IMF
Established in the wake of the Second World War, the IMF has come under increasing criticism that it is not fit for purpose in the climate change era.

The International Monetary Fund’s (IMF) climate change policies are obstructing access to the financing required to prepare for and adapt to climate change in countries on the frontline, a new report by a task force representing finance ministers from climate-vulnerable nations said.

The Task Force on Climate, Development and the International Monetary fund – the group of experts and NGOs that authored the report on behalf of over 70 countries – said the IMF is “falling short of the leadership necessary to accelerate a global and just transition.” 

The report sets out a simple premise: Without access to the money necessary to adapt to climate change, climate-vulnerable countries will be trapped in economic free-fall, unable to recover before the next natural disaster strikes. This makes the IMF’s focus on its core mission –  the pursuit of debt and deficit reduction – self-defeating, as if climate change destroys national economies, nothing will be left to repay outstanding debts. 

“There is no time to waste,” the report said. “The macroeconomic implications of climate change are [already] causing acute stress amid multiple crises in the world economy.”

The task force’s report points to a variety of failings in the IMF’s current policies, including the fund’s over-reliance on carbon pricing to offset the costs of a green transition, hyper-focus on fiscal austerity as a prerequisite for loan eligibility, and lack of flexibility in approaching different national environmental and economic contexts.

Carbon pricing won’t cut it 

The IMF’s one-track focus on carbon pricing as a means to fund a global green transition is the most fundamental criticism laid out in the report. 

Its authors calculated that not only can carbon pricing alone not raise enough money to pay for the trillions of dollars in necessary climate investments, but if the inbuilt incentive to carbon pricing – imposing a cost to steer companies towards reducing their carbon footprint – works, then money generated will continue to fall over time. 

The IMF disputed the report’s finding that it is exclusively reliant on carbon pricing, saying it is open to considering different policy approaches in view of the massive financial investments required to address climate change. 

This is backed up by IMF support for so-called “disaster clauses” which allow countries to freeze debt repayments as they recover from natural disasters. But lived examples of countries like Pakistan show the IMF still has a long way to go. 

Last August, when a third of Pakistan was underwater, its government renegotiated the terms of its debt repayment to the IMF, averting a default that would have collapsed the country’s economy. The $1.17 billion loan pulled the economy from the brink of disaster but came with the requirement to implement harsh austerity policies, shifting the burden of the country’s debt to ordinary Pakistanis.

At a press conference on the sidelines of a United Nations fundraising effort for Pakistan, Secretary General Antonio Guterres called the international financial system “morally bankrupt”. 

“The system routinely denies middle-income countries the debt relief and concessional funding needed to invest in resilience against natural disasters,” he said. “The present system is biased.”

Today, some 60% of developing countries are in what the IMF classifies as “critical” debt. 

“Get out of the way”: private sector investment 

Gigawatt Global’s solar field in Rwanada.

The report, like the vast majority of high-level international discussions on climate financing for developing countries, zeroes in on climate financing mechanisms that pull from national coffers in wealthy countries. 

But some in the private sector say the World Bank and IMF are getting in the way of private money, too, potentially sidelining trillions of dollars from the fight to achieve green transitions in low- and lower-middle income countries. 

Gigawatt Global, a frontier green energy developer that recently completed a 7.5 MW solar project in Burundi and has a 700 MW pipeline of projects in 10 African countries and Gaza, had a solar field project to provide 20 megawatts of energy to Liberia blocked by the World Bank in 2021, seven years into its development. 

“They were afraid that Liberia didn’t have the expertise to negotiate the balance price with a private sector player,” Gigawatt Global CEO Josef Abramovitz told Health Policy Watch in an interview. When Abramovitz told the World Bank his company would accept a benchmarked price for its solar power set by the World Bank, rather than one negotiated with Liberia’s government, nothing changed. 

“They were not nimble,” Abramovitz said. “Other than in blocking every sector.”

While the World Bank does not have a mandate to block private investments outright, the extreme reliance of low- and lower-middle income countries on its development funding give it powerful influence over decisions made by governments. 

“A simple solution [to unlock private investment] would be to make an exception for climate related investments,” Abramovitz said. 

The Road to Bridgetown

Mia Mottley, Prime Minsiter of Barbados, began campaigning for the Bridgetown Initiative at climate talks in Glasgow in 2021.

The task force’s report comes at a time when much of the world – even top-brass at the IMF and World Bank – is in agreement that the international financial system needs to change.

The cascading series of floods, droughts, hurricanes and fires blazing through climate-vulnerable countries has left them in dire need of financial assistance to recover from natural disasters. Yet their debt burdens to institutions like the IMF leave countries constantly behind the ball, unable to get back to square one before the next calamity strikes.   

Proposals to overhaul the two powerful institutions gained steam at the United Nations climate summit (COP27) in Egypt last year, where language calling for reforming the multilateral development banks was included in the final outcome document. No concrete steps have yet been taken to change the way the banks work.

An ambitious blueprint to retool the multilateral development banks set out by Barbados’ Prime Minister Mia Mottley last year – known as the “Bridgetown Initiative” – has received broad support from G7 nations like the US, France and Germany.

In addition to reforming the World Bank and IMF, Mottley’s plan proposes a more flexible sovereign debt architecture to improve liquidity in low- and middle-income countries in order to prevent fiscal crunches, mobilizing private finance for climate adaptation in vulnerable countries, and wider sharing of rich country’s financial resources. 

Documents obtained by Devex indicate that the Bridgetown agenda will be the guiding document of a development finance summit co-hosted by French President Emmanuel Macron and Mottley in Paris this June.

In two weeks, IMF and World Bank leaders will meet in Washington D.C. for the first time since the spotlight hit the institutions in Sharm el-Sheikh.

A historic vote for climate justice

Iririki Island, Vanuatu

The needle also shifted on climate justice this week as the United Nations General Assembly voted by consensus to request an opinion from the International Court of Justice (ICJ) on countries’ legal obligations to protect current and future generations from climate change.

The resolution submitted by the island state of Vanuatu and co-sponsored by 132 countries asks the world’s highest court to decide on the legal consequences for the “acts and omissions” of states that cause climate harm to others, especially small island nations like Vanuatu on the front lines of climate change.

In just three days at the start of March, Vanuatu was struck by two category-four hurricanes.

“The earth is already too hot and unsafe,” former Vanuatu Prime Minister Bob Loughman said as he declared a climate emergency on the island in May last year. “We are in danger now. Vanuatu’s responsibility is to push responsible nations to match the action to the size and urgency of the crisis.”

Loughman’s successor, Alatoi Ishmael Kalsakau, emphasized that the request to the ICJ was only a first step.

“This is not a silver bullet, but can make an important contribution to climate change, climate action,” Kalsakau said. 

ICJ opinions are not binding, but the General Assembly vote lends voice to mounting frustrations about the slow pace climate finance is being made available to the most affected countries – near all of whom have nothing to do with causing the climate crisis in the first place.

United Nations Secretary General Antonio Guterres said the opinion would “assist the General Assembly, the UN and Member States to take the bolder and stronger climate action that our world so desperately needs.” 

For the young generations living on the front line of climate change, the reality that their ancestral homes might disappear is already setting in.

“I don’t want to show a picture to my child one day of my island,” Cynthia Houniuhi, president of Pacific Islands Students Fighting Climate Change and native of the Solomon Islands told the General Assembly. “I want my child to be able to experience the same environment and the same culture that I grew up in.”

Image Credits: IMF, UNCTAD.

Iririki Island, Vanuatu. The south Pacific island is severely threatened by climate change.

The United Nations General Assembly (UNGA) resolved this week to ask the International Court of Justice (ICJ) to clarify the obligations of member states under international law “to ensure the protection of the climate system and other parts of the environment from anthropogenic emissions of greenhouse gases”.

The request came via a resolution passed by UNGA on Wednesday that was championed by Vanuatu, a collection of islands in the south Pacific that are under severe threat of climate change.

The resolution asks the Hague-based ICJ to provide a legal opinion on the legal consequences for states if, by their acts and omissions, they “have caused significant harm” to the climate and environment with respect to other states, in particular, small island developing states, and people affected by these adverse effects.

Major polluters such as the US and China could be sued for damages if the ICJ finds that they have violated their obligations in terms of various international agreements, including the UN Charter, the UN Framework Convention on Climate Change, the Paris Agreement and the UN Convention on the Law of the Sea.

In terms of the 2015 Paris Agreement, countries agreed to aim to limit warming to 1.5 degrees Celsius (2.7 degrees Fahrenheit) with an upper limit of 2 degrees Celsius (3.6 F).

The resolution was driven by Vanuatu, supported by Antigua & Barbuda, Costa Rica, Sierra Leone, Angola, Germany, Mozambique, Liechtenstein, Samoa, Micronesia, Bangladesh, Morocco, Singapore, Uganda, New Zealand, Vietnam, Romania and Portugal. It had the support of 133 nations.

“We in the Pacific live the climate crisis. It is our present and it is our future that is being sold out. The vote in the UN is a step in the right direction for climate justice,” said Cynthia Nouniuhi, president of the Pacific Island Students Fighting Climate Change (PISFCC) after the vote.

 

“If and when given, such an opinion would assist the General Assembly, the UN and member states to take the bolder and stronger climate action that our world so desperately needs,” UN Secretary General António Guterres told the General Assembly before the resolution was adopted.

The ICJ is expected to hold public hearings and could take up to two years to issue its advisory opinion.

Ahmed Ouma, Acting African CDC Director – told reporters Thursday that Marburg virus case count for Equatorial Guinea was unchanged – even after Ministry of Health reported 4 new cases.

Authorities in Equatorial Guinea have confirmed another four cases of deadly Marburg virus disease, bringing the total number of cases for the country’s current outbreak to 13 – although some sources warn that the case count could be much higher, due to the lack of lab capacity and reporting delays.

In a Twitter post late Thursday evening, the Ministry of Health reported that here had been”13 positive cases since the beginning of the epidemic; two hospitalized with mild symptoms, one patient recovered; 9 deceased” as of Tuesday, 28 March.

The ministry’s post came just hours after World Health Organization Director General Dr Tedros Adhanom Ghebreyesus challenged the country to report on new cases officially, stating: “WHO is aware of additional cases, and we have asked the government to report these cases officially to WHO.”

Tedros added that the dispersion of already confirmed cases, which are spread across the provinces of Kié-Ntem, Litoral and Centro Sur, areas some 150 kilometers apart, also is “suggesting wider transmission of the virus.”

CDC Acting Director unaware of new Marburg case count during Thursday briefing

However, at an African Centers for Disease Control press briefing on Thursday, CDC Acting Director Dr Ahmed Ouma, seemed to be unaware of the new numbers, telling Health Policy Watch that the case count remained unchanged.

“We are not aware, as Africa CDC, that any country is holding back any data of cases that have been confirmed for any outbreak, including Marburg virus disease,” Ouma said at the briefing, referring to the earlier reported count of 8 reported cases.

Marburg
Historical geographic distribution of Marburg virus infections in human and bat populations, which traditionally harbour the disease, as of July 2022.

As of late Thursday evening, neither WHO’s Headquarters, nor WHO’s African Regional Office had updated their official statistics on the outbreak either – with WHO’s latest news report on the eight cases associated with Equatorial Guinea’s outbreak dating to March 23.

Meanwhile, other sources were suggesting that there could be three times as many cases – if 20 probable cases,  which had not been confirmed, were counted.

The data lag highlighted the continuing political and technical challenges faced by both Africa CDC and the global health agency in reporting fast-moving outbreaks in real time.

Under the International Health Regulations (IHR), governments are required to share information regarding new cases of pathogens that pose an outbreak risk. However the data often has to go through political channels before it is actually released, admitted Dr Abdi Rahman Mahamud, WHO’s acting Director, Alert and Response Coordination, at WHO’s global briefing on Wednesday. And that leads to delays in public reporting by WHO and other official bodies on vital information. 

Public health experts becoming alarmed

Elsewhere, public health experts expressed alarm over the potential mushrooming of cases in remote settings where the technical difficulties of reporting on cases could potentially be compounded by official reluctance to acknowledge the outbreak’s real spread.  “Keep and eye on the Marburg virus outbreak” tweeted Isaac Bogoch, of the University of Toronto. “Cases near border regions & in urban areas.. some cases are distant from others, with no known epidemiological link. This has the potential to grow.”

‘One Health’ approach needs more attention to prevent spread of new and re-emerging pathogens

Speaking at the WHO briefing on Wednesday, Tedros also stressed that the spread of the Marburg virus within both Equatorial Guinea, as well as Tanzania, is yet “another reminder” of the linkages between environmental, animal and human health, which requires a more holistic “One Health” approach to prevent pathogen spread.

He repeated a joint call made by WHO together with the heads of the Food and Agriculture Organization (FAO), the UN Environment Programme (UNEP), and the World Organisation for Animal Health (WOAH) to prioritize “One Health” approaches “by strengthening the policies, strategies, plans, evidence, investment and workforce needed to properly address the threats that arise from our relationship with animals and the environment”.

The risk of virus spillover from animal habitats to humans is becoming all the more common in the face of massive logging and deforestation or other degradation of wildlife areas, encroachment of human habitats in forested areas, as well as hunting of wild animals and bush meat consumption.  All of those processes are rapidly accelerating in the face of road building, oil, gas and mineral exploitation, and the expansion of industrial farms or  agricultural plantations in Africa, Asia and the Americas, environmental critics say – increasing the intermingling of disease carrying rodents, bats, birds and wild mammals, with people.

“A ‘One Health’ approach will be essential for preventing viruses from spilling over from animals to humans,” he stated, adding “that’s how many outbreaks have started, including HIV, Marburg, Ebola, avian influenza, mpox, MERS and the SARS epidemic in 2003”.

Tedros said that he was pleased to see “One Health” included as a key principle in the “zero draft” of a future agreement on pandemic prevention, preparedness and response, currently under negotiation.

– with Paul Adepoju reporting from Ibadan, Nigeria 

Image Credits: WHO, Paul Adepoju , World Health Organization .

Unlocking the power of social media (illustrative)
Unlocking the power of social media (illustrative)

Since the outbreak of the COVID-19 pandemic in December 2019, an explosion of information and misinformation burned across the Internet. Health experts and officials had a choice: To turn a blind eye to the fake news being shared on social networks or to take action themselves and use these portals to disseminate essential information rapidly.

In Tanzania, initially one of the world’s most COVID skeptic countries although it made a big U turn later, Asad Lilani chose to do the latter. Lilani mounted an Africa-wide “One-by-One Campaign” using social media influencers to spread the message, in association with Access Challenge, a public health non-profit with branches in Nigeria and Dar Es Salaam.

“Social media is important in health, today and in the future,” he told Health Policy Watch in a video interview.

During the height of COVID, Lilani recruited “micro and macro influencers,” who were popular on different social and traditional media channels.

“We don’t just look for the biggest numbers of followers or engagement, but who the influencers are, as well, and what kinds of personalities they have,” he said. At the same time, the aim is undoubtedly reach. The team found influencers with as many as 10 million followers and people from multiple sectors – sports, music, business, etc.

One-by-One's Twitter page
One-by-One’s Twitter page

Access Challenge armed these influencers with information about the virus, vaccination and how to stay safe and let them loose to share the messages.

“Being a COVID influencer gave these influencers a sense of pride and unity,” Lilani said. “These were people who wanted to use their platforms for good.

UnitedHealth awards to reward positive use of social networks during COVID

Votes from more than 60 countries so far

Lilani, representing Access Challenge, is now one of the co-hosts of this year’s UniteHealth Social Media Awards, which will showcase individuals and organisations who used social media to strengthen collective understanding of the pandemic and evidence-based responses.

The awards, to be announced in May, are meant to say “thank you” to those who gave their time and expertise to create a positive influence on social media platforms, said Prof Jeffrey Lazarus, a health researcher at the Barcelona Institute of Global Health, and co-founder of the awards. Winners will be featured in a series of events and activities coinciding with the World Health Assembly that will help increase their social profile.

Nominations for award candidates are being solicited around the world on the open access platform which anyone can join. The platform is co-sponsored by UniteHealth and eight other non-profit organizations engaged in public health and health-related media work – including Health Policy Watch.

So far, more than 5,000 votes have been cast from more than 60 countries, with the highest levels of engagement from Mexico, the United Kingdom, Nigeria, Canada, Thailand and Spain, according to UniteHealth. So far, nominees include government officials, NGO workers, scientists, community activists, doctors, nurses, and journalists.

The COVID-19 Social Media Awards cover seven categories, ranging from technical areas of pandemic policy to understanding the virus, and COVID-19 vaccines. There is also a ‘Young Leader’ category to recognize the contributions of social media users and influencers under the age of 30.

“The interest in this year’s awards is remarkable,” said Lazarus. “It demonstrates how people in every corner of the world relied on getting credible information – and tackling frequent misinformation about COVID-19 – through their social media networks.”

The pandemic struck at a time when levels of trust in governments, and related to that, trust in health institutions, already was being called into doubt as a result of the creeping influence of ‘new media’, and with that, fake news. This sowed doubts about how governments responded, due to what motivations, and whether the responses were sound. In the context of the COVID pandemic, a vocal minority questions the effectiveness of public health approaches, from mask-wearing to social distancing and even vaccination.

On the one hand, skeptics took to social networks, sometimes spreading misinformation or causing confusion. Other the other, health institutions and experts also used social networks for disease surveillance, to disseminate health information, identify and combat misinformation and detect or predict COVID-19 cases.

Either way, users turned to social media networks to seek and share accurate health-related information and gain support.

“We cannot ignore social media, whether we like it or not,” Lilani observed. “Young people are on social media. We did a survey and saw that in Tanzania, for example, most people got information about COVID from social media. For example, some people said they stopped looking at the news and only checked Twitter.”

‘Knowledge changes attitudes’

Yulia Komo works with AFEW International, another co-host group and a Dutch-based non-profit focused on human rights in the health context of Eastern European and Central Asian (EECA) countries.  She is focused on Armenia, Azerbaijan, Georgia, Belarus, Moldova and Ukraine. Many years ago, she received a degree in communications but that was not her primary focus.  Moreover, when the pandemic hit, she was on maternity leave.  But she saw how panicked people were and realised she had the tools to take action.

“As a multi-language speaking mother, when COVID started, I realised that I had access to Zoom and could play a role in bringing NGO leaders together,” she told Health Policy Watch.

Komo started hosting regular calls with her colleagues to identify populations in need, exchange tips, and check information from each other’s countries. Because of her background in social impact campaigning, she took the information she learned and shared it on the networks.

Not only did she post openly, but she also engaged in chats and forums and used Facebook Messenger to raise people’s knowledge levels and decrease their fear.

“Knowledge changes attitudes and leads to more balance behavior,” she said. “People were panicking, and I found that social media was one of the best ways to help them. Also, we could use social media to find out what people may need and then ensure they received it, such as safely getting them medicines for chronic illnesses when they may not have had access because of the pandemic.”

Today, through AFEW, she has a team examining the use of social networks during pandemics or other crises and trying to identify basic communication concepts that can become a toolkit for the next emergency.

“Social media is a viral source to spread information,” Komo said. “Our role is to ensure that our virus – positive information – spreads faster than the actual COVID or other viruses so people are not scared.”

‘We started engaging religious and traditional leaders’

Nigeria’s Zakari Osheku, executive director of PHC Initiative Africa, has a similar take. One of the 300 award nominees so far, Osheku said that in his country, a large younger population relies on social media for their information. So during the pandemic, “we felt we could reduce tension and spread the right information by using social media platforms.”

Calming the community was incredibly challenging in his country, where he said fake news dominated the public sphere. According to Osheku, “there were a lot of misconceptions, even amongst the elite or educated people.”

He said people felt the COVID-19 vaccines would cause infertility, would put a tracking microchip in them and more.

“We started engaging religious and traditional leaders, as well as putting out messages to debunk the myths associated with the vaccine,” Osheku said.

Zakari Isiaka Osheku's profile page
Zakari Isiaka Osheku’s profile page

The team used Twitter, Facebook and Instagram to push their messages.

“Firstly, during the COVID-19 pandemic, we used social media to disseminate information and clarify misconceptions around COVID-19 and vaccines,” Osheku said. “Secondly, social media can monitor the spread of the virus by tracking conversations and posts related to COVID-19. This can help public health officials and researchers identify trends and hotspots and develop targeted responses.

“Thirdly, social media can be used to engage the public in pandemic response efforts, including promoting public health messages, encouraging social distancing, and sharing resources and support for those affected by the pandemic,” he continued. “Social media has also been used to provide mental health support during the pandemic, with many individuals turning to social media for emotional support, advice, and resources.”

Nominations and voting for the awards remain open until the end of 20 May 2023, and the winners will be announced on 13 June 2023. To take part, visit www.socmedawards.com/2023.

Image Credits: Erik McClean via UniteHealth.

 

The European Union (EU) has prioritised “common good” proposals and “legal provisions” in its initial text-based proposals for the pandemic accord, according to a rationale published alongside these proposals.

Both documents were initially published late Monday on the Delegation of the European Union to the UN and other international organisations in Geneva page of the EU website but removed on Tuesday.

The two documents are still publicly available elsewhere on the EU site along with a host of caveats about the status of the proposal:

“We believe that a mindset of working towards ‘the common good’ will help us to move forward towards finding convergence and towards adoption of the new agreement in the very short time-frame we have available,” the rationale states in relation to the 63-page proposal.

In addition, it has crafted legal provisions “with concrete obligations” for parties to the agreement and “commitments for cooperation” that will make a real difference to pandemic preparedness and response (PPR).

 “Provisions that will not merely be beautiful words on paper, but that will actually change the world for the better when it comes to PPR and ensure that we, collectively, will be much better equipped both in terms of avoiding future pandemics and in terms of being able to respond should they still hit,” according to the rationale.

Equitable access

The EU proposes that “high-income countries and other parties in a position to do so” ensure the “availability and affordability in access to counter-measures”. Related to this, parties shall “make all possible efforts” to ensure that availability and affordability commitments are built into agreements with manufacturers that get R&D support from member states.

While the zero draft developed by the Intergovernmental Negotiating Body’s (INB) Bureau suggests that 20% of pandemic counter-measures should be allocated to the World Health Organization (WHO) for distribution to member states that cannot afford to buy these, the EU has not committed to any percentages.

However, it proposes that if a countermeasure is in scarce supply, parties need to ensure that manufacturers reserve an as-yet undefined percentage of their production on a quarterly basis for sale to low-income countries and middle-income countries.

A WHO “partnership” should determine “the equitable allocation of the reserved countermeasure quantities”. Meanwhile, the Countermeasures Expert Committee shall issue pricing guidelines, including on not-for-profit and tiered pricing, for pandemic countermeasures.

Pathogen sharing

The EU proposes “free and rapid access to, and sharing of, pathogen samples, pathogen genomic sequence data and other relevant information related to pathogens obtained through their surveillance and detection activities”.

If a countermeasure is developed making use of this sharing, its developer needs to be held to commitments to ensure “general availability and affordability”.

Strong focus on ‘One Health’ 

The EU has proposed a raft of new clauses dealing with One Health, covering “farms, transport of animals, live animal markets, trade in wild animals and in veterinary practices both for food-producing and companion animals”.

Member states should be compelled to develop, strengthen and maintain the capacity to “detect, identify and characterize pathogens presenting significant risks, including pathogens in an animal population presenting a zoonotic risks, and vector-borne diseases”.

Measures to identify risks and prevent zoonotic spillover need to be applied to animals’ water and feed hygiene, infection prevention and control measures, biosecurity and animal welfare support measures.

Governance and Accord structure 

The EU also proposed structural changes to the Accord, opining that the zero-draft resembles a “compilation” from member states and “does not resemble an international legally binding agreement – neither in structure nor in content”, according to the EU.

“The EU believes that our collective task of adopting a new agreement in record time will be greatly facilitated if the First Draft will resemble the typical shape of an international agreement – both in terms of structure and in terms of the actual provisions,” it noted, making a number of structural changes to do this.

It also proposes a Conference of the Parties “as the main body responsible for promoting and supporting the implementation of the accord” be established by the WHO’s Director General within six months of the adoption of the agreement – slated for next May at the 2024 World Health Assembly.

It also proposes the establishment of a pandemic Countermeasure Expert Committee, which will make determinations such as whether a countermeasure is in scarce supply.

Negotiations on a global pandemic accord resume next Monday at the fifth INB meeting. The meeting agenda is an extension of the fourth INB meeting that ended on 3 March, as it will continue with the text-based negotiations. Member states are rushing to meet the 14 April deadline for the submission of textual proposals.

Image Credits: Alexandre Lallemand/ Unsplash .

A hospital corpsman prepares a flu vaccine
A hospital health worker prepares a vaccine

The World Health Organization (WHO) said that it is poised to begin clinical trials of three Marburg disease vaccine candidates if Tanzania and Equatorial Guinea, both struggling with outbreaks of the deadly disease, give the green light.  About 2000 finished doses are available from vaccine developers and could be administered to the identified contacts of victims of the deadly disease, WHO officials said at a press conference on Wednesday.  

“The WHO Committee has now reviewed the evidence for four vaccines. Trial protocols are ready and our partners are ready to support the trials,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General said at the briefing.  “We look forward to working with the governments of both countries (Tanzania and Equatorial Guinea) to begin these trials to help prevent cases and deaths now, and in future outbreaks.” 

The 2000 doses readily available are distributed among the active vaccine candidates in WHO’s pipeline: Sabin Vaccine Institute has 750 doses ready in vials, the University of Oxford has 1000 doses in vials and Public Health Vaccines has several hundred doses ready to be used immediately. 

This does not include vaccine products available in bulk, which will be available for use later in 2023. 

Explaining the steps forward, Dr Ana Maria Henao-Restrepo, the head of WHO’s R&D Blueprint team, said that the vaccines would be administered in a Phase 3 ”ring vaccination trial”. A ring vaccination trial involves administering vaccines to the close contacts of the infected individual. 

“It’s not that we are saying there are millions of doses out there, but based on our experience, we have sufficient doses to make rings of cases around these infected individuals,” she said. “Typically, Marburg outbreaks are small. The largest was about 300 cases. In the background of these numbers, the developers are working to put the bulk vaccines into vials and to increase their capacity.” 

No global stockpile of vaccines for Ebola Sudan strain or Marburg virus

Doses remain limited insofar as WHO does not yet have a global stockpile of vaccines against Marburg virus disease, or the Sudan strain of Ebolavirus – partly because the vaccines have not yet been approved by regulators for use. 

Tanzania reported its first ever Marburg virus disease outbreak on 21 March 2023, in which it confirmed eight cases, including five deaths. The remaining three infected individuals are receiving treatment. The authorities have identified 161 contacts of the infected individuals and are monitoring them. 

In Equatorial Guinea, nine cases have been confirmed so far across three provinces of the country. While the first three cases were reported in February, subsequent cases were confirmed in March. The distribution of the nine cases is spread across the Kié-Ntem, Litoral and Centro Sur provinces. 

“These three provinces are 150 kilometers apart, suggesting wider transmission of the virus. WHO is aware of additional cases, and we have asked the government to report these cases officially to WHO,” Tedros added.

Initial test results negative for Marburg in Burundi

After three persons died due to a mystery illness in a span of three days in Burundi, the WHO said that the initial test results of samples taken from these individuals have returned negative for Marburg virus disease. 

“In Burundi, we are aware of nine alerts and three of them are already dead. Initial samples were taken when they were alive and showed negative for Marburg, ebola and dengue,” Dr Abdi Rahman Mahamud, director of alert and response coordination department at the WHO said. 

He added that the Burundi government has established sensitive surveillance in the country and that the samples taken have been sent to an advanced laboratory in Uganda for further investigation. 

“As of now, the initial tests are negative, but we know very well there’s a long differential diagnosis. And until we have confirmation from the lab in Uganda and the WHO collaborating centers, all diagnoses are still in place.” 

New COVID-19 variant reported from India

As India reports an increase in COVID-19 cases in the past few days, the WHO said that a new subvariant of the Omicron variant of SARS-CoV-2 has been identified in the country. 

Named XBB.1.16, the newest subvariant Omicron is very similar to the XBB.1.5 subvariant, but is more infectious and has potential increased pathogenicity. 

Covid-19
Dr Maria van Kherkhove, WHO’s Covid-19 technical lead.

“There are only about 800 sequences of XBB.1.16 from 22 countries. Most of the sequences are from India, and in India, XBB.1.16 has replaced the other variants that are in circulation. So this is one to watch. It’s been in circulation for a few months,” Dr Maria van Kerkhove, the technical lead for COVID-19 at WHO said. 

India reported 2151 new cases of COVID-19 in the last 24 hours, which is the highest the country has seen in five months.

Reiterating that COVID-19 is still a Public Health Emergency of International Concern (PHEIC) at a global level, Dr van Kerkhove said that it is imperative to remain vigilant. 

The agency’s Strategic Advisory Group of Experts on Immunization (SAGE), meanwhile, said that additional COVID-19 vaccine boosters are not recommended for individuals with low to medium risk, if they are already vaccinated and boosted once. 

For “high priority” categories, SAGE recommended that an additional booster dose be administered once in six to 12 months after the previous dose. 

Image Credits: Flickr.

According to an article recently published in the Lancet, some 10% to 25% of the USD $7 trillion spent on healthcare globally every year is lost because of corruption – an amount that exceeds the investments needed to achieve universal healthcare by 2030.

To understand how corruption affects healthcare worldwide, the Global Health Centre at the Geneva Graduate Institute organised a panel to discuss how the phenomenon manifests itself and what can be done to fight it. The event was introduced by Vinh-Kim Nguyen, Co-Director at the Centre, and moderated by Priti Patnaik, Founder of Geneva Health Files.

“Corruption is a disease of the health system, as it is well described in the Lancet,” said David Clarke, acting head of the Health Systems Governance Unit at WHO, Geneva. He explained that agencies focused on criminal activities have traditionally dealt with corruption. However, in recent years the WHO has felt the need to work on fighting it from a healthcare perspective.

“There’s a significant range of activities that could be regarded as corruption,” he noted, mentioning informal payments, absenteeism, data manipulation, lack of transparency, falsified medical products, embezzlement, and bribery. “All of them distort health systems and negatively affect how people receive health services.”

Clarke mentioned how in some countries, up to 80% of non-salary funds in healthcare never reach local facilities and an estimated 140,000 children per year lose their life because of corruption.

The goal of WHO is to fight corruption by creating more transparency and accountability, specifically in the health systems, he pointed out.

According to Dr. Mushtaq Khan, a professor of Economics at the SOAS University of London, fighting corruption is complicated because each of its manifestations might have multiple causes.

“Lack of resources is one of the factors driving corruption,” he pointed out. “If you are in an under-resourced hospital, then there is excess demand, and people have to pay to get seen.”

In addition, he highlighted how political clientelism and patronage represent another driver of corruption.

“The way patronage is used to create jobs is not directly related to resource scarcity,” Khan said, adding that a weak rule of law is critical in allowing corruption to thrive.

Corruption in the health sector
Corruption in the health sector

Case study: Moldova

During the panel, Dr. Ion Bahnarel, a former Deputy Minister of Health in the Republic of Moldova and the Head of the Department of Hygiene, University of Medicine and Farmacie “Nicolae Testemițanu,” presented the efforts that his country is making to fight corruption.

“Our government has initiated several reforms,” he explained. “They include creating anti-corruption structures in local and state institutions.”

Bahnarel said that all medical institutions now offer a system for employees and patients to report episodes of corruption anonymously. In addition, an Ethics Committee has determined new rules and procedures for health organisations for transparency and accountability.

According to Dr. Monica Kirya, a Senior Adviser at U4 Anti-Corruption Resources Centre in her native Uganda, “it is safe to say that you could die if you do not have money to pay a bribe to move up the queue to see a doctor.”

Kirya resides in Norway where U4 is based.

Kirya emphasized that health workers are victims as much as perpetrators of corruption.

“It’s well known that in many developing countries such as Uganda, health workers are extremely poorly paid,” she said. “This is one of the drivers of absenteeism, informal payments and other corruption that health workers engage in to make ends meet.”

Kirya explained that it is essential to pay attention to the structural factors of the system that enable corruption to thrive, such as bans on public service recruitment.

“These bans on public service recruitment started as structural adjustment programs in the 80s and 90s to reduce government expenditure, and they remain in force from time to time as a way to balance the public budget,” she pointed out.

According to the expert, these bans favour political patronage being used in the recruitment and appointment of health workers.

“Because health is a decentralised service in Uganda, and recruitment is often done at the local government level, district politicians and civil service administration use recruitment to extort money from medical graduates,” she said.

While all experts highlighted how fighting corruption effectively is complicated for various reasons, they also suggested how it should be done.

“It is essential to have evidence-based analysis,” said Khan. “This is what should inform reform, while often, the reform is driven by abstract models of what drives corruption, which might be somewhat relevant to the advanced countries’ experience but not to the developing countries’ experience.”

Everyone agreed that to offer better health services defeating corruption is crucial.

“If you had a problem that affected your financial well-being, that was a threat to your life and was a threat to the way that you live, wouldn’t you do something about it? This is what corruption is all about,” said Clarke. “Unless we address corruption, much of our work on strengthening our health system will be a waste of time.”

Image Credits: Screenshot, Screenshot, Geneva Graduate Institute.

SAGE chairperson Hanna Nohynek

Additional COVID-19 vaccine boosters are not recommended for people at low to medium risk of the disease who have been vaccinated and boosted once, according to the World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE).

SAGE recommends an additional booster six to 12 months after the last dose for “high priority” people, depending on factors such as age and immuno-compromising conditions.

It defines the high-priority group as older adults, adults with significant comorbidities (eg diabetes and heart disease); those with immunocompromising conditions, including children from six months and older (eg people living with HIV and transplant recipients); pregnant women and frontline health workers.

New SAGE chair, Finland’s Dr Hanna Nohynek, said that the recommendations were “updated to reflect that much of the population is either vaccinated or previously infected with COVID-19, or both”.

“Countries should consider their specific context in deciding whether to continue vaccinating low-risk groups, like healthy children and adolescents, while not compromising the routine vaccines that are so crucial for the health and well-being of this age group,” she added.

SAGE, which met last week, also stressed that its recommendation for additional boosters applied in the current context only, and was not a recommendation for annual COVID-19 vaccine boosters.

It also urged countries to base decisions to continue vaccinating the low-priority group, primarily healthy children, on disease burden and cost-effectiveness “considering the low burden of disease” in this group.

This comes as vaccine manufacturers prepare to hike the cost of vaccines. Moderna and Pfizer are both planning an price increase of around 400% – from around $26 directly to the US government to $130 for the private market when government-sponsored vaccines are phased out.

Measles concern

Nohynek noted that every region of the world was reporting measles outbreaks, an indication that routine vaccinations for children had slipped during the COVID-19 pandemic.

SAGE will be reviewing the evidence “for vaccinating infants below six months and during pregnancy” which might lead to policy change, she added.In 2021, an estimated 25 million children missed their first dose of the measles vaccine, the worst level since 2008.

Impact of malaria vaccine

Dr Kate O’Brien

Dr Kate O’Brien, WHO’s Director of Immunization, Vaccines and Biologicals, said that the introduction of the RTS,S malaria vaccine in some of the worst affected malaria regions in Ghana, Kenya and Malawi, had resulted in a 10% reduction in all-cause mortality among children eligible to receive the vaccine.

“This is really a very remarkable impact of introducing this vaccine,” said O’Brien, stressing that it was only being introduced in areas with very high malaria rates.

However, there is high demand for the vaccine, with at least 28 countries expressing interest in introducing the vaccine, but supply remains highly constrained. For that reason, SAGE recommends flexibility in the immunization schedule in interval between the last two doses.

Four doses are currently indicated for children, from five months of age with doses administered monthly. 

The new R21/ Matrix-M malaria vaccine developed by Oxford University, “is in the late stages of clinical development, and we hope to review the final file in the coming months”, said Nohynek.

Identifying priority pathogens for new vaccines

WHO is in the process of defining regional priority targets for new vaccine development for non-epidemic pathogens. 

Early results indicate that tuberculosis, HIV, and antimicrobial-resistant pathogens such as Klebsiella pneumonia are important across all regions. Streptococcus pyogenes (Group A), Shigella, and respiratory syncytial virus (RSV) were identified as important by four or more regions, as was Plasmodium falciparum (malaria) by the African region.

There are “several candidate vaccines for TB in late-stage clinical trials” with the potential for multiple vaccines to receive regulatory authorization within three years, according to SAGE.

The candidate vaccine M72/ AS01E is showing the most promise 

Image Credits: Samy Rakotoniaina/MSH.

INB co-chair Precious Matsoso and Dr Tedros at the fourth INB meeting.

Negotiations on a global pandemic accord resume next Monday at the fifth meeting of the World Health Organization (WHO)’s Intergovernmental Negotiating Body (INB) amid calls for more attention to be paid to a One Health approach, and less to organised misinformation campaigns.

The meeting agenda is an extension of the INB meeting that ended on 3 March, as it will continue with the text-based negotiations, with member states rushing to meet the 14 April deadline for the submission of textual proposals.

In the three weeks since the fourth INB meeting ended, the INB Bureau has held three informal meetings to shed more light on a range of potentially tricky issues including the global supply chain, One Health, technology transfer and know-how and pathogen sharing.

Quadripartite Commitment to One Health

One of the key questions facing those crafting the pandemic accord is how to ensure that the One Health approach is central.

Monday saw the first annual meeting of the Quadripartite group – the WHO, Food and Agriculture Organization (FAO), United Nations Environment Programme (UNEP), and World Organisation for Animal Health (WOAH).

The leaders of the four bodies called for the One Health approach to “serve as a guiding principle in global mechanisms, including in the new pandemic instrument and the pandemic fund to strengthen pandemic prevention, preparedness and response”.

“Recent international health emergencies such as the COVID-19 pandemic, mpox, Ebola outbreaks, and continued threats of other zoonotic diseases, food safety, antimicrobial resistance (AMR) challenges, as well as ecosystem degradation and climate change clearly demonstrate the need for resilient health systems and accelerated global action,” according to the Quadripartite leaders.

The Quadripartite leaders urged all countries and key stakeholders to prioritize One Health in the international political agenda, strengthen their own national One Health policies, strategies and plans and accelerate their implementation.

They also called for strengthening and sustaining prevention of pandemics and health threats “at source” by targeting activities and places that increase the risk of zoonotic spillover between animals to humans.

More misinformation

However, alongside the negotiations, there has been an escalation of misinformation claiming that a pandemic accord will rob member states of their sovereignty, spread mostly by the same sources that pushed COVID-19 anti-vaccine messages.

“We continue to see misinformation on social media and in mainstream media about the pandemic accord that countries are now negotiating. As I said last week, the claim that the accord will cede power to WHO is quite simply false. It’s fake news,” said WHO Director-General Dr Tedros Adhanom during the body’s weekly press briefing last Friday

“Countries will decide what the pandemic accord says, and countries alone. And countries will implement the accord in line with their own national laws. No country will cede any sovereignty to WHO.”

The sources of this misinformation have tended to be the same as those that opposed COVID-19 vaccines.

According to a report in late 2021 by the US- and UK-based Center for Countering Digital Hate (CCDH), almost two-thirds of anti-vaccine messaging on Facebook and Twitter could be traced to just 12 prominent individuals.

These include Robert F. Kennedy Jnr,who campaigns against vaccines for children; Joseph Mercola, who sells dietary supplements and false cures as alternatives to vaccines, and ‘intuitive medicine’ proponent Christiane Northrup, who has also been linked to the conspiracy group, Q-Anon. This misinformation had reached 59.2 million English speakers by December 2020. 

Last week, Twitter owner Elon Musk, who has 132.7 million followers, poured fuel on the fire by commenting that countries should not “cede authority” to the WHO.

This prompted Tedros to call him out directly on Twitter, along with another prominent anti-vaxxer who calls himself Kanekoa, who has also promoted the idea that the pandemic accord seeks to remove power from member states.

However, some right-wing politicians in the US, Australia and Europe are also claiming that the WHO is seeking to usurp countries’ sovereignty with the pandemic accord, while Russia and China have already shared their concerns about this issue in various WHO forums.

Tanzanian health workers being trained to tackle with the Marburg outbreak.

The World Health Organization (WHO) hopes to be able to fast-track the testing of various Marburg candidate vaccines following outbreaks of this rare and deadly viral haemorrhagic fever in Tanzania and Equatorial Guinea.

“WHO is leading an effort to evaluate candidate vaccines and therapeutics in the context of the outbreak,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

“The developers are on board the clinical trial protocols are ready. The experts and donors are ready. Once the national government and the researchers give the green light,” he added.

Four or five candidate vaccines already have doses ready for human trials, WHO’s Dr Ana Maria Restrepo told a media briefing.

Restrepo, who heads the WHO’s R&D Blueprint team, said that a Marburg consortium had been working together since the Equatorial Guinea outbreak had been confirmed in January.

“We are working through a platform that is cooperative that involves all the regulatory and ethics committees in Africa,” stressed Restrepo.

There are 28 potential candidate vaccines for Marburg, according to WHO R&D Blueprint. The virus is from the same family as Ebola and has an 88% fatality rate.

“Marburg belongs to the same family of viruses as Ebola, causes similar symptoms, transmits between humans the same way and like Ebola, has a very high fatality ratio,” warned Tedros.

“In the meantime, we’re not defenceless. Careful contact tracing isolation and supportive care are powerful tools to prevent transmission and save lives.”

Tanzania reports first-ever outbreak

Meanwhile, Tedros said that Tanzania had confirmed eight cases, including five deaths, by testing samples at a WHO-supported mobile laboratory set up last year “to prepare for viral haemorrhagic fever outbreaks, including Ebola and Marburg”.

National responders, WHO and the US Centers for Disease Control and Prevention (CDC)  “have been deployed to the affected region to carry out further investigations, monitor contacts and provide clinical care,” added Tedros.

A week ago, Tanzanian health authorities initiated a frantic search for the cause of the mysterious disease that had claimed several lives in the country. 

Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.

Tanzania Chief Medical Officer Tumaini Nagu said multiple isolation units to help monitor and isolate people displaying symptoms are now operational. 

“The government is closely monitoring the situation and taking appropriate measures to contain the disease,” Nagu told Health Policy Watch.

Tanzania Chief Medical Officer Tumaini Nagu

Lack of capacity

Equatorial Guinea has struggled to identify cases because of a lack of laboratory capacity but had confirmed nine cases with a further 20 probable cases. 

The first case from the eastern province of Kié-Ntem was confirmed in early February by the Institute Pasteur in Senegal. Two other people from Kié-Ntem province were diagnosed by a mobile laboratory at the Regional Hospital of Ebibeyin. 

A month later another case was identified in Litoral province in the western part of the country that was epidemiologically linked to a confirmed case in Kié-Ntem, while cases have also been confirmed in Centro Sur province.

The wide geographic distribution of cases and uncertain epidemiological links between cases “suggests the potential for undetected community spread of the virus”, according to WHO.

The provinces that share international borders with Cameroon and Gabon, and the WHO is working with those countries identify any potential cases, Tedros confirmed.

Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control.

At the Africa CDC press briefing on Thursday, acting director Dr Ahmed Ouma, said the center is providing Equatorial Guinea with needed technical support, infrastructural development and capacity building required to test for Marburg virus disease. 

“The government is responsible for the testing and to release those results to us,” he said, adding that the turnaround time for result is currently five days and this is being improved upon by the authorities and partners.

“The capacity is still being built,” he said. “The main lab is still not fully functional. We are finalizing calibration this week. And that main lab should be up and running in a few days as soon as the calibration and capacity building is done. And I think before the middle of next week when all that has been completed, they should be up and running. And that will make it easier to do more samples and [will be] a little bit faster.”

Meanwhile, health authorities are expecting genomic analysis results soon to see whether there is any connection between the outbreaks in Equatorial Guinea and Tanzania.

Dr Matshidiso Moeti, WHO Regional Director for Africa, said that gene sequencing analyses are being conducted in both countries to reveal any possible connections for both outbreaks. “We know that the world is interconnected in many ways, [but] the likelihood is not that high,” Moeti told journalists.

“The confirmation of these new cases is a critical signal to scale up response efforts to quickly stop the chain of transmission and avert a potential large-scale outbreak and loss of life,” said Moeti. “Marburg is highly virulent but can be effectively controlled and halted by promptly deploying a broad range of outbreak response measures.”

At the Africa CDC press briefing on Thursday, acting director Dr Ahmed Ouma, said the center is providing Equatorial Guinea with needed technical support, infrastructural development and capacity building needed to test for Marburg virus disease. 

“The government is responsible for the testing and to release those results to us,” he said, adding that the turnaround time for result is currently five days and this is being improved upon by the authorities and partners.

“The capacity is still being built,” he said. “The main lab is still not fully functional. We are finalizing calibration this week. And that main lab should be up and running in a few days as soon as the calibration and capacity building is done. And I think before the middle of next week when all that has been completed, they should be up and running. And that will make it easier to do more samples and [will be] a little bit faster.”

Image Credits: Muhidin Issa Michuzi.