TB activists attend a community assembly in New York’s Battery Park to call for more investment in TB vaccines and treatments.

The United Nations (UN) is hosting three multi-stakeholder meetings in New York on Monday and Tuesday on tuberculosis, pandemic prevention, preparedness and response (PPPR) and universal health coverage (UHC).

They are aimed at getting the views of non-state actors in preparation for UN High-Level meetings in September, starting with pandemic preparedness on 20 September, followed by UHC, then TB on consecutive days.

On Sunday, a community assembly was held in New York’s Battery Park to call for more investment in TB, the second-biggest infectious disease killer after COVID-19. It included the public reading of the TB vaccine R&D investment open letter signed by almost 1200 individuals and organisations around the world.

“We have seen before that investing in averting TB deaths can bring significant economic benefits! Every dollar invested in this effort returns an average of $43 dollars, making it a smart and impactful investment for communities and economies alike,” said Kate O’Brien from We are TB USA.

“We need new TB vaccines to end TB, mitigate the impact of COVID-19 on the global TB response, and control the spread of drug-resistant TB, a key driver of antimicrobial resistance. Yet, the only available TB vaccine is the century-old Bacillus Calmette-Guérin (BCG) which is largely ineffective in adolescents and adults,” said Keyuri Bhanushali, a TB survivor and activist from Mumbai, India.

“Let’s invest in TB vaccine R&D to finally put an end to this devastating pandemic.”

Lack of consultation over pandemic and UHC meetings

However, some civil society participants told Health Policy Watch that there had been little consultation about participation, particularly in relation to the pandemic and UHC meetings, including over speakers on the panels and the procedures to be followed.

Many organisations had invested in bringing affected people from other parts of the world to the UN meetings yet they were unsure of whether they would be able to speak from the floor. In addition, they questioned why organisations’ statements would be loaded onto the website of the World Health Organization (WHO), not that of the UN.

In response, Paulina Kubiak, spokesperson for the President of the General Assembly (PGA), told Health Policy Watch that there had been “an open registration process on the UN Indico website for stakeholders to participate in the multi-stakeholder hearings”, with registration open from 2 March to 7 April. 

“The panellists were selected in accordance with the relevant resolutions of the General Assembly which require the PGA to organize the multi-stakeholder hearings with the support of the WHO and other relevant partners (Stop TB Partnership in the case of TB and UHC2030 in case of UHC),” said Kubiak.

“Written statements can be submitted by participants until May 15 and will be available on the WHO website in due course (pending the volume of submissions).”

The meetings are being broadcast live on the UN webTV:

Image Credits: UN Photo/Manuel Elias.

WHO Director General Dr Tedros Adhanom Ghebreyesus declares an end to the COVID-19 global public health emergency – but warns disease remains a threat.

The COVID global health emergency is over, said WHO Director General Dr Tedros Adhanom Ghebreyessus at a press conference on Friday.  His declaration came more than 39 months after WHO first declared a public health emergency of international concern (PHEIC) on 30 January 2020 over a mysterious respiratory virus that emerged in Wuhan, China but quickly overcame countries around the world.

Speaking at a media briefing, the WHO DG warned that the disease remains a threat along with multiple other stressors threatening global health and security – from climate change to weak health systems. Taken together, these could soon lead to yet another pandemic if not forcefully addressed.

He called upon political leaders to move quickly to finalise the terms of a new Pandemic Accord being negotiated by WHO member states, as well as agreeing to revisions in WHO’s existing International Health Regulations so as to “transform that suffering” of COVID 19 into “meaningful and lasting change” with a “commitment to future generations that we will not go back to the old cycle of panic and neglect that left our world vulnerable.”

He noted that “COVID-19 turned our world upside down” with a reported death toll of seven million deaths but a likely actual death toll of close to 20 million.

And “the virus is here to stay” he stressed, warning countries not to let down their guard.

Litany of damage

Coronavirus lockdown in a Roma community in Romania in May 2021. Poverty made social distancing and basic hygiene rules difficult, if not impossible, for billions.

In the warm-up to his announcement, the WHO DG reviewed the litter of global damage wrought by the virus that ripped like a hurricane through societies worldwide in early 2020:

“COVID has been so much more than a health crisis,” Tedros observed.  “it has caused severe economic upheaval, shaving trillions from GDP, disrupting travel and trade, shattering businesses and throwing millions into poverty.

“It caused severe social upheaval, with borders closed, movements restricted and schools shut, and millions of people experiencing loneliness, isolation, anxiety, and depression.

“COVID-19 has exposed and exacerbated political lines within and between nations.|

“It has eroded trust between people, governments and institutions, fueled by a torrent of myths and misinformation. And it has laid bare the searing inequalities of our world – with the poorest and most vulnerable communities the hardest [hit] and the last to receive vaccines and other tools.”

But in light of the steady downward trend in COVID-related mortality, brought about by a weakening virus, growing population immunity and increased vaccination rates, WHO’s COVID-19 Emergency Committee “recommended to me that I declare an end to the Public Health Emergency of International Concern (PHEIC), ” he said.  He was referring to the emergency provisions of WHO’s International Health Regulations (IHR) that legally obligate WHO members states to act on public health threats.

The Emergency Committee made its recommendation following a meeting Thursday in Geneva – the 15th such gathering since the SARS-CoV2 virus was first reported in Wuhan in early January 2020.

COVID is over as a global health emergency – but not as a global health threat

An Italian border guard checks the temperature of an arriving airline passenger in April 2020, as the first wave of the COVID pandemic crested.

“It’s therefore with great hope that I declare COVID-19 over as a global health emergency. However, that does not mean COVID-19 is over as a global health threat,” Tedros cautioned.

“Last week COVID-19 claimed one life every three minutes – and that’s just those that we know.  As we speak thousands of people around the world are fighting for their lives in intensive care units. And millions more continue to live with the debilitating effects of post COVID-19 conditions.

“This virus is here to stay. It’s still killing. And it’s still changing; the risk remains of new variants emerging that cause new surges in cases. So the worst thing any country could do now is to use this news as a reason to dismantle the systems it has built or to send the message to its people that COVID-19 is nothing to worry about.”

“This is not a signal for us to lower our guard”: Didier Houssin, head of the WHO COVID Emergency Committee

“This is not a signal for us to lower our guard,” added Didier Houssin, head of the WHO COVID Emergency Committee that had met Thursday and issued its recommendation to WHO for the COVID state of emergency to finally be lifted.

What the announcement does reflect, however, is that “it’s time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases,” Tedros said.

With that in mind, he said that he would deploy a “never used” provision in the WHO International Health Regulations, to establish a standing COVID Review committee to make and update recommendations to countries about management of the virus on an on-going basis.

Declaration was not unexpected

A WHO declaration on the end of the global health emergency had been anticipated for sometime, Tedros and other WHO officials speaking at the Friday briefing admitted.

“I emphasize that this is not a snap decision,” Tedros said. “It’s a decision that has been considered carefully for some time, planned for, and made on the basis of careful analysis of the data.”

WHO’s release Wednesday of an updated COVID-19 Global Strategic Preparedness, Readiness and Response Plan (SPRP) 2023-2025” had fueled speculation among seasoned WHO-watchers that an announcement was imminent.

Is the COVID Pandemic Over?

The document was billed as a guide for managing COVID “in the transition from an emergency phase to a longer-term, sustained response”.

Alongside reducing circulation of the SARS-CoV-2 virus and diagnosing and treating COVID-19, a third objective of the plan is to “to support countries as they transition from an emergency response to longer-term sustained COVID-19 disease prevention, control and management”, the WHO DG stated in a foreword.

Worldwide, countries have also gone back to near normal – with lockdowns and social distancing giving way to packed cafes and theatres.  Masking remains visible in some venues like airports and subways – but at a voluntary bare minimum.  And government travel and emergency decrees have now been lifted in even the most COVID-wary nations, like Japan and China – the latter of which saw a big wave of cases in late 2022 after intense public protests led to the removal of most domestic restrictions.

Coincidentally or not, the United States is also set to announce an end to its national COVID emergency next week, on 11 May.  That will see the lifting of most federal COVID vaccine mandates for groups like health workers – even though the virus still remained the fourth leading cause of death in the US in 2022.

Transform the suffering into meaningful and lasting change

But even as so-called ‘normalcy’ returns, Tedros urged global health leaders to rapidly conclude negotiations on a strong Pandemic Accord, as well agreeing to amendments in the existing WHO International Health Regulations (IHR), to avoid repeating the mistakes of the COVID pandemic once more.

“One of the greatest tragedies of COVID-19 is that it didn’t have to be this way,” Tedros said. “We have the tools and technologies to prepare for pandemics better, to detect them and then to respond to them faster and to mitigate their impact.  But globally, a lack of coordination, a lack of equity, and the lack of solidarity meant that those tools were not used as effectively as they could have been.  Lives were lost that should have been.

“We must promise ourselves, and our children and grandchildren that we will never make those mistakes again,” he said describing the draft treaty and IHR revisions as representing a “commitment to future generations that we will not go back to the old cycle of panic and neglect that left our world vulnerable.

“… If we all go back to the way things were before COVID-19, we will have failed to learn our lessons.”

Huge strides made should not be lost

Mike Ryan, WHO Executive Director, Health Emergencies

WHO’s Health Emergencies Executive Director Mike Ryan, echoed those sentiments noting how the COVID pandemic saw huge strides made in the expansion of national disease surveillance systems, laboratory testing, clinical care, and access to life-saving tools from new vaccines to oxygen.

“The challenge is really how to we keep up this momentum,” he observed, “because it’s not only important for COVID, it’s important for other diseases that are in circulation.

“We need the world to get into a preparedness mode,” he added.  “We can’t just keep responding and responding and responding.  We have to get the inequities out of our system.  We saw people in this pandemic literally bargaining for oxygen cannisters on the streets of major cities. This is the 21st century.  Is this what we want to witness in the next pandemic?

A COVID patient breathes in life-saving oxygen outside an overcrowded New Delhi hospital at the height of India’s COVID surge in 2021.

“We saw family members physically fighting to get their loved ones into a hospital bed.  We saw people die before they got to the emergency room. That’s the reality of our preparedness.  We talk about technology but we can’t just use technology to get out of the mess we’re in.  We have to address our systems. We have to address how we govern.  We have to address how we finance.”

Negotiating teams have just a year to reach broad consensus

Wholesale markets in Asia and Africa may often sell wild animals captured or bred for food consumption; SARS-CoV2 may have emerged from such a Wuhan market.

Within WHO, there are two member state groups leading negotiations on a draft pandemic accord and revisions in existing WHO health emergency (IHR) rules. The two bodies, the Intergovernmental Negotiating Body (INB) and the IHR Working Group have just one more year to complete their work in line with a mandate to bring draft agreements to the World Health Assembly by May 2024.  They are planning a joint meeting soon in an effort to sort out what topics, among the multiple issues facing negotiators, would better be handled in one instrument as compared to the other.

Together, they face a formidable task in reaching WHO member state consensus over a raft of issues – from measures to ensure stricter monitoring and reporting by countries of emerging threats to more sustainable financing of developing country health systems and more equitable distributions of vaccines, medicines and other vital health tools.

Along with that, climate change, ecosystem destruction, and poorly regulated wildlife markets and trade are constantly increasing the risks of zoonotic spillover of new and resurgent diseases from animals to humans. And these are problems that the health sector cannot effectively address without the active consent and collaboration of economic and environment sectors.

Appeals to UN General Assembly to show leadership

Ellen Johnson Sirleaf, former Liberian president and former co-chair of the Independent Panel.

The problems go beyond what WHO alone can handle, some leading advocates have asserted, calling for the UN General Assembly to play a more active role going forward. The UN General Assembly is scheduled to hold a high level meeting on pandemic preparedness, prevention and response on 20 September – with a civil society stakeholder meeting set for next week.

Among the voices calling for more UN-wide leadership are Helen Clark and Ellen Johnson Sirleaf, former co-chairs of the Independent Panel on Pandemic Preparedness and Response, which issued a scathing report to WHO in May 2021. On Thursday the two former co-chairs issued a new “Road Map”  calling for more assertive action by the UNGA alongside WHO.

“Bold political choices to protect the world” are needed, the report states, including UN-wide agreement on stronger international pandemic rules, equitable countermeasures and an independent monitoring body working alongside an “authoritative WHO”.

In terms of finance, at least US$10.5 billion annually is needed to support low- and middle-income countries to bring health systems preparedness up to par.  So far, only about 10% of that has been committed to a new World Bank-hosted Pandemic Fund. Debt relief for overstretched developing nations and innovative forms of climate and sustainable development finance also are critical to pandemic prevention, the report states, referring to the “Bridgetown Agenda” championed by Mia Mottley, prime minister of Barbados.

“At a time of difficult geopolitical divide, the UN General Assembly High-Level Meeting presents an historic opportunity to demonstrate the power of multilateralism and political leadership, and choose human collaboration to overcome the threat of pathogens that could materialise anywhere, anytime,” said Helen Clark, former Prime Minister of New Zealand.

“We will face new pandemic threats. The UNGA must draw on the hard lessons from COVID-19 and honour the memory of the many millions of people who have died, to commit to comprehensive reforms that leave no gaps in the system this time,” said Johnson Sirleaf, former president of Liberia.

Image Credits: Thomas Hackl/Flickr, Flickr, Peter Griffin/Public Domain Pictures.

INB co-chair Precious Matsoso

Equity and intellectual property (IP) rights are – unsurprisingly – the most important and trickiest issues facing countries negotiating the terms on which the next global pandemic will be addressed.

This emerged at a World Health Organization (WHO) briefing on Thursday addressed by Precious Matsoso, co-chair of the Intergovernmental Negotiating Body (INB) crafting a pandemic accord, and Dr Ashley Bloomfield, co-chair of the working group on amendments to the International Health Regulations (IHR).

Matsoso said that IP was being raised in discussions about how to “stimulate innovation” and “facilitate access” to pandemic-related products, including vaccines and medicines.

Meanwhile, Bloomfield said that a key discussion in the IHR working group was how to “effectively put equity into operation through the regulations”, particularly aiming at improving member states’ capacity to address future pandemics. 

“[The discussions] are around the funding for that, and they are around access and benefit sharing and, in particular, access to the technologies that are derived from the sharing of viral samples – in particular vaccines, but also treatments,” said Bloomfield, adding that these were also issues being discussed by the INB.

Combined processes

There is only a year left for both to complete negotiations on both a pandemic accord and changes to the IHR, the only globally binding rules to guide international disease outbreaks. Both the draft accord and proposed amendments are due to be presented to the 2024 World Health Assembly.

As there is significant overlap in the work of the INB and the IHR working group, they are currently planning a joint meeting, said Matsoso.

“Member states in a number of meetings have raised this issue of the overlaps and duplications, and they’ve called on us to bring these processes closer and ensure that we can delineate those areas that belong to different parts,” said Matsoso.

“We see this as a continuum because, you can imagine, if you’re in a country, and you’re hit with a pandemic and you have to refer to both these instruments once they’re adopted, there must be a systematic way in which they are followed,” said Matsoso.

“Our task is both bureaus (technical leads for the two processes)  is to help member states to organise this in such a way that there’s coherence and the synergy, but also a continuum so that they don’t see [the two instruments] as separate processes.”

Dr Ashley Bloomfield, co-chair of the IHR working group.

Bloomfield added that the bureaus “have met several times already together, virtually, and our last meeting most recent meeting was just a couple of days ago”.

At that meeting, bureau members had started to “shape up this request that we’ve got from both processes from the member states to hold a joint session to start to address these issues that we have in common”. 

For some member states, the same representatives are negotiating in both the INB and the IHR working group. Meetings have thus usually been organised “adjacent and back to back” to help these representatives, primarily from African countries and small island states.

Pandemic oversight

One of the weaknesses of the IHR is that there is insufficient monitoring, oversight and compliance with the regulations.

The US, Africa region and the European Union have all made proposals to address this gap, said Bloomfield.

“There’s quite a lot of similarity between those proposals so there’s work underway to see if we can get a single convergent proposal,” he said. 

“The tenor of the discussion we have had is very much of the flavour that we should be looking to how we can incentivize and support countries to implement the IHR in full and to comply with their obligations, rather than sanction,” he added.

Matsoso said that, within the INB, proposals had been made about peer review mechanisms, adding that “punitive measures have not been shown to work anywhere… But there must be some accountability mechanisms”.

National sovereignty

Panellists expressed surprise at the ongoing mis-and disinformation about how the pandemic negotiations would result in member states losing their national sovereignty to the WHO.

WHO Principal Legal Officer Steven Solomon described the two processes as “some of the most transparent in the history of WHO’s work on global health instruments”. 

WHO Principal Legal Officer Steven Solomon

“Member state-driven means that member states decide and, in the context of preparing instruments like this it means specifically that member states, countries, make the proposals,” said Solomon.

“Countries do the drafting country, do the negotiating, the work and finding consensus. Countries make the decision on what is to be agreed and then, under the Constitution, countries adopt whatever the outcome might be in the World Health Assembly,” he added. 

“Even at that point, this does not mean acceptance by a country after adoption in the Health Assembly, which is a formal act. Then countries individually must consider and decide whether they accept what was adopted in the Health Assembly. So there’s nothing automatic that happens in terms of the entry into force of whatever will be adopted at the Health Assembly.  Countries themselves will decide to accept or not the outcomes of that process of the assembly.”

Bloomfield also stressed that, despite the “myths and disinformation”, “member states are in the driving seat and they are the decision-makers”.

“It’s not really an issue that is troubling the discussions we’re having in the working group because all those people are fully aware of the mandate they have from their governments.”

RSV
On Wednesday, GSK’s Arexvy vaccine became the first in the world to be approved for use against the respiratory syncytial virus (RSV).

The US Food and Drug Administration (FDA) has approved the first-ever vaccine for respiratory syncytial virus (RSV). The single-shot vaccine intended for use in adults aged 60 or older represents the culmination of six decades of research to protect the world from RSV.

With the green light from the FDA on Wednesday, GSK’s Arexvy vaccine could be available as early as this fall, officials said. The speed of the vaccine’s public rollout hinges on receiving the final stamp of approval from the US Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices, which will meet in June.

RSV is a virus that kills over 100,000 children under the age of five every year. While RSV’s cold-like symptoms are often viewed as non-threatening to adults, the virus kills around 14,000 adults in the United States every year and has an annual global death toll of 160,000 people.

“Today’s approval of the first RSV vaccine is an important public health achievement to a disease which can be life-threatening,” said Dr Peter Marks, who heads the Center for Biologics Evaluation and Research at the FDA.

The US FDA approval follows its review of the data from an ongoing randomized control trial of nearly 25,000 older adults. Results from the study published in the New England Journal of Medicine in February showed the GSK vaccine reduced the risk of developing lower respiratory tract disease, which is caused by the virus, by 83%. It also reduced the risk of contracting severe lower respiratory tract disorder by 94%.

Dr Len Friedland, director of scientific affairs and public health at GSK, acknowledged the occurrence of several serious adverse side-effects throughout the study, but said they were evenly split between the group that got the vaccine and the one that received the placebo. Researchers would continue to monitor the vaccine’s safety profile as the trial moves forward, he added.

The most common minor side effects observed in the participants were injection site pain, fatigue, muscle pain, headache and joint stiffness.

A battle since the 1960s

Scientists have been trying to figure out a way to combat RSV since the 1960s. Between 1966 and 1968, a promising clinical trial for an early RSV vaccine candidate went badly wrong, killing two young children involved in the trials. Many more children vaccinated as part of the study needed to be hospitalized, with some suffering from more severe forms of RSV as the vaccine backfired.

It wasn’t until years later that scientists discovered that the protein inside the RSV virus shifts between two shapes, similar to the coronavirus SARS-nCOV-2. The shape-shifting nature of the protein meant scientists were trying to hit a moving target. The protein eluded the aim of scientists until 2013 when researchers from the National Institutes of Health (NIH) found a way to freeze the protein in one of its two shapes, allowing the development of vaccines targeted at the now immobile protein.

While RSV has long been a regular virus in the winter seasons, it gained attention when thousands of young children and older adults began filling up hospitals during the summer seasons in 2021 and 2022.

In 2020, most of the world was still under the COVID-19-induced lockdown and following precautionary measures like using face masks and frequently washing hands. As those precautionary measures were lifted, vulnerable groups of people began contracting RSV and ending up in hospitals.

Other RSV vaccines in the queue

The US FDA is set to decide on another RSV vaccine by the end of May. This vaccine is also targeted at older adults and is manufactured by Pfizer. If approved by the FDA, Pfizer’s vaccine will be up for final approval for public use alongside the GSK vaccine when the CDC’s Advisory Committee on Immunization Practices meets in June.

Another vaccine by Pfizer is also awaiting approval from the FDA by the end of August. This vaccine targets infants susceptible to RSV and, if approved, will be administered to pregnant women.

Moderna and Bavarian Nordic are also currently in phase-3 of clinical trials for their RSV vaccine candidates for older adults.

Image Credits: NIAID.

There is widespread speculation that the World Health Organization (WHO) will decide that COVID-19 is no longer a “Public Health Emergency of International Concern (PHEIC)” when its expert group convenes on Thursday.

The 15th meeting of the Emergency Committee for COVID-19 has been convened by the WHO Director-General in terms of the International Health Regulations (IHR).

Fueling the speculation is the WHO’s release late on Wednesday of a 20-page “updated COVID-19 Global Strategic Preparedness, Readiness and Response Plan (SPRP) 2023-2025”.

The document is a guide for countries on how to manage COVID-19 over the next two years “in the transition from an emergency phase to a longer-term, sustained response”, according to the global body.

WHO Director General, Dr Tedros Adhanom Ghebreyesus notes in the foreword that, aside from the usual objectives of reducing the circulation of SARS-CoV-2 and diagnosing and treating COVID-19, the plan adds a third objective: “to support countries as they transition from an emergency response to longer-term sustained COVID-19 disease prevention, control and management”. 

“We do not propose that countries abandon the 10 pillars that served as a foundation for the pandemic response,” adds Tedros. “Rather, the new strategy aligns these 10 pillars with the five core components of equitable, inclusive and effective health emergency preparedness, response and resilience: collaborative surveillance, community protection, safe and scalable care, access to countermeasures, and emergency coordination.”

The focus is on restoring, reinforcing and strengthening health systems, as well as “integrating COVID-19 surveillance and management into that of other respiratory diseases”. 

Long COVID focus

The new plan places a strong emphasis on long COVID, which may affect as many as 6% of those infected with COVID-19. It calls for more research to better understand the post-COVID condition, “including its risk factors and the role of immunity, and to develop methods to better quantify its burden”.

“Although we are in a much stronger position in facing the COVID-19 pandemic, the virus is here to stay and countries need to manage it alongside other infectious diseases,” according to the WHO.

Meanwhile, the WHO’s coronavirus dashboard notes no new COVID-19 cases have been reported in the past 24 hours – although it is widely recognised that many countries are no longer monitoring new infections.

In late March, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) decided that additional COVID-19 vaccine boosters were not recommended for people at low to medium risk of the disease who have been vaccinated and boosted once.

SAGE recommended 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.

On Monday, the US announced that it would end COVID-19 vaccine mandates for international travellers, health workers in hospitals and federal employees on 11 May.

“While vaccination remains one of the most important tools in advancing the health and safety of employees and promoting the efficiency of workplaces, we are now in a different phase of our response when these measures are no longer necessary,” said the White House.

Image Credits: Vital Strategies.

Dr Anthony Fauci, former Director of the National Institute of Allergy and Infectious Diseases, was attacked and vilified during the COVID-19 pandemic.

The conspiracy-based anti-science attacks on scientists and vaccines that proliferated during the COVID-19 pandemic in the US are likely to have chilling, long-term effects on biomedicine, according to Professor Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. 

The biggest casualty may be childhood vaccinations, leading to a surge in diseases that had been almost eradicated such as measles, whooping cough and polio, writes Hotez in FASEB BioAdvances journal.

Polio cases in New York city and an outbreak of measles in unvaccinated children in Ohio already bear this out.

Confidence in childhood vaccines has already dropped considerably during the pandemic, with 35% of US parents now opposed to routine immunisations being required before children could enroll in school, according to a Kaiser Family Foundation report in December 2022.

Meanwhile, a 2021 survey by YouGov found that less than half (46%) of parents who supported the Republican Party were in favour of childhood vaccines being mandatory for school attendance in contrast to 85% of Democrats. Overall, support for vaccine mandates dropped by 4% between 2020 and 2021.

The effect of Republican politicians’ promotion of anti-vaccine conspiracies has already been seen in COVID-19 death statistics, with Republican (“red”) states recording much higher death rates.

“During Delta, COVID-19 vaccinations exhibited over 90% protective immunity versus death and yet an estimated 40,000 Texans died because they declined to get immunized,” writes Hotez, who is based in Texas.

“Nationally, that number of unnecessary deaths was approximately four to five-fold higher. The analyses from The New York Times and healthcare data specialist, Charles Gaba, reports that those deaths overwhelmingly occurred in conservative or Republican-majority states. Moreover, the ‘redder’ the state in terms of voters, the lower the immunization rates, and the higher deaths climbed.”

Hotez cites multiple examples of Republican politicians discrediting the effectiveness and safety of COVID-19 vaccinations during the Delta and Omicron waves. The US has one of the highest global COVID death rates per capita in the world, with 1.1 million deaths.

“Thousands of Americans in conservative states believed it all, and they paid with their lives. They fell victim to a coordinated campaign of antiscience aggression. Its three major elements included anti-vaccine and antiscience rhetoric from federal and state elected officials, together with amplification nightly on Fox News (and other news outlets) and academic cover from a few universities and extremist think tanks,” argues Hotez.

Demoralising effect

Professor Peter Hotez has been harassed by anti-vaccine protestors.

Hotez, who has been subjected to persistent harassment by anti-vaccine protestors, warned that the anti-science movement will “demoralize biomedical scientists”, many of whom already report that they “live in a climate of fear” as they face an “avalanche of abuse” via emails, social media and physical confrontations.

The “unprecedented distrust of scientists” could result in a reduction in federal support for the National Institutes of Health (NIH) and other biomedical research institutions, and discourage university students from pursuing careers in the sciences. 

“I am regularly targeted online through social media and emails, as well as phone calls and even in-person confrontations. The Florida Governor has disparaged me on Fox News, despite my correct predictions regarding COVID-19 in his state, while about Dr Anthony Fauci he stated his desire to have ‘that little elf’ thrown “across the Potomac [River]”.

Fauci, the former director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to the president from 2021 to 2022, has faced almost constant derision and death threats during the pandemic.

Urgency to respond

Given that the rise in anti-science sentiment could undermine the future of biomedical science in America, Hotez argues that it is essential for both US President Joe Biden and the Office of Science and Technology Policy (OSTP) to respond. 

“The political drivers for the assaults on biomedical science and scientists remain unclear, but they resemble those directed against climate science and scientists that began a decade ago,” he notes.

“During the 20th century, science and scientists were attacked as part of larger ambitions for authoritarian control in the USSR and elsewhere. The motivation may be similar.”

Possible responses include “a federal plan to preserve science and protect American scientists” and a legal defence fund for scientists

As the pathogen causing the next pandemic may have both high mortality rates and transmissibility “we must find ways to limit the flow of disinformation to ensure that life-saving vaccines and therapeutics do not go unused as they did in America during the time of COVID-19,” he urges.

“More complicated is how we limit the spread of disinformation in a free and open society committed to first amendment rights. This concern must be balanced with the stark reality that anti-science aggression is causing a substantial loss of human life, possibly in the hundreds of thousands according to some estimates,’” he adds.

“All indications so far suggest that the biomedical scientific community has not prepared adequately, and there are few plans to counter these politically motivated attacks.”

Image Credits: flickr/The White House. Official White House Photo by Andrea Hanks.

TDR and Dr Garry Aslanyan are preparing to launch a third season of his Global Health Matters podcast with a new list of guests to help tackle core issues in the global health community.

Aslanyan is the executive producer and host of the podcast.

“We have learned a lot in terms of how we can produce episodes and how best to engage our audience,” said Aslanyan, a public health professional with TDR, the Special Programme for Research and Training in Tropical Diseases co-sponsored by UNICEF, UNDP, the World Bank and the World Health Organization.

He said, “We know that the podcast has struck a chord with many audiences and has received continuous feedback from listeners. In addition, we receive emails and voice messages from people who write reflections on some of the episodes.”

“I believe it is always important to convene people and spread new ideas, and Global Health Matters is doing that,” said Tom Wien, the founder of The Dignity Project, a campaign for more respectful international development.

The podcast’s purpose is three-fold; on the one hand, Aslanyan hopes to reduce some of the silos in the global health discourse. In addition, the goal is to offer a more in-depth reflection on core issues and to bring them to light in new and different ways. Finally, there is a focus on inspiring listeners.

“Through listening to the podcast, those already engaged in global health but maybe not in a specific area can learn from the guests – what they have accomplished, their unique approaches – and bring some of the lessons into their work,” Aslanyan said.

“From my perspective, this podcast can give visibility to scientists in fields and regions of the world who normally wouldn’t have such visibility,” said Prof Aída Mencía-Ripley. “It is a wonderfully diverse platform.”

This year, as the world moves beyond COVID-19, Aslanyan said the podcast would play an additional role: Making sure the health community remains focused on pandemic preparedness and does not “go back to business as usual” without putting steps in place to improve public health.

In his first year, Aslanyan hosted guests from across the public health community and worldwide, such as Rose Leke, founder of HIGHER Women Consortium Cameroon, who spoke about her work to research and fight malaria. He talked with Natalia Pasternak, founder of Instituto Questão de Ciência in Brazil, who advised how scientists can set up science communication institutes in their countries.

And there were many more.

“Surprisingly and to my delight, several senior global health leaders in countries, at WHO and other agencies wrote me and said they listen to the podcast,” Aslanyan said.

As TDR prepares for season three, Aslanyan said he would keep what works and expand based on what he has learned. For example, he said there will be more sharing of personal experiences. In addition, aside from the regular 10 episodes, there will be four in-depth, reflective episodes with one-on-one interviews with global health thinkers and leaders who have foresight into future challenges.

Most recently, Aslanyan hosted a live Twitter Space conversation and said he plans to integrate more of those into the mix.

“The podcast will not be the same because I am not the same person as I was two-and-a-half years ago,” Aslanyan noted. “I have many responsibilities in my job, and I never thought any of them would be a podcaster.”

Read all about the podcast here.

Leaders of the US conservative Christian group Family Watch International travelled to Uganda and met with Uganda’s first lady, Janet Museveni and other government officials to encourage the passing of the Bill.

Uganda’s Parliament passed a revised Anti-Homosexuality Bill on Tuesday, retaining executions for certain same-sex activity and introducing harsher penalties for some categories of ‘offences’.

Ugandan President Yoweri Museveni had declined to sign into law an earlier version of the Bill after the Deputy Attorney General (DAG) had advised him that it would be open to various legal challenges, sending it back to Parliament to be tightened up.

The inclusion of the death penalty in particular would leave the bill open to legal challenge in a country that has effectively ended the use of capital punishment, wrote DAG Kaafuzi Jackson Kargaba in a letter to the president.

However, Parliament has voted to retain the death penalty for “aggravated homosexuality” – defined as sex with a child or disabled person or while living with HIV. A 20-year prison sentence for “knowingly promoting homosexuality” has also been retained.

However, the Bill no longer makes it a crime to simply identify as LGBTQ and people are only obliged to report homosexual activity if a child is involved.

The Bill had the support of all but one of the MPs, many of whom have persistently equated homosexuals with paedophiles.

Speaker Anita Among took issue with Kargaba for pointing out the flaws in the earlier Bill and when he tried to explain his position, she refused to allow him to speak.

“Today Parliament has once again gone into the history books of Uganda, Africa and the world and clearly brought up the issue of homosexuality, the moral question, the future of of children and protecting families,” said Among.

“We have a culture to protect. The Western world will not come to rule Uganda,” she added.

Ironically, however, US conservative Christian groups have been pushing for the legislation since 2014 when a “kill the gays” Bill was passed but never implemented after being overturned in a legal challenge, and Among has been part of the high-level government officials meeting with these groups, including the Arizona-based Family Watch International.

“This legislation… is here to erase the entire existence of an LGBTQ person in Uganda, but also it radicalizes Ugandans into hatred of the LGBTQ community,” LGBTQ activist Frank Mugisha told MSNBC’s Rachel Maddow in an interview on Monday.

Since the previous Bill was passed a month ago, hate crimes and violence against LGBTQ people have risen sharply, according to the Human Rights and Awareness and Promotion Forum (HRAPF), a legal aid organisation.

In addition, police have arrested people on suspicion of being LGBTQ, according to HRAPF.

The Bill goes back to the president to be signed into law amid intense pressure for him not to from the US and European Union in particular.

pandemic
Countries across the world show first signs of significant recovery of health systems after the pandemic.

Three years after the COVID-19 pandemic began, health systems across the world are showing signs of recovery from its negative impact, with fewer countries reporting on scaling back delivery of essential health services as compared with 2020-21.  

Disruptions to the delivery of essential health services had almost halved by the end of 2022 when compared with the same period in 2021.

The interim report of the fourth Global Pulse survey on the continuity of essential health services during the COVID-19 pandemic released by the World Health Organization (WHO) on Tuesday stated: “The key informant survey results indicate that while essential health service disruptions persist in almost all countries across the globe, health systems are showing the first notable signs of recovery and transition beyond the acute phases of the pandemic”. 

This round of the survey covered responses from 125 countries and concluded that an average of 23% health service types (“tracers”) were disrupted in the last quarter of 2022 (October to December). Taking into account 84 countries that participated in all four rounds of the pulse survey, the service disruption decreased from 56% in the third quarter of 2020 to 23% in the fourth quarter of 2022.

Health services
Level of service disruption across 27 tracer services in 84 countries submitting responses to all four survey rounds

Some of these tracers include 24-hour emergency care, emergency surgeries, rehabilitative services, family planning and contraception, antenatal care, and routine facility-based immunization services. 

While an overall reduction in disruption to the delivery of health services is evident, countries still reported disruptions to around 25% of the tracer items covered through the survey. 

Dr Rudi Eggers, WHO Director for Integrated Health Services, acknowledged the recovery in delivery of health services and added, “But we need to ensure that all countries continue to close this gap to recover health services, and apply lessons learnt to build more prepared and resilient health systems for the future”.

Significant recovery since 2021

The data collected and presented in Tuesday’s report shows a significant positive change from the previous editions. 

The third Global Pulse survey report published in February 2022 stated that over 90% of the countries faced ongoing disruptions in delivering essential health services to its people due to the pandemic.  

In the third edition, healthcare workforce issues emerged as one of the major barriers to delivering essential services in over 35% of the countries that responded to the survey. Additionally, around 53% of the countries reported disruptions in delivering primary health care services and 38% of the countries reported disruptions in the delivery of community care services. 

The disruption in the delivery of primary health care services decreased to 26% in the latest edition of the report and the disruption in providing emergency life-saving care decreased to 16% in the latest edition. 

In the latest report, over 70% of the countries reported that they have successfully budgeted for and integrated COVID-19 services including case management, vaccines and diagnostics in their health systems. However, when it comes to managing post-COVID-19 conditions, only 60% of the surveyed countries stated having budgets and integration strategies for it. 

Around 80% of the countries still reported having at least one challenge in increasing access to one or more essential COVID-19 tool. 

Health services
Bottlenecks to scaling up access to essential COVID-19 tools (n=83)

Countries eye long-term preparedness and resilience

The report also poins out that countries have institutionalized some of the innovative practices that were born out of necessity during the COVID-19 pandemic, like telehealth consultations. 

Around 75% of the countries also reported an increase in their budget allocation towards bolstering and preparing their health systems for the long term. 

Image Credits: MSH, World Health Organization (WHO).

South Sudan’s Minster of Health, Elizabeth Chuei, being vaccinated at Juba Teaching Hospital with a vaccine delivered by COVAX.

By the end of 2022, COVID-19 vaccines delivered by the global vaccine access initiative, COVAX,  helped to avert 2.7 million deaths across 92 lower-income countries, according a new report based on modelling by researchers from Imperial College London.

COVAX’s biggest success was in low-income countries, where its vaccines were responsible for three-quarters of all deaths averted, with 73% of COVID deaths averted in Africa from COVAX vaccines. 

Between January 2021 and December 2022, COVAX delivered 1.9 billion vaccine doses to countries supported by the Advance Market Commitment (AMC), a financing mechanism where doses were largely funded by donor governments to countries that could not afford them.

By the end of 2022, over half the populations in AMC countries had received their full primary vaccines, according to the report, which was released on Tuesday by the global vaccine alliance, Gavi, one of the four key COVAX partners.

The report was released at the start of a two-day “global stocktake” of COVID-19 vaccine delivery, being held in Ethiopia. One of the aims of this meeting is to ensure that COVID-19 services are integrated into primary healthcare.

The modelling is an extension of earlier research published in The Lancet by researchers from Imperial College’s MRC Centre for Global Infectious Disease Analysis.

They explain their methodology thus: “A mathematical model of COVID-19 transmission and vaccination was separately fit to reported COVID-19 mortality and all-cause excess mortality in 185 countries and territories.

“The impact of COVID-19 vaccination programmes was determined by estimating the additional lives lost if no vaccines had been distributed.” 

COVAX vaccines offloaded in Abuja, Nigeria.

India vaccine export ban

COVAX’s vaccine supply was sharply curtailed in April 2021 when India, battling a severe COVID-19 outbreak, prevented the Serum Institute of India (SII) from exporting any of its vaccines. SII was to have been COVAX’s main supplier.

As a result, by the end of 2021, COVAX vaccines had contributed to a quarter of vaccine doses in the AMC countries, averting around 857,000 deaths averted – or 13%.

In a collosal understatement, the report acknowledges that “arguably more deaths could have been averted had access to doses not been hindered and had countries received them at scale earlier”.

However, while COVAX’s global market suffered from the export ban, the SII vaccines “contributed significantly to India’s coverage gains that year, which saw more than 850 million people receive at least one dose, with 617 million receiving the complete primary series in 2021”.

India conducted the world’s largest domestic COVID-19 vaccination campaign, and the SII vaccines – 80% of which had been destined for COVAX – averted “an estimated 3.6 million deaths in 2021 alone”, according to the report.

‘A ship built as it set sail’

Describing COVAX as “a ship that was built as it set sail”, the report identifies ”key learnings” in how equitable vaccine access can be achieved as fast as possible for low-income countries and African economies.

To avoid delivery delays, COVAX advocates for: 

  • Increased regional supply resilience and manufacturing capacity of life-saving interventions, such as vaccines, particularly across Africa. 
  • Transparency by manufacturers regarding their order books so that when delays occur or supplies are limited, it is possible to determine when countries that are unable to afford doses are in danger of disproportionally missing out. 
  • Contingency funding and surge capacity to enable global and regional health agencies to pivot during a global health crisis and mount a rapid global response.
  • Mechanisms for equitable access to pandemic products like vaccines, therapeutics and diagnostics to be in place before “disaster strikes”.
  • Global mapping of existing health solutions, mechanisms, networks, expertise, policies, frameworks and tools, including those created during COVID. It lists the Emergency Use Listing of health, indemnification and liability agreements and the No-Fault Compensation Scheme as examples.
Gavi’s Aurelia Nguyen

“When COVID-19 hit us, there was no playbook to handle what would become the deadliest global health emergency in 100 years,” said Aurélia Nguyen, Gavi Chief Programme Strategy Officer, and former COVAX managing director.

“The rapid actions of COVAX, which by the end of 2022 had averted 2.7 million deaths, show us how essential a coordinated, multilateral global response is. It also shows the importance of ensuring equitable access to vaccines is built in from the very beginning in any future effort, as many more lives would have been saved if vaccines had reached vulnerable populations earlier.” 

COVAX is the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, set up to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines.

COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi and the World Health Organization (WHO), with UNICEF as the key delivery partner for the vaccines.

Image Credits: UNICEF, NPHCDA.