After two days of more hopeful signs that new cases of the novel coronavirus in China might be stabilizing, a sharp increase of 14,840 new COVID-19 infections was reported Thursday by the Province of Hubei, more than 10 times the previous day.

Meanwhile, Vietnamese authorities had reportedly imposed a mass quarantine on a number of villages in the Son Loi commune, about 40 kilometers from Hanoi, where six among the 16 cases confirmed so far in Viet Nam, have been reported. It was the first mass quarantine to be placed on an entire community outside of China where over 50 million people remain under partial or total lockdown in the city of Wuhan and around Hubei Province, where the novel coronavirus first first emerged in a wild animal market in December 2019.

CNA News report shows police patrol on perimeter of Viet Nam’s Son Loi commune. (CNA News)

The upsurge in China cases was in part due to an expansion of diagnostic criteria, said Hubei officials in a statement. Those who show clinical signs of COVID-19 were previously not included in the count, which only tallied lab-confirmed cases. However, officials amended the definition so that patients who show clear symptoms of the disease based on clinical exams and chest x-rays “can receive standardized treatment…as early as possible to further improve the success rate of treatment”[translated from Chinese].

A total of 59,907 cases had been reported in China on Thursday, according to the latest Chinese government data, posted just before midnight Beijing time. There was also a steep 48-hour increase in deaths, with total fatalities inside China now at 1,368. The second death outside of China was registered in Japan, in a woman in her 80s. Some 500 people in 24 other countries were also infected with the virus as of Thursday evening, central European time.

“This increase that you have seen in the past 24 hours is largely due to a change in how cases are being diagnosed and reported,” said WHO’s Emergencies Director, Mike Ryan at a press briefing Thursday, explaining the huge leap in case reports in Hubei Province, the epidemic epicentre.  “We need to be very careful in interpreting any extremes.” He noted that some of the increase is also attributable to clinical cases reported days or even weeks ago, but only included now after the reporting criteria was changed.

There were further spikes in the two biggest COVID-19 hot spots outside of China.  On the Princess Diamond Cruise ship, where more than 3600 passengers and crew remained quarantined in Japan’s Yokohama harbor, a total of 218 passengers tested positive for the virus, a leap of 44 cases since Wednesday. Singapore, the next largest cluster, was reporting 58 cases Thursday evening, 11 more than Wednesday.

Government-reported data for COVID-19 cases in China, on a popular health workers website, as of 16:51 Central European Time.

Experts are carefully watching trends in the Asian city-state, where original contacts for some of the Singaporeans falling ill cannot be traced. This has sparked fears that wider community-based spread of the virus may be occurring, making Singapore the next test ground for virus containment. Elsewhere, conferences and meetings were being delayed or cancelled, and school start dates suspended, as the fallout from the virus echoed across the Western Pacific region, Europe, and beyond.

The sharp uptick in reported cases on Thursday occured only hours after Dr Tedros Adhanom Ghebreyesus, World Health Organization director general warned that ¨the number of newly reported cases reported from China has stabilized over the past week, but that must be interpreted with extreme caution.”

“The outbreak could still go in any direction” he told reporters Wednesday after the conclusion of a two-day Global Research and Innovation Forum in Geneva, and just hours before Hubei province officials released the new daily numbers.

The forum sought to identify the best clinical care treatment for patients with the virus; explore why some people become seriously ill while others do not; as well as to forge ahead with a coordinated approach to research on potential treatments and vaccine candidates, said Dr Soumya Swaminathan, WHO chief scientist, describing outcomes of the meeting.

WHO Press Briefing on Coronavirus situation

First Large-Scale China Study Finds Case Fatality Rate Higher Than Previous Estimates

Meanwhile, the first large-scale study of some 4,021 Chinese patients with COVID-19 reported that the case fatality rate of confirmed people who fell ill in January was averaging about 3%, significantly higher than the 2% fatality rate that had been cited previously.

According to a pre-print version of the study by researchers from China Centers for Disease Control (China CDC), published on MedRXiv, patients 60 years or older had even higher fatality rates of 5.4%, as compared to 1.43% for that of younger patients.

Male patients also had a case fatality rate more than triple that of female patients – 4.45% as compared to 1.25%, the study found.

The study, which examined cases in 30 Chinese provinces including the virus epicentre of Wuhan, also provides the first detailed age distribution of confirmed cases of the virus, which had been known to researchers as 2019-nCoV, until WHO gave it a formal name on Tuesday.

Despite the higher fatality rates than previously assumed, the new COVID-19 virus is still less deadly than Severe Acute Respiratory Syndrome (SARS), which had a case fatality rate of 9.2%, during the 2002-03 epidemic, the study’s authors conclude. The COVID-19 virus transmissibility is similar to that of SARS – with a single infected person passing the virus to nearly 4 other people [3.77], on average.

Among those studied, people aged 30-65 years comprised the majority of reported cases, while 47.7% of patients were age 50 and over. The lowest incidence of reported cases was among people under 20 years of age.

Overall, more men than women were reported to be infected, the study found – although gender differences in incidence were only significant outside of Wuhan.

“The high incidence subpopulation outside Wuhan tended to be younger than in Wuhan,” the study’s authors also noted.

The study is the first published report covering a large group of Chinese patients.  But WHO scientists have noted that the true case-fatality rate remains difficult to assess in the early stages. The fatality rate could also prove to be lower if many people with asymptomatic or mild infections are missed by hospital-based surveillance systems.

Experts Closely Watching new COVID-19 hubs like Singapore

Outside of China, global health experts were closely watching trends in Singapore, which has the largest concentration of COVID-19 cases outside of China – with the exception of the Diamond Princess cruise ship.

Singaporeans clear out supermarket shelves on 8 February as coronavirus fears spike

The most worrisome aspect of Singapore’s outbreak is the emergence of cases in people whose original contact with the virus couldn’t be traced, experts have observed. If the outbreak expands from known chains of contacts into more “community-based” transmission, then it’s “game over” in terms of containment and preventing a worldwide pandemic, in the words of one BBC commentator.

In fact, some experts are already using the so-called “P” word. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told Health Policy Watch.  There is a “real possibility that it’s a pandemic – which means it could be a worldwide epidemic where most citizens are at risk of being infected,” he said in an interview.

But while WHO is closely watching the “behaviour of the virus outside of China,” Mike Ryan, WHO’s Emergencies head, has sought to mitigate fears about virus expansion abroad. He notes that the number of cases where contacts cannot be traced remains limited.

Ultimately, public health officials need to  pursue a two-track strategy of both containment and preparation for further expansion. “We must stop the virus while preparing countries for the arrival of the virus…. even if that sounds like a contradiction,” Ryan said, speaking in a press briefing on Wednesday.

Speaking on Thursday he said, “We can only find eight cases [abroad] that are not linked in some way to one of the identified transmission chains,” he observed. He said that researchers are rushing to develop a simple blood test for virus antibodies. But in the absence of such a test, it is difficult to determine how much broader “community” transmission might be occuring. “This may be only the tip of the iceberg, or the iceberg may not be as great,” he said.

Clinical Trials For Vaccine Candidates Could Begin In April

Following the conclusion of the WHO Research and Innovation Forum, WHO’s Chief Scientist Swaminathan told Health Policy Watch that clinical trials of the first COVID-19 vaccine candidate, could begin as early as April.

She said that tests of the first vaccine candidate, an mRNA vaccine, are being supported by the Oslo-based Coalition Epidemic Preparedness Initiative (CEPI) as part of a collaboration with the pharmaceutical company Moderna and the US National Institutes of Health. The vaccine candidate functions on principles similar to vaccines tested against other coronaviruses, such as SARS.

Swaminathan said that she was optimistic about China’s ability to quickly ramp up manufacturing capacity to produce any new vaccine shown to be effective. “There was a Chinese vaccine company present at the meeting, and they were very interested in collaborating on this, and they did raise the issue of exploring manufacturing capacity from an early stage,” she said.

In terms of therapies, trials have already started on the widely-used HIV drug combination, lopinavir-ritonavir as well as on an experimental drug called remdesivir, she noted, although it is “too early” to identify what might be the most promising treatments.

Ad for HIV/AIDS combination drug now being tested for effifacy against COVID-19

Tests of other antivirals, some Chinese traditional medicines, and the FDA approved treatment for seasonal flu, oseltamivir (Tamiflu) are also rapidly being scaled up, she said.

But there are a broad range of other potential treatments as well, she observed: “When we look at our clinical study registry there are about 87 – 89 trials [of antivirals] already under way, and about one-third of them are clinical trials.”

WHO Protests Cases of Stranded Maritime Passengers

Meanwhile, cases of COVID-19 continued to climb aboard the Princess Diamond, the cruise ship that has been under quarantine in while docked in Yokohama, Japan, since 7 February.

Of the 48 new cases of infection outside of China that were reported on Wednesday, 40 were on the ship, noted WHO’s Dr Tedros in his briefing to the press. That adds up to 174 passengers with confirmed cases of the coronavirus.

Dr Tedros protested the fact that in the wake of the Princess Diamond case, two other cruise ships have also been turned away from ports, despite having no suspect cases of the coronavirus.

He said that WHO would be issuing a communique with the International Maritime Organization, asking countries to respect the principle of “free pratique”, for ships’ movement, and proper care of passengers.

And he praised Cambodia’s government for finally agreeing to allow one of two other cruise ships, the Westerdam, to dock, after days of being stranded in international waters.

“Based on what we have been told, there are no suspected or confirmed cases of COVID-19 on board the Westerdam,” he said, noting that the ship is due to arrive in Cambodia Thursday morning.

“This is an example of the international solidarity we have consistently been calling for,” he said.

Inside China – Rising Concerns Over Health Worker Infections & Freedom Of Speech

Inside China, there were growing concerns about the rate of health worker infections, as the South China Morning Post reported that over 500 medical workers had been infected by COVID-19 in Wuhan by mid-January. Although the Chinese government has been releasing daily case counts, no separate tally of health worker cases has been made public.

That issue surfaced against the continuing current of protest over how the Chinese authorities’ repression of free speech might have delayed warnings about the virus and exacerbated its spread in the early days, highlighted by a new petition circulating on freedom of speech. The petition has been signed by hundreds of Chinese, including a number of notable Chinese academics, reported the South China Morning Press.

The petition followed the widely-mourned death on 6 February of Li Wenliang, one of eight doctors punished by Wuhan authorities in early January for “spreading rumors,” after he tried to warn fellow health workers about the new coronavirus on a social media chat.

WHO and its Director General Dr Tedros have also been criticized for white-washing the Chinese repression of initial reports of the novel coronavirus, which is believed to have first infected people working in, or visiting, a wild animal market in Wuhan in December 2019.

Asked about such criticism at Thursday’s press briefing, the WHO head was adamant that he was not pandering to Chinese political pressures in his repeated praise for the Chinese response.

“China doesn’t need, or want, to be praised. Let the truth speak for itself and the world can judge,” he told journalists, adding that thanks to China’s response measures,  “The rest of the world is still safer and in a better shape.

“If there is any failure, that should be challenged. We will assess and learn from it,” he said, adding, “We should not be stigmatizing or attacking a country, but stand in solidarity and fight against this common enemy, COVID-19, as humanity because we are one. This virus attacks every human being.”

Grace Ren contributed to this story.

 

This story was updated 13 February 2020, at 3:19AM & 19:00 CET .

 

Image Credits: CNA News, Dingxiangyuan, Yang et al.2020, Medrxiv, Cattan2011.

The novel coronavirus has been officially named by the World Health Organization as COVID-19, in the first day of a global consultation with about 400 researchers and public health experts charged with designing a coherent way forward to confront the expanding epidemic.

However, as the case count rose by Tuesday afternoon to 42,747 people with confirmed infections in China and 394 abroad, and the death count rose to 1018 people, according to the latest Beijing government data, there were still far more questions than answers about the new virus, which first emerged in December 2019 in a Wuhan, China food market selling wild animals.

“The main outcome we expect from this meeting is not immediate answers to every question that we have,” said World Health Organization Director General Dr Tedros Adhanom Ghebreyesus, at a Tuesday press briefing following the first day of the Global Research & Innovation Forum convened by WHO in Geneva.  “The main outcome is [to be] an agreed roadmap on what questions we need to ask, and how we will go about answering those questions.”

A scientist doing coronavirus research at the US National Institute of Allergies and Infectious Diseases (NAID) Vaccine Research Center (VRC).

While WHO and other partners have all placed a great deal of emphasis on the transparent sharing of scientific knowledge about the virus to rapidly advance solutions to the epidemic, the two-day forum ongoing Tuesday and Wednesday in Geneva has been closed to the public, and participants were reportedly asked to avoid speaking to the media.

“We were instructed not to speak externally really but what I’ll say is that the atmosphere was quite good and the report will be quite action focused,” one participant from a leading global health research institution told Health Policy Watch.

Key questions that remain unanswered by WHO, its global partners and advisors cover some of the most characteristics of the virus as well as the outbreak dynamics, such as:

How contagious is the virus and what preventive measures can the public take? And how easily can asymptomatic carriers pass it to others? WHO’s Dr Tedros stressed in Tuesday’s press briefing that the virus can be passed by the respiration of tiny airborne droplets from an infected person – and that makes it far more contagious than diseases such as Ebola, which raged for a year in the Democratic Republic of Congo, but now appears to be finally on the wane. At the same time, besides hand washing and maintaining distance from people who are visibly ill, WHO and other public health authorities have so far been unable to issue clear guidance as to what else the general public can do to protect themselves from the virus. For example, WHO experts have said that there is mixed evidence about the extent to which simple surgical masks may or may not provide an added measure of protection – despite their increasingly widespread use not only in China, but also in other potential outbreak hotspots, as well as on some airline carriers.

How long is the virus incubation period? Most scientists have estimated 14 days, but there have been some estimates of up to 24 days. However, 24-days so far appears to be an outlier figure, noted WHO’s Sylvie Briand, in a briefing on Monday,

What is the actual death-rate?  In terms of a simple calculation of the numbers of the confirmed infections as compared with those who died, the fatality rate has hovered around 2.4%, which is higher than the death rate for seasonal flu, running at about .05% in the US this flu season, and for which vaccines also exist.  Better tracking of the COVID-19 virus, and inclusion in records of more asymptomatic cases, which seem to be common, might yield a lower fatality rate, some WHO experts have suggested. At the same time, the death rate could also prove to be higher, cautioned Gabriel Leung, infectious disease specialist and dean of medicine at the University of Hong Kong, writing in the New York Times.  He noted that in the early days of the SARS epidemic, experts believed that the case fatality rate was hovering between 2-3 percent. It later proved to be much more deadly – with the fatality rate for SARS in Hong Kong a “staggering 17 percent.”

Why are there variations in the death rate of those infected in China and abroad? Among the latter 394 cases, only one person has died. The disparity has been attributed by some scientists to the fact that most of the cases abroad were among travelers who were presumably younger and more fit, whereas the cases in China have involved the whole population.

What is the age and gender breakdown of those seriously ill?  While WHO has reported that about 15% of cases are serious enough to require hospitalization, and these tend to be older, no more detailed breakdown of cases has released. However, a study published last week in JAMA of 138 people hospitalized in Wuhan in January noted that their median age was 55 years of age.  This suggests that a significant proportion of those becoming seriously ill could be younger than had been assumed. Slightly more than half of the hospitalizations were men. And while most people recovered, they also required long periods of hospital care, averaging ten days or more, the study noted – something that could overwhelm a health care system with weaker hospital capacity.

What about children?  There have not, however, been many reported cases in children, said Nancy Messonnier, director of the US Centers for Disease Control’s Center for Immunization and Respiratory Diseases, speaking at a panel on the coronavirus Tuesday at the Aspen Institute.  That should be good news, although if the cases are mild or asymptomatic, then children could also “seed” cases to other more vulnerable family members in the household.

What is the animal source of the novel infection?  WHO’s Sylvie Briand said in Tuesday’s briefing that the original source for the new coronavirus had likely been a bat, which are common carriers of many different types of coronaviruses. However, an assessment by Chinese researchers last week in Nature, and also cited by Leung, points to the endangered species of pangolins, or other small mammals, as likely the point of contact with humans. Pangolins are commonly hunted and sold in Asian live animal markets for their meat, while their scales are used as an ingredient in traditional medicines.

Aerial shots of a large quarantine site being built in Hong Kong as coronavirus cases climb above 40.
WHO Boosting Diagnostics Capacity – But Many Countries Lack Respiratory Care Facilities   

As soon as a public health emergency was declared on 30 January, WHO swung into action to equip low-income countries, particularly in Africa, with diagnostics to identify the virus in suspected cases. The results have been impressive, in just two weeks, 13 African countries as well as Iran have been equipped with the laboratory tests, and technicians from a dozen African countries were trained in their use last week. Another 150,000 tests were about to be shipped to more than 80 labs worldwide, WHO has said. Personal protective gear for health workers, critical to infection control, is also being shipped from WHO emergency stocks to countries lacking strong supplies.

However, if cases clusters appear in Africa, or expand more widely in hotspots of South-East Asia and elsewhere – other serious capacity issues will emerge for health systems, including quarantine and containment facilities, which are expensive to mount and maintain. There is also a lack of hospital respiratory equipment to support those with pneumonia-like symptoms – one of the most common features of serious illness, one WHO official noted on Tuesday.

“Severe cases tended to be taken in charge by an intensive care unit where you have to provide the respiratory equipment, and this capacity is very limited in many African cities,” said Michel Yao, head of emergencies in WHO’s African Regional Office, in an interview with National Public Radio. That lack of supportive care could lead to a much higher death rate in poor and underserved regions.

At least a dozen R&D biopharmaceutical companies are working on vaccines, antivirals or other treatments to confront the fast-spreading coronavirus, said Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers, in an interview Monday with Health Policy Watch. The Chinese government has, meanwhile, authorized initial research or exploratory trials of some 30 existing anti-viral treatments developed to treat other serious viruses, including Ebola and HIV, as well as other coronaviruses such as SARS and MERS. Still, it may be some time before one or two of those being tested shows evidence of efficacy against this new virus.

And in the absence of effective medicines, providing good supportive care and preventing further infection spread, will be the main things that health care systems can do to combat the virus.

And that is why, for the moment, WHO’s Director General is placing his bets on “containment” strategies to slow the virus spread outside of China, what he is wont to call “a window of opportunity.”

“We are having a real problem in our hands, and we must take what is happening now seriously,” he said.  “I have a great concern that if this virus makes it to a weaker health system, it will create havoc. It will. For now, it doesn’t seem so, but this doesn’t mean that it will not happen. It depends on how we lead this response and how we respond to the outbreak,” he said.

Describing the virus as “Public Enemy Number 1,” the WHO Director General said: “The world talks about terrorism.  But to be honest, a virus is more powerful in creating economic, social and political upheaval than any terrorist attack.”

Grace Ren contributed to this story – Updated 12 February 2020

 

Image Credits: NIAID, Studio Incendo.

Governments are falling behind in the battle against a “global epidemic” of noncommunicable diseases (NCDs), say two new reports by the World Health Organization and the NCD Alliance, launched on the first day of a Global NCD Alliance Forum in Sharjah, United Arab Emirates.

Many countries are stalled in implementing basic prevention policies, such as reducing tobacco and harmful alcohol consumption; promoting health eating and physical activity; and strengthening early NCD detection and treatment in primary health care systems, according to the WHO NCD Progress Monitor 2020 report, released Monday. Such policies are among the so-called WHO “Best Buys” for NCD prevention.

Only 19% of 194 countries surveyed have fully implemented tobacco taxes; just 20% are meeting targets for salt-reduction, and one-third of countries are providing basic NCD health services such as drug therapy and counseling.  And less than half of the 194 countries surveyed met at least two of the ten targets that would reflect progress against NCDs – a “grim sign” as the report calls it.

Speakers of the opening plenary at the Global NCD Alliance Forum

“Countries are still failing to meet basic indicators. If they continue on this path then millions of people will die needlessly from heart attacks, stroke, diabetes, cancers, and respiratory disease.” said Ren Minghui, assistant director-general for Universal Health Coverage, Communicable & Noncommunicable Diseases at WHO in a joint press release, issued with the NCD Alliance at the Global NCD Forum.

According to the WHO report, about a quarter of all countries also do not have a national NCD plan in place, and one-third of all countries lack time-bound national targets to drive and monitor progress in the overall Sustainable Development Goal of reducing deaths from NCDs by one-third by 2030.

Data from the second report, the NCD Alliance’s Bridging the Gap backs up this stark reality. The report, based on surveys of national and regional NCD alliances, found that only 20 percent of members believed that their country is on track to meet global NCD targets. Some 82% of members did not believe their country had sufficient accountability mechanisms to ensure NCD targets were being met.

“This report confirms what we’ve long suspected – that the United Nations targets aimed at reducing NCDs are not bearing fruit on the ground,” said CEO of the NCD Alliance Katie Dain. “Unless the gaps in the response are addressed, we’ll be faced in 2030 with a tsunami of disease-related impacts, both human and economic, that could have been avoided.“

NCDs account for over 70% of all deaths worldwide. An estimated 41 million people die from NCDs such as cardiovascular disease, cancer, stroke, diabetes and respiratory illnesses every year.

5 Major Gaps Impeding Progress

The Bridging the Gap report points to gaps in five major areas that are impeding progress – political leadership, investment, care, community engagement, and accountability.

The report found that political commitment to NCDs at the country level is low – only Brazil and Turkey have implemented all five of the tobacco demand reductions measures from the Framework Convention on Tobacco Control for example. Additionally, while domestic financing in NCD control is increasing in some places, international funding for NCDs remains a paltry 2% of total multilateral aid for health.

Only about a third of all countries provide drug therapy and counseling to prevent heart attacks and strokes, and just 40% of countries provide palliative care in primary healthcare or in the community.

““We know what works — primary health care, with its emphasis on promoting health and preventing disease, is the most inclusive, effective and efficient way to reduce premature mortality from NCDs and promote mental health and well-being,” said Minghui.

The report also finds that countries are lagging in engaging communities of people affected by NCDs, and creating independent, civil-society led accountability mechanisms for monitoring progress on reducing NCDs. These measures, the report says, are crucial to push forward action on political promises for NCD control.

“The evidence before us is indicating that we need to move well beyond the health sector to really make a dent in the epidemic. We need to address the root causes of NCDs, in the food we eat, the water we drink, the air we breathe and the conditions in which people live, work and play,” said Minghui.

Image Credits: NCD Alliance/Gilberto Lontro, NCD Alliance.

[STAT News]

As China struggles to contain an epidemic caused by a new coronavirus, science is racing to develop vaccines to blunt the outbreak’s impact. Central to the effort is CEPI — the Oslo, Norway-based Coalition for Epidemic Preparedness Innovations — a global partnership created to spearhead development of vaccines in just this type of emergency.

Two weeks after China announced on 7 January that a new coronavirus had ignited a fast-growing outbreak of pneumonia cases in the city of Wuhan, CEPI announced funding for three efforts to develop a vaccine to protect against the virus, currently known as 2019-nCoV. A week later, it added a fourth. Just days after that, it announced major vaccine manufacturer GSK would allow its proprietary adjuvants — compounds that boost the effectiveness of vaccines — to be used in the response.

But to date, most of the CEPI-funded efforts are focused on partners that don’t have the production facilities to make a commercial product in bulk. They include Inovio, a partnership between Moderna and the National Institute of Allergy and Infectious Diseases; CureVac; as well as the University of Queensland, in Australia. All use innovative approaches that offer the promise of unprecedented speed to the development of a vaccine candidate. But none of the companies has yet licensed a vaccine.

Read the full interview on STAT News.

Image Credits: CEPI/University of Queensland.

The elements are all in place for expanding universal health coverage – what’s missing is more action at the country level, World Health Organization Director General Tedros Adhanom Ghebreyesus told the WHO Executive Board on Wednesday.

“All the political work is actually done now,” Dr. Tedros said.

He was reporting on WHO action since the  September 2019 Political Declaration of the United Nations High-Level Meeting on Universal Health Coverage, which followed up on the 2018 Astana Declaration on Primary Health Care.

The Executive Board report outlined the next steps WHO will be taking to help member states expand access to quality health services, despite the  many infrastructure and funding challenges that exist at national level.

One cornerstone of efforts will be the creation of a WHO Special Programme on Primary Health Care as a “one-stop” mechanism for providing support to member states on the scale-up of the most critical layer of health systems, which is regarded as a cornerstone of UHC.

The Special Programme will be run by a new WHO director, Suraya Dalil, former Afghanistan Minister of Health.

“It will put into action the operational framework for primary health care, once it is approved, which outlines 14 levers,” according to the Director General’s report to the EB.

Other next steps would include supporting countries to:

  • Scale up access to various forms of health insurance or financial protection, with an emphasis on reaching groups left furthest behind;
  • Better coordination with other UN and global health partners on programmes and services;
  • Strengthened accountability and monitoring.

Access to Health Coverage Gradually Increasing – But Costs Also Rising

According to the 2019 WHO Global Monitoring Report, released in September 2019, the proportion of people with health coverage has increased from an average of 45% in 2000 to 66% in 2017.

Universal Health Coverage Index in 2017, Global Monitoring Report (WHO,2019)

However, this was accompanied by a sharp rise in out-of-pocket spending. Between 2000 and 2015, the number of people with out-of-pocket health spending exceeding 10% of their household budget increased to about 930 million worldwide. Those with out-of-pocket spending exceeding 25 percent of household budgets, increased by about 210 million people.

The report called for government to increase spending on primary health care by at least 1 percent of their GPD in order to achieve health targets by 2030. The report projected that investing an additional US$ 200 billion a year on scaling up primary health care across low- and middle-income countries could save 60 million lives, and increase average life expectancy by 3.7 years by 2030.

Most countries can raise the necessary funding from domestic resources by increasing public spending on health, and reallocating spending towards primary health care, the report pointed out, adding that countries with the lowest incomes, will continue to require external assistance.

EB Members Agree Funding Needs To Be Increased

A group of prominent EB members, led by Indonesia, called on fellow member states to step up sustainable funding for health systems. Indonesia made the call on behalf of the Foreign Policy and Global Health Initiative composed of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand.

Their calls were supported by other WHO member states, such as Thailand and Bolivia, while Nigeria asked WHO to step up its assistance to developing countries on sustainable financing for primary health care.

Norway highlighted the fact that while international support remains important for some countries, national governments need to do more to close the domestic investment gap in health services.

Barbados, however, noted that demands to increase health budgets compete with other needs such as security and environment, while “UHC is not a low-cost endeavour.”

Delegates also underlined the need to improve global availability and access to affordable medicines, vaccines and other health products.

The United States expressed concern for health workers’ safety, and called on the WHO to focus more attention on the issue globally. In order to achieve UHC, countries will need to recruit and train some 18 million health workers globally in the next decade.

Another group of countries, led by Sri Lanka, and including Burkina Faso, Japan, France, the Netherlands, Sweden, and Tonga stressed the large economic burden imposed by poor oral health care, noting that this issue should be integrated more deeply in UHC. Poor oral health can contribute to diabetes, cancer and cardiovascular diseases. Sri Lanka’s delegate proposed that a global strategy on oral health be considered as a Board agenda item in 2021.

 

Image Credits: WHO Global Monitoring report .

The World Health Organization’s Executive Board tackled two big issues today – primary health care, a cornerstone of WHO’s Universal Health Coverage platform, and cancer, the world’s second leading cause of premature deaths.

In a comprehensive report released on World Cancer Day, WHO outlined an action plan that could save 7 million lives from cancer in the next decade – a framework that includes recommendations on prevention policies, expansion of screening and early treatment services at the primary care level, and guidance on financing cancer interventions and price transparency for cancer therapeutics.

The 149-page report, launched in parallel with a whopping 613-page companion report by the International Agency for Research on Cancer (IARC), was launched Tuesday. Shortly afterward, the WHO Executive Board reviewed and tacitly endorsed a new WHO operational plan for dramatically scaling up Primary Health Care services in countries worldwide.

Cancer Action Plan Could Save 7 Milion Lives

“At least 7 million lives could be saved over the next decade, by identifying the most appropriate science for each country situation, by basing strong cancer responses on universal health coverage, and by mobilizing different stakeholders to work together,” said Dr Tedros Adhanom Ghebreyesus, director-general of WHO in a press release on the cancer action plan.

The report warns that if current trends continue, there will be a 60% increase in cancer cases over the next two decades, the report warns. Low-income countries with limited health resources will be hardest hit – some 81% of the new cases are projected to occur in those countries where survival rates are also the lowest.

In terms of cancer death prevention, the report highlights measures that can be taken to prevent and cure cervical cancer, the fourth most common cause of cancer in women, as “a global priority.” It underscores that most effective cervical cancer interventions – vaccination, screening, and early diagnosis and treatment – can be provided at the primary care level – where health services can be inexpensively provided.

Just a day later, the WHO EB unanimously recommended that the first draft strategy for the elimination of cervical cancer be adopted by the 73rd World Health Assembly in May.

Primary Health Care – Requires Political Will

Yet in many countries, investing in primary health care where many such services can be provided, is an uphill political battle, “like going against the wind, because politicians advocate for hospital beds,” warned Dr Tedros on the second day of 146th Session of the Executive Board. “During elections, even communities want to see something visible like… a big hospital.”

But he added, if we are going to make “a dent in noncommunicable disease and communicable diseases, primary health care is the answer – that goes for high-income countries and low-income countries as well… If we really believe in primary health care we need to stand against the wind.”

At the same time, awareness of the importance primary health care plays as a building block of health systems is growing, said Zsuzsanna Jakab, deputy-director of the WHO, and there is now “an unprecedented political movement to move forward… it has to be at the center of the functional health system.”

The new operational framework outlines 14 operational “levers” that “comprise all the components of primary health care,” said Jakab, who introduced the framework details to Executive Board members.

“Essential components” like multi-sectoral action, community engagement, policy and government frameworks, and funding must be “integrated” with public health functions like “immunization surveillance, prevention, promotion, and protection” to address “all the determinants of health.”

Expansion of primary health care services is one of the key accelerators of health-related Sustainable Development Goals, endorsed by both WHO and UNICEF, she added.

A WHO Special Programme for Primary Health Care will provide differentiated support to countries that aim to expand such services, focusing on fragile health systems, said Jakob.

The framework was widely welcomed by members and observers at the EB session, although the absence of a strong reference to nutrition and special consideration to the needs of small island states battered by climate change effects were issues raised by Bangladesh, the United Kingdom, and Tonga.

In its response to the plan, Eswatini called on countries to “avoid erecting economic or political boundaries… and to promote healthy partnerships,” a jab at yesterday’s showdown on Taiwan’s political status. Guatemala also thanked Taiwan for “generous support.”

Firing back, China’s EB delegate said that the “Taiwan region is part of China and concern’s China’s internal affairs,” and called on countries to stop hijacking “the so-called Taiwan issue.”

Six Target Actions for Cancer Control

Along with cervical cancer – the WHO Report on Cancer details trends in other most common and deadly cancers – including lung, breast, colorectal, prostate, and stomach cancers. Cancer caused 9.8 million deaths in 2018 alone, the report notes. Lung cancer remained the world’s most common cause of new cancer cases and deaths, with  2.1 million new cases and 1.8 million deaths in 2018. Breast cancer followed at a close second, with 2.1 million new cases and 627,000 deaths in 2018.

Estimated rise in the global burden of cancer based on United Nations population projections.

With limited health resources focused on combatting infectious diseases and improving maternal and child health, health systems in many low-income countries are ill-equipped to prevent, diagnose, and treat cancers. According to the report, in 2019 less than 15% of low-income countries had comprehensive cancer treatment  available in the public health system, compared to 90% of high income countries.

“The past 50 years have seen tremendous advances in research on cancer prevention and treatment,” says Dr Elisabete Weiderpass, director of IARC.

She added that while “deaths from cancer have been reduced,” the improvements have mostly been seen in high-income countries.

In rich countries, “prevention, early diagnosis and screening programmes…together with better treatment, have contributed to an estimated 20% reduction in the probability of premature mortality between 2000 and 2015, but low-income countries only saw a reduction of 5%,” Weiderpass said.

Ultimately, she added, “we need to see everyone benefitting equally.”

“This is a wake-up call to all of us to tackle the unacceptable inequalities between cancer services in rich and poor countries,” added Ren Minghui, assistant director-general of the Division of Universal Health Coverage/ Communicable and Noncommunicable Diseases at WHO.

The solution is two-pronged – strengthen health care services for cancer, particularly at the primary care level, and scale up proven interventions for cancer prevention. The report lists six high-yield priorities for prevention and early treatment:

  • Control tobacco use – responsible for an estimated 25% of all cancers;
  • Reach 90+% vaccination coverage against hepatitis B and human papillomavirus, respectively responsible for a majority of liver and cervical cancers;
  • Screen for cervical cancer with 70+% participation rate;
  • Focus on early diagnosis and treatment for so-called “curable cancers” – such as many childhood cancers – that have proven, effective treatments;
  • Scale-up capacity to manage 200 million cancer cases in the next decade;
  • Provide palliative care for all cancer patients.

Actions that reduce air pollution, promote active lifestyles and increase healthy eating can also reduce cancer rates, while having a broader effect on the reduction of non-communicable diseases such as diabetes as well, the report notes.

Financing Cancer Services

Scaling up expensive treatments for cancers may be more complex, the report admits. In low- and middle-income countries, donor support and budgets allocated for cancer services, and non-communicable diseases (NCD) more broadly, are limited in comparison to spending on other health priorities.

An analysis of spending patterns in 40 low- and middle-income countries showed that NCD spending has grown, now averaging about a quarter of domestic budgets, but international aid for NCDs still lagged at about 2% of total health-related assistance.

Recommending a “progressive” approach to expand cancer services, the report stated that countries should  “incrementally” increase resources to cover “ever larger segments of the population,” mobilizing “innovative financing mechanisms” such as airline levies, tobacco taxes, or other sources of non-traditional revenue. 

Price Transparency of Medicines Can Increase Affordability

But the report also touches on the thorny issue of price transparency – particularly relevant in the case of expensive, new cancer therapies. It recommends that governments “enforce price caps on medicines, with or without progressive reduction of prices over time; create competition among therapeutically similar medicines, including generic and biosimilars; and use voluntary license agreements, applying the flexibility of TRIPS for patented medicines, where appropriate.”

The report recommends that “health systems should disclose the net transaction prices of cancer medicines to relevant stakeholders in order to strengthen the governance of procurement” and “countries should disclose and control prices along the supply chain to avoid excessive mark-ups” are an endorsement of price transparency for cancer treatments. Pooled procurement mechanisms – which allow small countries with little market power to collectively bargain on treatment prices – “should extend their scope to include cancer medicines and related health products… when relevant and feasible.”

The recommendations align with WHO’s steps over the past year to increase competition in the cancer treatment arena. Recently WHO  created a channel for pharma manufacturers to gain WHO’s quality seal of approval for biosimilar versions of a breast cancer drug, Trastuzumab, through the WHO Prequalification Programme.

“If people have access to primary care and referral systems then cancer can be detected early, treated effectively and cured. Cancer should not be a death sentence for anyone, anywhere,” said Minghui.

This story was updated 5 February 2020

Image Credits: WHO, WHO Report On Cancer.

World Health Organization Director General Dr Tedros Adhanom Ghebreyesus called for “solidarity, solidarity and solidarity” amongst WHO member states to meet the new challenge of a novel coronavirus epidemic – at Monday’s opening of a week-long meeting of WHO’s Executive Board in Geneva.

“The rule of the game is solidarity, solidarity, solidarity. But we see this missing in many corners, and that has to be addressed,” he said, speaking before the 34-member governing board.

The WHO Director General also stressed that “there is no reason for measures that unnecessarily interfere with travel or trade” – despite the widespread curbs that many countries have imposed on travel to or from China.

Dr Tedros gives his annual report at the 146th Meeting of the WHO Executive Board

WHO is tracking countries that impose travel and trade restrictions, and some of those imposing limits have been asked to justify their policies on public health grounds, a WHO official told Health Policy Watch. The official declined to indicate which countries might be called to account. A global WHO roundup of such measures is reported to Member States on a weekly basis. But that won’t be made public until the World Health Assembly in May, the official added.

Under the provisions of the International Health Regulations, a binding treaty among WHO member states, countries are supposed to refrain from unnecessary travel and trade restrictions when health emergencies occur.

But as the case load of the novel virus soared to over 17,341 people worldwide and 361 deaths reported on Monday, what might be a  “necessary” or “unnecessary” restriction has varied widely in different corners of the world. Countries across Europe, Asia and North America have severely tightened travel restrictions, also imposing mandatory quarantine measures on travelers returning from China. African countries, such as Nigeria, however, said the doors would remain open.

It remained unclear exactly what measures WHO was recommending that countries outside of China do take to meet the challenge of the spiraling outbreak-turned-epidemic, which some observers now warn could even become a “pandemic.”

Speaking Monday morning, the WHO Director-General called on countries “to implement decisions that are evidence-based and consistent,” adding that WHO stood ready “to provide advice to any country that is considering which measures to take.”

He said that universal measures should include policies to:

  • combat the spread of rumours and misinformation;
  • review preparedness plans, identify gaps and evaluating the resources needed to identify, isolate and care for cases, and prevent transmission;
  • sharing data, sequences, knowledge and experience with WHO and the world.

The world must also “support countries with weaker health systems,” as well as “accelerate the development of vaccines, therapeutics and diagnostics” to combat the new virus, he said.

Dr Tedros praised China’s response to the outbreak, and the “personal leadership” and “commitment” of President Xi Jinping, saying that China’s actions were protecting other countries around the world.

Medical workers conduct temperature checks of passengers at a subway station in Beijing.

“If we invest in fighting at the epicentre, at the source, then the spread to other countries is minimal and also slow.  If it’s minimal and slow, that is going outside can also be controlled easily,” Dr Tedros said. “So it can be managed – when I say this, don’t make a mistake, it can get even worse. But if we give it our best, the outcome could be even better.”

Dr Tedros added: “The only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation. We are all in this together, and we can only stop it together.

“The rule of the game is solidarity, solidarity, solidarity. But we see this missing in many corners, and that has to be addressed.”

While most EB board members followed Tedros example in praising China’s response to the outbreak, stories about delays in the initial Chinese government response were multiplying in global media.

Valuable time was thus lost to contain the mushrooming epidemic, critics said. One expert, Anthony S. Fauci, director of the US National Institute of Allergy and Infectious Diseases, told the New York Times, “It’s very, very transmissible, and it almost certainly is going to be a pandemic… some epidemiological models indicated that there could actually be 100,000 or more cases.”

Spat over Taiwan Status in Emergency Response  

Solidarity was singularly absent in a subsequent EB debate over the treatment of Taiwan – which in WHO terms, falls under the jurisdiction of the mainland government in Beijing.

Complaining of “political conflicts” that hinder outbreak response, Eswatini’s representative complained that “The Republic of China Taiwan has limited access, if any, to the WHO IHR (International Health Regulations) processes.

“Taiwan’s technical experts are denied participation in technical meetings of the WHO. This unfortunately leaves over 23 million people in Taiwan vulnerable to such epidemics, yet we know that Taiwan has cutting-edge expertise that will benefit all of us. A case in point is the management of the current novel coronavirus outbreak where inaccurate info enlisting what lead to unfortunately misplaced decisions impacting the people of Taiwan.”

China’s EB representative hotly denied the claims, saying that Taiwan had been fully informed of cases involving Taiwanese on the mainland, and that Taiwanese specialists had even visited the mainland and Hubei province to learn about containment measures being taken.

“There does not exist a so called gap in the epidemic preparedness system as a consequence of Taiwan’s inattendance at the WHA,” said China’s EB representative. “Instead it is just the lies and excuses of the Taiwanese authorities made in an attempt to participate in the WHA [World Health Assembly].”

Year In Review – Unprecedented Challenges, Achievements & Transformation

While the coronavirus outbreak has dominated headlines in early 2020, the threat posed by the deadly outbreak of Ebola in the Democratic Republic of Congo, has now been virtually squashed, the WHO Director-General reminded the EB – in remarks that also included a wide-ranging review of the challenges and accomplishments of 2019.

Paying homage to the health workers who lost their lives combating both the Ebola virus as well as DRC armed groups that frequently attacked health responders, Dr Tedros said their determination is the reason: “Why Ebola is almost zero, the last 16 days are almost done. We had one case again yesterday, but I hope we will finish it as soon as possible. For the Ebola situation to be what it is now, we paid in lives.. we have to give them due respect.”

Fighting the Ebola outbreak, he said, was just one example of how, “2019 was a year of unprecedented challenges, unprecedented achievements and unprecedented transformation. We touched every corner of the organization while fighting emergencies and launching new initiatives.”

New WHO Focus on “Healthy Populations”  

The year also saw a new emphasis on health promotion and illness prevention, Dr Tedros noted, with the foundation of a WHO division on “Healthy Populations” as well as a new department on Social Determinants of Health.

An agreement was reached with the  International Food and Beverage Association to eliminate cancer-causing “transfats” from processed foods by 2023.

More than 80 cities in more than 50 countries committed to reaching WHO air quality guidelines, and WHO also began implementing a new initiative on climate and health in Small Island States – countries threatened with virtual extinction by rising seas and climate change.

“The urgency of this challenge was brought home to me during my trip to my trip to Tahiti, Tonga, Tuvalu and Fiji last year,” said Dr Tedros. “In Tonga, I planted a mangrove in an area which used to be a rugby field, where Tonga and Fiji played each other in 1924, but it’s now fully consumed by saltwater.”

In terms of preventing non-communicable diseases that cause 70% of the world’s deaths, the WHO Director-General noted that:

  • Countries are scaling up hypertension control – only 200 million of the 1.2 billion people with hypertension currently use control measures. Another effort aims to dramatically expand diabetes diagnosis and treatment.
  • The number of men using tobacco is finally starting to decline…. on the other hand the threat of e-cigarettes is rising.
  • Global initiatives were launched on mental health – aiming to increase access to services for 100 million more people as well as to combat childhood cancer.
  • Global standards were published for safe use of personal audio devices to reducing hearing loss.
  • A draft strategy for eliminating cervical cancer, now mostly preventable through vaccines and screening, has been developed; it is to be considered at this week’s Executive Board.
Universal Health Coverage

In terms of progress on Universal Health Coverage (UHC), South Africa and The Philippines passed new laws for UHC, while Greece, India and Kenya rolled out “ambitious programmes to expand coverage”, Dr Tedros said.

The WHO flagship initiative that aims to expand affordable, accessible health care to the entire world by 2030 was also the focus of a high-level UN declaration in September 2019.

In line with the UHC drive, the WHO Director General said that “access to health services expanded in all regions of the world and across all income groups in 2019. But that comes with a big caveat – we are going backwards on financial protection.”

“In 2015, 930 million people spent 10% or more of their household consumption on health, and we know that number is growing every year… The world spends almost 10% of global GDP on health,” Dr Tedros said, adding that “too many countries spend too much of their health budgets on managing disease, instead of promoting health and preventing disease, which is far more cost-effective.”

He repeated a longstanding WHO call for countries to increase public spending on primary health care by at least 1% of their GDP: “As you have heard me say many times, health is a political choice. But it’s a choice we see more and more countries making.”

Executive Board members and observers rise for a moment of silence in memory of Peter Salama, WHO Executive Director of Universal Health Coverage, who died suddenly in late January.
Access To Medicines

In another historic moment last year, WHO signed a memorandum of understanding with the African Union to establish an African Medicines Agency. The new agency is expected to speed approval and rollout of new medicines across the continent – overcoming the complexities of national approvals. Last year, WHO also launched new initiatives to approve through WHO “pre-qualification” channels, new manufacturers for an expensive breast cancer treatment as well as for human insulin, which is often too pricey for the poor to afford.

The moves are expected to foster more competition in the production of life-saving drugs that are now often too expensive now for low- and even middle-income countries.

“We expect to prequalify more and more of these very effective but very expensive medicines in the coming years,” said Dr Tedros.

Infectious diseases – Egypt Leading in Hepatitis C Elimination

Egypt, which has one the world’s highest burden of hepatitis C (HCV) infections, is now on track to be one of the first countries to eliminate the disease, noted Dr Tedros.

The national elimination strategy has included access to screening for 60 million people, and treatment for 3.7 million found to be infected. HCV screening has been combined with screening and treatment of hypertension and diabetes, as well as cervical and breast cancer – at primary health care level. “This is a truly stunning achievement, which could be a good lesson for other countries,” declared the WHO Director General.

Australia, France, Georgia and Mongolia are also moving towards Hepatitis C elimination, enabled by dramatic reductions in the price of direct-acting antivirals that offer 95% or greater cure rates. In terms of other leading infectious diseases, the Director General noted progress on the following:

  • HIV/AIDS – By the end of 2019, 77 countries had national policies that support HIV self-testing, helping to reach people at higher risk from HIV, including those who are most marginalized and not accessing health services.
  • Malaria – a pilot programme for the world’s first malaria vaccine was launched in Ghana, Malawi and Kenya. Argentina and Algeria were certified as malaria-free. And a WHO Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication both published milestone reports on what the world needs to do to eliminate malaria.  “Despite these gains, we continue to see more than 200 million cases of malaria annually. More than 400,000 people die each year from this preventable and treatable disease,” he said. In response, WHO and the RBM Partnership to End Malaria launched a new initiative to accelerate action on malaria in the 11 countries of Sub-Saharan Africa that are responsible for 70% of the global malaria burden.
  • Tuberculosis – 7 million people were diagnosed and treated for TB in 2018, up from 6.4 million in 2017. WHO’s aim for 2020 is 8 million.WHO has also developed new policies and guidelines to ensure better outcomes for those affected, including strong recommendations for the first time for fully oral regimens for the treatment of multi-drug resistant TB.
  • Polio – WHO certified the global eradication of wild poliovirus type 3, and launched a new Global Polio Eradication strategy with US $2.6 billion pledged by donors. Despite 173 cases of another wild polio virus type in 2019, as well as many outbreaks of vaccine devised outbreaks, mostly in Africa, the WHO Director General said he was “confident we are on our way to realizing our vision of a polio-free world.”
  • Neglected Tropical Diseases – Yemen and Kiribati eliminated lymphatic filariasis, and Mexico eliminated rabies. And for the first time, the number of human African sleeping sickness cases reported globally fell below 1000.
Antimicrobial Resistance – Drug Resistant Pathogens

WHO has strengthened collaboration with the Food and Agriculture Organization (FAO) as well as the World Organization For Animal Health (OIE) to make more rational use in agriculture and animal husbandry of antibiotics critical to  human health.

To stimulate research and development into new and much-needed medicines, WHO is working with the European Investment Bank on a new investment fund – “we will have more news about that in the coming months,” said Dr Tedros. “At the same time, we’re striving to protect the antibiotics we have by working with countries to strengthen infection prevention, stewardship, hygiene and water and sanitation. As part of that:

  • Some 135 countries have developed national action plans to combat drug resistant germs.
  • Some 90 countries have enrolled in the WHO global surveillance platform (GLASS) that will monitor how well countries are doing in fighting AMR, as part of a new Sustainable Development Goals indicator.
  • With support from the Governments of the Netherlands and Sweden WHO launched the Multi-Partner Trust Fund on AMR, to catalyse action in countries.

 

Image Credits: Wikimedia Commons: Pau Colominas, Twitter: @WHO, Twitter: @WHO.

This week’s Executive Board meeting features a heavy agenda of topics, including a review of progress in WHO’s flagship Universal Health Coverage (UHC) initiative; steps taken to confront the burgeoning coronavirus health emergency; and review of a first-ever WHO strategy to eliminate cervical cancer. Debates over the long-term challenges posed by drug resistant pathogens and access to medicines among the world’s poorest populations are also on the docket. Here is a rundown of the key items on the agenda, and what to watch:

Universal health coverage, with a focus on non-communicable disease prevention and management, is high on the priority list following the high-level political declaration on UHC signed at the United Nations General Assembly in October 2019.

Dr Tedros giving the “Report of the Director-General” at the 146th Meeting of the WHO EB

The EB is to review a progress reports on the implementation of the political declaration and provided guidance on a menu of policy options and interventions to promote mental health and well-being, reduce premature deaths from air-pollution related NCDs, and reduce the harmful use of alcohol. The EB will also be weighing on draft proposals for the first ever WHO strategy on cervical cancer elimination and an action plan for a “Decade of Healthy Aging.”

As the world teeters on the edge of a global epidemic due to a novel coronavirus that emerged late last year from Wuhan, China, the EB is also set to review work on public health preparedness and response. Influenza preparedness, polio eradication, and cholera control are main items up for discussion on the health emergencies agenda, but observers say the agenda may change with ongoing outbreak of the novel coronavirus, 2019-nCoV, which was just declared a “public health emergency of international concern” last week.

The EB will also recommend that a draft strategy for tuberculosis research and innovation be endorsed by the WHA in May, and will be providing guidance on the next iteration of a global strategies for immunization and combatting neglected tropical diseases.

Lastly, the EB will be debating access to medicines – focusing on the thorny issues surrounding innovation and intellectual property. Specifically, the EB will provide further comments on a global action plan for 2020 – 2022, which will be finalized for endorsement by the WHA. In related items, the EB will review a proposed workplan for the implementation of the Nagoya Protocol – an international agreement that provides guidance on sharing of genetic information – and approve the first ever strategy on digital health for 2020-2024.

The EB will also comment on the final methods of measuring outputs of 13th General Program of Work, and assess existing collaborations and a list of applications under the Framework of Engagement with Non-State Actors.

Appointment of Regional Directors For Europe and Africa

Dr Tedros welcoming Kluge into his new role as WHO Regional Director for Europe.

In actions taken on Monday, the EB opening day, Dr Hans Kluge was appointed as the new WHO Regional Director for Europe today, following former Regional Director Zsuzsanna Jakab’s promotion to Deputy-Director General of the WHO. Kluge, who previously directed the Division of Health Systems and Public Health at the WHO European Regional Office, explained that his platform would focus on “applying the best data and evidence, demanding increasing investment in health, strengthening health systems around people’s needs, and extending inclusive and non-discriminatory access to health care to all” in a WHO press release.

“Every child, every woman and every man in our beautiful and diverse Region has the right to health. I am committed to delivering united action for better health,” Kluge vowed.

Dr Tedros congratulates Matshidiso Moeti on her re-election as WHO Regional Director for Africa.

Dr Matshidiso Moeti was re-elected to a second term as the WHO Regional Director for Africa. Moeti’s platform will focus on “accelerating action” towards universal health coverage to increase access to healthcare “without financial hardship.”

Serving since 2015, Moeti said that she was “greatly honored” by WHO’s decision to reappoint her “as Africa increasingly faces the double burden of disease.”

Moeti added, “Thank you for the trust you have shown…The next five years in public health will be crucial in laying a strong foundation to reverse this burden.”

Image Credits: Twitter: @WHO, Twitter: @WHO.

In the wake of a World Health Organization declaration Thursday of an international public health emergency, there is growing uncertainty among disease control experts over whether even the drastic measures now being taken will be too little too late to contain the outbreak.

The concerns came as the reported case count of 9811 exceeded that of the 2002-03 SARS outbreak, and the fatalities rose to 213 dead. The United States and eight other countries issued stiff advisories against travel to China, while other countries and territories closed or restricted border entries, suspended visa authorizations, and cancelled flights.

However, such measures seemed to pale in the face of reports such as one published Friday by researchers from the University of Hong Kong, in The Lancet, which estimated that up to 75,800 individuals could be infected with the virus in the epicentre of Wuhan, a city of 10 million where the 2019-nCoV coronavirus first emerged in December 2019.

A medical team from Beijing’s Tsinghua (清华) University is sent to Wuhan to help fight the outbreak.

“In a manner of 3-5 weeks, countries around the world are going to be seeing outbreaks not that dissimilar to what we’ve been seeing in China,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch.

He warned that the dynamics of the outbreak were moving into “uncharted territory,” with the virus looking as infectious as the seasonal flu, and the current case-fatality approaching the alarming death rate seen in the 1918 Spanish Flu pandemic, which killed an estimated 50 million people worldwide.

The virus is also spreading silently among people with asymptomatic or mild infections who may not require or seek medical attention, reported the New England Journal of Medicine, in a letter Thursday. The letter, signed by over a dozen doctors from Munich’s University Hospital described the case of a 33-year old German businessman who fell ill with the virus and infected three other co-workers, shortly after meeting a Chinese business partner from Shanghai – who appeared healthy at the time, but became ill on her return flight home.

“The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” said the authors. Osterholm added that although it’s suspected asymptomatic patient are less infectious than those showing symptoms, experts are still determining how often asymptomatic transmission happens.

Although WHO’s Director General Dr Tedros Adhanom Ghebreyesus had said Thursday, during his announcement of the international public health emergency (PHEIC) that WHO did not recommend restrictions in trade or travel – which can cause “more harm than good” by hindering information-sharing and medical supply chains – his advice was being widely ignored.

The United States State Department Thursday issued a level-4 “do not travel” advisory for China – the highest level of travel restriction advisory. Canada, The United Kingdom, France, India, New Zealand, Finland, Australia, and Germany also have recommended against travel to China and particularly Hubei Province.

Egypt, Hong Kong, Russia, Malaysia, and Singapore took even more drastic measures to limit travel to and from China – including cutting flights, temporarily suspending visas, and even closing borders to the mainland – especially targeting travelers to and from Hubei.

On Friday, the Chinese Mission to the United Nations protested the increased travel restrictions in a Twitter post that said: “There is no reason for measures that unnecessarily interfere with international travel and trade. WHO doesn’t recommend limiting trade and movement.”

As for other measures governments should be taking to protect against 2019-nCoV, Osterholm told HPW that countries should be “preparing their health systems as much as they can” with an eye towards “protecting their healthcare workers.”

“Many hospitals in China that are reporting cases in healthcare workers do not have adequate protective equipment because they’ve run out,” said Osterholm.

He added that other countries should prepare for “a major increase in patients with respiratory disease like this who are not only going to need a bed, but some form of isolation so that they don’t transmit the virus to others. And that includes protecting healthcare workers.”

China Blamed For Cracking Down On Medical Reports Of New Virus in Early December

While the WHO Director General repeatedly praised China for its fast and efficient response, other media reports criticized the Chinese government for covering up details of the new virus in its early days in December – and hauling doctors who reported the initial emergence of the novel infections before police for punishment.

“In late Dec a Wuhan doctor said in a WeChat group that there were 7 cases of SARS connected to the seafood market. He was then scolded by the party disciplinary office, and made to sign a “I’m wrong” statement with police. He’s still in critical condition [from the disease],” reported Yaxue Cao, founder and editor of the respected ChinaChange.org website, which reports on Chinese civil society and the rule of law, in a Twitter thread that was circulating widely among Chinese and abroad.

“From the same report, we learned that Wuhan health authorities were having overnight meetings about the new “SARS” at end of Dec. Earlier today the Wuhan mayor said he was not “authorized” to publicize the epidemic until Jan 20. Q[uestion] is, “what went on during the 3 weeks in between?” said Cao.

Li Wenliang, doctor at Central Hospital of Wuhan, was one of the 8 people reprimanded by police for spreading “rumors” about the new viral disease.

“The first known coronavirus infections in the city of Wuhan presented symptoms beginning on December 1 and by 8 December, there was alarm in Wuhan’s medical circles. That would have been the moment for the authorities to act decisively. And act decisively they did – not against the virus but against whistle-blowers who were trying to call attention to the public health threat,” said New York Times journalist Nicholas Kristof, in an 30 January Op-Ed that related the authorities’ detention of a group of Wuhan medical doctors’ who had reported the emergence of an unidentified SARS-like virus on WeChat social media. One doctor who was among the group detained in January later posted his story and photo online, and is currently recovering from the disease himself.

Other reports have also confirmed that China was busy cracking down on journalists and social media about the virus in early and mid-January – at a time when more information might have strengthened the early response effort.  A Hong Kong news station said its reporters were approached by police during an interview in a Wuhan hospital in mid-January, and forced to delete their interviews and photographs.

Shanghai sources reached by Health Policy Watch also confirmed that the “government told Chinese citizens not to talk about the outbreak on social media” a couple of weeks ago.

Virus May Have Spread Too Far To Be Squashed Like SARS – Africa At Risk

Speculation was now growing over whether the virus could in fact be contained and effectively eliminated, as was the case with SARS in the 2002-2003 outbreak, or if it might enter permanently into the global chain of viral transmission – at least until a vaccine could be developed.

Already, the number of reported cases has outnumbered those of SARS, which reached 8,000, and also appears to be more insidiously infectious – although SARS still had a higher fatality rate.

And that is not including the asymptomatic cases, which may number as high as 75,000 in Wuhan alone, according to a study published Friday in The Lancet.

African countries, which have a deep and embedded network of links with China may be particularly at risk. Even though so far, no cases had been reported on the continent, several individuals suspected of infections had been quarantined. And asymptomatic cases could be slipping through borders undetected, experts feared.

It was the need to bolster response in low-income countries with weaker health systems and fewer resources was a key consideration in the WHO declaration of a PHEIC on Thursday, Dr Tedros repeatedly emphasized.

Already earlier this week, senior officials from African Union (AU) said screening and surveillance was being enhanced across the continent.

John Nkengasong, the director of African Centre for Diseases Control and Prevention warned that the continent stood at “risk” given its existing links with China at the moment.

“It is very possible that we have cases, but not recognised,” Nkengasong told reporters at the African Union (AU) headquarters in Addis Ababa.

Airports across the continent have increased screening for passengers, even as carriers announced flight cancellations. Kenya Airways halted flights to Guangzhou, backtracking on earlier statements that it would continue to monitor the situation. Ethiopian Airlines has also suspended its flights.

Some African countries were considering evacuating their citizens from the Chinese province – although only Morocco said it would actually evacuate 100 nationals. An estimated 4,600 African students are residing in Hubei Province, ground zero for the rapidly spreading virus.

As the virus struck just before the Chinese Lunar New Year, some students had already travelled back home to Africa before Wuhan and the Hubei region were placed under lockdown. But a large number of students still remain trapped in Hubei.

However so far, no cases have been reported among the returning students. Kenya’s Health Cabinet Secretary, Cecily Kariuki, Ministry of Health confirmed that a student who had been quarantined at Kenyatta National Hospital in Nairobi after returning to Kenya from Wuhan on 28 January was virus-free. Zweli Mkhize, South Africa’s Minister for Health said the country had screened 55 frequent travelers to China at points of entry, all who were found to be virus-free.

“We have remained vigilant on the development regarding the movement and behaviour of the viral infection across the world and we continue to engage with the international academic fraternity to better understand how the virus behaves,” Mkhize told News24.

However, with the climbing reports of confirmed cases, models suggesting tens of thousands more in China, and reports of asymptomatic carriers able to infect others within days, the chances of any country remaining virus-free for much longer were rapidly diminishing.

“Trying to control transmission of a virus like this, an influenza-like virus, is virtually impossible. So you can try to keep it out or minimize its arrival into your area into a very limited degree, but generally it’s going to make its way,” Osterholm told Health Policy Watch.

“In terms of what actions countries and governments can take right now, it’s really preparing their health systems as much as they can. And one of the things to prepare in fact is protection for their healthcare workers.”

Further Actions To Speed Vaccine Trials Announced

Meanwhile, as public health experts looked towards a new vaccine as a potential solution, the Oslo-based Coalition for Epidemic Preparedness (CEPI), announced its fifth collaboration in just a few weeks – to accelerate development of a vaccine against the new coronavirus.

CEPI said that it had signed a collaboration with CureVac AG, a biopharmaceutical company pioneering the field of mRNA-based drugs, aims to “safely advance vaccine candidates into clinical testing as quickly as possible, and would include US $8.3 million from CEPI to fund accelerated vaccine development, manufacturing and clinical tests,” according to a press release.

Rendering of the novel coronavirus, 2019-nCoV, created by the US CDC.

The coronavirus is made up of a single RNA chain enclosed in a spiky, spherical envelope.

Yesterday CEPI also launched a new call for proposals to rapidly develop and manufacture already proven vaccine technology that can be used against the new coronavirus. The call is rolling and open for two weeks.

CEPI also has three other collaborations underway with the Pharma company Inovio, The University of Queensland (Australia) as well as a third partnership involving Moderna, Inc. and the US National Institute of Allergy and Infectious diseases.

Grace Ren and Fredrick Nzwili contributed to this story

Image Credits: Twitter: @Tsinghua_Uni, Nandu News, US Centers for Disease Control and Prevention.

Some 50 million people in China were under quarantine as infections by the novel coronavirus first discovered in Wuhan accelerated rapidly, and new research suggested that it was far more infectious than previously thought.

China’s Minister of the National Health Commission acknowledged that “the epidemic had entered a grave and complex period,” as the country reported 2858 cases of the 2019-nCoV virus on Monday – three times that of Friday – along with 81 deaths.

World Health Organization Director General Dr Tedros Adhanom Ghebreyesus meanwhile rushed to Beijing to confer with authorities on their outbreak control efforts, and the Chinese sent top government officials to Wuhan – the epicentre of the outbreak.

Li Keqiang, Premier of the State Council of China, visited Wuhan on Monday to inspect and guide the outbreak control work.

A dozen countries outside of China had also confirmed cases of the novel coronavirus 2019-nCoV, including new confirmed cases in France, Canada and Australia, as well as in Nepal and Malaysia. Singapore, Japan, Taiwan and Thailand had already reported cases last week. As of Monday, more than 5000 suspected cases await clarification around the world, including 2 suspected cases in Zurich, Switzerland.

On Friday, a team of UK and US researchers published a preliminary research paper estimating that the real number of cases in Wuhan, a city of 10 million people at the epicentre of the outbreak, could be as high as 11,341 as of 21 January – in contrast to the official number of 440 on 23 January.

The paper, which has not yet undergone peer review, appeared on a health sciences preprint server, Medrxiv. Since last Tuesday, the number of diagnosed coronavirus patients in Wuhan has virtually doubled.

Their model further forecast that within 14 days, those infected could exceed 190,000 in Wuhan alone.

The model estimates that the virus’s reproduction number – e.g. the number of people one person can infect before being contained– relatively high at 3.6-4, is comparable to the infectious potential of the 2002-03 SARS coronavirus, which was 2-5. However, SARS was also deadlier with a case-fatality rate around 9%, while the current virus has a mortality rate of around 2%.

Other recent estimates have been more conservative. A team of  Harvard researchers estimated the viral reproductive number at 2-3.3 in a preliminary assessment also published over the weekend, while WHO officials had on Thursday estimated it at 1.4- 2.5.

However, there was broad scientific agreement that a much larger reservoir of people were becoming infected, and rapidly transmitting the virus, without necessarily showing symptoms themselves, as per another study published in The Lancet by a Chinese research team. The team, which examined data from the first 41 patients that had been admitted to hospitals in Wuhan, estimated that the virus incubation period is only 3-6 days and it can cause serious pneumonia-like symptoms even in healthy people, and not just older individuals with underlying health issues. A number of the

Chinese officials acknowledge grave concerns

The researcher’s concerns were echoed by the Chinese Minister of the National Health Commission, Ma Xiaowei, who spoke Sunday at a press conference captured by the government-owned CCTV network.

“According to recent clinical data, the novel coronavirus seems to be more infectious,” Xiaowei said. “Currently the transmission of the epidemic is rather speedy which has posed some challenges and pressures on the prevention work. Experts have predicted that the epidemic has entered a rather grave and complex period.”

Ma further added that the epidemic was still in an “early and sporadic phase.” Therefore, given the increased pace of the outbreak, he predicted “it may last for some time.”

“It is likely that there will be a rise of the number of cases in the coming period,” warned Ma.

However, as stringent outbreak control measures implemented in the area around Wuhan and “top-level” public health emergency responses take effect throughout the country, “the epidemic intensity of the outbreak will go down.”

Such outbreak control measures include the expansion of travel restrictions to more cities over the weekend, with over 50 million Chinese citizens now under lockdown. By Monday, three military medical teams composed of some 450 doctors and nurses from Shanghai, Chongqing, and Xi’an had been deployed to Wuhan to help hospitals manage the overwhelming influx of patients.

Meanwhile, medical equipment companies ramped up production as demand for medical devices surged. Workers in over 30 factories around China worked through the annual Lunar New Year celebration to produce face masks, thermometers, and other tools for the outbreak response.

The national Chinese government increased funding for the outbreak response to approximately US $1.2 billion, according to a statement from the National Health Commission.

Coronavirus Outbreak in the Legacy of SARS:

As case numbers seem to double every day, a mixture of fear, solidarity, and hope permeate the lives of Chinese citizens over what is normally a celebratory holiday season.

One Wuhan resident currently abroad told HPW that the state of emergency imposed by this new coronavirus is giving citizens chilling flashbacks to life during the 2002-2003 SARS epidemic.

“My mom was isolated during the SARS period in 2003 for a month and a half. She didn’t have the virus, just some similar symptoms,” the person said. “I don’t have much memory of it since I was only 6, but my family keeps telling me how terrifying it was back then.”

“My parents are staying safely at home, mainly because they are the most vulnerable people that have the highest possibility to be infected. My dad currently has diabetes and high-blood pressure, and all the obesity-related diseases you can think of. Thus, it’s really dangerous for him in the current environment.

Added the person, “The most worried case is my aunt’s family, who are isolated at home because my aunt’s mother recently passed away from swine flu. It’s really terrifying given how close the timeframe is, so that’s why they chose to isolate themselves spontaneously in that way. My family was not aware of how bad the situation was when the government released the first news.”

Just this morning, the source said, a person in their aunt’s apartment complex was suspected of being sick with the coronavirus. Neighborhood committee members visited the person fully equipped in protective gear, but ultimately chose to isolate the person in their home rather than send them to the hospital.

“They did not sanitize the public area in the apartment complex at all,” the source protested.

Still, most people in Wuhan are “really behaving” and complying with the quarantine, and Chinese around the world have come together to participate in the emergency response.

Videos of whole apartment complexes singing “Wuhan, add oil!” – a common Chinese encouragement – in unison are trending on Weibo, China’s Twitter equivalent. Volunteer groups both in the country and abroad are banding together to send emotional and material support to the besieged city.

Said another Chinese citizen currently abroad who has participated in one of the many donation drives, “We just teamed up and fight for this, united all the resources we have, and donate them to Wuhan.”

Image Credits: China Government Network.