Unhealthy food habits drive obesity

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

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

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

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

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

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

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

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

Government Lockdowns Have Far-reaching Impacts On Frail Food Systems

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

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

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

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

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

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

Fostering Food Resilience – Stronger Governance Critical

Bees are essential to pollinate food crops

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

Good governance is part of the answer, he said.

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

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

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

Protecting Health – Smart Investments, Legislation & Stakeholder Engagement 

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

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

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

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

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

Data Is Vital To Identify Malnourished and Undernourished

Githinji Gitahi, CEO of Amref Health Africa.

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

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

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

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

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

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

Image Credits: Flip, photophilde.

Smiling schoolgirls get their pictures taken near Jinja, Uganda.

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

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

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

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

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

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

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

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

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

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

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

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

COVID-19 Closures Lead to Increase In Violence Against Children

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

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

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

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

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

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

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

INSPIRE Framework Promotes Key Child Protection Strategies

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

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

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

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

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

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

Mwelecele Ntuli Malecela, director of NTD Control at WHO

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

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

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

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

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

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

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

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

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

For more on NTDs, see the draft Roadmap here.

WHO experts speak at the 17 June 2020 COVID-19 press briefing

A rising star in the COVID-19 treatment arena, dexamethasone – a powerful corticosteroid – has stirred excitement among World Health Organization experts and researchers around the world, following the publication of promising early results from the United Kingdom’s Recovery trial. 

In COVID-19 patients only receiving supplemental oxygen, the trial found that dexamethasone reduced mortality by 20%. In patients requiring mechanical ventilation, the drug cut the mortality rate by up to a third.

“We will update our clinical guidance to reflect how and when dexamethasone should be used to treat COVID-19,” announced WHO Director-General Dr Tedros Adhanom Ghebreyesus on Wednesday. “WHO has now started to coordinate a meta-analysis pulling data from several clinical trials to increase our overall understanding of this intervention.”

The cheap drug could become the ‘standard-of-care’ for patients suffering from more severe forms of the disease, Soumya Swaminathan, WHO Chief Scientist, told the Financial Times, echoing comments from Peter Horby, one of the UK trial’s principal investigators. Producers are already poised to ramp up production of the common drug – including Cipla, an Indian generics manufacturer; Aché, the biggest dexamethasone producer in Brazil, and Hikma Pharmaceuticals, a large dexamethasone manufacturer. 

WHO Experts Urge Restraint In Using Dexamethasone

Dexamethasone tablets

The drug acts as an anti-inflammatory drug, calming the swelling around severely ill patients’ lungs, rather than targeting the virus itself like another promising treatment – the antiviral remdesivir.

“[Dexamethasone] is a very, very powerful anti inflammatory drug. It can rescue patients who are in very serious condition where their lungs and cardiovascular system around their lungs may be very inflamed,” said WHO Health Emergencies Executive Director Mike Ryan. “This possibly allows the patients to continue getting oxygen into the blood from the lungs for a very critical period, or it rapidly reduces inflammation at a critical period in the illness.”

However, the drug has shown to only improve outcomes in patients suffering more serious illness. No benefit was observed in patients who did not require respiratory support, and health experts are urging caution for using the drug.

“This is not for mild cases, this is not for prophylaxis,” clarified Ryan. “It is not a treatment for the virus itself, it is not a prevention for the virus.

“In fact, steroids, particularly powerful steroids can be associated with viral replication in other words they can actually facilitate the division and replication of viruses in human bodies. So it’s exceptionally important that this drug is reserved for use in severely ill and critical patients who can clearly benefit from the drug.”

WHO Hydroxychloroquine Trial Stopped Again

Ana Maria Henao Restrepo clarifies WHO will be stopping the hydroxychloroquine arm of its Solidarity Trial

Meanwhile, the much hyped antimalarial drug hydroxychloroquine seems to be fading from favor, as WHO announced they would stop enrolling new patients into the hydroxychloroquine arm of its multicountry SOLIDARITY trial for COVID-19 treatments. New patient enrollment has also been stopped in the hydroxychloroquine arm of France’s DISCOVERY trial, one of the country arms of the larger WHO trial.

The move was prompted by early results released by the United Kingdom’s Recovery trial, which found no reduction in mortality among around 3000 COVID-19 patients taking the drug compared to those receiving standard treatment.

“After deliberations [between investigators from the Solidarity and Recovery trials], they have concluded that the hydroxychloroquine arm will be stopped in the Solidarity Trial,” announced Ana Maria Henao Restrepo, a medical officer in WHO’s Health Emergencies Programme.

“The internal evidence from the Solidarity-Discovery trial, the external evidence from the UK Recovery trial, and the combined evidence from these large randomized trials brought together suggest that hydroxychloroquine, when compared to the standard of care, in the treatment of hospitalized COVID-19 patients, does not result in the reduction of mortality for those patients,” said Restrepo

The move represents another nail in the coffin for hydroxychloroquine, once touted as one of the most promising COVID-19 treatments, following the United States Food and Drug Administration rescinding emergency use approval for the drug on Monday. The hydroxychloroquine arm of the Solidarity trial had just resumed after being paused for 1 week, following the publication of a massive, now retracted, study in The Lancet that claimed patients taking the drug were at higher risk of mortality.

Still, Restrepo emphasized that the move to stop the hydroxychloroquine arm did not “constitute an official WHO policy,” nor does it apply to investigations around the use of hydroxychloroquine as a preventative treatment for COVID-19.

“This is just based on results from the trials. This does not apply to the evaluation of hydroxychloroquine as possible prophylaxis in patients exposed to COVID-19 – that’s a different thing,” clarified Restrepo.

Image Credits: Twitter: @WHO.

About 1.7 billion people, or 22% of the world’s population, has at least one underlying health condition that puts them at increased risk of becoming seriously ill with COVID-19, according to a new modelling study published in Lancet Global Health.  

Based on the new assessment, about 4% of the world’s population, in total, is at high risk of developing severe COVID-19 requiring hospitalization.  But the actual risk of serious forms of the disease varies considerably by age – from less than 1% of people under the age of 20 to about 20% of those 70 years and older. 

The new estimates reinforce findings from previous studies indicating that older people and those with chronic diseases are at higher risk. 

However, it is the first of its kind to provide national as well as regional and global estimates of people at risk of severe COVID-19 for 188 countries worldwide – based on age, sex and reporting of underlying health conditions. 

“It is time to evolve from a one-size-fits all approach to one that centres on those most at risk…It is time to acknowledge that we are not all at equal risk of severe outcomes from COVID-19 and to work together with those most affected to tailor an effective response,” said lead author Nina Schwalbe, of Columbia University’s Mailman School of Public Health in a statement.

The study also included co-authors from London School of Tropical Hygiene and Medicine, Imperial College London, University College London, the University of Edinburgh, Sun Yat-Sen University, China and the University of Washington, USA.

Seventy Year Olds Are Thirteen Times More Likely To Have One Underlying Condition Than Twenty Year Olds 

About two thirds of people above the age of 70 are at risk of severe COVID-19, in comparison to only 1% of people younger than 20, largely because older people were about thirteen times more likely to have one underlying condition, in comparison to twenty year olds, the study notes.

As a result, regions with older populations, like Europe and Northern America, are at highest risk of having large number of severe COVID-19 cases, in comparison to regions such as Latin America, the Caribbean or Africa, whose populations are younger on average.  

In Europe, for instance, an average of 6.5% of people are at high-risk of developing severe COVID-19, as opposed to 3.1% of people in Africa – mainly because Europe also has double the number of people with a pre-existing health condition.

To quantify the risk of severe COVID-19 in countries, researchers assessed hospitalisation rates for COVID-19 with reference to UN population estimates; disease prevalence data from the Global Burden of Disease 2017, Injuries and Risk Factors Study; and the list of underlying health conditions relevant to COVID-19.

Those, according to the WHO and public health agencies in the United States and the United Kingdom, include: cardiovascular disease, chronic kidney disease, diabetes and chronic respiratory diseases.

Proportion of world’s population at increased risk of severe COVID-19

Avoiding Complacency – An “Unmitigated Pandemic” In Africa Could Put 23 Million At Risk Of Severe COVID-19 

 

Although regions such as Africa, are generally less vulnerable to severe COVID-19 due to their population demographics, that evidence needs to be ‘carefully communicated’ to avoid complacency, warned researchers:

“The share of the population at increased risk of severe COVID-19 is generally lower in Africa than elsewhere due to much younger populations, but a much higher proportion of severe cases could be fatal in Africa than elsewhere,” mostly because health system capacity and resilience is much lower in Africa compared to other regions of the world. 

As a result, an unmitigated pandemic in Africa could put 23 million people at risk of severe COVID-19, the authors concluded.

A child with HIV takes antiretroviral medication

However, the researchers also warn that if routine health services in African health systems continue to be seriously disrupted, more deaths could also result from tuberculosis, malaria or other, even more deadly viruses such as Ebola, which has resurged in recent weeks in the Democratic Republic of the Congo.

Additionally, African countries with a high HIV/AIDS prevalence, such as Eswatini and Lesotho, will have more people at higher risk of severe COVID-19. Similarly, small island nations with high diabetes prevalence, like Fiji and Mauritius, may also see more severe cases. 

Projections Will Help Policymakers Plan How Many Vulnerable People Need To Be Shielded From COVID-19

Shoppers mob malls in Geneva after restaurants and stores reopened on 6 June – following nearly two months of lockdown

As lockdowns continue to be relaxed or lifted around the globe, the study’s projections will help policymakers understand how many vulnerable people need to be shielded from the coronavirus, allowing countries to minimize COVID-19 deaths, while also taking the edge off overwhelmed health systems:

“Shielding has the potential to reduce mortality in susceptible groups (direct benefits), while at the same time mitigating the expected surge in demand for hospital beds (indirect benefits).”

Vulnerable populations, like older people, can be shielded by physical distancing and by receiving priority access to a COVID-19 vaccine or treatment.

But the study is only a ‘starting point’, caution its authors, because estimates don’t take into account other strong drivers of COVID-19 infection and death, such as ethnicity, socioeconomic deprivation, and obesity: 

“Although older age and underlying conditions increase [the risk of severe COVID-19], people subject to structural inequities are more likely to develop underlying conditions and receive poor quality health care…[and] emerging evidence shows that those with unmanaged chronic conditions, including HIV, are more vulnerable to severe outcomes [of COVID-19].”

For example, one other study of COVID-19 death rates in all of the counties of the United States, by the MIT Sloan School of Management, found that death rates in counties doubled for every 10 % increase in African Americans. COVID-19 death rates have been ten times higher than average when African Americans make up 85% of the county’s population.

Image Credits: The Lancet , The Lancet, Deep Knowledge Group, Paul Kamau/ DNDi, S. Lustig Vijay/HP-Watch.

Dexamethasone is an anti-inflammatory drug used against arthritis and asthma

A major clinical trial ongoing in the United Kingdom has fingered dexamethasone, a common anti-inflammatory drug used to treat arthritis and asthma, as the “first” treatment to actually reduce mortality among COVID-19 patients – by as much as one-third. 

The preliminary findings were announced by the trial’s principal investigators, Martin Landray and Peter Horby, both professors at Oxford University. The trial results were welcomed by a number of health experts, including those at the World Health Organization.

“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release. “This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough.”

Low doses of dexamethasone, a 59-year old corticosterone drug, reduced deaths among COVID-19 patients on a ventilator by one third, and by 20% among patients on simpler forms of oxygen treatment.

Overall, dexamethasone reduced the 28-day mortality rate by 17%. However, the drug did not appear to have any benefits in patients that did not require respiratory support, and patients outside the hospital setting were not studied.

‘Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result,” said Peter Horby, Professor of Emerging Infectious Diseases at the University of Oxford, also a principal investigator of the trial.

The randomized clinical trial, which is part of the WHO and Wellcome Trust co-sponsored  RECOVERY initiative, compared some 2100 patients receiving 6 mg of dexamethasone daily for ten days, either by mouth or by intravenous injection, and with 4321 patients that received standard care.

Given it is widely available, cheap and has a ‘large’ survival benefit, dexamethasone should already become the new standard of care, said Horby:

“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

“It’s going to be very hard for any drug really to replace this, given that for less than 50 pounds [$63.26],” eight patients on a ventilator can be treated and one life can be saved, said Landray in an online briefing. And for every 25 COVID-19 patients on oxygen support, one life would be saved by treating them with dexamethasone, said Landray.

Researchers explained that the anti-inflammatory drug can calm the cytokine storm that overwhelms the immune systems of seriously ill patients. 

While preliminary results demonstrate “very clearly” that dexamethasone can curb mortality in patients with severe COVID-19, researchers did not make available the full data set on the study, a move that was criticized by some:

“It is unacceptable to tout study results by press release without releasing the full paper,” said Atul Gawande, a public health researcher and surgeon, in a tweet.

Meanwhile, a WHO spokesperson said that the Organization would share a reaction once it had completed the initial review of the preliminary results.

Over 11,500 patients from over 175 National Health Service hospitals (NHS) have been enrolled in the UK’s RECOVERY to test five other treatments for COVID-19:

  • lopinavir/ritonavir, an antiviral
  • hydroxychloroquine, an anti-malarial
  • azithromycin, an antibiotic
  • tocilizumab, an anti-inflammatory
  • convalescent plasma from recovered individuals

There is still no approved treatment or vaccine for COVID-19, apart from Gilead’s remdesivir, a failed Ebola drug that does not improve the odds of survival – though it speeds up recovery in patients with COVID-18 from 15 to 11 days. 

In a parallel development, the recently touted hydroxychloroquine was shown to be “useless” earlier this month by Landray’s group. And yesterday, the US Food and Drug Administration revoked their Emergency Use Authorization (EUA) for the drug.

“Based on its ongoing analysis of the EUA and emerging scientific data, the Food and Drug Administration determined that chloroquine and hydroxychloroquine are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA,” said the FDA on Monday.

Image Credits: Phillip Jeffrey.

Staff check passengers’ temperatures at a subway station in Beijing, China

Countries must be prepared to detect and control resurgences, warned the World Health Organization on Monday, as Beijing, China faced its first local cluster of COVID-19 cases in almost two months, and reopened states across the United States saw sharp rises in new cases.

“Even in countries that have demonstrated the ability to suppress transmission, they must stay alert to the possibility of resurgence,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

Over 100 cases have been detected in China’s capital city of Beijing since Friday 12 June, after a 50-day streak of recording no new cases, according to Dr. Tedros. He added that the origins of the outbreak are still being investigated, although Chinese authorities have linked over 79 infections to Xinfadi fresh fruit market in the southwestern part of the city.

New cases linked to the fruit market outbreak have already been detected in the wider province of Hebei and neighboring province of Liaoning. Vice Premier Sun Chunlan said on Sunday that the risk of spread remains “very high,” according to Xinhua News Agency.

The district in Beijing announced ‘wartime measures’ over the weekend – reflecting strict lockdown measures that were taken to contain the spread of the virus in the first three months of the year. The market was shut down on Saturday, and 11 residential compounds close to the market were locked down. Residents will have their daily necessities delivered, and their temperatures will be monitored on a daily basis. 

US States That Reopened in May See Surge In New Coronavirus Cases

Meanwhile, several states in the US that lifted stay-at-home measures in May saw a steadily rising trend in new cases the past week.

Some 21 states  saw a sharp uptick in cases recently, according to the Washington Post. In Arizona for example, the daily new case count has hovered at 1500 new cases per day for the past week, significantly higher than the 500 new cases per day rate in April, while a shelter-at-home order was in place. The states are similarly seeing rises in hospitalizations.

New York State and Texas additionally warned eager citizens that lockdown measures could be reinstated if people continue to flout social distancing rules and mandatory masking policies even in the first phases of lockdowns lifting. New York City, the biggest epicentre of the US epidemic, entered phase 1 of reopening in the first week of June.

Most health experts agree that the sharp uptick in cases seen in recent weeks are a result of states reopening, however there are some concerns that cases will also rise in wake of the massive protests against racism and police brutality that have gripped the nation. 

On Friday, some 1,288 doctors, nurses, and epidemiologists submitted an open letter supporting the protests as “vital to the national public health and to the threatened health specifically of Black people in the United States.”

Southern Hemisphere Faces Double Threat of Flu Season & COVID-19 

Influenza surveillance has declined or suspended in several countries since another respiratory disease, COVID-19, gripped the planet, according to Dr Tedros.

“Influenza affects every country every year, and takes its own deadly toll. Circulation of COVID-19 and influenza can worsen the impact on health care systems that are already overwhelmed,” said Dr. Tedros on Monday.

“There has been a sharp decline in sharing of influenza information and viruses, because of COVID-19. Compare with the last three years, we have seen a dramatic decrease in the number of specimens tested for influenza globally,” he added.

Influenza virus sample shipments to WHO collaborating centers has fallen by 62% , and the the number of influenza viruses with genetic sequence data uploaded to the WHO global influenza surveillance and response system database has fallen by a dramatic 94%.

Monitoring these samples is essential to help determine which strains of  flu are most likely to be circulating every year, and develop appropriate seasonal flu vaccines. Additionally, the surveillance system helps detect potential hyper-deadly pandemic flu strains.

“It’s quite understandable that as countries have fought COVID-19, a lot of the resources that are within the flu network have been… entirely appropriately pushed into COVID surveillance. We now need to find that balance to ensure that we’re also able to track influenza properly during that same period,” said WHO Health Emergencies Executive Director Mike Ryan.

“The [threat of] influenza is always there; seasonal influenza and also influenza of pandemic potential,” said Wenqing Zhang, director of WHO’s Global Influenza programme. “So when we are entering into the southern hemisphere influenza season, it is a time to prepare for Northern Hemisphere season [as well].”

 

Image Credits: Wikimedia Commons: Pau Colominas.

Restaurants, bars and shopping centers reopen in Geneva, Switzerland

Preliminary results from a Swiss study found that the prevalence of antibodies against SARS-CoV-2, the virus that causes COVID-19, in children ages 5 to 9 years old is 68% lower than the seroprevalence in adults aged 20 to 49 years old. 

The study, titled SEROCoV-POP, reported seroprevalence results from almost 2800 participants followed from April 6 to May 9, the first five weeks of a 12 week followup period. A previous paper posted in the preprint server MedRxiv, which analyzed data from the first three weeks of the study period, found that there was no significant difference in the seroprevalence in children compared to adults. Both studies found that older adults had a lower seroprevalence.

The most recent analysis found only about 11% of the Swiss population has antibodies against SARS-CoV-2, slightly higher than the 9.7% seroprevalence estimated in the previous paper.

“Our results highlight that as the end of the epidemic curve in Geneva approaches, the immunological landscape has not substantially changed since before the pandemic, with most people having no evidence of past infection,” wrote the authors, representing Geneva University Hospitals and the Johns Hopkins Bloomberg School of Public Health. 

They also noted that the Geneva study represents one of the most high quality, representative seroprevalence studies to date. Existing sero-surveys from the USA, Brazil or Denmark don’t ‘accurately reflect’ the true proportion of the population with antibodies, because study participants were likely to be healthier than the average person, or were recruited from less affected areas.

The serosurvey results come as a Lancet Correspondence from Thursday claims that there is “little evidence” to support herd immunity – A controversial theory that assumes exposing an entire population to a disease will eventually lead most to develop immunity. Experts from the World Health Organization have repeatedly cautioned against assuming that herd immunity will protect against further waves of the virus. 

The cumulative mortality rate per capital has plateaued at different levels in different countries, and countries that went into lockdown early experienced fewer deaths, indicating that public health measures, and not herd immunity, were responsible for reductions in mortality.

“Under herd immunity, the cumulative mortality rate due to COVID-19 per million of the population would be expected to plateau at roughly the same level in different countries (assuming similar basic reproduction numbers). This is not what the data show,” the authors of the Commentary wrote. 

The Lancet Correspondence, which was submitted by the UK’s MRC Centre, Imperial College London and Oxford University, analysed cumulative per-capita COVID-19 mortality data from a number of countries, as well as seroprevalence studies.

US Chamber Of Commerce Spokesperson Supports Transparency Around COVID-19 Vaccine
Spike glycoproteins decorating SARS-CoV-2’s membrane surface; highlighted in red is a potential neutralization site, which is a protein sequence that might be used as a target for vaccines.

A spokesperson for the United States Chamber of Commerce, the largest trade lobbying group in the country, has supported increased transparency for a COVID-19 vaccine, according to the Independent. 

However, finer details of the Chamber’s endorsement is still unclear, and does not extend to supporting voiding of intellectual property and patent rights. 

“The short answer is yes [more transparency is needed]. But we don’t have a clear-cut US Chamber position on that,” Patrick Kilbride, a senior vice president of the US Chamber’s Global Innovation Policy Centre (GIPC), told The Independent. 

The US Chamber’s tepid support comes amidst repeated calls from global leaders, including France’s President Emmanuel Macron and Germany’s Chancellor Angela Merkel, for any COVID-19 vaccine developed to be a ‘global public good.’ 

AstraZeneca, along with Johnson & Johnson and Glaxosmithkline (GSK) announced In late May that they were taking a ‘not-for-profit’ approach for vaccine development. But access advocates have argued that further transparency and disclosure around costs of production are needed in order to ensure true ‘no-profit’ prices.

“This is a unique situation and I feel comfortable saying that a higher level of transparency is warranted, especially given the unusual public sector contribution to some of the efforts that are ongoing,” said Kilbride.

“There’s this enormous and unprecedented mobilisation of R& D by business, and to a certain extent added to by government and various other non-governmental organisations,” Robert Grant, director of international policy at the GIPC. “It really is a considerable collective effort that is typically much less common in non-crisis times.”

For example, Pfizer, which announced in late May they were moving towards Phase 3 clinical trials in July, has received funding from the United States Health and Human Services Biomedical Advanced Research and Development Authority department for clinical trials. AstraZeneca is closely working with Oxford University on their vaccine candidate. 

See the full story on The Independent.

Image Credits: S. Lustig Vijay/HP-Watch, National Institutes of Health/David Veesler, University of Washington.

A severe disruption of reproductive and children’s health services during the pandemic could cause more deaths in women, children, and adolescents than COVID-19 itself,  according to World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus.

“The indirect effects of COVID19 on this group may be greater than the number of deaths due to the virus itself,” warned Dr Tedros. “Because the pandemic has overwhelmed health systems in many places, women may have a heightened risk of dying from complications of pregnancy and childbirth.”

As health facilities pivot towards providing COVID-19 care, reports of women unable to reach childbirth facilities have emerged in countries like Peru. Many maternity hospitals have also shut down.   

“Maternity and child health services are not functioning, or only partially functioning in over 150 locations around the world. Many thousands could die from preventable complications in childbirth and pregnancy,” said Executive Director for the UN Family Population Fund (UNFPA) Natalia Kanem.

Amidst the scarcity of health services, unintended pregnancies and child marriages could shoot up, as women, children, and adolescents lose access to health programmes. For every six months of lockdown, some 47 million women could lose access to contraception, leading to 7 million more unintended pregnancies. 

With people stuck at home during lockdowns, domestic violence has also shot up, as survivors quarantine with their abusers. 

“It’s truly an emergency pandemic within the pandemic,” said Kanem. “We are joining WHO to sound a ‘red alert’ to stop gender based violence – to offer timely assistance to women and girls who are now trapped in abusive situations.”  

Image Credits: Twitter: @Atayeshe.

Roberto Azevêdo (left) meets with the United States President, Donald Trump, at the World Economic Forum Annual Meeting in Davos, Switzerland.

The early resignation of Roberto Azevedo from the post of Director General (DG) of the World Trade Organization (WTO), sets the stage for a highly politicized competition over his successor – who will face a major challenge in demands to reshape the WTO in the wake of repeated US complaints about its trade dispute rulings and policies with an alleged pro-China tilt.

Azevedo announced in May that he would be resigning from the position as of 31 August 2020, a year before his term formally ends. Azevedo, a seasoned and well-regarded member of Brazil’s diplomatic corps before taking on the role of WTO DG, presided over a period when the WTO’s effectiveness as a negotiating forum was eroded. Political conflict between economically powerful Members, most recently precipitated by the United States, brought its highly regarded dispute settlement system to a standstill. Now, as the COVID-19 crisis has sent global trade into a tailspin, the question is who – if anyone – can revitalize the Organization and reassert its preeminence in trade governance.

The new Director General will face a range of sharp debates around trade issues that are critical to health – including the need to ensure wide global access to new COVID-19 medicines and vaccines. But beyond the current pandemic, the WTO may also play a lead role on other critical  policies that affect health as well as broader economic well-being, including: import and export barriers affecting fragile economies; policies around trade in agriculture and food products; and ever more urgent questions surrounding trade, climate and sustainability.

The Candidates
(left-right) formally nominated WTO DG candidates; Jesús Seade Kuri, Ngozi Okonjo-Iweala, Abdel-Hamid Mamdouh

So far, four candidates have been formally nominated: Jesús Seade Kuri, Mexico’s chief negotiator for the ‘New NAFTA’; Abdel-Hamid Mamdouh, former director of the Trade in Services Division of the WTO; and Ngozi Okonjo-Iweala, board chair of Gavi, the Vaccine Alliance and former Nigerian Finance Minister, who also spent 25 years in Washington, DC with the World Bank. The Republic of Moldova’s Minister of Foreign Affairs, Tudor Ulianovschi, also had his name thrown in the ring on June 16.

On Tuesday, June 9, European Trade Commissioner Phil Hogan told reporters that he was also considering a bid to become WTO Director General. At a meeting with European Union trade ministers he identified trade and health issues, and the urgency of addressing the COVID-19 crisis, as priorities. Hogan also suggested that the European Union should put forward a single candidate, saying: “The EU has very strong multilateral credentials and is recognized as a force that could shore up the WTO and protect the multilateral trading system. This puts the EU in a legitimate position to offer a Director General to the WTO.” The Croatian Foreign Minister confirmed that EU members would discuss whether to unify around a single EU candidate during the next month.

The fact that Phil Hogan has put his name forward does not assure his position as the EU nominee. Other Europeans also reported to have expressed interest include: Arancha González-Laya, Spain’s Minister of Foreign Affairs and a former WTO Chief of Staff; and; Sigrid Kaag of The Netherlands, currently Dutch Trade Minister, formerly UN Under-Secretary-General, with experience at UNICEF and UNDP. (An interesting – if perhaps academic – question: The EU has exclusive authority over trade matters for its member states, while the EU and each of its member states are Members of the WTO, with a unique voting arrangement. If the EU nominates a DG candidate, does that preclude individual member states from nominating their own candidates?) Peter Mandelson, of the United Kingdom (now no longer EU!), but a former EU Trade Commissioner and UK Secretary of State for Trade and Treasury, has signaled interest too. While there is a long history of European heads of the WTO antecedent, the General Agreement on Tariffs and Trade, whether this argues for or against a new DG from Europe is not clear.

Jockeying between the power blocs
Two workers pin rolls of fabric in a large clothing factory in Cape Town, South Africa.

Appointments to leadership posts at multilateral organizations take account of the merits of the candidates, but realistically they must be viewed through the lens of political gaming and the exercise of power. Neither China nor the United States have as yet nominated a candidate, and perhaps neither country will because of the almost-certain divisiveness this would evoke. But it would be a mistake to think that either Beijing or Washington view this appointment exercise as one of identifying the smartest trade expert in the room. The recent battle over the appointment of a Director General for the World Intellectual Property Organization (WIPO) was hard-fought between US and China-sponsored candidates. With the US having prevailed, China will be looking again to assert its growing power. And, we have not yet heard from India.

Also, tradition holds that the leading positions in the United Nations and other multilateral organizations are divided up between regions – and that balance will play a role in the debate over whether a candidate from Asia, Africa, Europe or the Americas will succeed.

A candidate from Africa, such as Ngozi Okonjo-Iweala, might seem a “neutral” prospect as compared to candidates from one of the major trading powers. Okonjo-Iweala, who studied at Harvard and earned a PhD from MIT, might also be someone who the Americans would support. Kenya’s Amina Mohamed, former Ambassador and Permanent Representative for Kenya in Geneva, served as the first woman to chair the WTO General Council and as chair of the 10th WTO Ministerial Conference in Nairobi, and is certainly qualified, as is Abdel-Hamid Mamdouh of Egypt. Yonov Fredrick Agah, of Nigeria, currently a WTO Deputy Director-General, and previously Nigeria’s Ambassador to the WTO is said to have expressed interest, along with Eloi Laourou, of Benin, currently Ambassador and Permanent Representative of Benin to the UN in Geneva.

In terms of UN agency heads, Dr. Tedros Adhanom Ghebreyesus of Ethiopia is currently leading the WHO and Mukhis Kituyi of Kenya is leading UN Conference on Trade and Development (UNCTAD). Viewed through the lens of regional diversity, this might seem an obstacle to appointment of another Geneva DG from Africa. (Asia is poised at the top of WIPO, with Daren Tang of Singapore elected to succeed Francis Gurry.) Through a wider UN and global lens, however, the UN (António Guterres) and the International Monetary Fund (Kristalina Georgieva) Secretariats are headed by Europeans, and an American (David Malpass) is leading the World Bank. Seen from that perspective, the prospects for a third African Geneva leader may look brighter.

In years past, despite their differences, the United States and European Union were allies with shared trading system interests that would ultimately cooperate over the selection of a WTO (or former GATT) Director General, even if each had a candidate in the running. However, the Trump Administration has done everything it can to blow up the US relationship with the EU, so a prospective alliance over the choice of a candidate for WTO right now is in doubt.

As if to illustrate that doubt, following a recent statement by EU Trade Commissioner Phil Hogan that the US trade representative (USTR) Robert Lighthizer supported a WTO DG candidate from a developed country, USTR Lighthizer’s office responded saying, “Ambassador Lighthizer does not support any candidate at this time, nor does he feel that a candidate must necessarily be from a developed country.”

The Selection Process
Pepper farming in India

This is not the best time to be “counting chickens” as we still are at relatively early days in the nominating process – which is scheduled to run until 8 July 2020.

Following that, candidates “will have a period of time to make themselves known to members,” according to the process outlined by WTO. That is to include a special meeting of the WTO’s General Council, which includes all WTO member states, “where the candidates will be invited to make presentations, followed by the consensus-building phase devoted to selecting and appointing one of the candidates.”

However, the final appointment date remains unclear. General Council Chair, Ambassador David Walker (New Zealand) has said only that he will be “will be consulting with members in order to establish expedited deadlines for the post-nomination phases so that members may have clarity on the timeline for the appointment process by the end of the nomination period.”

In theory, then, the DG appointment could also be delayed beyond the US Presidential elections scheduled for November.

Public Health and the WTO

The choice of WTO DG is important to the future of public health. Through the implementation of the Agreement on Trade-Related Aspects of Intellectual Property Rights (“TRIPS Agreement”), the WTO sets the ground rules for the granting and use of intellectual property rights, including patents, for  diagnostics, medicines, treatments and vaccines. The TRIPS Agreement embodies important “flexibilities” that allow governments to take measures to promote and protect public health, including to grant compulsory patent and government use licenses for the generic production or import of patented drugs, and to make use of other exceptions to IP rights. Historically, the exercise of these flexibilities has provoked controversy. The COVID-19 crisis, whereby hundreds of existing and new drug formulations, as well as vaccines, are currently being trialed in combat against the virus, is expected to further test those WTO TRIPS flexibilities – and the ability of WTO to support comprehensive and equitable distribution of health products.

The new WTO Director General will thus be called upon to reassure member states that they can provide for vital national health needs – without facing undue pressure over Intellectual property interests or issues.

COVID-19 In the shadow of the HIV Legacy 
fixed-dose, antiretroviral HIV treatment

The new WTO director will be confronting COVID-19 in the shadow of the historic dispute over access to medicine that raged while the HIV-AIDS epidemic grew unchecked in the mid- and late-1990s. At that time, the government of South Africa came under intense pressure from the United States, the European Union and the innovator pharmaceutical industry based on unsupported allegations that South Africa’s 1997 health legislation amendments, permitting measures such as the parallel import of patented HIV/AIDS drugs, violated the TRIPS Agreement. Collapse of the industry case was followed by adoption of the WTO Doha Declaration on the TRIPS and Public Health along with the TRIPS Article 31bis amendment on compulsory patent licensing predominantly for export. This further clarified the rights of countries to produce or import generics of vitally needed health products in times of need.

Throughout the saga, either one of the two successive WTO Director General’s, including Renato Ruggiero (to September 1999) or Mike Moore (to September 2002), could have issued a clear public statement that the South African legislation did not violate the TRIPS Agreement, a fact which no serious trade and IP expert doubted (and which has been confirmed not only by the Doha Declaration, but even by the US Supreme Court).

Had they done so, the pharmaceutical industry would have had a very difficult time justifying its litigation, and the EU would also have been under considerable pressure to withdraw its trade threats (which the US did earlier on). But neither Director General spoke out. Not only did the failure to support  South African prolong insecurity in South Africa’s health system, but it damaged the public perception of the WTO as an institution, because the basic charge of the pharmaceutical industry was “we have these patent rights given to us by the WTO that are under threat”, while in fact WTO rules allocated no such rights.

Pandemic Will Test Mettle of WTO Flexibilities

In case you were on the recent space shuttle mission, and missed entirely the start of the COVID-19 pandemic, international interest in the legal mechanisms that will be used to develop and distribute vaccines, treatments, diagnostics and medical devices to address the pandemic is at a historic high – and WTO once again has an important role to play.

In fact, several governments, several governments – including France and Germany — already have modified their legislation to facilitate the compulsory licensing of patented health products to address the pandemic.  Israel has issued a compulsory license.

Along with the much-touted WHO-supported voluntary COVID-19 patent pool launched two weeks ago, proposals for compulsory patent pools are in the works, as are suggestions for taking advantage of the TRIPS Article 31bis provision allowing compulsory licensing predominantly for export. So, the mettle of WTO rules regarding intellectual property are likely to be tested again, perhaps even more severely than before, as the current pandemic has touched rich and poor countries alike in the greatest global public health crisis of a century. The new WTO DG will thus be called upon to provide leadership in assuring that TRIPS Agreement and other WTO flexibilities are respected.

In addition, there are critical health-related issues involving export restrictions on critical health products, subsidies to the pharmaceutical sector, and others that involve complex questions of WTO law and will need to be addressed. Again, a strong DG voice at the WTO may be important.

Economic well-being is also a health issue
Restaurants, bars and shopping centers reopen in Geneva, Switzerland after two months of lockdown

Finally, economic well-being is a major determinant of health, and the WTO has an important role to play in assuring that its Members are able to continue to export and import to support their fragile economies. The new DG will confront serious obstacles as he or she seeks to counterbalance the current trend towards higher national barriers in international trade.

The COVID-19 pandemic has had devastating economic consequences everywhere; but developing countries have been hit particularly hard because of the inherent vulnerability of their economies, and jobs dependent on international trade.

The consequences of sharply falling income, particularly among economically vulnerable groups, can be as severe as a deadly virus.

The fact that some middle- and high-income countries have started to “pull up the drawbridges” and to re-shore production will have significant consequences for developing countries. One task of the WTO DG will be to help remind and persuade developed country political constituencies that trade is not a zero-sum game, in which export success by one country means that other countries are losing. At the same time, the WTO DG must help address unfair trading practices, that damage the system and consequently hurt all participants in the long run.

Trade and Sustainability
Commercial fishing boat

And at the same time, in an era when climate has been described as the next global health crisis, the WTO and its Director General may be asked to re-examine longstanding WTO rules and frameworks that ignore the oft-heavy carbon costs of international trade, and thereby hinder the development of sustainable, local industries.

For example, the WTO Appellate Body ruled that India’s legislative preference for locally-produced solar panels was inconsistent with WTO national treatment rules. The Appellate Body correctly interpreted existing WTO law. But from a policy standpoint telling India to buy its solar panels from China (or the United States) when India faces tremendous requirements for new energy supplies, as well as wide underemployment, was not good climate or development policy. Particularly in light of the fact that the main alternative to solar power is massive new coal power plant construction. The WTO needs to adjust its rules to accommodate the large-scale changes in energy supply needed to reduce carbon output and promote development.

WTO negotiations on fisheries subsidies which are critical to reducing overfishing of depleted fish stocks are stalled. This represent another important area where leadership of the new WTO DG may be important.

Changes to government policies that encourage transition to sustainable agricultural practices, that facilitate the development of industries transitioning away from reliance on fossil fuels, and that recognize the damage done by industries employing outsize carbon intensity should be pursued under the direction of new WTO leadership.

Does it Really Matter? The Director General’s Authority
World Trade Organization building in Geneva, Switzerland

As the electioneering commences, the WTO is at a critical, nearly life-or-death, juncture.

Yet in the final analysis, the WTO Director General has rather limited “actual authority” – rather like the head of the World Health Organization. The constitutional document of the WTO,  the 1995 Agreement Establishing the World Trade Organization, provides that the WTO Secretariat will be headed by a Director General, appointed by the Ministerial Conference (of member states), which will also “adopt regulations setting out the powers, duties, conditions of service and term of office”.

Significantly, WTO members never adopted the called-for regulations setting out the powers and duties of the DG, although they have established the term of office and conditions of employment.

Even so, along with staff appointments and budget management, a recurring and significant role of the Director General involves the appointment of expert panelists at the first level of WTO dispute settlement proceedings, should disputing parties fail to agree.

The Director General traditionally has also played a major role in the negotiation of new WTO (and former GATT) agreements. The DG has acted as Chair of the Trade Negotiations Committee that coordinates the proposals and drafts of the agreements that are ultimately presented to the Members for adoption, and through that function, past Director Generals have played a critical role in facilitating compromise texts and solutions to disagreements between member states. The DG brings interested groups of WTO delegates together for face-to-face discussions as they address issues in various negotiating contexts.

Yet with these things said, the WTO DG is mainly a political figure at the head of the institution who gives the appearance of “leading”. The extent to which that leadership is taken seriously by WTO Members or the wider public may also depend on the personal character and charisma of the individual. He or she – bearing in mind there has never been a female Director General at the WTO – can only persuade. The DG does not issue orders, other than to the Secretariat staff.

Efforts to accommodate what may be some legitimate US concerns are problematic because President Trump appears to have no real interest in “solving” the technical problems with the way the WTO works. He requires some grand gesture for which he can claim victory — or to use his current jargon “total domination”.

Grand gestures are all the more important to Trump as the DG appointment process coincides with the lead-up to the US presidential elections in November.  While a new DG should, in theory, be put into place by 1 September, it’s not at all clear that will happen in the current environment.

Selection of a strong and charismatic figure to “right the ship” of the WTO is thus important for many reasons, including for public health. Developing economies remain dependent on an open international trading system, and the health of people around the world is certainly affected by their economic conditions. As discussed, there are specific WTO rules that may have a significant impact on health affairs, and how the WTO manages its rule system makes a difference. But multilateral cooperation in economic affairs, as in other spheres, is important not only for the particular end that an institution seeks to achieve, but also to avoid devolution of international relations that ultimately might come to a bad end.

It is far from clear that any single individual will be able to pull the WTO out of its current difficulties. But the right appointment is likely to have meaningful consequences in terms of giving the organization a fighting chance. And the next WTO DG must be committed to improving standards of living, including standards of healthcare, for all. The world could use a WTO DG who can actually help make that happen.

___________________________________________

Frederick Abbott, Professor of International Law at Florida State University College.

Frederick M. Abbott is Edward Ball Eminent Scholar Professor of International Law at Florida State University College of Law, USA. He has served as expert consultant and legal representative for numerous international organizations, governments and NGOs, mainly in the fields of trade, intellectual property, public health, technology transfer, and sustainable development. He served as Rapporteur for the International Trade Law Committee of the International Law Association (ILA) (1993-2014) and presently is Co-Chair of the ILA Committee on Global Health Law. He has served as counsel in dispute settlement at the WTO, and has advised governments on TRIPS-related negotiations and implementation. He is on the Board of Editors of the Journal of International Economic Law (Oxford), and of the WIPO-WTO Colloquium Series. http://frederickabbott.com

Image Credits: World Trade Organization, WTO, King & Spalding Law, World Trade Organization, Bread for the World, Government ZA/GCIS, S. Lustig Vijay/HP-Watch, World Trade Organization, World Trade Organization.