The COVID-19 outbreak has sparked new trends in counterfeit medical products, including masks, medicines, hand sanitizers, and vaccines.

The approval of the world’s first COVID-19 vaccine candidate last week in the United Kingdom is stoking fears that the global rollout of vaccines to fight the pandemic could also stimulate a counter-pandemic of fake online cures as well as criminal attempts to sabotage or interrupt vaccine supply chains. 

To counter the growing threat, a new industry-backed alliance to fight fake COVID-19 medicines and vaccines was launched on Monday. Building on the informal Fight the Fakes advocacy campaign and week (7-13 December), the new Fight the Fake Alliance aims to muster more government, civil society and private sector awareness and support about the risks posed by the attempts of organized crime, individual profiteers and hackers to interfere with the COVID-19 vaccine and medicines supply chain, as well as profit from fake products. 

The Alliance was formed just a few days after Interpol, the international criminal police organization, issued a sharp warning to law enforcement agencies in its 194 member states that criminal networks were laying plans to target COVID-19 vaccine supply chains, physically and online, disrupting distribution of legitimate products and sowing confusion. 

“As governments are preparing to roll out vaccines, criminal organizations are planning to infiltrate or disrupt supply chains,” said Jürgen Stock, Interpol Secretary General, in a statement released last Wednesday (2 December). “Criminal networks will also be targeting unsuspecting members of the public via fake websites and false cures, which could pose a significant risk to their health, even their lives.” 

Interpol Infographic on the dangers of fake medicines and medical supplies
Interpol infographic warning about the dangers of counterfeit medical supplies.

The Alliance is composed of 15 groups involved in various aspects of the medical supply chain and representing health care professionals, manufacturers, wholesalers, researchers and patients. Its members include the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), International Alliance of Patients’ Organizations (IAPO), and International Council of Nurses (ICN).

“In the current environment of misinformation – the so-called ‘infodemic’ by the World Health Organization (WHO) – it is particularly important to prevent the manufacture and trade of falsified COVID-19 vaccines as they have the potential to undermine trust in modern medicine, health care professional and health care systems as a whole,” the Alliance’s new Vice Chair and Director of Partnerships & Programmes at the World Heart Federation, Andrea Vassalotti told Health Policy Watch.  

“With the on-going COVID-19 pandemic and the rise in falsified medicines now and in the future, our combined efforts to mitigate, control and ultimately eradicate the damage they cause to patient health and lives are more crucial than ever,” said Adam Aspinall, Chair of the new Fight the Fakes Alliance and Senior Director of Access and Product Management at Medicines for Malaria Venture, in a press release. 

“The threat of fake medicines knows no borders,” said Miriam Holm, co-head of the Secretariat for Fight the Fakes, in a podcast Monday hosted by King’s College London lecturer, Bahijja Raimi-Abraham. “I think it’s only a matter of a few weeks until we have fake COVID vaccines circulating.” 

“We have joined forces with the Fight the Fakes Campaign to raise awareness of the dangers of fake medicines,” said the International Council of Nurses (ICN), one member of the new alliance, in a statement. “ICN supports international initiatives to combat counterfeiting and urges nurses and national nurses associations to collaborate with pharmacists, physicians and others to disseminate accurate information on detection and elimination of counterfeit medicines.”

High Income Countries not Immune to Attacks 

While low- and middle-income countries with weaker regulatory systems have been the most typical targets for the trade in fake medicines, high-income countries are not immune either.

That was evident as news emerged last week about cyberattacks targeting the vaccine distribution networks in the United States that are being prepared to roll out new COVID-19 vaccines, following expected approval of a Pfizer vaccine later this week. 

According to the Cybersecurity and Infrastructure Security Agency, which operates under the Department of Homeland Security, cyber actors were impersonating a biomedical company in phishing emails, which aimed to steal log-in credentials of executives and officials at companies and government organizations involved in distributing vaccines. One aim of the hackers was the disruption of sensitive vaccine cold chain processes. 

The cold chain process is the refrigeration system critical for the storage, transportation, and distribution of vaccines, especially mRNA vaccines, such as the ones developed by Pfizer and Moderna, which require sub-zero storage temperatures. Interference with this system could affect the quality or effectiveness of the vaccine and compromise the infrastructure to deliver vaccines to billions of people globally. 

Organizations in Taiwan, South Korea, Germany, and Italy, involved in development of solar-powered vaccine cooling systems, as well as UNICEF, which has been part of the WHO co-sponsored vaccine planning in low-income countries, were targeted in similar cyberattacks, the New York Times reported. 

Rise In Falsified COVID-19 Diagnostic Kits Heralded New Threat 

The launch of the new Fight the Fakes Alliance coincides with the third annual Fight the Fakes week, designed to raise awareness about the dangers of falsified and substandard medicines among governments, industry and civil society. 

“Fight the Fakes Week 2020 is appropriately timed to inform the general public of the importance of consulting health care professionals for legitimate advice on COVID-19 vaccines,” Vassalotti told Health Policy Watch. 

“While we saw a rise in falsified diagnostic testing kits and substandard personal protective equipment during the initial stages of the pandemic, falsified COVID-19 vaccines will likely emerge sooner rather than later,” she added.

Early on in the pandemic, when numerous countries were experiencing shortages of personal protective equipment for healthcare workers, there was a surge in the circulation of poor quality and fake masks, gloves, and diagnostic testing kits. Additionally, with the speculation of hydroxychloroquine as a treatment for COVID-19 came reports of falsified versions, particularly in the African region.

An Interpol operation in March in Mozambique seized dangerous falsified pharmaceuticals related to COVID-19 worth USD 14 million.

WHO’s Global Surveillance and Monitoring System for Substandard and Falsified Medical Products issued a medical product alert in late March to warn consumers, healthcare professionals, and health authorities against a range of falsified products claiming to prevent, treat, or cure COVID-19

The convergence of falsified medical products with the infodemic, characterized by the overabundance of misinformation and falsified information, is highly damaging. Together, these crises have the potential to undermine the already shaky trust of the public in the reliability of vaccines and health institutions. The existing hesitancy of accepting a COVID-19 vaccine could be further fueled by the circulation of falsified products and misinformation.

Substandard and Falsified Medicines

Substandard medical products are authorized products that nonetheless fail to meet quality standards, perhaps due to incorrect storage or damage during transportation. Falsified products, on the other hand, deliberately misrepresent their identity, composition and source and do not meet regulatory requirements. 

One in 10 medical products in low- and middle-income countries is either substandard or falsified, according to a study by the WHO. These medicines not only fail to treat or prevent diseases, but can also cause serious illness or death. 

The higher burden in developing countries is due in part to less rigorous regulatory requirements and more porous borders, which allows for illegal trade between countries. While fake medicines have posed a danger in all disease areas for decades, COVID-19 has amplified the threat of fake medicines to public health.

The lack of access to necessary medicines and vaccines creates a vacuum often filled by falsified and substandard medical products.
Fake Medicines Also Can Fuel Antimicrobial Resistance

Along with the immediate issues of the COVID-19 pandemic, falsified and substandard antibiotics, anti-viral and anti-parasitic medications can also contribute to another major global health threat, antimicrobial resistance (AMR). 

The administration of weakened drugs may foster the development of drug-resistant microbes that will then be resistant to full drug course as well. While a great deal of research has documented how the overuse of antibiotics is stimulating the rise of antimicrobial resistance, there is, however, relatively little work examining the role of poor drug quality in fostering resistance of bacteria, fungi, viruses and parasites to drugs. 

Antibiotics are, however, among the most frequently reported falsified medical products. One study found that antimicrobials with low doses of active ingredients lead to low levels of the drug in the patient. Exposing drug-resistant microbes to subtherapeutic doses of medicines, through falsified or substandard drugs, enables the survival and spread of resistance.

Falsified medical products also cause very immediate and direct damage because they compromise the treatment of potentially deadly chronic and infectious diseases, causing disease progression and even death. 

For instance, falsified pneumonia medicines cause an estimated 170,000 children to die each year, according to the Alliance. 

Image Credits: Interpol, Interpol, Interpol, Interpol, WHO.

WHO Director General has said he is “concerned” by the growing perception that the pandemic is over, as WHO officials reasserted the need to adhere to prevention methods like wearing a mask or social distancing.

While the UK and US are likely to start vaccinating its citizens against COVID-19 before the end of the year, the 189 countries that are part of the COVAX initiative should expect to start getting vaccines towards the end of the first quarter of 2021, the World Health Organization (WHO) has said.

Soumya Swaminathan, WHO Chief Scientist.

Currently through COVAX,  the vaccine arm of the WHO-led Access to COVID-19 Tools (ACT) Accelerator, WHO has agreed deals that could provide 700 million doses of a COVID vaccine.

“But that’s not sufficient,” said Dr Soumya Swaminathan, WHO’s Chief Scientist, at a media briefing on Friday. “The goal is to get at least two billion doses by the end of 2021, which would be enough to vaccinate approximately 20%, of the populations of the countries that are part of COVAX.”

She stressed that equitable access was key, as there is “no point in having products that do not reach the majority of the world’s population”.

COVAX, a global collaboration to accelerate the development, production, and equitable access to COVID-19 products, covers 90% of the global population.

The programme would be able to negotiate good prices with manufacturers because of the volume of its orders, but it “urgently needs another US$5 billion in order to meet that goal of two billion does”, stressed Swaminathan, adding that political leaders around the world also had to demonstrate their commitment to equity by “sharing available doses of vaccines fairly around the world”.

WHO ‘Concerned’ by Growing Belief the Pandemic is Over

Describing the UK’s emergency authorization of Pfizer’s COVID-19 vaccine as a sign that there is “light at the end of the tunnel”, the pandemic is far from over, warned the WHO  Director-General Dr Tedros Adhanom Ghebreyesus.

Dr Michael Ryan, WHO Executive Director for Emergencies.

Many countries are currently experiencing second spikes in cases, with heightening transmission rates, as others enter national “circuit-breaker” lockdowns. Dr Michael Ryan, WHO’s Executive Director of Emergencies flagged that “there is no prospect that vaccines will end that transmission in time”.

“WHO is concerned that there is a growing perception that the pandemic is over,” Dr Tedros warned. “The truth is, at present, many places are witnessing a very high transmission of the virus, which is putting enormous pressure on hospitals, intensive care units and health workers.”

Supporting Dr Tedros, Ryan, said that “vaccines do not equal zero COVID” and while “vaccination will add a major, powerful tool to the toolkit, by themselves, they will not do the job [of eliminating the virus]”. 

Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead, appealed for patience and adherence to wearing masks and social distancing to contain the virus: “The next six months require … strict adherence and vigilance to keep ourselves safe.”

Ryan added: “We need to recognise that the vaccine will not be with everyone, early next year.”

Maria Van Kerkhove
Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead.

He cited that many authorities around the world were following WHO advice: to  prioritise the safety of frontline workers, older persons and people with underlying conditions.

“Focusing on those groups will significantly reduce severe disease and that will take the pressure off the health system that will take a lot of the sorrow of this pandemic. But it will not stop the transmission by itself,” he closed.

“We’re all tired and we need hope, but we also need to be realistic. We’re in a pivotal moment and there are some countries whose health systems are at a point of collapse, and right now we have got to take the heat out of this transmission in order that those health systems can cope and bring that vaccine on quickly and safely.”

WHO: Countries Should Prepare Systems for Vaccine Distribution

Dr Tedros called on all countries to conduct “readiness assessments that take into account cold chain capacity, health worker capacity, micro-planning, initial target populations and training”.

Establishing the framework for a national deployment strategy and vaccination plan ahead far in advance would help identify where potential bottlenecks might occur, or prevent them entirely.

“This means passing any legislation and policies needed to expedite the process ensuring the regulatory process is fit for purpose, and confirming that the financing is in place,” he said.

Professor Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, stressed that “no country is going to have enough supply from the very beginning to immunise everybody who should be immunised’.

“With vaccines, we are really at the very, very beginning. And we do expect to have more vaccines that will reach authorization based on the efficacy trials that are being conducted.

“We’re also seeing in the media some concerns around who will go first. Prioritisation in every country is going to need to take place, and it’s really critical that the communities, and the population of each country has a clear understanding of what the basis was for those choices and, and why there are certain groups that are going first and which groups there are and the evidence is for that.”

Image Credits: Wikimedia Commons: Alteo31300, WHO.

The UK has seen large anti-vaccine protests in its capital as it approved the Pfizer vaccine for use: a similar resistance in Africa could be more challenging to combat.

Information about COVID-19 has been viewed online more than 270 billion times globally since February, with a large proportion deliberately misleading, misinforming, or lying to readers. But a new ‘infodemic’ response alliance, launched by the World Health Organisation (WHO) Regional Office for Africa, is hoped to improve scientific literacy among the general public, as countries around the world prepare to begin their vaccination campaigns.

The Africa Infodemic Response Alliance (AIRA) will aim to support journalists by encouraging disclosure by data holders, WHO has said, and to aid individual African countries by developing tailored responses based on behavioural trends.

The network consists of 13 international and regional organizations and fact-checking groups specialising in behavioural science and epidemiology, including WHO, United Nations (UN), and Africa Centres for Disease Control and Prevention (CDC).

“During health emergencies, people need proven scientific facts to make informed decisions about their health and well being,” WHO Regional Director for Africa, Dr Matshidiso Moeti, said in a press briefing on Thursday. “News of coronavirus has many people on edge. From social media to street corners, people are hearing conspiracy theories.

“Rumors on the origin of the virus, its mode of transmission and its severity harms people’s physical and mental health.”

AIRA will rely on four pillars – identifying, simplifying, amplifying and quantifying – designed to flag knowledge gaps in the population, present information in a simple manner, promote correct information more actively, and evaluate how effective the interventions have been. Key actions to be taken in 2021 include:

  • Monitoring the media and social media discourse surrounding COVID-19 vaccines to identify information gaps.
  • Working with community leaders, religious leaders and social influencers to disseminate timely and accurate information.
  • Launching a social media brand dedicated to debunking health misinformation.
  • Briefing media and fact checkers on key technical updates related to vaccines.

The steps are similar to those outlined in the WHO technical advisory group guidance for improving vaccine uptake, published on Friday.

Dr Matshidiso Moeti, WHO Regional Director for Africa.

The launch comes at a key turning point in the global response to the COVID-19 pandemic, as countries worldwide are experiencing second or third spikes, while other, high-income countries prepare vaccination campaigns en masse.

“This is all the more important,” Moeti said. “Compared to last month, cases are increasing in around half of the countries in the African region, and countries [elsewhere] are preparing for the introduction of COVID-19 vaccines.”

But there is growing concern for uptake of the vaccine, given the amount of misinformation, and the staggered rollouts globally caused by lack of availability and inequity.

“We have two concerns,” said Melissa Fleming, UN’s Under-Secretary-General for Global Communications. “One is that we won’t have enough people to actually take the vaccine so that we won’t be able to create herd immunity because people are listening to this misinformation and are becoming fearful, and our second concern is that there will not be enough availability of the vaccine.”

Africa Health Officials to Monitor UK Vaccine Campaign

From as early as next week, the UK will begin its rollout of Pfizer and BioNTech’s COVID-19 vaccine to immunise 20 million people, after it became the first country to approve a vaccine for public use.

“If I had it my way and I could take a flight to the UK, I would take that vaccine right now,” John Nkengasong, Director of the Africa CDC, one of the 13 institutions forming the AIRA, told Health Policy Watch. “I want everyone to be very clear, and on the same page.

“There are no issues of safety, there are no issues of efficacy. We heard prior to the UK announcement that the vaccine is around 95% effective, and that is on a large number of people that took part in large clinical trials.”

John Nkengasong, Director of the Africa CDC.

But the UK has seen large anti-vaccine protests in its capital, leading to 150 arrests made last weekend: a similar resistance in Africa could be more challenging to combat. High levels of scientific illiteracy could realistically undermine a successful, government-led vaccination campaign.

Nkengasong noted, however, that it was important to remember this is far from the African continent’s first mass-vaccination campaign, and that there is reason to be confident in the success of the COVID vaccine rollout, currently expected to take place in spring.

“This is not the first time that the continent will be dealing with vaccines against an infectious disease,” he told Health Policy Watch. “Personally, I’ve received over seven different vaccines over my lifetime from childhood to now.

“The history of infectious diseases shows that vaccines are the most potent public health tools that we have. The Africa CDC is working very hard to ensure that only the best vaccine is introduced on the continent.”

“Interestingly, it’s most pervasive in countries in the West – in the US and in countries in Europe,” Fleming said at the WHO briefing. “It seems that in Africa, people are more accustomed to and are very embracing, and understanding of the wonders of vaccines and vaccination.”

Melissa Fleming, UN’s Under-Secretary-General for Global Communications.
Facebook: Cracking Down On Conspiracies

In a separate statement made on the same day as the WHO and CDC announcement, Facebook said that it will begin actively removing false claims about COVID vaccines from its platform and from Instagram, if they have been debunked by health experts.

It cited a recent conspiracy theory circulating on the site that these new vaccines contain microchips, or that specific populations are being targeted for vaccine trials without their consent.

It noted that it will regularly update its guidance as public health authorities “learn more” and as “facts about COVID-19 vaccines … continue to evolve”.

Image Credits: National Institutes of Health (NIH) , Africa CDC.

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

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

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

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

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

Enabling Environment

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

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

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

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

Social Influences

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

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

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

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

Image Credits: Keystone/ Hans Pennick.

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

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

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

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

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

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

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

 

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

Still Time For Global Reset

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

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

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

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

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

Lancet – Forty Global Indicators Still Show Worsening Impacts On Health

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

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

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

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

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

A Comprehensive Report

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

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

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

Higher temperatures are driving dengue spread to new regions

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

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

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

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

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

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

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

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

Maize growth duration has decreased since 1981–2010

Huge Losses

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

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

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

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

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

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

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

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

Special Representative for Global Health Diplomacy, Ambassador Deborah Birx.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Invest in Peer-Led HIV/AIDS Services 

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

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

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

Global AIDS Response Off Track Before COVID-19

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

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

 

 

Image Credits: UNAIDS .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr Tedros Adhanom Ghebreyesus, WHO Dicrector General.

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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