190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. COVID-19 Lockdowns Could Lead to 1.4 Million More Tuberculosis Deaths – But The Solution Is ‘Not Rocket Science’ 06/05/2020 Svĕt Lustig Vijay Peru – Mobile truck screens for Tuberculosis in one of the poorest districts of Lima, Carabayllo. A 3-month long lockdown could lead to an additional 1.4 million TB deaths and an additional 6.3 million cases over the next five years – if existing tuberculosis services are put on a prolonged hold, reports a new study by the Stop TB Partnership, which estimated the global impact of COVID-19 lockdowns on TB. The study has important implications for policymakers as they struggle to balance the length of lockdowns with other impacts, including on health systems. However, if TB services are rapidly restored, the long-lasting impacts of the COVID-19 lockdown on TB could be minimized, concludes the study, released on Wednesday. In the best case scenario of a 2-month lockdown and an ‘enhanced’ 2-month long recovery period, there would be a 4% increase in TB deaths (342,500) and 3% increase in TB cases (1,826,400) over the next 5 years, predicted the researchers. Existing TB services thus need to be restored as quickly as possible; otherwise COVID-imposed lockdowns could set back the fight against tuberculosis by 5-8 years, warned the Stop TB Partnership’s Executive Director, Lucica Ditiu, in an interview with Health Policy Watch: “In the agitation of COVID, it appears people forgot that there are other diseases…all existing financial efforts and tools have been disrupted or diverted, and all the efforts you have made for the past 5-8 years may be gone. “By disrupting existing services, we will pay this price later and it will cost us much more,” said Ditiu. TB is the biggest infectious disease killer worldwide, leading to 1.5 million deaths and 10 million cases every year. The mortality rate from TB is about 3% – equal or even greater to that of COVID-19, depending on the estimates. It is estimated that about a quarter of the world’s population has at some time in their lives been infected by TB – although many infections also remain latent and are eventually overcome by the body’s own defenses. TB incidence and mortality dynamics following COVID-19 lockdown The USAID-supported study, carried out by Imperial College, Avenir Health, and Johns Hopkins University examined two scenarios for how the pandemic might impact TB prevention, treatment and control. In the study, a number of scenarios were modelled, including 2-3 month lockdowns and 3-10 month recovery periods. The study finds that on average, for every month of lockdown, there would be an excess of 130 000 deaths and 600 000 cases of TB per month. In the worst case scenario, a 3-month long lockdown and a slow 10-month long recovery period could lead to an additional 1,367,300 deaths in the next five years, increasing total TB deaths by 16%. In this scenario, TB cases would increase by 10% to 6,331,100 cases over the next 5 years. The “worst-case scenario” reported by the study is probably an underestimate, said Ditiu. “The restoration period is likely to be more than 10 months because it looks like lockdowns are going to continue. I think that we will see a much bigger mortality than the modelling study suggests.” The study’s authors contend that these are probably underestimates of true TB infection and death trends, mainly because they did not include underlying comorbidities like direct interactions between the Tuberculosis bacterium and the SARS-CoV-2 virus. There is already some evidence that people with TB history or existing TB are more vulnerable to the SARS-CoV-2 virus, just like any other patient with an underlying illness, said Deputy Executive Director of the Stop TB Partnership Suvanand Sahu, in a webinar Tuesday launching the report. Increased poverty due to COVID-19 lockdowns can further increase TB burden over the next few months because TB disproportionately affects people living in poverty. Poverty was not included in the study’s model, however. However, COVID-19 will increase poverty for the first time in 22 years, according to a recent report by the World Bank, which predicts that over 8% of the world’s population will sink below the poverty line as a result of COVID-19. Carabayllo, one of the poorest districts at the edge of Peru’s Capital, Lima Rapidly Restoring Existing Tuberculosis Services Can Minimize Negative Impact Of COVID-19 Lockdowns The lockdown has already led to a worrying drop in TB diagnosis in the two countries with the highest TB burden in the world – Indonesia and India. Identification of cases has dropped by 80% in India and by 70% in Indonesia, said Ditiu. Lockdowns can have a profound effect on TB burden because people are often unable to visit health clinics for more routine care, and this leads to missed opportunities to diagnose and treat undetected TB cases. “Rapid restoration of TB services is critical for minimising these adverse impacts [of COVID-19 lockdowns]…Long term outcomes can be strongly influenced by the pace of short-term recovery,” said the study. As the pandemic drags on, a range of supplementary measures and resources can be used to recover pre-pandemic TB detection rates, the study highlights: “Such measures may include ramped-up active case-finding, alongside intensive community engagement and contact tracing…[as well as ensuring an]…uninterrupted supply of quality assured treatment and care for every single person with TB.” It’s Not Rocket Science To Address Both COVID-19 & TB; Romania’s Timis County Tests and Treats Both Simultaneously Executive Director of the Stop TB Partnership Lucica Ditiu spoke at the Stop TB Webinar on Tuesday It is not difficult to address both COVID-19 and existing diseases, and it is not necessary to disrupt existing services. “The solution is not rocket science”, said Ditiu, in an interview with Health Policy Watch. “There is no need to disrupt existing services for which treatments are available such as immunization programs or malaria, especially for diseases that cause millions of deaths. “Furthermore, we can address TB and COVID-19 simultaneously because we already have the infrastructure to do both in parallel,” said Ditiu. The Geneva-based, UN-hosted organization, includes more than 2,000 partners worldwide. ‘There are many intersection points between TB and COVID-19, that’s absolutely clear. Firstly, healthcare staff working for TB programs know a lot about diagnosis, treatment and infection control measures for COVID-19. Secondly, we can also use the GeneXpert machines [to diagnose both TB and COVID-19] as well as other putting other measures that are already in place like contact tracing [to work].” In March, Cepheid, the manufacturers of GeneXpert, a widely-used TB diagnostic, received emergency US Food and Drug Administration approval for a COVID-19 test on the platform. In Western Romania’s Timis County, the TB situation is “very good” because it is protocol to maintain existing TB services during the emergency period, said Adriana Socaci, TB Coordinator for the Timis County, in an interview with Health Policy Watch. Timis County has thus maintained ambulatory TB diagnosis and treatment services in the region, administering some 400 tests in the past two months. So far, ambulatory TB services have identified 2 patients with both TB and COVID-19, said Socaci. However, TB hospital visits are being spaced further apart snce the lockdown to respect COVID-19 social distance guidelines, and that has led to an overall reduction in the number of patients that can be seen. During routine COVID-19 testing in Timis County, healthcare workers also collect sputum samples to test patients for TB when lung X-rays are suggestive of the bacterial disease. Sputum samples, which are analyzed for TB using a combination of already-existing smear testing and the higher-throughput GeneXpert tests, were used to identify 8 patients with TB that did not have COVID-19, said Socaci. In the past two months, almost 125 suspected COVID-19 cases have also been tested for TB. Romania – Healthcare worker prepares for routine Tuberculosis screening in Victor Babes Hospital, Timis County National Policies Must Adjust To Regional And Local Conditions; Funding Must Triple As countries try to address COVID-19 and TB, Ditiu warns that policies need to adjust based on each country’s conditions and the location of available services. “There is no one solution that can be generalized across countries, as every country is different. Policies need to adjust based on the country’s conditions and the location of available services.We will have to be mindful of whether these services are centralized or not.” Funding will also be a big question, said Ditiu. We will need to triple current spending to get back to where we were with respect to TB. We will also need to find ways to ensure that money currently earmarked and available for TB gets used, he stressed. “While Africa’s funding for TB has not been suspended, Africa’s capacity to spend the money for TB right now is 0.” Tuberculosis – a disease of the poor Image Credits: Socios en Salud, Svĕt Lustig Vijay, PLOS Medicine. Mobilization For And In Africa Is Certainly Insufficient – Says Geneva Health Forum’s Eric Comte 06/05/2020 Kyra Dupont/Geneva Solutions Geneva Health Forum 2018 (Photo Credit: Louis Brisset/HUG) From a small and modest gathering of booths and stands in 2006, the Geneva Health Forum has grown into an international event with a strong array of scientific sessions. Although the GHF was forced to postpone its eighth annual conference, from March to 16-18 November due to the COVID-19 pandemic, that has not prevented the Forum’s leadership, including GHF Director, Dr Eric Comte, from responding to the unprecedented challenge created by the crisis. A medical doctor and epidemiologist by training, who worked for Médecins Du Monde (MDM) and Médecins sans Frontières, Comte also witnessed the spread of Ebola in West Africa. Geneva Solutions interviewed Comte to hear about the role GHF is playing in the present emergency, and his views gleaned from years in epidemic management. Geneva Solutions (GS): What role is the Geneva Health Forum trying to play in this crisis? Eric Comte (EC): Geneva benefits from a special position due to the presence of the World Health Organization and many organizations which revolve around it. We are fortunate to have this extremely rich environment and the advantages of a small city which greatly facilitates contacts. We generally have two objectives: On the one hand, to facilitate discussions between the various health stakeholders who are willing to work together but who are caught up in their fields of activity and their schedules. Getting people to work together is not so natural. On the other hand, promote links between actors based here and those from countries with more limited resources. The objective is to see what the innovative practices are to improve access to health, in Europe as well as in developing countries. Since the start of the crisis, our interlocutors have been contacting us to tell us about their initiatives and to collect information that we may have, thanks to our network. We are exploring how we might better organize these initiatives. We also are called upon by those who are active in global health, including medical practitioners, policymakers, and academics, including various actors working in Africa who need guidance about how to respond. In this context, we are also trying to bring together various strategic documents produced by WHO, the African Center for Diseases Control, as well as MSF operational documents, that provide guidance in the establishment of emergency response healthcare structures, adapted to the conditions of resource-limited countries. Our role is to share them. We are not the only ones doing it, but this an example of the type of work we are trying to do. GS: ‘Coordination’ seems to be the key word in this crisis? EC: Yes, but there is also information sharing and anticipation. I would like to point out that WHO has been widely criticized on Ebola, but as a result has set up an emergency department which activates a Task Force during crises. In this pandemic, in their coordination function, they were very proactive and produced a lot of useful guidance with clear messages, which comes back to the mantra: test the cases as soon as possible and trace the affected patients to isolate them. GS: Have we not totally missed the point despite the warnings of the WHO? Many countries have failed to follow their recommendations. EC: The only thing I can say is: we have to follow these measures. Often in epidemics, there are recommendations that should be followed but there are limitations in the field. You will always find problems with implementation in the field. A month ago, [for example] tests were not available. There are two possible ways to react. The first is to do everything to make them available. The second, is to cope with the scarcity, which many countries did. We are late, yes. GS: The second key word you mentioned is ‘sharing information’, is that happening? EC: I think there is a lot of sharing going on. The big difficulty is that many documents are in English and much less available in other languages like French or Spanish. This is a major obstacle for areas like West Africa, it creates an important barrier. But it is also true that we are also sharing much more than a decade ago thanks to the electronic network. This effort must be continuous. GS: But there is no withholding of information as there is sometimes in the medical field due to issues of ego, commercial strategies, etc.? EC: There are certainly economic interests. This is not a big open generous market, but there is a desire for openness and sharing – without being naive. GS: What about the third key word, ‘anticipation’? EC: As the experience with the lack of tests in Europe shows – governments are just starting to acquire tests – the ideal would have been to have them a month ago. The mobilization should ideally have been done earlier. Now there has been a surge of cases in Africa, but the mobilization of African actors is still quite weak. There the epidemic will definitely reach a critical point within 10 days to two weeks and in an epidemic that is a lot. In such a rapid epidemic like COVID-19, you must be early and proactive. Mobilization for and in Africa is certainly insufficient. GS: What is the big challenge for Africa? EC: Clear strategy guidelines are needed so that each country does not act alone. We must learn from other countries that have gone through the crisis. Additionally, resource shortages can make it difficult to treat severe cases, so the decisive impact that can be made would be in case detection. It is important to test, identify positive cases and isolate them at home. So, the challenge is to set up massive testing very quickly. But test availability is not the only problem. Once you obtain tests you have to have a clear strategy for where to test and who to test. Like the new drive-in test initiatives, we have seen elsewhere, Africa needs decentralized testing locations, outside of the regular hospital quarters, so as to speed up results and avoid infecting other patients and health workers. It’s not that difficult but it’s a race against the clock to make sure the strategies are in place when the tests arrive. GS: People are very afraid for their future. What scares you the most in this crisis? EC: When you work in Africa on cholera epidemics, you have all the ingredients that we are facing here today. Local players are confronted with overloaded hospitals, racing against the clock to detect positive cases, containing the epidemic, and treating serious cases. What’s going on here isn’t so exceptional. What is exceptional is that it has happened in Europe where we were no longer used to this, and obviously did not have the necessary structures in place. This is exceptional by the geographic scale and the number of patients, but it is a classic epidemic pattern. We had this with Ebola in West Africa. It was the same scenarios. The trauma in Sierra Leone and Guinea were the same: destruction of health systems, exceptionally large number of deaths among health workers, fear within the population, destruction of local economies. GS: Based on your experience, what would you say? EC: We need to keep calm, mobilize communities, which is being done. The reactions are not bad. We are always late in a crisis. The lockdown measures of “confinement” are being respected; the tests came late but they are on the way. If we compare with Ebola, in this crisis we are much responding much faster, only five years later. GS: What are your hopes? EC: With what is in place, we will succeed in limiting the cases. One must not feel afraid. Fear in an epidemic is not a good reflex. We must try to implement the WHO guidelines and normally we should have an influence on bending the curve. ________________________________________________________ Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates. Image Credits: Louis Brisset/HUG, Geneva Health Forum. Research Into Traditional Remedies For COVID-19 Welcomed By World Health Organization 05/05/2020 Svĕt Lustig Vijay Rows of artemisia annua in West Virginia Research into traditional medicines for COVID-19 should be welcomed, so long as it is held to the same standards as research into other drug candidates, the World Health Organization Africa Regional Office expressed in a statement issued Monday. The diplomatically-framed WHO statement came after widespread media coverage of Madagascar’s president and other African leaders over the weekend, who suggested that the medicinal plant artemisia annua (sweet wormwood) was effective against the coronavirus. “WHO recognizes that traditional, complementary and alternative medicine has many benefits, and Africa has a long history of traditional medicine,” said the WHO statement. Several decades ago, the same plant was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria. While no such studies of the plant’s effect in COVID-19 patients have been published, initially promising results from cell studies conducted by Chinese researchers in 2005 showed that artemisia annua extract may have activity against the SARS-CoV virus – a cousin to the SARS-CoV-2 virus that causes COVID-19. The Max Planck institute in Germany recently announced a collaboration with researchers in the United States and Denmark to investigate the plant’s efficacy against SARS-CoV-2. According to WHO COVID-19 Technical Lead, Maria Van Kerkhove, there are “hundreds” of ongoing clinical trials exploring the use of traditional remedies for the coronavirus. “The idea of traditional medicines, particularly for COVID-19, is something that is is well under investigation,” she told reporters Monday. However, WHO warned that, “caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. “Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.”” The statement comes as hydroxychloroquine, an anti-malarial drug is making headlines as a potentially dangerous COVID-19 therapeutic. While hope is still being pinned on the drug, recent studies showed that it could cause heart arrhythmias at high doses, underlining the importance of conducting proper clinical trials before approving a drug for use. The naturally-occurring source of hydroxychloroquine is the chinchona tree, a national symbol of Peru. Global Trends Number of cases by WHO region Of the 27 000 new cases recorded Sunday in Europe, almost a third of cases, some 10 000 new cases, were in the Russian Federation, and 20% of new cases were in the UK, according to the latest WHO situational report. So far, Europe hosts about half of COVID-19 cases and 60% of deaths worldwide. As countries like Italy, Portugal and Austria relaxed their lockdowns on Monday, and Spain recorded its lowest numbers since a peak in March, COVID-19 is still not over in Europe, nor in any other region of the world. This week, the UK will announce a comprehensive roadmap to lift its month-and-a half- long lockdown despite the meagre reductions in cases since mid-April, with 5000 new cases reported over the past day. On Sunday morning, the third flight from China delivered 2.1 million face masks and 32,000 surgical gowns to Ireland’s capital, Dublin. The three flights were organized and funded by Dublin-based aircraft leasing company Avolon, which has raised a total of €350,000 in a crowdfunding campaign. Rock band U2 contributed € 10 million to the cause. In the Americas, meanwhile, the USA, Brazil and Peru accounted for over 80% of new cases reported in the continent in the past day, according to the latest WHO situational report. As of Monday, 26 000 new cases were confirmed in the USA and 6000 new cases were reported in Latin America’s epicentre Brazil, with a total of 102,717 cases and 7,025 deaths. The Amazonian city of Manaus emerged as the new hotspot of the virus, experiencing widespread chaos in morgues and coffin shortages after recording most of the country’s new cases. On Monday, Brazilian Health Minister Nelson Teich arrived in the Manaus to expand testing and to ensure that the region received reinforcements of some 270 health professionals. In the Western Pacific, two countries have experienced an uptick in cases in recent days – Singapore and Japan. Singapore’s outbreak declined in mid-April, but it has reported the most new cases in the Western Pacific in the past day, with 650 cases on Monday and 932 new cases on Friday. The majority of Singapore’s cases in past days have been traced to dormitories of foreign construction workers and common worksites, said Lawrence Wong, Minister For National Development, in a statement on Monday. To curb the outbreak, Singapore has halted the movement of workers in and out of all dormitories, and put the construction workers living outside the dormitories on a stay-home requirement. Like Singapore, Japan’s cases have also risen since last week, mostly in Hokkaido and the capital, Tokyo, with 300 new cases reported in the past 24 hours. In the Eastern Mediterranean region, cases are growing in Afghanistan and Saudi Arabia. In the past day, Saudi Arabia became the Eastern Mediterranean region’s hotspot. Over 70% of civilians in the holy city of Mecca could be infected with the virus, according to senior Saudi medical sources, reported Middle East Eye late last week.Like in Mecca, up to a third of people in the capital Kabul could have COVID-19 according to a random test of 500 Afghanis, reported AP on Sunday. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. -Updated on 6 May Image Credits: Jorge Ferreira, WHO, Johns Hopkins CSSE. Countries Pledge 7.36 Billion Euros Towards Global COVID-19 Response – Nearly Reaching Goal 04/05/2020 Grace Ren Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response. The European Commission kicked off the event with a 1 billion Euro pledge. “Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president. But funding committed at the initial pledging event, which aimed to raise 7.5 billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. “To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added. Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis. Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. “Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic. Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus. “This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.” In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.” Boris Johnson announces the UK pledge The UK has committed up to £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’ “Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday. World Health Organization Says It Will Investigate Animal Source Of SARS-CoV-2, The Virus Behind COVID-19 01/05/2020 Elaine Ruth Fletcher China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’ “We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. The Emergency Committee had recommended that WHO “work with the OIE, FAO, and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.” The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday. Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. “We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.” Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus. And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed. Dr Tedros signs the WHO-EIB Memorandum of Understanding WHO Signs MOU With European Investment Bank At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10 African countries, as well as countries elsewhere with weaker health systems. The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans. The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. The EIB president declined to comment on which nations would receive funding. “I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,” said Hoyer. Werner Hoyer announces the European Investment Bank – WHO collaboration The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region. In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported. The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” USAID also is one of the world’s largest bilateral donors to health systems in developing countries. Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday. On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers. The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing. “These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said. We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria. WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020 In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic. “Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.” Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent. Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story Image Credits: Breaking Asia. Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. COVID-19 Lockdowns Could Lead to 1.4 Million More Tuberculosis Deaths – But The Solution Is ‘Not Rocket Science’ 06/05/2020 Svĕt Lustig Vijay Peru – Mobile truck screens for Tuberculosis in one of the poorest districts of Lima, Carabayllo. A 3-month long lockdown could lead to an additional 1.4 million TB deaths and an additional 6.3 million cases over the next five years – if existing tuberculosis services are put on a prolonged hold, reports a new study by the Stop TB Partnership, which estimated the global impact of COVID-19 lockdowns on TB. The study has important implications for policymakers as they struggle to balance the length of lockdowns with other impacts, including on health systems. However, if TB services are rapidly restored, the long-lasting impacts of the COVID-19 lockdown on TB could be minimized, concludes the study, released on Wednesday. In the best case scenario of a 2-month lockdown and an ‘enhanced’ 2-month long recovery period, there would be a 4% increase in TB deaths (342,500) and 3% increase in TB cases (1,826,400) over the next 5 years, predicted the researchers. Existing TB services thus need to be restored as quickly as possible; otherwise COVID-imposed lockdowns could set back the fight against tuberculosis by 5-8 years, warned the Stop TB Partnership’s Executive Director, Lucica Ditiu, in an interview with Health Policy Watch: “In the agitation of COVID, it appears people forgot that there are other diseases…all existing financial efforts and tools have been disrupted or diverted, and all the efforts you have made for the past 5-8 years may be gone. “By disrupting existing services, we will pay this price later and it will cost us much more,” said Ditiu. TB is the biggest infectious disease killer worldwide, leading to 1.5 million deaths and 10 million cases every year. The mortality rate from TB is about 3% – equal or even greater to that of COVID-19, depending on the estimates. It is estimated that about a quarter of the world’s population has at some time in their lives been infected by TB – although many infections also remain latent and are eventually overcome by the body’s own defenses. TB incidence and mortality dynamics following COVID-19 lockdown The USAID-supported study, carried out by Imperial College, Avenir Health, and Johns Hopkins University examined two scenarios for how the pandemic might impact TB prevention, treatment and control. In the study, a number of scenarios were modelled, including 2-3 month lockdowns and 3-10 month recovery periods. The study finds that on average, for every month of lockdown, there would be an excess of 130 000 deaths and 600 000 cases of TB per month. In the worst case scenario, a 3-month long lockdown and a slow 10-month long recovery period could lead to an additional 1,367,300 deaths in the next five years, increasing total TB deaths by 16%. In this scenario, TB cases would increase by 10% to 6,331,100 cases over the next 5 years. The “worst-case scenario” reported by the study is probably an underestimate, said Ditiu. “The restoration period is likely to be more than 10 months because it looks like lockdowns are going to continue. I think that we will see a much bigger mortality than the modelling study suggests.” The study’s authors contend that these are probably underestimates of true TB infection and death trends, mainly because they did not include underlying comorbidities like direct interactions between the Tuberculosis bacterium and the SARS-CoV-2 virus. There is already some evidence that people with TB history or existing TB are more vulnerable to the SARS-CoV-2 virus, just like any other patient with an underlying illness, said Deputy Executive Director of the Stop TB Partnership Suvanand Sahu, in a webinar Tuesday launching the report. Increased poverty due to COVID-19 lockdowns can further increase TB burden over the next few months because TB disproportionately affects people living in poverty. Poverty was not included in the study’s model, however. However, COVID-19 will increase poverty for the first time in 22 years, according to a recent report by the World Bank, which predicts that over 8% of the world’s population will sink below the poverty line as a result of COVID-19. Carabayllo, one of the poorest districts at the edge of Peru’s Capital, Lima Rapidly Restoring Existing Tuberculosis Services Can Minimize Negative Impact Of COVID-19 Lockdowns The lockdown has already led to a worrying drop in TB diagnosis in the two countries with the highest TB burden in the world – Indonesia and India. Identification of cases has dropped by 80% in India and by 70% in Indonesia, said Ditiu. Lockdowns can have a profound effect on TB burden because people are often unable to visit health clinics for more routine care, and this leads to missed opportunities to diagnose and treat undetected TB cases. “Rapid restoration of TB services is critical for minimising these adverse impacts [of COVID-19 lockdowns]…Long term outcomes can be strongly influenced by the pace of short-term recovery,” said the study. As the pandemic drags on, a range of supplementary measures and resources can be used to recover pre-pandemic TB detection rates, the study highlights: “Such measures may include ramped-up active case-finding, alongside intensive community engagement and contact tracing…[as well as ensuring an]…uninterrupted supply of quality assured treatment and care for every single person with TB.” It’s Not Rocket Science To Address Both COVID-19 & TB; Romania’s Timis County Tests and Treats Both Simultaneously Executive Director of the Stop TB Partnership Lucica Ditiu spoke at the Stop TB Webinar on Tuesday It is not difficult to address both COVID-19 and existing diseases, and it is not necessary to disrupt existing services. “The solution is not rocket science”, said Ditiu, in an interview with Health Policy Watch. “There is no need to disrupt existing services for which treatments are available such as immunization programs or malaria, especially for diseases that cause millions of deaths. “Furthermore, we can address TB and COVID-19 simultaneously because we already have the infrastructure to do both in parallel,” said Ditiu. The Geneva-based, UN-hosted organization, includes more than 2,000 partners worldwide. ‘There are many intersection points between TB and COVID-19, that’s absolutely clear. Firstly, healthcare staff working for TB programs know a lot about diagnosis, treatment and infection control measures for COVID-19. Secondly, we can also use the GeneXpert machines [to diagnose both TB and COVID-19] as well as other putting other measures that are already in place like contact tracing [to work].” In March, Cepheid, the manufacturers of GeneXpert, a widely-used TB diagnostic, received emergency US Food and Drug Administration approval for a COVID-19 test on the platform. In Western Romania’s Timis County, the TB situation is “very good” because it is protocol to maintain existing TB services during the emergency period, said Adriana Socaci, TB Coordinator for the Timis County, in an interview with Health Policy Watch. Timis County has thus maintained ambulatory TB diagnosis and treatment services in the region, administering some 400 tests in the past two months. So far, ambulatory TB services have identified 2 patients with both TB and COVID-19, said Socaci. However, TB hospital visits are being spaced further apart snce the lockdown to respect COVID-19 social distance guidelines, and that has led to an overall reduction in the number of patients that can be seen. During routine COVID-19 testing in Timis County, healthcare workers also collect sputum samples to test patients for TB when lung X-rays are suggestive of the bacterial disease. Sputum samples, which are analyzed for TB using a combination of already-existing smear testing and the higher-throughput GeneXpert tests, were used to identify 8 patients with TB that did not have COVID-19, said Socaci. In the past two months, almost 125 suspected COVID-19 cases have also been tested for TB. Romania – Healthcare worker prepares for routine Tuberculosis screening in Victor Babes Hospital, Timis County National Policies Must Adjust To Regional And Local Conditions; Funding Must Triple As countries try to address COVID-19 and TB, Ditiu warns that policies need to adjust based on each country’s conditions and the location of available services. “There is no one solution that can be generalized across countries, as every country is different. Policies need to adjust based on the country’s conditions and the location of available services.We will have to be mindful of whether these services are centralized or not.” Funding will also be a big question, said Ditiu. We will need to triple current spending to get back to where we were with respect to TB. We will also need to find ways to ensure that money currently earmarked and available for TB gets used, he stressed. “While Africa’s funding for TB has not been suspended, Africa’s capacity to spend the money for TB right now is 0.” Tuberculosis – a disease of the poor Image Credits: Socios en Salud, Svĕt Lustig Vijay, PLOS Medicine. Mobilization For And In Africa Is Certainly Insufficient – Says Geneva Health Forum’s Eric Comte 06/05/2020 Kyra Dupont/Geneva Solutions Geneva Health Forum 2018 (Photo Credit: Louis Brisset/HUG) From a small and modest gathering of booths and stands in 2006, the Geneva Health Forum has grown into an international event with a strong array of scientific sessions. Although the GHF was forced to postpone its eighth annual conference, from March to 16-18 November due to the COVID-19 pandemic, that has not prevented the Forum’s leadership, including GHF Director, Dr Eric Comte, from responding to the unprecedented challenge created by the crisis. A medical doctor and epidemiologist by training, who worked for Médecins Du Monde (MDM) and Médecins sans Frontières, Comte also witnessed the spread of Ebola in West Africa. Geneva Solutions interviewed Comte to hear about the role GHF is playing in the present emergency, and his views gleaned from years in epidemic management. Geneva Solutions (GS): What role is the Geneva Health Forum trying to play in this crisis? Eric Comte (EC): Geneva benefits from a special position due to the presence of the World Health Organization and many organizations which revolve around it. We are fortunate to have this extremely rich environment and the advantages of a small city which greatly facilitates contacts. We generally have two objectives: On the one hand, to facilitate discussions between the various health stakeholders who are willing to work together but who are caught up in their fields of activity and their schedules. Getting people to work together is not so natural. On the other hand, promote links between actors based here and those from countries with more limited resources. The objective is to see what the innovative practices are to improve access to health, in Europe as well as in developing countries. Since the start of the crisis, our interlocutors have been contacting us to tell us about their initiatives and to collect information that we may have, thanks to our network. We are exploring how we might better organize these initiatives. We also are called upon by those who are active in global health, including medical practitioners, policymakers, and academics, including various actors working in Africa who need guidance about how to respond. In this context, we are also trying to bring together various strategic documents produced by WHO, the African Center for Diseases Control, as well as MSF operational documents, that provide guidance in the establishment of emergency response healthcare structures, adapted to the conditions of resource-limited countries. Our role is to share them. We are not the only ones doing it, but this an example of the type of work we are trying to do. GS: ‘Coordination’ seems to be the key word in this crisis? EC: Yes, but there is also information sharing and anticipation. I would like to point out that WHO has been widely criticized on Ebola, but as a result has set up an emergency department which activates a Task Force during crises. In this pandemic, in their coordination function, they were very proactive and produced a lot of useful guidance with clear messages, which comes back to the mantra: test the cases as soon as possible and trace the affected patients to isolate them. GS: Have we not totally missed the point despite the warnings of the WHO? Many countries have failed to follow their recommendations. EC: The only thing I can say is: we have to follow these measures. Often in epidemics, there are recommendations that should be followed but there are limitations in the field. You will always find problems with implementation in the field. A month ago, [for example] tests were not available. There are two possible ways to react. The first is to do everything to make them available. The second, is to cope with the scarcity, which many countries did. We are late, yes. GS: The second key word you mentioned is ‘sharing information’, is that happening? EC: I think there is a lot of sharing going on. The big difficulty is that many documents are in English and much less available in other languages like French or Spanish. This is a major obstacle for areas like West Africa, it creates an important barrier. But it is also true that we are also sharing much more than a decade ago thanks to the electronic network. This effort must be continuous. GS: But there is no withholding of information as there is sometimes in the medical field due to issues of ego, commercial strategies, etc.? EC: There are certainly economic interests. This is not a big open generous market, but there is a desire for openness and sharing – without being naive. GS: What about the third key word, ‘anticipation’? EC: As the experience with the lack of tests in Europe shows – governments are just starting to acquire tests – the ideal would have been to have them a month ago. The mobilization should ideally have been done earlier. Now there has been a surge of cases in Africa, but the mobilization of African actors is still quite weak. There the epidemic will definitely reach a critical point within 10 days to two weeks and in an epidemic that is a lot. In such a rapid epidemic like COVID-19, you must be early and proactive. Mobilization for and in Africa is certainly insufficient. GS: What is the big challenge for Africa? EC: Clear strategy guidelines are needed so that each country does not act alone. We must learn from other countries that have gone through the crisis. Additionally, resource shortages can make it difficult to treat severe cases, so the decisive impact that can be made would be in case detection. It is important to test, identify positive cases and isolate them at home. So, the challenge is to set up massive testing very quickly. But test availability is not the only problem. Once you obtain tests you have to have a clear strategy for where to test and who to test. Like the new drive-in test initiatives, we have seen elsewhere, Africa needs decentralized testing locations, outside of the regular hospital quarters, so as to speed up results and avoid infecting other patients and health workers. It’s not that difficult but it’s a race against the clock to make sure the strategies are in place when the tests arrive. GS: People are very afraid for their future. What scares you the most in this crisis? EC: When you work in Africa on cholera epidemics, you have all the ingredients that we are facing here today. Local players are confronted with overloaded hospitals, racing against the clock to detect positive cases, containing the epidemic, and treating serious cases. What’s going on here isn’t so exceptional. What is exceptional is that it has happened in Europe where we were no longer used to this, and obviously did not have the necessary structures in place. This is exceptional by the geographic scale and the number of patients, but it is a classic epidemic pattern. We had this with Ebola in West Africa. It was the same scenarios. The trauma in Sierra Leone and Guinea were the same: destruction of health systems, exceptionally large number of deaths among health workers, fear within the population, destruction of local economies. GS: Based on your experience, what would you say? EC: We need to keep calm, mobilize communities, which is being done. The reactions are not bad. We are always late in a crisis. The lockdown measures of “confinement” are being respected; the tests came late but they are on the way. If we compare with Ebola, in this crisis we are much responding much faster, only five years later. GS: What are your hopes? EC: With what is in place, we will succeed in limiting the cases. One must not feel afraid. Fear in an epidemic is not a good reflex. We must try to implement the WHO guidelines and normally we should have an influence on bending the curve. ________________________________________________________ Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates. Image Credits: Louis Brisset/HUG, Geneva Health Forum. Research Into Traditional Remedies For COVID-19 Welcomed By World Health Organization 05/05/2020 Svĕt Lustig Vijay Rows of artemisia annua in West Virginia Research into traditional medicines for COVID-19 should be welcomed, so long as it is held to the same standards as research into other drug candidates, the World Health Organization Africa Regional Office expressed in a statement issued Monday. The diplomatically-framed WHO statement came after widespread media coverage of Madagascar’s president and other African leaders over the weekend, who suggested that the medicinal plant artemisia annua (sweet wormwood) was effective against the coronavirus. “WHO recognizes that traditional, complementary and alternative medicine has many benefits, and Africa has a long history of traditional medicine,” said the WHO statement. Several decades ago, the same plant was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria. While no such studies of the plant’s effect in COVID-19 patients have been published, initially promising results from cell studies conducted by Chinese researchers in 2005 showed that artemisia annua extract may have activity against the SARS-CoV virus – a cousin to the SARS-CoV-2 virus that causes COVID-19. The Max Planck institute in Germany recently announced a collaboration with researchers in the United States and Denmark to investigate the plant’s efficacy against SARS-CoV-2. According to WHO COVID-19 Technical Lead, Maria Van Kerkhove, there are “hundreds” of ongoing clinical trials exploring the use of traditional remedies for the coronavirus. “The idea of traditional medicines, particularly for COVID-19, is something that is is well under investigation,” she told reporters Monday. However, WHO warned that, “caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. “Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.”” The statement comes as hydroxychloroquine, an anti-malarial drug is making headlines as a potentially dangerous COVID-19 therapeutic. While hope is still being pinned on the drug, recent studies showed that it could cause heart arrhythmias at high doses, underlining the importance of conducting proper clinical trials before approving a drug for use. The naturally-occurring source of hydroxychloroquine is the chinchona tree, a national symbol of Peru. Global Trends Number of cases by WHO region Of the 27 000 new cases recorded Sunday in Europe, almost a third of cases, some 10 000 new cases, were in the Russian Federation, and 20% of new cases were in the UK, according to the latest WHO situational report. So far, Europe hosts about half of COVID-19 cases and 60% of deaths worldwide. As countries like Italy, Portugal and Austria relaxed their lockdowns on Monday, and Spain recorded its lowest numbers since a peak in March, COVID-19 is still not over in Europe, nor in any other region of the world. This week, the UK will announce a comprehensive roadmap to lift its month-and-a half- long lockdown despite the meagre reductions in cases since mid-April, with 5000 new cases reported over the past day. On Sunday morning, the third flight from China delivered 2.1 million face masks and 32,000 surgical gowns to Ireland’s capital, Dublin. The three flights were organized and funded by Dublin-based aircraft leasing company Avolon, which has raised a total of €350,000 in a crowdfunding campaign. Rock band U2 contributed € 10 million to the cause. In the Americas, meanwhile, the USA, Brazil and Peru accounted for over 80% of new cases reported in the continent in the past day, according to the latest WHO situational report. As of Monday, 26 000 new cases were confirmed in the USA and 6000 new cases were reported in Latin America’s epicentre Brazil, with a total of 102,717 cases and 7,025 deaths. The Amazonian city of Manaus emerged as the new hotspot of the virus, experiencing widespread chaos in morgues and coffin shortages after recording most of the country’s new cases. On Monday, Brazilian Health Minister Nelson Teich arrived in the Manaus to expand testing and to ensure that the region received reinforcements of some 270 health professionals. In the Western Pacific, two countries have experienced an uptick in cases in recent days – Singapore and Japan. Singapore’s outbreak declined in mid-April, but it has reported the most new cases in the Western Pacific in the past day, with 650 cases on Monday and 932 new cases on Friday. The majority of Singapore’s cases in past days have been traced to dormitories of foreign construction workers and common worksites, said Lawrence Wong, Minister For National Development, in a statement on Monday. To curb the outbreak, Singapore has halted the movement of workers in and out of all dormitories, and put the construction workers living outside the dormitories on a stay-home requirement. Like Singapore, Japan’s cases have also risen since last week, mostly in Hokkaido and the capital, Tokyo, with 300 new cases reported in the past 24 hours. In the Eastern Mediterranean region, cases are growing in Afghanistan and Saudi Arabia. In the past day, Saudi Arabia became the Eastern Mediterranean region’s hotspot. Over 70% of civilians in the holy city of Mecca could be infected with the virus, according to senior Saudi medical sources, reported Middle East Eye late last week.Like in Mecca, up to a third of people in the capital Kabul could have COVID-19 according to a random test of 500 Afghanis, reported AP on Sunday. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. -Updated on 6 May Image Credits: Jorge Ferreira, WHO, Johns Hopkins CSSE. Countries Pledge 7.36 Billion Euros Towards Global COVID-19 Response – Nearly Reaching Goal 04/05/2020 Grace Ren Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response. The European Commission kicked off the event with a 1 billion Euro pledge. “Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president. But funding committed at the initial pledging event, which aimed to raise 7.5 billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. “To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added. Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis. Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. “Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic. Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus. “This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.” In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.” Boris Johnson announces the UK pledge The UK has committed up to £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’ “Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday. World Health Organization Says It Will Investigate Animal Source Of SARS-CoV-2, The Virus Behind COVID-19 01/05/2020 Elaine Ruth Fletcher China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’ “We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. The Emergency Committee had recommended that WHO “work with the OIE, FAO, and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.” The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday. Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. “We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.” Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus. And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed. Dr Tedros signs the WHO-EIB Memorandum of Understanding WHO Signs MOU With European Investment Bank At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10 African countries, as well as countries elsewhere with weaker health systems. The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans. The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. The EIB president declined to comment on which nations would receive funding. “I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,” said Hoyer. Werner Hoyer announces the European Investment Bank – WHO collaboration The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region. In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported. The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” USAID also is one of the world’s largest bilateral donors to health systems in developing countries. Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday. On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers. The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing. “These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said. We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria. WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020 In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic. “Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.” Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent. Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story Image Credits: Breaking Asia. Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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COVID-19 Lockdowns Could Lead to 1.4 Million More Tuberculosis Deaths – But The Solution Is ‘Not Rocket Science’ 06/05/2020 Svĕt Lustig Vijay Peru – Mobile truck screens for Tuberculosis in one of the poorest districts of Lima, Carabayllo. A 3-month long lockdown could lead to an additional 1.4 million TB deaths and an additional 6.3 million cases over the next five years – if existing tuberculosis services are put on a prolonged hold, reports a new study by the Stop TB Partnership, which estimated the global impact of COVID-19 lockdowns on TB. The study has important implications for policymakers as they struggle to balance the length of lockdowns with other impacts, including on health systems. However, if TB services are rapidly restored, the long-lasting impacts of the COVID-19 lockdown on TB could be minimized, concludes the study, released on Wednesday. In the best case scenario of a 2-month lockdown and an ‘enhanced’ 2-month long recovery period, there would be a 4% increase in TB deaths (342,500) and 3% increase in TB cases (1,826,400) over the next 5 years, predicted the researchers. Existing TB services thus need to be restored as quickly as possible; otherwise COVID-imposed lockdowns could set back the fight against tuberculosis by 5-8 years, warned the Stop TB Partnership’s Executive Director, Lucica Ditiu, in an interview with Health Policy Watch: “In the agitation of COVID, it appears people forgot that there are other diseases…all existing financial efforts and tools have been disrupted or diverted, and all the efforts you have made for the past 5-8 years may be gone. “By disrupting existing services, we will pay this price later and it will cost us much more,” said Ditiu. TB is the biggest infectious disease killer worldwide, leading to 1.5 million deaths and 10 million cases every year. The mortality rate from TB is about 3% – equal or even greater to that of COVID-19, depending on the estimates. It is estimated that about a quarter of the world’s population has at some time in their lives been infected by TB – although many infections also remain latent and are eventually overcome by the body’s own defenses. TB incidence and mortality dynamics following COVID-19 lockdown The USAID-supported study, carried out by Imperial College, Avenir Health, and Johns Hopkins University examined two scenarios for how the pandemic might impact TB prevention, treatment and control. In the study, a number of scenarios were modelled, including 2-3 month lockdowns and 3-10 month recovery periods. The study finds that on average, for every month of lockdown, there would be an excess of 130 000 deaths and 600 000 cases of TB per month. In the worst case scenario, a 3-month long lockdown and a slow 10-month long recovery period could lead to an additional 1,367,300 deaths in the next five years, increasing total TB deaths by 16%. In this scenario, TB cases would increase by 10% to 6,331,100 cases over the next 5 years. The “worst-case scenario” reported by the study is probably an underestimate, said Ditiu. “The restoration period is likely to be more than 10 months because it looks like lockdowns are going to continue. I think that we will see a much bigger mortality than the modelling study suggests.” The study’s authors contend that these are probably underestimates of true TB infection and death trends, mainly because they did not include underlying comorbidities like direct interactions between the Tuberculosis bacterium and the SARS-CoV-2 virus. There is already some evidence that people with TB history or existing TB are more vulnerable to the SARS-CoV-2 virus, just like any other patient with an underlying illness, said Deputy Executive Director of the Stop TB Partnership Suvanand Sahu, in a webinar Tuesday launching the report. Increased poverty due to COVID-19 lockdowns can further increase TB burden over the next few months because TB disproportionately affects people living in poverty. Poverty was not included in the study’s model, however. However, COVID-19 will increase poverty for the first time in 22 years, according to a recent report by the World Bank, which predicts that over 8% of the world’s population will sink below the poverty line as a result of COVID-19. Carabayllo, one of the poorest districts at the edge of Peru’s Capital, Lima Rapidly Restoring Existing Tuberculosis Services Can Minimize Negative Impact Of COVID-19 Lockdowns The lockdown has already led to a worrying drop in TB diagnosis in the two countries with the highest TB burden in the world – Indonesia and India. Identification of cases has dropped by 80% in India and by 70% in Indonesia, said Ditiu. Lockdowns can have a profound effect on TB burden because people are often unable to visit health clinics for more routine care, and this leads to missed opportunities to diagnose and treat undetected TB cases. “Rapid restoration of TB services is critical for minimising these adverse impacts [of COVID-19 lockdowns]…Long term outcomes can be strongly influenced by the pace of short-term recovery,” said the study. As the pandemic drags on, a range of supplementary measures and resources can be used to recover pre-pandemic TB detection rates, the study highlights: “Such measures may include ramped-up active case-finding, alongside intensive community engagement and contact tracing…[as well as ensuring an]…uninterrupted supply of quality assured treatment and care for every single person with TB.” It’s Not Rocket Science To Address Both COVID-19 & TB; Romania’s Timis County Tests and Treats Both Simultaneously Executive Director of the Stop TB Partnership Lucica Ditiu spoke at the Stop TB Webinar on Tuesday It is not difficult to address both COVID-19 and existing diseases, and it is not necessary to disrupt existing services. “The solution is not rocket science”, said Ditiu, in an interview with Health Policy Watch. “There is no need to disrupt existing services for which treatments are available such as immunization programs or malaria, especially for diseases that cause millions of deaths. “Furthermore, we can address TB and COVID-19 simultaneously because we already have the infrastructure to do both in parallel,” said Ditiu. The Geneva-based, UN-hosted organization, includes more than 2,000 partners worldwide. ‘There are many intersection points between TB and COVID-19, that’s absolutely clear. Firstly, healthcare staff working for TB programs know a lot about diagnosis, treatment and infection control measures for COVID-19. Secondly, we can also use the GeneXpert machines [to diagnose both TB and COVID-19] as well as other putting other measures that are already in place like contact tracing [to work].” In March, Cepheid, the manufacturers of GeneXpert, a widely-used TB diagnostic, received emergency US Food and Drug Administration approval for a COVID-19 test on the platform. In Western Romania’s Timis County, the TB situation is “very good” because it is protocol to maintain existing TB services during the emergency period, said Adriana Socaci, TB Coordinator for the Timis County, in an interview with Health Policy Watch. Timis County has thus maintained ambulatory TB diagnosis and treatment services in the region, administering some 400 tests in the past two months. So far, ambulatory TB services have identified 2 patients with both TB and COVID-19, said Socaci. However, TB hospital visits are being spaced further apart snce the lockdown to respect COVID-19 social distance guidelines, and that has led to an overall reduction in the number of patients that can be seen. During routine COVID-19 testing in Timis County, healthcare workers also collect sputum samples to test patients for TB when lung X-rays are suggestive of the bacterial disease. Sputum samples, which are analyzed for TB using a combination of already-existing smear testing and the higher-throughput GeneXpert tests, were used to identify 8 patients with TB that did not have COVID-19, said Socaci. In the past two months, almost 125 suspected COVID-19 cases have also been tested for TB. Romania – Healthcare worker prepares for routine Tuberculosis screening in Victor Babes Hospital, Timis County National Policies Must Adjust To Regional And Local Conditions; Funding Must Triple As countries try to address COVID-19 and TB, Ditiu warns that policies need to adjust based on each country’s conditions and the location of available services. “There is no one solution that can be generalized across countries, as every country is different. Policies need to adjust based on the country’s conditions and the location of available services.We will have to be mindful of whether these services are centralized or not.” Funding will also be a big question, said Ditiu. We will need to triple current spending to get back to where we were with respect to TB. We will also need to find ways to ensure that money currently earmarked and available for TB gets used, he stressed. “While Africa’s funding for TB has not been suspended, Africa’s capacity to spend the money for TB right now is 0.” Tuberculosis – a disease of the poor Image Credits: Socios en Salud, Svĕt Lustig Vijay, PLOS Medicine. Mobilization For And In Africa Is Certainly Insufficient – Says Geneva Health Forum’s Eric Comte 06/05/2020 Kyra Dupont/Geneva Solutions Geneva Health Forum 2018 (Photo Credit: Louis Brisset/HUG) From a small and modest gathering of booths and stands in 2006, the Geneva Health Forum has grown into an international event with a strong array of scientific sessions. Although the GHF was forced to postpone its eighth annual conference, from March to 16-18 November due to the COVID-19 pandemic, that has not prevented the Forum’s leadership, including GHF Director, Dr Eric Comte, from responding to the unprecedented challenge created by the crisis. A medical doctor and epidemiologist by training, who worked for Médecins Du Monde (MDM) and Médecins sans Frontières, Comte also witnessed the spread of Ebola in West Africa. Geneva Solutions interviewed Comte to hear about the role GHF is playing in the present emergency, and his views gleaned from years in epidemic management. Geneva Solutions (GS): What role is the Geneva Health Forum trying to play in this crisis? Eric Comte (EC): Geneva benefits from a special position due to the presence of the World Health Organization and many organizations which revolve around it. We are fortunate to have this extremely rich environment and the advantages of a small city which greatly facilitates contacts. We generally have two objectives: On the one hand, to facilitate discussions between the various health stakeholders who are willing to work together but who are caught up in their fields of activity and their schedules. Getting people to work together is not so natural. On the other hand, promote links between actors based here and those from countries with more limited resources. The objective is to see what the innovative practices are to improve access to health, in Europe as well as in developing countries. Since the start of the crisis, our interlocutors have been contacting us to tell us about their initiatives and to collect information that we may have, thanks to our network. We are exploring how we might better organize these initiatives. We also are called upon by those who are active in global health, including medical practitioners, policymakers, and academics, including various actors working in Africa who need guidance about how to respond. In this context, we are also trying to bring together various strategic documents produced by WHO, the African Center for Diseases Control, as well as MSF operational documents, that provide guidance in the establishment of emergency response healthcare structures, adapted to the conditions of resource-limited countries. Our role is to share them. We are not the only ones doing it, but this an example of the type of work we are trying to do. GS: ‘Coordination’ seems to be the key word in this crisis? EC: Yes, but there is also information sharing and anticipation. I would like to point out that WHO has been widely criticized on Ebola, but as a result has set up an emergency department which activates a Task Force during crises. In this pandemic, in their coordination function, they were very proactive and produced a lot of useful guidance with clear messages, which comes back to the mantra: test the cases as soon as possible and trace the affected patients to isolate them. GS: Have we not totally missed the point despite the warnings of the WHO? Many countries have failed to follow their recommendations. EC: The only thing I can say is: we have to follow these measures. Often in epidemics, there are recommendations that should be followed but there are limitations in the field. You will always find problems with implementation in the field. A month ago, [for example] tests were not available. There are two possible ways to react. The first is to do everything to make them available. The second, is to cope with the scarcity, which many countries did. We are late, yes. GS: The second key word you mentioned is ‘sharing information’, is that happening? EC: I think there is a lot of sharing going on. The big difficulty is that many documents are in English and much less available in other languages like French or Spanish. This is a major obstacle for areas like West Africa, it creates an important barrier. But it is also true that we are also sharing much more than a decade ago thanks to the electronic network. This effort must be continuous. GS: But there is no withholding of information as there is sometimes in the medical field due to issues of ego, commercial strategies, etc.? EC: There are certainly economic interests. This is not a big open generous market, but there is a desire for openness and sharing – without being naive. GS: What about the third key word, ‘anticipation’? EC: As the experience with the lack of tests in Europe shows – governments are just starting to acquire tests – the ideal would have been to have them a month ago. The mobilization should ideally have been done earlier. Now there has been a surge of cases in Africa, but the mobilization of African actors is still quite weak. There the epidemic will definitely reach a critical point within 10 days to two weeks and in an epidemic that is a lot. In such a rapid epidemic like COVID-19, you must be early and proactive. Mobilization for and in Africa is certainly insufficient. GS: What is the big challenge for Africa? EC: Clear strategy guidelines are needed so that each country does not act alone. We must learn from other countries that have gone through the crisis. Additionally, resource shortages can make it difficult to treat severe cases, so the decisive impact that can be made would be in case detection. It is important to test, identify positive cases and isolate them at home. So, the challenge is to set up massive testing very quickly. But test availability is not the only problem. Once you obtain tests you have to have a clear strategy for where to test and who to test. Like the new drive-in test initiatives, we have seen elsewhere, Africa needs decentralized testing locations, outside of the regular hospital quarters, so as to speed up results and avoid infecting other patients and health workers. It’s not that difficult but it’s a race against the clock to make sure the strategies are in place when the tests arrive. GS: People are very afraid for their future. What scares you the most in this crisis? EC: When you work in Africa on cholera epidemics, you have all the ingredients that we are facing here today. Local players are confronted with overloaded hospitals, racing against the clock to detect positive cases, containing the epidemic, and treating serious cases. What’s going on here isn’t so exceptional. What is exceptional is that it has happened in Europe where we were no longer used to this, and obviously did not have the necessary structures in place. This is exceptional by the geographic scale and the number of patients, but it is a classic epidemic pattern. We had this with Ebola in West Africa. It was the same scenarios. The trauma in Sierra Leone and Guinea were the same: destruction of health systems, exceptionally large number of deaths among health workers, fear within the population, destruction of local economies. GS: Based on your experience, what would you say? EC: We need to keep calm, mobilize communities, which is being done. The reactions are not bad. We are always late in a crisis. The lockdown measures of “confinement” are being respected; the tests came late but they are on the way. If we compare with Ebola, in this crisis we are much responding much faster, only five years later. GS: What are your hopes? EC: With what is in place, we will succeed in limiting the cases. One must not feel afraid. Fear in an epidemic is not a good reflex. We must try to implement the WHO guidelines and normally we should have an influence on bending the curve. ________________________________________________________ Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates. Image Credits: Louis Brisset/HUG, Geneva Health Forum. Research Into Traditional Remedies For COVID-19 Welcomed By World Health Organization 05/05/2020 Svĕt Lustig Vijay Rows of artemisia annua in West Virginia Research into traditional medicines for COVID-19 should be welcomed, so long as it is held to the same standards as research into other drug candidates, the World Health Organization Africa Regional Office expressed in a statement issued Monday. The diplomatically-framed WHO statement came after widespread media coverage of Madagascar’s president and other African leaders over the weekend, who suggested that the medicinal plant artemisia annua (sweet wormwood) was effective against the coronavirus. “WHO recognizes that traditional, complementary and alternative medicine has many benefits, and Africa has a long history of traditional medicine,” said the WHO statement. Several decades ago, the same plant was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria. While no such studies of the plant’s effect in COVID-19 patients have been published, initially promising results from cell studies conducted by Chinese researchers in 2005 showed that artemisia annua extract may have activity against the SARS-CoV virus – a cousin to the SARS-CoV-2 virus that causes COVID-19. The Max Planck institute in Germany recently announced a collaboration with researchers in the United States and Denmark to investigate the plant’s efficacy against SARS-CoV-2. According to WHO COVID-19 Technical Lead, Maria Van Kerkhove, there are “hundreds” of ongoing clinical trials exploring the use of traditional remedies for the coronavirus. “The idea of traditional medicines, particularly for COVID-19, is something that is is well under investigation,” she told reporters Monday. However, WHO warned that, “caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. “Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.”” The statement comes as hydroxychloroquine, an anti-malarial drug is making headlines as a potentially dangerous COVID-19 therapeutic. While hope is still being pinned on the drug, recent studies showed that it could cause heart arrhythmias at high doses, underlining the importance of conducting proper clinical trials before approving a drug for use. The naturally-occurring source of hydroxychloroquine is the chinchona tree, a national symbol of Peru. Global Trends Number of cases by WHO region Of the 27 000 new cases recorded Sunday in Europe, almost a third of cases, some 10 000 new cases, were in the Russian Federation, and 20% of new cases were in the UK, according to the latest WHO situational report. So far, Europe hosts about half of COVID-19 cases and 60% of deaths worldwide. As countries like Italy, Portugal and Austria relaxed their lockdowns on Monday, and Spain recorded its lowest numbers since a peak in March, COVID-19 is still not over in Europe, nor in any other region of the world. This week, the UK will announce a comprehensive roadmap to lift its month-and-a half- long lockdown despite the meagre reductions in cases since mid-April, with 5000 new cases reported over the past day. On Sunday morning, the third flight from China delivered 2.1 million face masks and 32,000 surgical gowns to Ireland’s capital, Dublin. The three flights were organized and funded by Dublin-based aircraft leasing company Avolon, which has raised a total of €350,000 in a crowdfunding campaign. Rock band U2 contributed € 10 million to the cause. In the Americas, meanwhile, the USA, Brazil and Peru accounted for over 80% of new cases reported in the continent in the past day, according to the latest WHO situational report. As of Monday, 26 000 new cases were confirmed in the USA and 6000 new cases were reported in Latin America’s epicentre Brazil, with a total of 102,717 cases and 7,025 deaths. The Amazonian city of Manaus emerged as the new hotspot of the virus, experiencing widespread chaos in morgues and coffin shortages after recording most of the country’s new cases. On Monday, Brazilian Health Minister Nelson Teich arrived in the Manaus to expand testing and to ensure that the region received reinforcements of some 270 health professionals. In the Western Pacific, two countries have experienced an uptick in cases in recent days – Singapore and Japan. Singapore’s outbreak declined in mid-April, but it has reported the most new cases in the Western Pacific in the past day, with 650 cases on Monday and 932 new cases on Friday. The majority of Singapore’s cases in past days have been traced to dormitories of foreign construction workers and common worksites, said Lawrence Wong, Minister For National Development, in a statement on Monday. To curb the outbreak, Singapore has halted the movement of workers in and out of all dormitories, and put the construction workers living outside the dormitories on a stay-home requirement. Like Singapore, Japan’s cases have also risen since last week, mostly in Hokkaido and the capital, Tokyo, with 300 new cases reported in the past 24 hours. In the Eastern Mediterranean region, cases are growing in Afghanistan and Saudi Arabia. In the past day, Saudi Arabia became the Eastern Mediterranean region’s hotspot. Over 70% of civilians in the holy city of Mecca could be infected with the virus, according to senior Saudi medical sources, reported Middle East Eye late last week.Like in Mecca, up to a third of people in the capital Kabul could have COVID-19 according to a random test of 500 Afghanis, reported AP on Sunday. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. -Updated on 6 May Image Credits: Jorge Ferreira, WHO, Johns Hopkins CSSE. Countries Pledge 7.36 Billion Euros Towards Global COVID-19 Response – Nearly Reaching Goal 04/05/2020 Grace Ren Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response. The European Commission kicked off the event with a 1 billion Euro pledge. “Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president. But funding committed at the initial pledging event, which aimed to raise 7.5 billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. “To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added. Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis. Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. “Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic. Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus. “This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.” In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.” Boris Johnson announces the UK pledge The UK has committed up to £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’ “Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday. World Health Organization Says It Will Investigate Animal Source Of SARS-CoV-2, The Virus Behind COVID-19 01/05/2020 Elaine Ruth Fletcher China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’ “We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. The Emergency Committee had recommended that WHO “work with the OIE, FAO, and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.” The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday. Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. “We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.” Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus. And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed. Dr Tedros signs the WHO-EIB Memorandum of Understanding WHO Signs MOU With European Investment Bank At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10 African countries, as well as countries elsewhere with weaker health systems. The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans. The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. The EIB president declined to comment on which nations would receive funding. “I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,” said Hoyer. Werner Hoyer announces the European Investment Bank – WHO collaboration The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region. In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported. The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” USAID also is one of the world’s largest bilateral donors to health systems in developing countries. Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday. On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers. The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing. “These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said. We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria. WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020 In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic. “Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.” Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent. Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story Image Credits: Breaking Asia. Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Mobilization For And In Africa Is Certainly Insufficient – Says Geneva Health Forum’s Eric Comte 06/05/2020 Kyra Dupont/Geneva Solutions Geneva Health Forum 2018 (Photo Credit: Louis Brisset/HUG) From a small and modest gathering of booths and stands in 2006, the Geneva Health Forum has grown into an international event with a strong array of scientific sessions. Although the GHF was forced to postpone its eighth annual conference, from March to 16-18 November due to the COVID-19 pandemic, that has not prevented the Forum’s leadership, including GHF Director, Dr Eric Comte, from responding to the unprecedented challenge created by the crisis. A medical doctor and epidemiologist by training, who worked for Médecins Du Monde (MDM) and Médecins sans Frontières, Comte also witnessed the spread of Ebola in West Africa. Geneva Solutions interviewed Comte to hear about the role GHF is playing in the present emergency, and his views gleaned from years in epidemic management. Geneva Solutions (GS): What role is the Geneva Health Forum trying to play in this crisis? Eric Comte (EC): Geneva benefits from a special position due to the presence of the World Health Organization and many organizations which revolve around it. We are fortunate to have this extremely rich environment and the advantages of a small city which greatly facilitates contacts. We generally have two objectives: On the one hand, to facilitate discussions between the various health stakeholders who are willing to work together but who are caught up in their fields of activity and their schedules. Getting people to work together is not so natural. On the other hand, promote links between actors based here and those from countries with more limited resources. The objective is to see what the innovative practices are to improve access to health, in Europe as well as in developing countries. Since the start of the crisis, our interlocutors have been contacting us to tell us about their initiatives and to collect information that we may have, thanks to our network. We are exploring how we might better organize these initiatives. We also are called upon by those who are active in global health, including medical practitioners, policymakers, and academics, including various actors working in Africa who need guidance about how to respond. In this context, we are also trying to bring together various strategic documents produced by WHO, the African Center for Diseases Control, as well as MSF operational documents, that provide guidance in the establishment of emergency response healthcare structures, adapted to the conditions of resource-limited countries. Our role is to share them. We are not the only ones doing it, but this an example of the type of work we are trying to do. GS: ‘Coordination’ seems to be the key word in this crisis? EC: Yes, but there is also information sharing and anticipation. I would like to point out that WHO has been widely criticized on Ebola, but as a result has set up an emergency department which activates a Task Force during crises. In this pandemic, in their coordination function, they were very proactive and produced a lot of useful guidance with clear messages, which comes back to the mantra: test the cases as soon as possible and trace the affected patients to isolate them. GS: Have we not totally missed the point despite the warnings of the WHO? Many countries have failed to follow their recommendations. EC: The only thing I can say is: we have to follow these measures. Often in epidemics, there are recommendations that should be followed but there are limitations in the field. You will always find problems with implementation in the field. A month ago, [for example] tests were not available. There are two possible ways to react. The first is to do everything to make them available. The second, is to cope with the scarcity, which many countries did. We are late, yes. GS: The second key word you mentioned is ‘sharing information’, is that happening? EC: I think there is a lot of sharing going on. The big difficulty is that many documents are in English and much less available in other languages like French or Spanish. This is a major obstacle for areas like West Africa, it creates an important barrier. But it is also true that we are also sharing much more than a decade ago thanks to the electronic network. This effort must be continuous. GS: But there is no withholding of information as there is sometimes in the medical field due to issues of ego, commercial strategies, etc.? EC: There are certainly economic interests. This is not a big open generous market, but there is a desire for openness and sharing – without being naive. GS: What about the third key word, ‘anticipation’? EC: As the experience with the lack of tests in Europe shows – governments are just starting to acquire tests – the ideal would have been to have them a month ago. The mobilization should ideally have been done earlier. Now there has been a surge of cases in Africa, but the mobilization of African actors is still quite weak. There the epidemic will definitely reach a critical point within 10 days to two weeks and in an epidemic that is a lot. In such a rapid epidemic like COVID-19, you must be early and proactive. Mobilization for and in Africa is certainly insufficient. GS: What is the big challenge for Africa? EC: Clear strategy guidelines are needed so that each country does not act alone. We must learn from other countries that have gone through the crisis. Additionally, resource shortages can make it difficult to treat severe cases, so the decisive impact that can be made would be in case detection. It is important to test, identify positive cases and isolate them at home. So, the challenge is to set up massive testing very quickly. But test availability is not the only problem. Once you obtain tests you have to have a clear strategy for where to test and who to test. Like the new drive-in test initiatives, we have seen elsewhere, Africa needs decentralized testing locations, outside of the regular hospital quarters, so as to speed up results and avoid infecting other patients and health workers. It’s not that difficult but it’s a race against the clock to make sure the strategies are in place when the tests arrive. GS: People are very afraid for their future. What scares you the most in this crisis? EC: When you work in Africa on cholera epidemics, you have all the ingredients that we are facing here today. Local players are confronted with overloaded hospitals, racing against the clock to detect positive cases, containing the epidemic, and treating serious cases. What’s going on here isn’t so exceptional. What is exceptional is that it has happened in Europe where we were no longer used to this, and obviously did not have the necessary structures in place. This is exceptional by the geographic scale and the number of patients, but it is a classic epidemic pattern. We had this with Ebola in West Africa. It was the same scenarios. The trauma in Sierra Leone and Guinea were the same: destruction of health systems, exceptionally large number of deaths among health workers, fear within the population, destruction of local economies. GS: Based on your experience, what would you say? EC: We need to keep calm, mobilize communities, which is being done. The reactions are not bad. We are always late in a crisis. The lockdown measures of “confinement” are being respected; the tests came late but they are on the way. If we compare with Ebola, in this crisis we are much responding much faster, only five years later. GS: What are your hopes? EC: With what is in place, we will succeed in limiting the cases. One must not feel afraid. Fear in an epidemic is not a good reflex. We must try to implement the WHO guidelines and normally we should have an influence on bending the curve. ________________________________________________________ Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates. Image Credits: Louis Brisset/HUG, Geneva Health Forum. Research Into Traditional Remedies For COVID-19 Welcomed By World Health Organization 05/05/2020 Svĕt Lustig Vijay Rows of artemisia annua in West Virginia Research into traditional medicines for COVID-19 should be welcomed, so long as it is held to the same standards as research into other drug candidates, the World Health Organization Africa Regional Office expressed in a statement issued Monday. The diplomatically-framed WHO statement came after widespread media coverage of Madagascar’s president and other African leaders over the weekend, who suggested that the medicinal plant artemisia annua (sweet wormwood) was effective against the coronavirus. “WHO recognizes that traditional, complementary and alternative medicine has many benefits, and Africa has a long history of traditional medicine,” said the WHO statement. Several decades ago, the same plant was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria. While no such studies of the plant’s effect in COVID-19 patients have been published, initially promising results from cell studies conducted by Chinese researchers in 2005 showed that artemisia annua extract may have activity against the SARS-CoV virus – a cousin to the SARS-CoV-2 virus that causes COVID-19. The Max Planck institute in Germany recently announced a collaboration with researchers in the United States and Denmark to investigate the plant’s efficacy against SARS-CoV-2. According to WHO COVID-19 Technical Lead, Maria Van Kerkhove, there are “hundreds” of ongoing clinical trials exploring the use of traditional remedies for the coronavirus. “The idea of traditional medicines, particularly for COVID-19, is something that is is well under investigation,” she told reporters Monday. However, WHO warned that, “caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. “Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.”” The statement comes as hydroxychloroquine, an anti-malarial drug is making headlines as a potentially dangerous COVID-19 therapeutic. While hope is still being pinned on the drug, recent studies showed that it could cause heart arrhythmias at high doses, underlining the importance of conducting proper clinical trials before approving a drug for use. The naturally-occurring source of hydroxychloroquine is the chinchona tree, a national symbol of Peru. Global Trends Number of cases by WHO region Of the 27 000 new cases recorded Sunday in Europe, almost a third of cases, some 10 000 new cases, were in the Russian Federation, and 20% of new cases were in the UK, according to the latest WHO situational report. So far, Europe hosts about half of COVID-19 cases and 60% of deaths worldwide. As countries like Italy, Portugal and Austria relaxed their lockdowns on Monday, and Spain recorded its lowest numbers since a peak in March, COVID-19 is still not over in Europe, nor in any other region of the world. This week, the UK will announce a comprehensive roadmap to lift its month-and-a half- long lockdown despite the meagre reductions in cases since mid-April, with 5000 new cases reported over the past day. On Sunday morning, the third flight from China delivered 2.1 million face masks and 32,000 surgical gowns to Ireland’s capital, Dublin. The three flights were organized and funded by Dublin-based aircraft leasing company Avolon, which has raised a total of €350,000 in a crowdfunding campaign. Rock band U2 contributed € 10 million to the cause. In the Americas, meanwhile, the USA, Brazil and Peru accounted for over 80% of new cases reported in the continent in the past day, according to the latest WHO situational report. As of Monday, 26 000 new cases were confirmed in the USA and 6000 new cases were reported in Latin America’s epicentre Brazil, with a total of 102,717 cases and 7,025 deaths. The Amazonian city of Manaus emerged as the new hotspot of the virus, experiencing widespread chaos in morgues and coffin shortages after recording most of the country’s new cases. On Monday, Brazilian Health Minister Nelson Teich arrived in the Manaus to expand testing and to ensure that the region received reinforcements of some 270 health professionals. In the Western Pacific, two countries have experienced an uptick in cases in recent days – Singapore and Japan. Singapore’s outbreak declined in mid-April, but it has reported the most new cases in the Western Pacific in the past day, with 650 cases on Monday and 932 new cases on Friday. The majority of Singapore’s cases in past days have been traced to dormitories of foreign construction workers and common worksites, said Lawrence Wong, Minister For National Development, in a statement on Monday. To curb the outbreak, Singapore has halted the movement of workers in and out of all dormitories, and put the construction workers living outside the dormitories on a stay-home requirement. Like Singapore, Japan’s cases have also risen since last week, mostly in Hokkaido and the capital, Tokyo, with 300 new cases reported in the past 24 hours. In the Eastern Mediterranean region, cases are growing in Afghanistan and Saudi Arabia. In the past day, Saudi Arabia became the Eastern Mediterranean region’s hotspot. Over 70% of civilians in the holy city of Mecca could be infected with the virus, according to senior Saudi medical sources, reported Middle East Eye late last week.Like in Mecca, up to a third of people in the capital Kabul could have COVID-19 according to a random test of 500 Afghanis, reported AP on Sunday. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. -Updated on 6 May Image Credits: Jorge Ferreira, WHO, Johns Hopkins CSSE. Countries Pledge 7.36 Billion Euros Towards Global COVID-19 Response – Nearly Reaching Goal 04/05/2020 Grace Ren Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response. The European Commission kicked off the event with a 1 billion Euro pledge. “Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president. But funding committed at the initial pledging event, which aimed to raise 7.5 billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. “To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added. Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis. Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. “Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic. Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus. “This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.” In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.” Boris Johnson announces the UK pledge The UK has committed up to £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’ “Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday. World Health Organization Says It Will Investigate Animal Source Of SARS-CoV-2, The Virus Behind COVID-19 01/05/2020 Elaine Ruth Fletcher China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’ “We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. The Emergency Committee had recommended that WHO “work with the OIE, FAO, and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.” The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday. Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. “We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.” Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus. And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed. Dr Tedros signs the WHO-EIB Memorandum of Understanding WHO Signs MOU With European Investment Bank At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10 African countries, as well as countries elsewhere with weaker health systems. The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans. The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. The EIB president declined to comment on which nations would receive funding. “I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,” said Hoyer. Werner Hoyer announces the European Investment Bank – WHO collaboration The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region. In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported. The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” USAID also is one of the world’s largest bilateral donors to health systems in developing countries. Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday. On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers. The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing. “These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said. We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria. WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020 In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic. “Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.” Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent. Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story Image Credits: Breaking Asia. Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Research Into Traditional Remedies For COVID-19 Welcomed By World Health Organization 05/05/2020 Svĕt Lustig Vijay Rows of artemisia annua in West Virginia Research into traditional medicines for COVID-19 should be welcomed, so long as it is held to the same standards as research into other drug candidates, the World Health Organization Africa Regional Office expressed in a statement issued Monday. The diplomatically-framed WHO statement came after widespread media coverage of Madagascar’s president and other African leaders over the weekend, who suggested that the medicinal plant artemisia annua (sweet wormwood) was effective against the coronavirus. “WHO recognizes that traditional, complementary and alternative medicine has many benefits, and Africa has a long history of traditional medicine,” said the WHO statement. Several decades ago, the same plant was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria. While no such studies of the plant’s effect in COVID-19 patients have been published, initially promising results from cell studies conducted by Chinese researchers in 2005 showed that artemisia annua extract may have activity against the SARS-CoV virus – a cousin to the SARS-CoV-2 virus that causes COVID-19. The Max Planck institute in Germany recently announced a collaboration with researchers in the United States and Denmark to investigate the plant’s efficacy against SARS-CoV-2. According to WHO COVID-19 Technical Lead, Maria Van Kerkhove, there are “hundreds” of ongoing clinical trials exploring the use of traditional remedies for the coronavirus. “The idea of traditional medicines, particularly for COVID-19, is something that is is well under investigation,” she told reporters Monday. However, WHO warned that, “caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. “Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.”” The statement comes as hydroxychloroquine, an anti-malarial drug is making headlines as a potentially dangerous COVID-19 therapeutic. While hope is still being pinned on the drug, recent studies showed that it could cause heart arrhythmias at high doses, underlining the importance of conducting proper clinical trials before approving a drug for use. The naturally-occurring source of hydroxychloroquine is the chinchona tree, a national symbol of Peru. Global Trends Number of cases by WHO region Of the 27 000 new cases recorded Sunday in Europe, almost a third of cases, some 10 000 new cases, were in the Russian Federation, and 20% of new cases were in the UK, according to the latest WHO situational report. So far, Europe hosts about half of COVID-19 cases and 60% of deaths worldwide. As countries like Italy, Portugal and Austria relaxed their lockdowns on Monday, and Spain recorded its lowest numbers since a peak in March, COVID-19 is still not over in Europe, nor in any other region of the world. This week, the UK will announce a comprehensive roadmap to lift its month-and-a half- long lockdown despite the meagre reductions in cases since mid-April, with 5000 new cases reported over the past day. On Sunday morning, the third flight from China delivered 2.1 million face masks and 32,000 surgical gowns to Ireland’s capital, Dublin. The three flights were organized and funded by Dublin-based aircraft leasing company Avolon, which has raised a total of €350,000 in a crowdfunding campaign. Rock band U2 contributed € 10 million to the cause. In the Americas, meanwhile, the USA, Brazil and Peru accounted for over 80% of new cases reported in the continent in the past day, according to the latest WHO situational report. As of Monday, 26 000 new cases were confirmed in the USA and 6000 new cases were reported in Latin America’s epicentre Brazil, with a total of 102,717 cases and 7,025 deaths. The Amazonian city of Manaus emerged as the new hotspot of the virus, experiencing widespread chaos in morgues and coffin shortages after recording most of the country’s new cases. On Monday, Brazilian Health Minister Nelson Teich arrived in the Manaus to expand testing and to ensure that the region received reinforcements of some 270 health professionals. In the Western Pacific, two countries have experienced an uptick in cases in recent days – Singapore and Japan. Singapore’s outbreak declined in mid-April, but it has reported the most new cases in the Western Pacific in the past day, with 650 cases on Monday and 932 new cases on Friday. The majority of Singapore’s cases in past days have been traced to dormitories of foreign construction workers and common worksites, said Lawrence Wong, Minister For National Development, in a statement on Monday. To curb the outbreak, Singapore has halted the movement of workers in and out of all dormitories, and put the construction workers living outside the dormitories on a stay-home requirement. Like Singapore, Japan’s cases have also risen since last week, mostly in Hokkaido and the capital, Tokyo, with 300 new cases reported in the past 24 hours. In the Eastern Mediterranean region, cases are growing in Afghanistan and Saudi Arabia. In the past day, Saudi Arabia became the Eastern Mediterranean region’s hotspot. Over 70% of civilians in the holy city of Mecca could be infected with the virus, according to senior Saudi medical sources, reported Middle East Eye late last week.Like in Mecca, up to a third of people in the capital Kabul could have COVID-19 according to a random test of 500 Afghanis, reported AP on Sunday. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. -Updated on 6 May Image Credits: Jorge Ferreira, WHO, Johns Hopkins CSSE. Countries Pledge 7.36 Billion Euros Towards Global COVID-19 Response – Nearly Reaching Goal 04/05/2020 Grace Ren Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response. The European Commission kicked off the event with a 1 billion Euro pledge. “Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president. But funding committed at the initial pledging event, which aimed to raise 7.5 billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. “To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added. Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis. Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. “Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic. Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus. “This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.” In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.” Boris Johnson announces the UK pledge The UK has committed up to £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’ “Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday. World Health Organization Says It Will Investigate Animal Source Of SARS-CoV-2, The Virus Behind COVID-19 01/05/2020 Elaine Ruth Fletcher China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’ “We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. The Emergency Committee had recommended that WHO “work with the OIE, FAO, and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.” The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday. Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. “We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.” Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus. And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed. Dr Tedros signs the WHO-EIB Memorandum of Understanding WHO Signs MOU With European Investment Bank At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10 African countries, as well as countries elsewhere with weaker health systems. The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans. The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. The EIB president declined to comment on which nations would receive funding. “I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,” said Hoyer. Werner Hoyer announces the European Investment Bank – WHO collaboration The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region. In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported. The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” USAID also is one of the world’s largest bilateral donors to health systems in developing countries. Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday. On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers. The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing. “These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said. We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria. WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020 In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic. “Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.” Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent. Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story Image Credits: Breaking Asia. Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Countries Pledge 7.36 Billion Euros Towards Global COVID-19 Response – Nearly Reaching Goal 04/05/2020 Grace Ren Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response. The European Commission kicked off the event with a 1 billion Euro pledge. “Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president. But funding committed at the initial pledging event, which aimed to raise 7.5 billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. “To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added. Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis. Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. “Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic. Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus. “This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.” In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.” Boris Johnson announces the UK pledge The UK has committed up to £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’ “Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday. World Health Organization Says It Will Investigate Animal Source Of SARS-CoV-2, The Virus Behind COVID-19 01/05/2020 Elaine Ruth Fletcher China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’ “We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. The Emergency Committee had recommended that WHO “work with the OIE, FAO, and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.” The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday. Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. “We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.” Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus. And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed. Dr Tedros signs the WHO-EIB Memorandum of Understanding WHO Signs MOU With European Investment Bank At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10 African countries, as well as countries elsewhere with weaker health systems. The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans. The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. The EIB president declined to comment on which nations would receive funding. “I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,” said Hoyer. Werner Hoyer announces the European Investment Bank – WHO collaboration The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region. In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported. The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” USAID also is one of the world’s largest bilateral donors to health systems in developing countries. Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday. On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers. The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing. “These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said. We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria. WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020 In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic. “Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.” Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent. Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story Image Credits: Breaking Asia. Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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World Health Organization Says It Will Investigate Animal Source Of SARS-CoV-2, The Virus Behind COVID-19 01/05/2020 Elaine Ruth Fletcher China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’ “We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. The Emergency Committee had recommended that WHO “work with the OIE, FAO, and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.” The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday. Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. “We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.” Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus. And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed. Dr Tedros signs the WHO-EIB Memorandum of Understanding WHO Signs MOU With European Investment Bank At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10 African countries, as well as countries elsewhere with weaker health systems. The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans. The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. The EIB president declined to comment on which nations would receive funding. “I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,” said Hoyer. Werner Hoyer announces the European Investment Bank – WHO collaboration The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region. In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported. The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” USAID also is one of the world’s largest bilateral donors to health systems in developing countries. Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday. On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers. The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing. “These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said. We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria. WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020 In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic. “Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.” Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent. Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story Image Credits: Breaking Asia. Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Malaria in Pregnancy – MMV Makes Renewed Efforts To Protect This High-Risk Group 01/05/2020 Elaine Ruth Fletcher & Grace Ren Pregnant women remain one of the groups at highest risk of complications from malaria infection. Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April. Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease. In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative. MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.” Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa. In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk. During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report. “Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”. A key tool to protect pregnant women – Intermittent Preventive Treatment A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention. A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight. “IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu. Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy. Scaling Up Access to IPTp However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa. The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.” He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided. Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment. As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery. “We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit. WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy. Malaria – A Particular Risk in the First Pregnancy Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy. “There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu. That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016. In subsequent pregnancies, on the other hand, immunity appears to be less impacted. Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease. In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages. In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies. IPTp – Part of a Wider MiMBa Strategy Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers. As other elements of the MiMBa initiative, MMV also aims to: Fill the gaps on existing compounds to inform on their use in pregnant women and neonates; Develop new antimalarial medicines to address the needs of pregnant women and neonates; Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy; Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population. While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough. “The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions. Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego . Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Conflicting Remdesivir Trial Results Released; Experts Urge More Research 29/04/2020 Grace Ren SARS-CoV-2 (red), the virus that causes COVID-19, attacking a dying cell (blue). Preliminary results of a clinical trial released by the US National Institutes of Health (NIH) found that in patients who received remdesivir recovered faster than those who did not receive the treatment. The largest trial to date, which followed 1063 patients, found that patients who received the drug recovered on average 4 days earlier than those who did not. Additionally, the death rate was 8% in the group that received remdesivir compared to 11.6% in the control group, although this result was not statistically significant. “What [this trial] has proven is that a drug can block the virus,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), told reporters in a rare show of optimism on Wednesday. Fauci has emerged as the most reliable expert voice on the US national coronavirus taskforce. He reflected that the moment he saw the results were reminiscent of the moment the NIAID reviewed preliminary results from the first large-scale study on the use of antiviral combination therapy for HIV/AIDS – the first in a series of technological breakthroughs against that virus. “We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” he said. In seemingly contradictory news, a new study published Wednesday in The Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19 in Wuhan, China. Some 14% of patients in the remdesivir treatment group died after 28 days, compared to 13% in the group that did not receive the treatment. The Lancet study followed 237 adult patients with severe COVID-19 in Wuhan, China, the original epicentre of the pandemic. “Unfortunately, our trial found that while safe and adequately tolerated, remdesivir did not provide significant benefits over placebo”, says lead researcher Bin Cao from China-Japan Friendship Hospital and Capital Medical University in China, in a press release. The formal publication in the Lancet confirmed initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week. Independent experts have urged for continued research in order to create a larger pool of conclusive evidence to judge remdesivir’s effectiveness on COVID-19. The Wuhan study had been terminated early due to lack to new patient enrollment, resulting in a much smaller sample size. “Each individual study is at heightened risk of being incomplete [in a pandemic situation],” wrote John Norrie, professor of Medical Statistics from the University of Edinburgh, in a separate Lancet comment. “Pooling data across several such ‘underpowered’ but high-quality studies looks like it will be our best way to obtain robust insights into what works, safely, and on whom.” Remdesivir, a failed Ebola antiviral developed by Gilead Sciences, was tapped as one of a handful of promising COVID-19 treatments for a global Solidarity trial coordinated by WHO. It has only been available to patients under emergency or compassionate use protocols, which allow patients to access experimental medications in the absence of any known treatments for COVID-19. WHO experts declined to pass judgement on remdesivir in a press briefing Wednesday. Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis, remarked, “Typically you don’t have one study that will come out that will be a game changer. Once we look at all of the studies, and we judge them collectively we can come away with some kind of a conclusion of ‘yes we see an effect’ or ‘no we don’t.’” WHO Executive Director of Health Emergencies, Mike Ryan, said that he had not yet read the full study, but “fervently hoped” that one of the many drugs under investigation around the world would help improve clinical outcomes. In a parallel move, Gilead unveiled early results from a trial exploring the efficacy of different durations of remdesivir treatment on Monday. The so-called SIMPLE trial found that treatment outcomes were similar in patients with severe COVID-19 receiving a 10 day course and those receiving a 5 day course. However, the Gilead trial results fail to assess remdesivir efficacy against a control group, making The Lancet study the first published RCT to explore whether remdesivir has any overall benefit to COVID-19 patients. Findings from the Lancet Study – Small Sample Size a Major Limitation 3D molecular structure of remdesivir, an antiviral drug The Lancet study found no significant differences in the death rate or amount of virus in the body between patients who received remdesivir and those who did not. Overall, 22 of 158 patients died in the remdesivir group compared with 10 of the 78 in the placebo group after 28 days. Treatment with remdesivir did not reduce the amount of SARS-CoV-2, the virus that causes COVID-19, in the body or respiratory tract compared to the control group. However, patients who were treated within 10 days of illness onset had a slightly lower mortality rate at 11% compared to 15% in those who did not receive remdesivir. Similarly, patients who were on invasive mechanical ventilation were weaned off an average of 8.5 days earlier compared to those who did not receive the drug. No significant differences were noted between the groups in overall length of oxygen support, length of hospital stay, or time to discharge or death. Still, the authors say that the results must be interpreted with caution due to the small sample size in the study. “This is not the outcome we hoped for, but we are mindful that we were only able to enroll 237 of the target 453 patients because the COVID-19 outbreak was brought under control in Wuhan,” said Cao. “What’s more, restrictions on bed availability resulted in most patients being enrolled later in the disease course, so we were unable to adequately assess whether earlier treatment with remdesivir might have provided clinical benefit.” Despite the limitations, independent experts praised the study’s protocol, including the use of a well-designed control group. All patients enrolled in the study received standard care including treatment with lopinavir–ritonavir, interferons, and corticosteroids. “Most other released data did not have a proper comparison group, while this trial has a group given standard treatment but no remdesivir, allocated at random. The description of the methods makes it clear that this was a well-conducted trial,” said Stephen Evans, a professor in the Department of Medical Statistics at the London School of Hygiene & Tropical Medicine, in a separate comment. WHO Director-General to Reconvene Emergency Committee for COVID-19 WHO Director-General Dr Tedros Adhanom Ghebreyesus will reconvene the emergency committee under the international health regulations on Thursday to reassess the status of the COVID-19 pandemic. The meeting will take place three months after Dr Tedros declared COVID-19 a ‘public health emergency of international concern’ (PHEIC) on 30 January. The group of experts was deadlocked over whether COVID-19 constituted a PHEIC, the highest level of alarm the WHO can raise, in late January, meeting several times to debate the issue. “WHO is committed to transparency and accountability in accordance with the International Health Regulations. I will reconvene the emergency committee tomorrow,” said the Director-General on Wednesday. However, Dr Tedros refrained from making public comment on the plans for the 74th World Health Assembly, WHO’s largest and most important annual meeting of Member States, usually planned for mid-May. Sources told Health Policy Watch on Tuesday that the Organization was considering for the first time a one-day virtual World Health Assembly on 18 May – focusing only on COVID-19. European Countries and US States Slowly Unwind Lockdown Restrictions – Even as the US Surpasses 1 Million Infections The US crossed the threshold of 1 million coronavirus cases on Tuesday, confirming 1,013,168 cases and 58,368 deaths as of Wednesday morning. Even so, many states are gearing to reopen – Alabama will replace its stay-at-home order with a safer-at-home mandate beginning Thursday, allowing employers and beaches to reopen “subject to good sanitation and social distancing rules,” Governor Kay Ivey said. Florida Governor Ron DeSantis stated on Wednesday that he will outline reopening plans during an Oval Office meeting with President Donald Trump. Still, public health experts fear a second, deadlier wave of coronavirus in the fall. Anthony Fauci said, “I’m almost certain it will come back, because the virus is so transmissible and it’s globally spread,” during an Economic Club of Washington webinar. Meanwhile, several European nations are eyeing a gradual end to their coronavirus lockdowns as infection rates slow and death rates decline. Swiss councillor Alain Berset announced in a Federal Council press conference on Wednesday that the country’s three-step re-opening will be sped up due to a dramatic decrease in the infection curve. The council has now authorized the reopening of more businesses than was previously allowed for 11 May, also authorizing restaurants and gyms to reopen, with appropriate sanitation and social distancing methods. Switzerland has recorded 29,407 coronavirus cases with 1408 deaths. Spain is hoping for a return to relative normality by the end of June, said officials in Madrid, announcing a four-phase plan on Tuesday to lift the toughest set of restrictions as the daily death toll fell to 301, less than a third of a record high of 950 in early April. Meanwhile in France, widespread coronavirus testing will be launched on 11 May so that the country can slowly unwind its lockdown to avoid an economic meltdown. Still, Europe remains the worst-affected continent, with over 1.2 million confirmed cases and more than 125,000 deaths. Spain, Italy, France and the United Kingdom are the most affected countries with 236,899, 201,505, 169,053 and 162,350 cases respectively; each has recorded over 20,000 deaths. Total cases of COVID-19 as of 8:30PM CET 29 April 2020, with cumulative case distribution globally. Gauri Saxena contributed to this story This story was updated 4 May. Image Credits: NIAID, ChiralJon – Remdesivir 3D, Johns Hopkins CSSE. COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
COVID-19: Exposing & Exacerbating Global Inequality 28/04/2020 Grace Ren A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. Posts navigation Older postsNewer posts