the Israeli-occupied Palestinian West Bank and Gaza. 

Iran, Syria and Cuba also protested unilateral sanctions imposed by the USA.

“The US must be held accountable for continuing to intensify sanctions against Iran, which are undermining our ability [to fight] against the virus,” said a statement by Iran. 

Replying to the political punches from Syria, Cuba and Iran, the US rebutted that its sanctions had not blocked COVID-19 related assistance, and it was even facilitating humanitarian and medical assistance. 

Election of 10 New Members To the WHO Executive Board

In a final item of business, the WHA elected ten new members to the WHA Executive Board, the 34 member governing body that provides oversight to the organization throughout the years. 

Those included representatives from Botswana, Colombia, Ghana, Guinea Bissau, India, Madagascar, Republic of Korea, the United Kingdom of Great Britain and Northern Ireland, and the Russian Federation.

Ukrainian delegate at the World Health Assembly on Tuesday

While Ukraine did not block the Russian Federation’s membership, it dissociated itself from the decision – denouncing Russia for violating international law and hampering health services delivery in occupied regions of the Ukraine affected by COVID-19. 

In a fiery rebuttal, the Russian Federation condemned Ukraine’s statement, calling it an attempt to scapegoat its own failure to handle the outbreak:

“Ukrainian authorities appear to be trying to push the responsibility” for its own failures “onto somebody else’s shoulders,” said the statement by Russia, where COVID-19 cases have exploded, leaving it as the second most infected country in the world, with almost 300,000 total cases that have been reported, and over 9,000 new cases over just the past 24 hours.

See more on WHA resolution.

Total cases of COVID-19 as of 8:32 PM CET 19 May 2020, with active case distribution globally. Numbers change rapidly.

Image Credits: WHO / Antoine Tardy, Johns Hopkins CSSE.

Colorized electron microscope image of SARS-CoV-2 (yellow), the virus that causes COVID-19
Thomas Cueni

Now, more than ever, the pharma industry has been thrust into the limelight – as the world races to find new drugs and a hoped-for vaccine to beat COVID-19 and ensure universal access to critical treatment. Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), talks about the old-new tensions between profit and public needs and how a fiercely competitive industry is testing new models of cooperation.

Health Policy Watch: There is finally an agreed text on the EU-led resolution on COVID-19 Response, that was passed unanimously at the World Health Assembly on Tuesday.  What is your take on the result?

Thomas Cueni: Resolutions quite often have symbolic meaning. When I look at the outcome, it has the right focus, tasking the global community to work together to contain and one day to defeat COVID 19.   It does address the issues of health systems resilience; it does look at lessons to be learned and it calls for collaboration with WHO.

In the development of the call to action, which has become the ACT Accelerator, there are three pillars: vaccines, therapeutics and diagnostics. But there is also a focus on health systems. We’ve been working on the ACT A for three weeks now, and we are making progress in working together towards a common goal to tackle COVID 19.

There are, however, three references to countries’ rights to override patents with the use of WTO  TRIPS flexibilities in the text – something civil society saw as a modest victory.

What we got was a united, rapid, unprecedented industry response to COVID 19, in terms making decisions collectively, repurposing existing medicines, joining together for development of vaccines. When you look at who holds the keys to these, I think there is a recognition that it is indispensable to partner with the private sector and more specifically the biopharmaceutical industry. There has been a recognition among the broader health community that the industry has responded at amazing speed.  It is scaling up manufacturing, in some cases joining up, and committing to huge collaboration efforts in vaccine development. This is not our normal business model. Companies are putting aside normal rivalry and fierce competition, and working on the basis of high risk for high reward. Here companies are acting very differently, with a deep sense of responsibility. As a founding partner of the ACT Accelerator, pharma joins with it a strong belief in the need for solidarity, equity, and a clear notion that what comes out of our labs needs to be affordable.

[The reference to TRIPS] is symbolic and to some extent concerning. It is thanks to a flourishing, thriving innovation ecosystem based on IP that we have so many treatments and vaccines already being tested. Pharma companies moved really extremely fast opening, for example, their libraries to NIH and IMI [Innovative Medicines Initiative].IP has not been a hindrance to finding solutions, it has been an enabler. Without the IP system, we would not be where we are in just three months.  The pharma industry is teaming up with regulatory agencies around the world. It is sharing data. It did not need to be forced to move into discussions about how we can ramp up. Gilead has already contracted with the Medicines Patent Pool – [for voluntary licensing of remdesivir].  The scale, the size of [pharma’s engagement] is unprecedented. All of this is done voluntarily.

So, I was somewhat concerned that there are institutions or people that try to hijack COVID-19 to pursue the traditional attack on IP.  It’s not necessary right now – because companies are doing the right thing.  Undermining IP will be extremely dangerous, because when we have future pandemics and we will have future pandemics, it sends the signal that your IP won’t count for anything.  Honestly, that would be a dangerous signal because companies are doing the right thing. If somebody is already doing the right thing and is met by threats of coercion that would not be the best way to get them to engage.

HPW: Can you talk a little more about the Gilead collaboration with MPP on remdesivir for voluntary licensing of the treatment and these other industry collaborations?  

TC: Gilead is working with MPP, but they also have bilateral contracts. There are multiple ways of doing voluntary licenses.  Decisions in terms of testing, further ramping up [production], giving away huge doses, all of that, to the best of my knowledge was done by Gilead.

It is also important that companies maintain oversight over who they choose to collaborate. They have a responsibility to pick partners based on quality checks and assurances, because quality does matter.

One initiative that underscores our common goal of solidarity and equity, and I think has not been given adequate attention, is the ACT Accelerator initiative launched on April 24 by Dr Tedros. So many leaders among them: the European Commission President Ursula von der Leyen, French President Macron, German Chancellor Merkel, South African President Cyril Ramaphosa, and others spoke of this as they supported the WHO Conference Call for action that day.

In a matter of weeks, this [ACT Accelerator] has been implemented. We are making great progress in the work of these various accelerators. CEPI and GAVI are in the lead of an effort searching for a vaccine from end to end.  And everyone agrees that WHO should play a major role when it comes to allocation. We know that at the beginning [when a vaccine or hopefully vaccines are available], demand will far outstrip supply. In the industrialized world there are only handful of companies with the skill sets to scale up the manufacturing of vaccines, which are going to be needed in the hundreds of millions and probably billions [of doses]. In the case of vaccines, it is not just a question of IP, it is also a question of know-how and that you acquire over time. We will need global guidance on who should get the vaccine first: health care workers and vulnerable populations. This is why we support the vaccine accelerator.

Similar for a therapeutics accelerator. People are keen to get more guidance in terms of clinical practice. We should not focus on a few countries. We need a global focus on what is the best clinical practice in terms of treating COVID-19 patients.

HPW: Overall, there has been less talk about collaboration in the therapeutics accelerator ? Can you recap.

TC: There are three pillars under the ACT umbrella:vaccines diagnostics, therapeutics.

It is really good to see that there are tremendous dynamics coming out of ACT, based on the understanding that there will be a light touch coordination mechanism. And there will be leading roles for the likes of CEPI, GAVI, The Global Fund and FIND.

The Vaccine Accelerator is by far the most developed in terms of global approach. In therapeutics, you have a lot of progress happening at national level.  In the therapeutics, testing the different treatments is a key preoccupation. For therapeutics you already have leading regulatory agencies involved, and market mechanisms, whereas for vaccines, you need end-to-end collaboration. At the same time [whether for COVID-19 treatments or vaccines] you are confronted with the same problem: you want to know once they work that they also need to be made available to low- and middle-income countries.

HPW: Is IFPMA completely opposed to the use of TRIPS Flexibilities – or are there times this is justified?   

TC: Most countries have national emergency frameworks. In times of war, in times of crisis, countries can sequester production facilities through public interest compulsory license. I see it as a last resort. It would be very dangerous if this was seen as something that should be done systematically. It would send the wrong signal. If the industry engages in voluntary licenses in collaboration, emphasizes the importance of equity, then I believe that a general call for compulsory licensing would frighten them, and it would not be conducive to what needs to be done. Industry is already sharing the data, they are going to member states, WHO, asking for advice in allocation.  For example, UNICEF [which is also involved in the ACT Accelerator] in quite a number of cases has a huge experience in medicines and vaccines deployment and delivery. It is easier to get results if everyone has a common purpose than if you approach it in antagonistic manner.

HPW: What about transparency ?  There have been calls for more transparency around the prices of new COVID-19 drugs and particularly R&D costs for drugs such as remdesivir, which received very large public sector investments?  

TC: We are likely to see that there will be differential pricing. If you want to make sure that everyone who needs has access, there will have to be tiered prices

As for the transparency of R&D costs for new COVID-19 drugs and vaccines. I would expect that the affordability issue is handled through public private partnerships. It does include the know-how of who puts in how much.

Image Credits: NIAID.