[Medicines for Malaria Venture]

Geneva and Liverpool (8 March 2020) – A new collaboration announced on International Women’s Day 2020 aims to help establish pregnancy registries in malaria-endemic countries in Africa to help fill the data gap on the use of antimalarials in one of the most vulnerable populations to malaria.

The study, led by Medicines for Malaria Venture (MMV) and the Liverpool School of Tropical Medicine (LSTM), will set up pregnancy registers to capture data through a prospective observational study on the real-life use of ACTs during all stages of pregnancy, including the first trimester. The study will be conducted in three countries across Africa with the goal of collecting enough safety and exposure data that, if positive, would allow for policy change on the use of ACTs in the first trimester of pregnancy.

“Pregnant women are disproportionately affected by malaria – 29% of all pregnancies in sub-Saharan Africa were infected in 2018,” said Dr David Reddy, MMV’s CEO. “Yet their needs have not been fully addressed. We are delighted to be collaborating with LSTM to establish a pregnancy registry – a clear first step towards collecting the data necessary to support the medical needs of women suffering from malaria, during every stage of pregnancy.”

Artemisinin-based Combination Therapies (ACTs) are the standard of care for malaria, and are recommended by the World Health Organization (WHO) for children and adults including pregnant women who are in their second and third trimester. Even though they are recommended by the WHO, limited data are available in second and third trimester for the more recently approved ACTs. In addition, ACTs are currently not recommended in the first trimester of pregnancy owing to a historic lack of safety data. However, there is evidence that a significant proportion of women seeking treatment for malaria in early pregnancy are treated with ACTs either because they do not know, or are unable to declare that they are pregnant.

The effort will also contribute to healthcare systems strengthening and capacity building, and encourage a sustainable pharmacovigilance culture in resource-constrained healthcare systems. Furthermore, in partnership with researchers and local regulatory authorities that are responsible for pharmacovigilance, a longer-term goal of the project is to develop a standard protocol and a network of sites that will collect safety data for all antimalarials and medicines for infectious diseases (e.g. HIV, TB) circulating in relevant endemic regions.

Professor Feiko ter Kuile, Head of the Malaria Epidemiology Unit at LSTM, said: “This new collaboration with MMV will give us the opportunity to gather much-needed data and provide a robust framework from which policy makers can make informed decisions that will benefit women when they are at particular risk of malaria, during pregnancy. The work will build on our extensive research and clinical experience in the field, and this pregnancy registry should allow us to gather safety data, not only on anti-malarials, but for drugs for the treatment of other infectious diseases that affect pregnancy.”

For more information, see the press release at MMV.

Image Credits: Elizabeth Poll/MMV.

Babies are particularly vulnerable to complications from malaria.

[Medicines for Malaria Venture]

  • EDCTP grants the PAMAfrica research consortium €21.9 million over a 5 year period; MMV, Novartis and other partners will provide an additional €22 million.
  • The PAMAfrica consortium brings together a global medicines company, a not-for-profit product development partnership and leading academic institutions in Africa and Europe. PAMAfrica aims to develop new medicines for both severe and uncomplicated malaria, designed to combat emerging artemisinin resistance.
  • The projects will include development of the first new malaria treatment for babies under 5kg, a new fast-acting medicine for the treatment of severe malaria, and new combinations to treat drug-resistant uncomplicated malaria. 

The Hague, the Netherlands; Geneva and Basel, Switzerland (3 March 2020) – The European & Developing Countries Clinical Trials Partnership (EDCTP) awarded a new grant to the new PAMAfrica research consortium led by Medicines for Malaria Venture (MMV). The consortium will support the development of new treatments for malaria in the most-at-risk populations, including babies, patients with severe malaria, and those with drug-resistant infections. The EDCTP grant of €21.9 million is to be matched by funding from MMV, Novartis and partners. Over a period of 5 years, the grant will support the development of a portfolio of projects executed under the umbrella of the PAMAfrica research consortium. Clinical trial capabilities in Africa will also be strengthened to ensure each site involved can effectively operate to ICH-GCP regulatory standards. The consortium includes seven research organizations from Burkina Faso, Gabon, Germany, Mozambique, Spain and Uganda. In addition to Novartis, other pharmaceutical company partners may join the consortium.

The PAMAfrica research consortium will conduct three clinical trials, supporting efforts to build clinical capacity and train scientists across Africa. One trial will explore new combinations of compounds, including new chemical classes, for the treatment of uncomplicated malaria in adults and children. These compounds are all known to be fully active against all drug-resistant strains, including the artemisinin-resistant Kelch13 strains. The second trial will evaluate a new generation, rapid-acting treatment for severe malaria, cipargamin, also known as KAE609, which is being developed by Novartis, supported by a grant from the Wellcome Trust. In the third study, a novel formulation/ratio from Novartis of the current gold standard treatment artemether-lumefantrine will be tested in newborn infants weighing less than 5 kg or who are malnourished.

Dr Timothy Wells, Chief Scientific Officer of MMV and the coordinator of the PAMAfrica group, said: “All three of these research projects address areas of urgent need in malaria treatment. Antimalarial drug resistance, originally seen in Southeast Asia, is being reported in Africa and may threaten current treatments. It is important to have new therapies that are active against this emerging threat of resistance. The work on newborn infants and in severe malaria is groundbreaking in bringing medicines to this neglected group. Thanks to this critical support from EDCTP we are not only able to bring together the necessary African and European expertise to conduct these projects to address unmet needs, but in doing so, we are also able to support the training and development of the next-generation of leaders in clinical malaria research in Africa.”

Dr Michael Makanga, Executive Director of EDCTP, said: “Malaria continues needlessly to take 405,000 lives a year and must remain a global and national priority in endemic countries. We hope our funding for PAMAfrica will contribute to the development of successful new treatments that will support malaria eradication, while supporting the development of African research capacity.”

Caroline Boulton, Global Program Head, Malaria, Novartis, said: “Despite advances in malaria control, we still have a long way to go. New antimalarials are urgently needed to tackle rising parasite resistance to current therapies. In response, Novartis has committed to advance research and development of a number of next-generation antimalarial treatments. Partnerships play a critical role in helping to bring these novel agents forward and we sincerely appreciate the crucial support of EDCTP to this process.”

Image Credits: Jaya Banerji/MMV.

UNFPA distributes clean baby delivery kits to women in Kasaï province, Democratic Republic of the Congo.

[UN News]

(3 March 2020) – In an emotional ceremony on Tuesday, the last Ebola patient in the DRC – a woman called Masiko – was discharged from the treatment centre in Beni, the World Health Organization reported.

“There are currently zero cases of Ebola in DRC after over a year of fighting this outbreak”, WHO Regional Director Dr. Matshidiso Moeti said in Tweet sharing a video of Masiko leaving the facility to the cheers of a waiting crowd.

“So proud of all involved in the response. We are hopeful, yet cautiously optimistic that we will soon bring this outbreak to an end”.

Dr Tedros in a daily briefing on Ebola added that no new Ebola cases had been reported in the past two weeks.”

The milestone comes as countries increasingly report cases of respiratory disease caused by a new strain of the coronavirus, which first appeared in the Chinese city of Wuhan late last year.  To date, more than 60 additional countries have been affected.

Africa Prepares for COVID-19

Following the virus’s spread to the continent, the African Union and the Africa Centres for Disease Control and Prevention organized an emergency ministerial meeting last month where the DRC was identified among 13 countries most at risk of coronavirus disease 2019 (COVID-19) due to their direct travel links with China.

“Some countries in Africa, including DRC, are leveraging the capacity they have built up to test for Ebola, to test for COVID-19”, WHO Director-General Tedros Adhanom Ghebreyesus told the meeting. “This is a great example of how investing in health systems can pay dividends for health security.”

WHO’s Africa office this week held an emergency partnership meeting on coronavirus , aimed at boosting engagement and developing an effective preparedness and response plan for countries in the region.

Organizations in attendance included fellow UN agency the UN Population Fund (UNFPA), which believes that compared to countries with little experience in large-scale infection prevention and control, the DRC may be better positioned to prevent the spread of the coronavirus because of the Ebola measures already implemented.

Lessons :earned from the Ebola outbreak

UNFPA health workers have been supporting Ebola response in the DRC: the tenth such outbreak in the country’s history. It has occurred against the backdrop of one of the world’s most protracted crises and in a region of the country that has been scarred by deadly armed group attacks. Overall, nearly 16 million Congolese citizens require support, including 3.5 million women and girls of reproductive age: that is between 15-49 years old.

Workers disposing of Ebola-contaminated materials

While all people living in affected areas are at risk of contracting Ebola, UNFPA explained that  health workers face increased risk due to frequent contact with infected persons, their biological fluids and contaminated objects. They also risk spreading the disease to other patients and practitioners during care. More than five per cent of Ebola victims in DRC were health workers who contracted the disease through contact with an infected patient’s bodily fluids, according to the agency.

Midwife Rachelle Mbavindi was infected with Ebola while working in the Mangina Referral Health Centre, which was renovated by UNFPA. Located in North Kivu province, it is at the epicentre of the humanitarian crisis and Ebola outbreak.

Rachelle and nine colleagues spent 90 days in quarantine and treatment after contracting the disease. Despite the difficulty of her experience, Rachelle returned to work following her release.

“After my experience with Ebola, I felt born again,” she said, “and I carry out my work with great caution and attention.”

UNFPA expanding interventions

As a midwifery supervisor, Rachelle trains her colleagues in the proper implementation of practices that can make the difference between life and death in the prevention of fatal diseases. These steps include proper hand hygiene, face protection and clothing, prevention of injuries causing open wounds, respiratory hygiene: that is, preventing viral spread through coughing, systematic cleaning of rooms and linens, and appropriate management of biological wastes.

Rachelle is applying her personal and professional experience with Ebola to prepare for the potential spread of coronavirus.

“Thanks to the Ebola training provided by UNFPA, I feel reassured that my maternity ward can prevent and control a new epidemic, including the coronavirus”, she said.

“In addition to the training and related supervision, UNFPA provides maternity wards with essential equipment to ensure full implementation of the infection prevention and control measures”, said Dr. Polycarpe Takou, UNFPA humanitarian coordinator for Ebola response.

UNFPA regional and country offices are now working to expand such interventions in preparation for the potential spread of COVID-19.

Image Credits: UNFPA DRC, UN News.

WHO’s team of experts lands in Tehran to support the COVID-19 response in Iran.

As Iran faces one of the most serious surges in COVID-19 cases around the world, WHO’s Director General Dr Tedros Adhanom Ghebreyesus, welcomed US President Donald Trump’s olive branch toward its bitter enemy, who on Monday told the Conservative Political Action Congress  “if we can help the Iranians with this problem we are certainly willing to do so.”

“I would like to comment on the statement of the United States, in support of Iran,” said Ghebreyesus, speaking at a WHO press briefing, shortly after a WHO team had touched down in Tehran, laden with materials for 200,000 COVID-19 lab tests as well as health worker protective equipment, funded by the United Arab Emirates.

“I think we have a common enemy now, and using health, and especially fighting this virus as a bridge for peace, is very, very important,” Dr. Tedros said, adding that the United Arab Emirates support for the aid parcel was “another example of solidarity.”

“This is very encouraging,” he added.  “We would like to thank the two countries, but also stressing the importance of solidarity at this time. It’s a common enemy and we have to stand together in unison to fight it. These early signs are very encouraging and as humanity we should stand together.

Despite reports of some 8739 infections proliferating in over 60 countries abroad, WHO Officials remained optimistic that containment of the new COVID-19 virus might still be possible – even to the point of eventually interrupting transmission “if we are effective and lucky.”

But even if that endgame proves elusive, the same aggressive measures will slow down the virus’s onward march – as China’s example has now demonstrated, said WHO’s top emergency team leadership on Monday.

The effects of China’s containment strategy were visibly on display Monday, Dr Tedros underlined. China was reporting just 207 cases in the last 24 hours, the lowest numbers since 22 January, and only 8 of those cases had occurred outside of the virus epicentre of Hubei Province. In contrast, cases abroad were nine times higher than the previous day. Along with Iran, epidemics in in Italy, the Republic of Korea and Japan continued “are our greatest concern,”  the WHO Director General underlined.

Global Cases of COVID-19 as of 5:30PM CET 2 March 2020.

UN in Geneva, Louvre and Other European Institutions Follow Italy In Closing Doors To Public

In Europe, both governments and institutions were ramping up their responses, amidst spontaneous reactions of public concern.

The UN headquarters in Geneva, which welcomes about 100,000 visitors a year, “temporarily” suspended public tours on Monday. Switzerland banned public gatherings of over 1,000 people, a move that was soon followed by the cancellation or postponement of upcoming meetings and events in the Geneva hub of international institutions and NGOs, which are clustered in the city.

And the Louvre Museum in Paris which welcomes some 30,000 visitors a day, remained closed for a second day, while employee union representives reviewed personal protective measures with the museum management, which had offered them hand sanitizer, while they were requesting masks.

Currently, there is no WHO recommendation for workers in such settings to wear masks. Rather WHO has said that wearing masks by healthy people in the workplace is only necessary in health care settings, for emergency response teams and cleaning crews, or for interviews of suspected COVID-19 cases by border guards. The Louvre’s union representatives, however, had also asked why the museum wasn’t covered by the official French ban on gatherings of more than 5,000 people, which issued last week as a COVID-19 response.  “You will easily admit that the Louvre Museum is a confined space and that it receives more than 5,000 people a day,” union representative Christian Galani was quoted as saying to the Associated Press.

Such moves followed Italy’s temporary closure last week of several major Milanese tourist sites and the premature closure of the Venice Carnivale, while cases in northern Italy escalated throughout the week.  As of Monday evening, Italy was reporting some 1694 cases, and 34 deaths, nearly three times as many as it had reported on Friday.

However, Dr Tedros expressed hope that the sharp increases of infections in the European country most affected by the outbreak would soon begin to subside, saying that Italy had dramatically boosted its surveillance.  “Of course they were surprised, but they have strong institutions and we believe that they can bring it together,” he said.

In countries such as Korea, which was reporting some 4,335 cases, nearly double the number of last Friday, the virus epicentre continued to revolve around known infection clusters around the city of Daegu, where the outbreak first began amongst members of a cult-like church.  However that also offers hope that the outbreak can be brought under control, said the WHO Director General.

“Containment is possible in all countries that are affected. That is why we are saying the comprehensive approach is very, very important,” said Tedros.

“OK,  we are close to 90,000 cases, we have more than 3,000 deaths and some 65 countries are affected.  But among those countries, 38 have less than ten cases. And among other 20 countries, you have 120-140 cases,” he said.

“So a one side fits all approach doesn’t work, blanket recommendation doesn’t work,” he said.

Treatment of Seriously Ill – Big Confounder for Health Systems

One of the biggest confounding factors is not just the fatality rate of the new virus – which at 2% is still much higher than seasonal flu – but the threat it poses to health care systems ability to provide adequate intensive care at the sheer numbers that could be required if the virus spread accelerates.

While 80% of people only experience mild symptoms, some 20% of victims require hospitalization. And of those hospitalized, about 30-40% of people require care with medical oxygen, supplied  through a respirator, said WHO technical lead Maria Van Kherkove.

Hospital intensive care units and respiratory beds in middle- or high-income countries with excellent health systems can easily become overwhelmed by people who become seriously ill, said WHO officials, citing the experience in Hubei Province as such an example. In lower income settings, such equipment may be rare or non-existent in many hospital settings.

“Most countries, even sophisticated health systems, have very limited intensive care capacity, in terms of the clinical beds that they have,” said Mike Ryan, WHO Emergencies head. “Ventilators need trained technicians, extra-corporeal oxygen support requires very high level of technical support. This is not just an issue for weaker health systems.”

Ryan said that focusing on early diagnosis and provision of care will also help prevent some of the progression to more serious cases. “Most countries will struggle if they see large numbers of patients needing intensive care.”

The length of care required is another challenge, he added, saying. “We are seeing patients spending many, many days, up to 24 days, in a critical care environment. That is occupying a lot of beds for a very long time.  So all countries are going to have to think very carefully about how they manage the critical care component of this disease.”

That reinforces the message, that tough containment strategies, including vigilant identification of suspected cases, testing, quarantine and treatment of those found ill, along with aggressive tracing and following of contacts, all are essential to bring down the overall case load that countries might face, Ryan said.

“Here we have a disease where we don’t have a vaccine, we don’t have treatments, we don’t understand its transmission and its mortality,” he said. “All countries can be looking for cases right now and can aggressively find cases and follow them, so we can help each other.

“Here we have seen that with the right measures, it can be suppressed.”

WHO Updates Travel Advice – Acknowledges that “Temporary” Restrictions May Be Useful

Following a spike in cases around the world, which were traced back to travel from the new  COVID-19 hotspots of Italy and Iran, WHO issued new travel restriction recommendations, most notably acknowledging that “in certain circumstances, measures that restrict the movement of people may prove temporarily useful.”

That contrasts sharply with the strong advice against any travel restrictions whatsosever that the Agency had maintained until this point.

However, the updated advice still contains the caveat that such bans should be “short in duration,” and reassessed regularly to make sure they are “proportionate” to public health risks.

“Travel measures that significantly interfere with international traffic may only be justified at the beginning of an outbreak, as they may allow countries to gain time, even if only a few days, to rapidly implement effective preparedness measures,” the guidance states.

At a press conference of the European Commission, officials pledged to maintain the “mobility” of European citizens, and maintain open borders between countries of the so-called Schengen zone – although health checks in some instances could be reinforced. A new assessment by the European Centres for Disease Control (ECDC) Risk Assessment described the regional risks associated with the COVID-19 epidemic to be “moderate to high.”

The ECDC warned, however, that “In the event of established and widespread community transmission, current containment measures may no longer be an efficient use of resources. If this occurs, action should be taken to prepare for a mitigation strategy that includes co-ordinated efforts to protect the health of EU/EEA and UK citizens by decreasing the burden on healthcare systems and protecting populations at risk of severe disease.”

EU COVID-19 response site has been established to provide situation updates and relevant information on medical, transport and economic issues linked to the epidemic.

Elsewhere, the US confirmed it’s first two deaths by the coronavirus in Washington state over the weekend, where a cluster of 10 cases in King County is suspected to be the first identified local outbreak of COVID-19 in the country.

Nancy Messonier, director of the US CDC’s Center for the National Center for Immunization and Respiratory Diseases (NCIRD) said in a statement on Saturday, “We will continue to respond to COVID-19 in an aggressive way to contain and blunt the threat of this virus. While we still hope for the best, we continue to prepare for this virus to become widespread in the United States.”

Still, the new WHO recommendations do not explicitly sanction restrictions on the movement of people within so-called “affected-areas” – locales which are seeing sustained local transmission of the virus rather than just a cluster of imported cases.

Citing Hubei Province as an example of an “affected” area, WHO indicates that recommended containment measures should include: “control measures that focus on prevention… active surveillance for the early detection and isolation of cases, the rapid identification and close monitoring of persons in contacts with cases, and the rapid access to clinical care, particularly for severe cases.” 

The agency falls short of recommending measures some of the more drastic that were taken in Hubei, and have been tried  more recently in countries such as Italy, including restricting public transportation and locking down towns and villages with local transmission. 

However, the spirit of the new measures clearly is influenced by the recent report issued by the WHO-China Joint Mission, that returned last week from China and reported how effective measures there had been.

Image Credits: Twitter: @DrTedros, John's Hopkins CSSE.

Abdul Rasyid, a TB MDR patient, works as a motivator in the inpatient TB MDR ward at the Persahabatan Hospital in Jakarta, Indonesia

While health leaders battle a global outbreak of a dangerous new virus, a consortium of partners is entering the fight against one of humankind’s oldest infectious diseases, tuberculosis.

A group of philanthropic, non-profit, and private sector organizations on Thursday launched a collaboration to accelerate development for a “pan-TB” treatment regimen to treat drug-sensitive and drug-resistant forms of the deadliest infectious disease in the world.

The first-of-its kind Project to Accelerate New Treatments for Tuberculosis (PAN-TB collaboration) aims to develop safe treatment regimens that have little to no drug resistance and advance them through phase 2 clinical trials – universal regimens that can treat multiple different strains of TB.

“The development of a regimen that can treat both drug-sensitive and drug-resistant tuberculosis could be a game changer for how the world addresses TB and growing antimicrobial resistance,” said Penny Heaton, chief executive officer of the Bill & Melinda Gates Medical Research Institute, a founding member of the consortium, in a press release. 

The need for new treatment options is high. There exists no single treatment available to treat all forms of TB. Only three new drugs have been approved for the treatment of TB in the past 50 years – bedaquiline, delamanid, and pretomanid, which was just approved in August 2019 by the United States Food and Drug Administration.

In 2018, the World Health Organization estimated that there were 10 million new cases of TB and almost 1.5 million deaths. It’s estimated that there were 500,000 cases of drug-resistant TB, in which almost half of the patients died.

Currently, even the easiest to treat strain of TB – known as drug-sensitive or drug-susceptible TB – requires a regimen of four core drugs taken for at least 6 months.

Despite being known as the easiest to treat form of active TB, the current WHO-recommended regimen for drug-sensitive TB still consists of a grueling 6 month treatment – a combination of four different antibiotic pills taken daily for two months, followed by another four months of taking two antibiotics per day.

But even this regimen is not sufficient to treat forms of drug-resistant TB, or strains resistant to any of the four core drugs. These deadly strains require different treatment courses – which may contain more than 5 different drugs and take up to two years to complete. It’s estimated such drug-resistant TB strains killed 230,000 people in 2017.

However, to diagnose drug-resistant TB, patients must undergo additional testing.

The new PAN-TB initiative aims to develop regimens that can be used to cure both drug-sensitive and drug-resistant strains of TB, cutting down on the need to test for drug-resistance and potentially giving patients safer, shorter, and simpler treatment options.

A spokesperson for the consortium told Health Policy Watch that the exact drug candidates for the phase 2 trials are still being identified.

However, the spokesperson added that the Bill and Melinda Gates Foundation has committed grant funds for non-clinical studies to identify promising compounds for the treatment course. The Bill and Melinda Gates Medical Research Institute will fund and lead clinical studies in the partnership.

The pharmaceutical partners include Evotec, GlaxoSmithKline, Johnson & Johnson, and Otsuka Pharmaceuticals, and will contribute in-kind resources, including providing access to a library of candidate compounds, and dedicating scientific and technical expertise to the initiative.

The global PAN-TB collaboration aims to link up with another TB drug development initiative launched just a few weeks prior on 29 January, the European Accelerator of Tuberculoses Regime (ERA4TB) project, a 30-partner initiative funded by the European Commission. ERA4TB aims to accelerate preclinical identification of promising compounds, while PAN-TB aims to take such preclinical discoveries through to the end of costly phase 2 clinical trials.

Image Credits: Bill & Melinda Gates Foundation/Prashant Panjiar.

Governments around the world are ramping up COVID-19 containment measures as new infections outside of China surged by 497 cases over the past 24 hours, outnumbering those inside the country for the first time ever during the epidemic.

The increase abroad was largely linked to an acceleration of COVID-19 outbreaks in Italy, Iran, and South Korea, which also were spilling over into other countries, in Europe and the Middle East.  Officials were aggressively restricting movement in areas with confirmed local transmission in an effort to curb person-to-person spread of the contagious virus.

On a more positive note, nine countries with COVID-19 cases had not reported any new cases in two weeks, including Belgium, Cambodia, Finland, India, Nepal, Philippines, the Russian Federation, Sri Lanka, and Sweden.

“The primary objective of all countries with cases must be to contain the virus,” said World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus in his opening remarks at a WHO briefing to UN Missions in Geneva on the emergency.  “I read the list of 9 countries who have not reported cases for two weeks. We should do the same: try to contain.”

Map shows growing case numbers in Italy, Iran, and South Korea. (Source: Johns Hopkins CSSE Global Map of COVID-19 Cases)

As of 4:30PM CET, China continued reporting a downwards trend in new cases, with 416 infections and 52 deaths by COVID-19 over the past 24 hours, for a cumulative total of 78195 cases and 2718 deaths since the epidemic began. Around the world, there have now been a total of 81,265 cases and 2770 deaths.

The highest overnight increase in cases was in South Korea, which reported 368 new infections and 4 new deaths in the past 24 hours. The country, now the largest center of an outbreak outside of China, has reported a total of 1261 cases and 12 deaths. Iran, meanwhile, reported 46 new infections, for a total of 139 cases and 19 deaths, making it the country with the highest number of deaths from the virus outside China. Italy saw an increase in 52 infections, to 374 total cases and 12 deaths.

Across all three countries, authorities have undertaken aggressive measures to lock down cities and communities with the highest concentration of cases.  Classes suspended in schools and universities; local public transportation was shut down, mass gatherings were canceled, and community members were strongly encouraged to stay home.

Despite the escalation of cases in multiple countries, the WHO director-general emphasized that, for the moment, the COVID-19 emergency had not reached “pandemic status” as there was no “sustained and intensive community transmission” of the virus, nor was there “large-scale severe disease or death.”

However, he underlined that all countries, whether they have cases or not, must prepare for a “potential pandemic”.  

Officials Pursue Containment of Outbreak in Italy and Iran

Officials across Europe were ramping up measures to stop the virus in its tracks, as cases linked to Italy were confirmed in Austria, Croatia, Germany, Spain, and Switzerland. An Italian adult who arrived in Algeria on 17 February became the second confirmed case of COVID-19 on the African continent on Tuesday, and a 61-year old patient in Brazil who had recently traveled to Italy was confirmed by the Brazilian Ministry of Health as the first case on the South American continent.

“In the European Union we are still in the containment phase, it is important to underline this,” Stella Kyriakides health commissioner of the European Center for Disease Control (ECDC) said at a press briefing in Rome at the conclusion of a joint WHO-ECDC mission to Italy.

However, “given how quickly the situation can change, even if we are currently in the containment phase, our public health care response across the EU must be ready to deal with increased numbers of COVID-19 infections,” she stressed. EU member states are currently reviewing pandemic plans, health care capabilities, and capacities for tracking contacts of infected individuals, diagnosing and testing cases, and treating acute respiratory illnesses.

Kyriakides praised countries for keeping borders with Italy open rather than “resorting to what at this point could be considered disproportionate and inefficient measures.” In Italy however, train service had been interrupted and there were barriers on roads around the 11 towns in Lombardy and Venetto at the center of Italy’s outbreak. Residents remained largely confined to their homes as authorities try to track down all suspected cases of COVID-19.

Health officials in Algeria discuss the country’s first COVID-19 case

Meanwhile, Algeria confirmed its first case of COVID-19 on Tuesday, just days after Dr Tedros met with African Ministers of Health at an emergency meeting on the coronavirus outbreak on 22 February. A WHO survey previously had determined that the African regional readiness level for COVID-19 was about 66% of what should be full preparedness capacity. Algeria was among 13 countries on the continent initially identified as “high priority” due to direct links and a high volume of travel to China, although the first confirmed case was in an Italian adult.

“The window of opportunity the continent has had to prepare for coronavirus disease is closing,” said Dr Matshidiso Moeti, WHO’s Regional Director for Africa in a press release. “All countries must ramp up their preparedness activities.”

WHO will be sending a team of experts to assist the response in Algeria in the coming days to assist in response efforts.

This upcoming weekend, the agency is also sending a team of experts to Iran, where numbers of cases and fatalities have climbed rapidly as officials tracked down suspected cases. Following in the footsteps of other countries with larger outbreaks, Iran has begun to limit large gatherings and public events, including suspending classes at 10 universities across the country by the end of the week, including schools in Qom where Iran’s first cluster of COVID-19 cases, rapidly followed by an out-sized number of deaths, was detected.

US CDC Warns Communities To Prepare For Community Spread

Across the Atlantic in the United States, US Centers for Disease Control officials warned journalists at a press briefing on Tuesday to “ultimately expect” to see community spread of the virus and prepare for “severe” disruption to everyday life.

The messaging represents a huge shift in tone for the US, which had up until then been largely focused on “largely successful” existing quarantine measures.”  There are currently 54 confirmed cases and no deaths in the country.

Nancy Messonier, director of the National Center for Immunization and Respiratory Diseases at the US CDC said that the country is now pursuing a “dual strategy” of continuing measures to contain the disease, while preparing “strategies to minimize the impact on communities.” She added that if communities experienced local transmission, the government may enact measures such as “school closures and dismissals,” encourage businesses to allow workers to telecommute, and postpone or cancel mass gatherings – similar to the strict measures China has taken to attempt to curb the outbreak.

“CDC is concerned about the situation… And now is the time for businesses, hospitals, community schools, and everyday people to begin preparing as well,” said Messonier.

COVID-19 response planning at the US CDC’s Emergency Operations Center.

Image Credits: European Center for Disease Control, Johns Hopkins CSSE, WHO AFRO, US Centers for Disease Control and Prevention.

Pilgrims visit the Holy City of Qom in Iran. (Photo Credit: Pierre Le Bigot)

Containing an explosion of COVID-19 cases in Korea and Iran have become top priorities for global health officials battling to prevent the epidemic from growing into a worldwide pandemic. While new lab-confirmed cases in China on Friday numbered 896, more than double the day before, that was still part of an generally downward trend as compared to the two weeks before. But expanding clusters of cases in prisons, including one in the eastern Chinese province of Shandong, elevated concerns about Chinese hotspots outside of Wuhan, the epicentre of the outbreak.

Early Friday evening, meanwhile, Italian health officials announced a cluster of 8 new cases in the northern Italy town of Codogno, five among medical staff at the local hospital, where 3 infected patients who had contracted the virus, were already being treated. The new reports brought Italy’s total of confirmed cases to 16.

The Italian, Korean and the Iranian cases illustrate how seemingly random events involving just a few individuals can drive much larger outbreaks of the highly contagious virus. In South Korea, just one woman has infected dozens of other fellow members of her church in the city of Daegu.

In the case of Iran, a mysterious series of geographically dispersed clusters led to reports of some 18 infections as of Friday, four deaths in the pilgrimage city of Qom, and onwards transmission of the virus by two infected travelers who were identified upon arriving in Canada and Lebanon.

“The window of opportunity may be closing,” said Dr Tedros Adhanom Ghebreyesus in a press briefing on Friday. “Although the total number of cases outside China remains relatively small, we are concerned about the number of cases with no clear epidemiological link, such as travel history to China or contact with a confirmed case.”

Origins of Iran’s COVID-19 Cases Unclear 

While most of the cases outside of China have until now been linked to travel to the epicenter of the outbreak or known contacts of confirmed cases, the transmission patterns in Iran are so far unclear. Reports of cases in Lebanon and Canada, linked to recent travel from Iran, but not to China, were later confirmed by health officials in both countries.

An Iranian Ministry of Health official told CNN news that it was “possible” more cases existed in cities across the country, and speculated that the virus was possibly imported by Chinese workers living in Qom, an important center of Shiite Muslim pilgrimage. China has continued to do business with the Islamic Republic in defiance of US sanctions. However, a Ministry of Health official told Iranian News Agency IRNA on Thursday that two patients who had died of COVID-19 in Qom had not reported any contact with foreigners or Chinese nationals, and their families had not yet been subjected to quarantine.

“We’re getting information [from Iran], but we need to engage with them more,” said Tedros. “These dots or trends are very concerning and we’re working with the government to fully understand the transmission dynamics.”

Meanwhile, cases in South Korea shot up by 100 new cases in the past 24 hours to a total of 204 confirmed cases, making South Korea the country with the highest number of cases outside China. According to the Korean Centers for Disease Control, at least 129 of those cases are members of the Shincheonji church, a Christian organization considered cult-like by many mainstream churches. Most cases related to the church have been clustered in Daegu, although cases in church members have also been reported in Seoul and Gwangju.

Sweeping Closure of Commercial Activities & Public Events In Italy’s Lombardy Region 

In response to outbreak in northern Italy, Minister of Health Roberto Speranza announced a sweeping series of measures in Codogno and about ten other surrounding towns, including: suspension of all public events, commercial activities, schools and day care centers, municipal works, public transport services, and recreation services.

The total number of people infected in the Lombardy region now stands at 14, said the minister and other health officials at a press conference Friday.  The officials’ descriptions of the infection chain illustrates how very casual contacts played a role in the expanding outbreak. The first person to be infected was a 38-year-old man who had become ill after meeting a friend recently returned from China.  He then infected his wife, and a running group acquaintance. They were all hospitalized. Three older friends of the runner, who all frequented the same bar, were then infected, followed by the five health workers at the local hospital, who were treating the initally infected patients, and several others.  There are reportedly two other COVID-19 cases in Italy’s Veneto region.

Despite the fast-changing path of the virus, WHO’s Director General said he still believed that the outbreak could potentially be contained, if countries step up preparedness measures.

“The window of opportunity is still there but [it] is narrowing, and that is why we call on the international community to act, including the financing, and that is not what we see.”” said Dr. Tedros.

China Changes Reporting Protocol Again Amid New Spread In Prisons

As of 5:30pm CET, there were 896 new cases of the virus in China according to official Chinese data, higher than the increase of 404 cases recorded yesterday, but much lower than the 2,000-3,000 new cases reported almost daily in the previous week. Total cases in China were 75,571, while abroad the total number of cases exceeded 1,225 in 27 countries, late Friday afternoon, as Israel also reported its first coronavirus case – in a passenger returning from the Diamond Princess cruise ship.  That latest count did not include the late breaking reports of infections in Italy.

The significant decline in new confirmed Chinese cases may indicate that authorities there are finally getting the infection more under control.  But it is also partly due to another change in the way China reports numbers. After adding over 14,000 clinically diagnosed cases to the number of confirmed cases in Hubei province on Wednesday last week, authorities have reverted back to only including lab diagnosed cases in the count, WHO officials said today at the press briefing. They said that the zig zag was due to the fact that with less pressure on health systems, most suspected cases were now being rapidly lab confirmed.

In a place with the lab capacity to test every suspected case for the virus, the “recommended approach” is to classify lab-confirmed cases as confirmed, and other cases as “suspected,” explained Tedros. “We’re glad China has gone back to this approach, we think it will bring more clarity.”

In response to concerns about the confusing changes in reporting measures, WHO’s director of epidemic and pandemic diseases Sylvie Briand stressed, “As long as we understand the situation, it helps us. Surveillance or monitoring disease is about taking the best possible decision and collecting numbers for action, not numbers for numbers… Beyond the numbers what’s important is trends.”

“Understanding the definition” rather than where the numbers are reported is the basis for decisions, she added. “At the end of the day, as long as the decision behind the numbers is a good decision, that is what matters most.”

WHO Director General Expresses “Concern” Over Increase of Cases In Shandong Province – Reference to Prison Hotspot   

WHO’s Tedros also said that WHO was “concerned about an  increase in the number of cases in Shandong province.” According to a local news station Qilu Evening News, 200 of the 202 new cases reported in Shandong Thursday night occurred in Rencheng prison. Some 207 cases have been reported in total from the prison, including 7 prison guards and 200 prisoners.

The reports were confirmed by state owned news agency Xinhua on Friday, which reported that the index case was a prison guard who was diagnosed on 12 February. However, proper infection prevention control measures were not taken until much later, leading to a dramatic overnight rise in confirmed cases in the prison. The debacle led to the national government launching a formal investigation into the handling of the outbreak, which resulted in the replacement of the director of the Provincial Justice Department and sacking of a number of prison officials, including the director of Rencheng prison, according to Xinhua.

But the South China Morning Post reported that there have been a number of other prisons in China where outbreaks are flourishing in confined and closed conditions. These include a Wuhan Woman’s Prison, which has reported some 230 cases, and smaller clusters in Shayang Hanjin prison in Hubei province and Shilifen Prison in Zhejiang province.

Reports about the contagious virus’ spread in prisons mirror the growing concern around transmission of the virus in so-called “re-education” centres in Xinjiang province, where China has reportedly detained 1-1.5 million ethnic Muslim Uyghurs in overcrowded facilities with limited access to medical care, contact with friends and family, according to a report by the UN’s Office of the High Commissioner for Human Rights (OHCHR).

So far, WHO has not made any public comment on the potential transmission of the virus in the camps, which have been criticized by the OHCHR as “amounting to detention centres” due to their “coercive nature.”

Updated Saturday 22 February 

Image Credits: Flickr: Pierre Le Bigot.

The Diamond Princess, docked in Yokohama, Japan, now has a total of 454 cases, the largest case load outside of mainland China.

The rise in new cases of COVID-19 seemed to be slowing in mainland China, but concerns remain about local transmission in cities abroad such as Hong Kong, Singapore, and Japan, and on cruise ships.

China has confirmed 70644 cases and 1772 deaths as of 5 p.m. Central European Time, representing an increase of 2060 cases in the last 24 hours, according to the latest Chinese data. This comes even after the Chinese health authorities expanded diagnostic criteria to count “clinically confirmed” cases on top of lab-confirmed cases, the rate of new infections appears to have slowed.

However, “this trend must be interpreted very cautiously,” WHO Director General Dr Tedros Adhanom Ghebreyesus told reporters at a press briefing Monday. “It is too early to tell if this reported decline will continue.”

The slow, but steady growth in cases outside of China, however, particularly in Singapore and Japan, has also been a cause for concern among public health experts closely watching the epidemic unfold.  A total of 694 cases in 25 countries have been reported, along with three deaths.

Of particular note is yet another huge spike in the number of infections on the quarantined cruise ship, the Diamond Princess, to 454 confirmed cases as of Monday evening, which now represents the largest cluster of cases outside China. Some 189 passengers were classified as “asymptomatic carriers,” according to a statement from Japan’s Ministry of Health. The ship has been docked in Japan’s Yokohama port since 3 February.  Many of the original 3,600 passengers remain under a two-week quarantine while the Japanese government tests every one on the ship.  Some 1,723 have been tested so far. Those found to be infected with the virus, elderly people and those with other medical conditions have been allowed to disembark and complete their quarantine period in special facilities on shore.  Most of the 400 Americans on board the ship were evacuated earlier this morning, although they will they will have to undergo another two weeks of quarantine in the United States.

The strict measures being enacted for passengers on the Diamond Princess were not repeated for the Westerdam, a cruise ship that was finally allowed to dock in Cambodia last week after being stranded at sea for two weeks. Once clearing temperature and health checks, passengers were allowed to continue on their travel itineraries. However, one COVID-19 case was confirmed in a passenger after she had already disembarked and traveled to Malaysia.

Two more former Westerdam passengers, were, however, suspected of being ill are awaiting lab results for the virus after traveling to Singapore. Some 255 guests and 747 crew members are still waiting aboard the ship to complete further health checks.

Holland America, the owner of the Westerdam, said in a statement that no passengers had elevated temperatures upon disembarking. The 20 individuals who reported to the ship’s medical center also later tested negative for COVID-19.

The drastically different treatment of the passengers on the Westerdam and Diamond Princess highlight the very different national policies governing public health responses to contain the spread of the virus, as well as the different circumstances involving each ship. WHO’s Director General Dr Tedros Adhanom Ghebreyesus last week strenuously urged the government of Cambodia to allow the cruise ship to dock.  In the aftermath, he has not commented on the discovery of cases aboard the second ship, or on the very different procedures undertaken by Cambodia to screen and disembark passengers, as compared to Japan.  The Westerdam, which departed Hong Kong on 1 February had not identified any cases aboard while at sea, although the incubation period of the virus is believed to average 14 days.

“Measures should be taken proportional to the situation… Blanket measures may not help,” said Dr Tedros, in a press briefing today. “”There is no zero risk…[every action] has to be proportional to the situation.”

Number of COVID-19 cases worldwide, collected by Dingxiangyuan, which tracks national and sub-national press releases from health authorities.

Will COVID-19 Become a Pandemic?

Experts are worried that, despite the decline in new cases on mainland China, there may be potential for further spread, leading to some questioning whether it was time to label the outbreak a “pandemic” – or a global outbreak where every citizen could be infected.

The media frenzy around the outbreak has also been whipped up by published and pre-print studies estimating that the current number of infections is much higher than reported due to a high number of asymptomatic and mild cases, with some estimates in the range of 75,000 thousand infections in Wuhan alone. A WHO advisor, Ira Longini from the University of Florida, was quoted by Bloomberg News as projecting that up to two-thirds of the world’s population could be afflicted by COVID-19 if current measures to contain the virus’ spread are unsuccessful.

However, WHO scientists are cautious about using the “p” word, for fear of inducing widespread panic.

“For the general public, I think [pandemic] means the worst-case scenario. We need to be cautious… because it can create panic unnecessarily,” said WHO’s Sylvie Briand in Monday’s press briefing.

Added Mike Ryan, WHO’s head of Emergencies, “We have said that the risk for regional and global spread is high – that is not high of a pandemic, it’s high for further spread.

“We need to be careful not to drive fear in the world right now.”

On the WHO advisor’s prediction that the majority of the world could get infected by COVID-19, Ryan added that, “all predictions are important. But most predictions are wrong.”

Image Credits: Flickr/ Yoshikazu TAKADA, ncov.dxy.cn.

[Press Information Bureau, Government of India]

In light of the threats to human health and biodiversity due to climate

and pollution, India marks the beginning of the “super year of Biodiversity” with the hosting of the 13th Conference of Parties (COP) of the Convention on the Conservation of Migratory Species of Wild Animals (CMS), an environmental treaty under the aegis of United Nations Environment Programme, from 17th to 22nd February 2020 at Gandhinagar in Gujarat.

Shri Prakash Javadekar (left) and Sveinung Rotevan (right)

Addressing a press conference, Union Environment Minister Shri Prakash Javadekar said that the year 2020 is a super year of Environment and will set the tone and tenor for the decade ahead. Highlighting the urgent nature of global environment issues including marine plastic litter, plastic pollution and microplastics, the Union minister said the issues cannot be solved by any one country alone.

On the side-lines of the COP, the Union Minister met a delegation led by Norwegian Minister of Climate and Environment, H.E. Mr. Sveinung Rotevan. India and Norway today agreed to jointly tackle concerns related to oceans, environment and climate matters.

The text of the Joint statement is as follows:

India – Norway Joint Statement on Climate and Environment

  1. Meeting at the beginning of the ‘2020 Super Year’ for the environment, the Ministers stressed that they will do their share to ensure that the 2020s will be a decade of rapid action on climate and environment.
  2. The two sides expressed interest to continue and strengthen the mutually beneficial cooperation on environment and climate between the two countries, including on ocean affairs.
  3. Actions that target climate change and air pollution at the same time pose a win-win situation. The two sides recognized that such actions should be stepped up, and agreed to work together to raise this agenda.
  4. The Ministers recognized that the Kigali Amendment to the Montreal Protocol for phasing down use of Hydrofluorocarbons (HFCs) could prevent up to 0.40C of warming by end of the century, Further, noting that universal ratification of Kigali Amendment to the Montreal Protocol shall allow realization of its full potential.
  5. The Ministers noted the results of the projects supported by Norway on issues / aspects related with phase down of HFCs. It was agreed to continue such projects for facilitating a smooth transition towards energy efficient solutions and technologies while phasing down HFCs.
  6. If managed properly, the ocean holds the key to meeting many of the Sustainable Development Goals. Integrated ocean management is central to achieving a sustainable blue economy. In 2019 Prime Minister Modi and Prime Minister Solberg welcomed the signing of the MoU on India-Norway Ocean Dialogue and the establishment of the Joint Task Force on Blue Economy for Sustainable Development. The two Ministers were pleased with the progress that has been made under this MoU, including the establishment of the Marine Pollution Initiative. They were particularly satisfied that Norway and India will sign a Letter of Intent on integrated ocean management including sustainable Blue Economy initiatives.
  7. The Ministers also noted the importance of delivering concrete, scalable solutions for ocean health and wealth at the UN Ocean Conference in Lisbon on June 2020.
  8. The Ministers further noted the importance of sustainable management of chemicals and waste and welcomed the cooperation between India and Norway on the implementation of the Stockholm Convention on Persistent Organic Pollutants and on the minimisation of discharge of marine litter.
  9. The Ministers emphasized a shared understanding of the global and urgent nature of marine plastic litter and microplastics and underlined that this issue cannot be solved by any one country alone. They are committed to supporting global action to address plastic pollution and exploring the feasibility of establishing a new global agreement on plastic pollution.
  10. The Ministers agreed to support and work together with other political leaders to prompt a global and effective response to curb the direct and indirect drivers of biodiversity loss. They agreed to work together to deliver an ambitious, strong, practical and effective global biodiversity framework at COP15 of CBD to be held in Kunming, China, in 2020.
  11. The Ministers further discussed the conservation of migratory species of wild animals. The Ministers recognized the importance of integrating ecological connectivity into the post-2020 global biodiversity framework.
  12. The Ministers stressed that international supply chains and finance must de-invest from deforestation and destruction of nature and invest in companies and projects that improve smallholder livelihoods while promoting sustainable production and consumption. They agreed to continue the discussion on forests and deforestation free supply chains.
  13. The Ministers stressed that the fifth United Nations Environment Assembly of the United Nations Environment Programme offers a good opportunity to call for greater international action on several environmental issues, in particular strengthening action for nature to achieve the Sustainable Development Goals.
  14. Minister Rotevan thanked Minister Javadekar for the great hospitality extended to him and his delegation during the visit. He invited Minister Javadekar to visit Norway and the Arctic, to further strengthen the collaboration between India and Norway on climate and environment.
  15. Norway and India will explore areas of cooperation in forestry and linking the same with climate change

The Opening Ceremony and Plenary session of the COP will take place on 17th February followed by Side Events and Working Group meetings till the Closing Ceremony on 22nd February. Prime Minister Narendra Modi will inaugurate the COP 13 via video conferencing. Numerous national and international organizations will showcase best practices in wildlife conservation during the course of the conference.

As the host, India shall be designated as the Presidency during the intersessional period following the meeting. The COP Presidency is tasked to provide political leadership and facilitate positive outcomes that further advance the objectives of the Convention, including steering efforts towards implementing the Resolutions and Decisions adopted by the Conference of Parties.

Migratory species of wild animals move from one habitat to another during different times of the year, due to various factors such as food, sunlight, temperature, climate, etc. The movement between habitats, can sometimes exceed thousands of kilometers/miles for some migratory birds and mammals. A migratory route will typically have nesting sites, breeding sites, availability of preferred food and requires the availability of suitable habitat before and after each migration.

India is home to several migratory species of wildlife including snow leopard, Amur falcons, bar headed Geese, black necked cranes, marine turtles, dugongs, humpbacked whales, etc.

Image Credits: Press Information Bureau Government of India.

A healthcare worker vaccinates a man against Ebola.

The Director General of the World Health Organization today decided that the smoldering Ebola outbreak in the Democratic Republic of the Congo should remain a “public health emergency of international concern,” following recommendations from a committee of experts convened under the International Health Regulations.

The last embers of the 1.5 year long outbreak appeared to be dying out, with only 3 cases reported in the past week, and no cases in the past 3 days. The outbreak has been contained to only two health districts.

“As long as there is a single case of Ebola in an area as insecure and unstable as eastern DRC, the potential remains for a much larger epidemic,” said Dr Tedros Adhanom Ghebreyesus, director general of the WHO at a press briefing Wednesday.

With the WHO and worldwide media attention occupied by the coronavirus outbreak, “we must not forget Ebola,” added the Director General.

“Strengthening a health system may not be as sexy as responding to an outbreak, but it’s just as important,” he added. Dr Tedros will be flying to Kinshasa, DRC tomorrow to meet with president Félix Tshisekedi and discuss plans to further strengthen the country’s capacity to handle health emergencies.

There is a high “risk of resurgence” and a “risk of complacency” if the  PHEIC designation is abandoned, added the chair of the Emergency Committee, Robert Steffen.

Additionally, Steffen pointed to “two dark clouds on the horizon” – one being the continued security incidences that have “compromised the action of the health teams,” and the second being a lack of “solidarity” in the response. Security incidences have continued to be on the rise in the past few months, according to the Emergency Committee’s assessments.

For those reasons, WHO has determined that the risk of national and regional spread is still “high.”

Nonetheless, the Director general said, the “signs are extremely positive” in the Ebola outbreak. It seems likely that all districts affected by the outbreak will reach the 42-day Ebola-free threshold needed to declare the outbreak over by the next time the Emergency Committee reconvenes.

As of 10 February 2020, there were a total of 3431 cases and 2253 deaths. Between 3 and 9 February 2020, three new confirmed cases were reported in Beni Health Zone, North Kivu. More than 2000 contacts were being followed.

The Emergency Committee assessment noted that sustaining progress towards reducing the rate of new cases depended on the security situation and control of the well-known drivers of transmission, particularly in traditional health facilities, and on continued engagement with the community. A risk communication and community engagement programme has been developed, as has an EVD survivors programme.

Image Credits: Twitter: @WHOAFRO.