1 IHP news 570 : Heading for pandemic confrontation? ( 1 May 2020) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, This week’s short introduction – see below - is from my colleague Willem van de Put. On tipping points, a new balance, collateral damage, unexpected gains – or how time is running out for a mono- sectoral approach I really hope this is the last pandemic framed as a disease, for which we need 'global health'. First, because the old models of “global health expertise” are no longer valid; secondly, because time is up for the medical experts (after trust in experts got an initial boost in most countries, virologists and other medical experts are slowly losing some of their newfound “rockstar”-appeal; in addition, now that things get messier, we are more and more crying for economists and psychologists to help out; and thirdly, because we knew all along (not only the misty Jane Goodall) that Covid-19 is a dark warning for the real forthcoming global threat - in other words, pandemics are “wake up calls”, deep down. So, at the junction of the honeymoon and disillusionment phase of this crisis, it is time to get ahead of the game and think about restoration. Time for bold ideas – real ideas, not relabelling old wine in new bottles, like adding more layers and institutions to the current architectural conundrum of global health actors, or simply continuing to take advantage of the chaos (by some of the usual suspects). Questions about the collateral damage for the ‘have nots’, but also about the unexpected gains for the ‘haves’, bring home the message that we need global expertise to find answers to the questions that really matter. These questions point first and foremost to the radically different answers needed for the ‘haves’ versus the ‘have nots’. We, the ‘haves’ who read this stuff, can ponder the question whether we ‘live to be healthy’ or instead ‘need health to live our lives’. The’ have nots’ depend for their very survival on decisions of others. I like the advice of Slavoj Žižek: let’s now be both modest and bold! Let’s try not to behave as the ‘intellectuals yet idiots’, who have no ‘skin in the game’. Let’s get on with it, and don’t forget to sometimes listen to music that reminds us to try not to get sick, and try to play nice. Willem van de Put (ITM)
Transcript
1
IHP news 570 : Heading for pandemic confrontation?
( 1 May 2020)
The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.
Dear Colleagues,
This week’s short introduction – see below - is from my colleague Willem van de Put.
On tipping points, a new balance, collateral damage, unexpected gains – or how time is running out for a mono-sectoral approach
I really hope this is the last pandemic framed as a disease, for which we need 'global health'. First, because the old models of “global health expertise” are no longer valid; secondly, because time is up for the medical experts (after trust in experts got an initial boost in most countries, virologists and other medical experts are slowly losing some of their newfound “rockstar”-appeal; in addition, now that things get messier, we are more and more crying for economists and psychologists to help out; and thirdly, because we knew all along (not only the misty Jane Goodall) that Covid-19 is a dark warning for the real forthcoming global threat - in other words, pandemics are “wake up calls”, deep down.
So, at the junction of the honeymoon and disillusionment phase of this crisis, it is time to get ahead of the game and think about restoration. Time for bold ideas – real ideas, not relabelling old wine in new bottles, like adding more layers and institutions to the current architectural conundrum of global health actors, or simply continuing to take advantage of the chaos (by some of the usual suspects).
Questions about the collateral damage for the ‘have nots’, but also about the unexpected gains for the ‘haves’, bring home the message that we need global expertise to find answers to the questions that really matter.
These questions point first and foremost to the radically different answers needed for the ‘haves’ versus the ‘have nots’. We, the ‘haves’ who read this stuff, can ponder the question whether we ‘live to be healthy’ or instead ‘need health to live our lives’. The’ have nots’ depend for their very survival on decisions of others. I like the advice of Slavoj Žižek: let’s now be both modest and bold! Let’s try not to behave as the ‘intellectuals yet idiots’, who have no ‘skin in the game’. Let’s get on with it, and don’t forget to sometimes listen to music that reminds us to try not to get sick, and try to play nice.
In this newsletter issue, we’ll make a first (hesitant) effort to again feature more “other than Covid-19” global health news and publications, even if (1) the Covid-19 info-tsunami is, like the pandemic, far from over, and (2) most “other global health causes” are heavily influenced by Covid-19 these days, unfortunately. (PS: for the diehards, some Covid-19 related reads we also put in the extra ‘Miscellaneous’ section.)
Meanwhile, the Donald and his crooked party seem hellbent on pandemic confrontation instead of cooperation for strategic reasons.
Enjoy your reading.
Kristof Decoster
Featured Article
Solidarity in turbulent times: reflections on the East African Community countermeasures against the COVID-19 pandemic
Albino Kalolo ( East African correspondent for IHP)
The COVID-19 pandemic has jeopardised solidarity globally. Even if there have also been encouraging signs, communities such as the European Union, the African Union (and its regional economic communities), and the ASEAN region have all experienced problems with solidarity in this time of crisis. There is widespread fear that Africa will harbour the pandemic for a long time due to weak solidarity and weak health systems. This editorial will focus more in particular on the East African Community (EAC).
Re-established in 2000 after its dissolution in 1977, the EAC is composed of six member states: Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda. The EAC has four main integration pillars: the Customs Union, Common Market, Monetary Union, and Political Federation. They are at different stages of implementation, with the last two still underway. The health sector is under the Customs Union pillar and aims to:
“Undertake joint action towards the prevention and control of communicable and non-communicable diseases and to control pandemics and epidemics of communicable and vector-borne diseases that might endanger the health and welfare of the residents of the Community and cooperate in facilitating mass immunisation and other public health community campaigns.”
As of 26 April 2020, the EAC had recorded 918 COVID-19 cases (5% of the cases in Africa) with the most in Kenya (37%), Tanzania (33%), and Rwanda (20%). As you can imagine, there is considerable variation across countries with some doubts on the reliability of reports due to testing capacity and levels of transparency.
As has been reported, lessons from the Ebola outbreak may be shaping decisions on COVID-19 in some African countries such as Sierra Leone and DR Congo. The EAC also has pandemic preparedness strategies and plans, based on experience with Ebola outbreaks in some countries in the region (such as Uganda) and outbreaks of other infectious diseases including Rift Valley, Cholera, Marburg, and Yellow Fever in most member states.
Like most countries in the world, and in spite of some WHO guidance on preparedness plans, post-colonial African governments have limited experience with fighting pandemics of this nature, however. As post-colonial governments, neither are they very familiar with the history and impact of the 1918 influenza “Spanish flu” pandemic, which occurred during World War I and killed about 50–100 million people globally. Terrible stories of how the pandemic disrupted the social fabric and lead to massive deaths in Africa have been documented:
“In rural areas tilling, planting and harvesting came to a halt and cows were left unmilked because whole households lay sick or dying in their homes.” ; “Addis Ababa ‘looked like a dead city’.”
Furthermore, evidence attests how government functions collapsed as a result of the pandemic:
“The Abyssinian government [was] utterly disorganised as a result of influenza epidemic”, and it was “no longer possible to regard the Government as a serious organization with which the Powers can satisfactorily treat.”
In an arguably very different era, what are the chances that the COVID-19 pandemic will lead to damage equivalent to (or even higher than) the Spanish flu? Responses to this question are mixed, but most don’t consider this a very likely scenario given the widespread knowledge on infection control, antibiotics to prevent secondary bacterial infections, and advances in technology. And of course, this time it concerns a coronavirus, not a flu. Nevertheless, with rising Covid-19 figures now on the continent, Africa may only be at the beginning. Having said that, it’s not clear yet what awaits Africa, some reports already hint at a continent that might have ‘dodged a bullet’. In any case, it seems too early for conclusions – and the picture will surely get clearer the coming months.
While some aspects have undoubtedly improved in Africa over the last 100 years, and the continent might for once turn out relatively “lucky” compared to other regions in the world, this could still become a huge catastrophe (both in terms of health and economically), if responses are not up to the challenge.
The three F’s and the need for regional solidarity and coordination
The pandemic has already impacted several social and economic activities and overloaded the health care system leading to paralysis of equally important services such as HIV treatment, diabetes, and maternal and child services. The scarce human workforce is unprotected either due to the unavailability of personal protective equipment (PPE) or lack of clear guidance on PPEs and other important measures to protect themselves and their patients.
The dire reality can be described as three F’s: Fragile health systems, Frustrated people, and Fractured (political) decisions to mount control measures as per the WHO recommendations have
surfaced (and dominated) in the COVID-19 talk about Africa. Comparatively little attention has been paid to solidarity between countries and regions within the continent.
Although the WHO Afro region and Africa CDC are leading the continental fight against COVID-19, coordination between East African countries is also especially necessary.
In this pandemic, sadly, there are barely coordinated countermeasures in the region and each country is more or less fighting its own battle. Collective actions and obligations to help each other as stipulated in the EAC establishment treaty seem to be sidelined. The community has taken scattered actions to protect the people and economy, such as organizing a meeting of the ministers responsible for health and EAC affairs. This meeting deliberated on implementing some measures to control infections across borders and distributing mobile laboratory and testing kits to member states.
The COVID-19 countermeasures also vary across member states. Kenya, Uganda, and Rwanda went far to include “strong” lockdowns and curfews while Burundi, Tanzania, and South Sudan have instituted only a few “relaxed” measures carefully (or less carefully in some cases). However, without coordination/solidarity in countermeasures, cross-border transmissions will impact all member states. There are already reports from Rwanda and Uganda of truck drivers acquiring infections from neighbouring countries. As a remedy to reduce deaths and economic meltdown, solidarity in countermeasures is a prerequisite.
Recognizing that one-size-fits-all measures rarely work, based on the context and political economy of the region, the EAC could come up with a minimum package of countermeasures for its member states. These could include: 1. a community package: hand hygiene promotion, universal mask-wearing (mandatory in public transport and public places), targeted social distancing, and restricted social gatherings; 2. a health facility package: increasing testing rates, universal mask-wearing and hand hygiene by health care workers, enhanced oxygen supply and triage of patients, and rational use of PPEs; and 3. multi-sectoral action plans for quick wins instead of considering the pandemic as a health sector business.
Challenges for coordination and solidarity in the EAC at this time include political landscapes (Burundi and Tanzania have elections this year) and the fact that some member states have multiple and confusing memberships to other regional communities that weaken their solidarity. With exception of South Sudan, other EAC countries are members of either the Southern African Development Community (SADC), Common Market for Eastern and Southern Africa (COMESA), or Economic Community of Central African States (ECCAS).
Nevertheless, since there will be an Extraordinary Summit of the East African Community Heads of State on COVID-19—an earlier scheduled event (15 April 2020) was postponed on request by South Sudan to a later (not yet disclosed) date—we expect to soon see more tangible solidarity and coordination in the region, so needed in these turbulent times.
Rather important news from last weekend. “Bill Gates says new commitment means the charity’s other public health work will suffer.”
“Bill Gates says his foundation, the world’s wealthiest charity, will give its “total attention” to the Covid-19 pandemic — even at the risk that its other public health work will suffer. In a telephone interview from his Seattle base, Mr Gates said the Bill & Melinda Gates Foundation, which has an endowment of more than $40bn, would focus its resources on a pandemic which he fears will cost the global economy “tens of trillions of dollars.” “… … Although the foundation has directly given $250m to the Covid-19 response, its actual commitment of manpower and expertise is much greater, Mr Gates said. “ We’ve taken an organisation that was focused on HIV and malaria and polio eradication, and almost entirely shifted it to work on this,” he said. “This has the foundation’s total attention. Even our non-health related work, like higher education and K-12 [schools], is completely switched around to look at how you facilitate online learning.”
“…Mr Gates said clinical trials of a promising new Aids drug and campaigns for measles vaccinations and polio eradication would suffer as a result of the focus on Covid-19….”
For some reason, reactions were largely positive (including by dr. Tedros). Some see a link with the upcoming EC/WHO pledging event (4 May). Anyway, there’s a lot to say about this move from Gates – it’s rather intransparent at the very least. Hope global citizens will get more clarification instead of this rather vague FT interview.
We recommend, among others this short analysis by Simon Rushton : The Gates Foundation's new move
Excerpts: “…The Gates Foundation is a major WHO donor (by far the largest private donor), so the praise is politically understandable. It’s also understandable that people retweet their boss. But – if the FT story is to be believed – it is more than a little surprising that WHO officials aren’t much more hesitant than they appear to be about the downsides of this move by the Gates Foundation. Of course many more resources are needed to bring the COVID-19 pandemic to an end. But the wider consequences of this move by the Gates Foundation seem so obvious as to scarcely need pointing out. Ongoing issues such as HIV, polio and malaria are not going away during the COVID crisis – indeed they are being made even more difficult to tackle. Taking resources away from them at this moment seems problematic, to say the least. … … … Whatever the reason, this episode surely reveals many of the problems of the philanthropic model as a way of fulfilling the right to health: too unaccountable, too narrowly targeted, too subject to rapidly changing priorities at the whim of the donor. What’s more, if the aim is to encourage governments to give more, I have serious reservations about this as a strategy. Surely governments are far more likely to provide money for the COVID emergency response than they are to backfill the work on HIV, malaria and polio that
Gates is moving away from? We need more resources for COVID-19. But don’t take them from health! Take them from military spending. Raise taxes on the rich. Do almost anything except de-fund HIV, polio and malaria.”
WHO May Host Virtual World Health Assembly Meeting May 18 – With COVID-19 Main Agenda Topic
HPW;
“For the first time ever, the World Health Assembly appears set to meet in a one-day virtual session on May 18, which would be devoted largely to debate the global COVID-19 pandemic, sources told Health Policy Watch on Tuesday. European Union member states are hopeful that a draft WHA resolution to create a voluntary patent pool of new COVID-19 health technologies could be approved in the rapid-fire session – and they are holding daily worldwide consultations with WHO member states online, with the hopes of sealing a deal on the potentially game-changing resolution in time for the WHA meeting. In the 73rd session of the one-day virtual WHA, 10 new members of the WHO’s 34 member governing body, the Executive Board (EB), will be elected, sources said. ..”
WHO has also confirmed it now. But not yet clear whether this virtual WHA meeting will continue after 18 May (see: the EB meeting, virtual, also, is scheduled for 22 May).
World Day for Safety and health at work (28 April)
WHO calls for healthy, safe and decent working conditions for all health workers,
amidst COVID-19 pandemic
WHO key facts & key messages to support the day;
“On World Day for Safety and Health at Work, the World Health Organization calls upon all governments, employers and workers organizations and the global community to take urgent measures for strengthen countries’ capacities to protect occupational health and safety of health workers and emergency responders respect their rights to decent working conditions, and develop national programmes for occupational health of health workers and to provide them with occupational health services. Amidst the COVID-19 pandemic, ILO has dedicated World Day for Safety and Health at Work 2020 in addressing the outbreak of infectious diseases at work, in particular, on the COVID-19 pandemic….”
“Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence….”
Tweet: “In the #COVID19 pandemic, shortage of staff & resources and increasing social tensions result in increased level of violence against #HealthWorkers and even attacks against health care facilities.”
UN News - Protect workers during and after lockdowns, urges UN labour agency
https://news.un.org/en/story/2020/04/1062732
“Marking the World Day for Safety and Health at Work, the International Labour Organization (ILO) has urged States to take action to prevent and control COVID-19 in the workplace.”
“In the face of a pandemic: Ensuring Safety and Health at Work, the report highlights the occupational safety and health risks that have arisen from the contagion. It also explores measures to prevent and control the risks associated with the COVID-19 pandemic, including psychosocial, ergonomic, and other work-related safety and health issues.”
Planetary Health
Guardian - Halt destruction of nature or suffer even worse pandemics, say world’s
« Only one species is responsible for coronavirus – humans – say world’s leading biodiversity experts.”
“ The coronavirus pandemic is likely to be followed by even more deadly and destructive disease outbreaks unless their root cause – the rampant destruction of the natural world – is rapidly halted, the world’s leading biodiversity experts have warned. … … “There is a single species responsible for the Covid-19 pandemic – us,” they said. “Recent pandemics are a direct consequence of human activity, particularly our global financial and economic systems that prize economic growth at any cost. We have a small window of opportunity, in overcoming the challenges of the current crisis, to avoid sowing the seeds of future ones.” … … Professors Josef Settele, Sandra Díaz and Eduardo Brondizio led the most comprehensive planetary health check ever undertaken, which was published in 2019 by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES). It concluded that human society was in jeopardy from the accelerating decline of the Earth’s natural life-support systems. … .. … The scientists said the multitrillion-dollar economic recovery packages being rolled out by governments must be used to strengthen and enforce environmental protection: “ … … A global “One Health” approach must also be expanded, they said. … … Furthermore, surveillance programmes and health services need to be properly funded in nations on the frontlines of pandemic risk, they said: “This is not simple altruism – it is vital investment in the interests of all to prevent future global outbreaks.””
“The pandemic-induced global economic meltdown has triggered a drop in energy demand and related carbon emissions that could transform how the world gets its energy -- even after the disease wanes, according to a report released today by the International Energy Agency (IEA)….”
Some numbers: “Global energy demand is expected to drop by 6% in 2020, compared to the previous year. That’s a seven times bigger drop than in the wake of the 2008 recession. The biggest change is predicted for the most developed economies, with a 9% decline in the U.S. and 11% in the European Union. Carbon emissions from the energy sector are expected to fall by 8% for the year – almost 2.6 gigatonnes. That make it the largest drop ever recorded and six times the decline caused by the last recession….”
See also the Guardian - Covid-19 crisis will wipe out demand for fossil fuels, says IEA.
“Renewable electricity will be the only source resilient to the biggest global energy shock in 70 years triggered by the coronavirus pandemic, according to the world’s energy watchdog….”
“… For many this situation fuels a sense of eco-anxiety, which is perhaps particularly prevalent among the young who will live with greater change but have little direct influence. In this issue we present four Comments that tackle different dimensions of the psychological burden of environmental change. … … These pieces were written before the pandemic and before lockdowns were widely instigated in response to COVID-19. And of course, these isolation measures will also have a tremendous burden on mental health for many, particularly since hardship is likely to fall most on those who are already marginalised and vulnerable. The COP26 climate conference has been postponed and there is concern that this pandemic will lead to a myopic focus on re-establishing the pre-coronavirus economic business as usual, thus detracting from carbon reduction efforts. For many this sense of a stalled process could further exacerbate feelings of eco-anxiety, combined with new pressures and concerns. The full impact of COVID-19 and associated countermeasures remains to be seen, but once we emerge from lockdown it will be into a new and uncertain world with a climate change curve still to flatten. Eco-anxiety will likely remain an important, if painful, part of our journey.”
We also recommend:
• Comment - Mental health and climate change: tackling invisible injustice
• Comment - Linking health justice, social justice, and climate justice
• Lancet Planetary Health research paper – Metal mining and birth defects: a case-control
study in Lubumbashi, Democratic Republic of the Congo
(by D Van Brusselen, B Nemery et al)
“Widespread environmental contamination caused by mining of copper and cobalt has led to concerns about the possible association between birth defects and exposure to several toxic metals in southern Katanga, Democratic Republic of the Congo (DRC). We therefore aimed to assess the possible contribution of parental and antenatal exposure to trace metals to the occurrence of visible birth defects among neonates. …” Conclusion: “… the first study of the effects of mining-related pollution on newborns in sub-Saharan Africa. Paternal occupational mining exposure was the factor most strongly associated with birth defects”
World Malaria Day (25 April)
We already paid some attention to World Malaria Day in the previous newsletter.
Lancet Global Health - Diagnosing malaria and other febrile illnesses during the
COVID-19 pandemic
S Dittrich et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30210-
2/fulltext
“…to ensure continued access to diagnosis and care for patients with malaria during a pandemic, frontline workers need the appropriate training, equipment, and health-care packages to distinguish between different febrile diseases.” Includes a table with ‘Recommendations for health-care packages in community and primary health care to differentiate febrile diseases’.
“Fourteen vaccination campaigns that would have covered more than 13 million people have been postponed because of the crisis caused by the Covid-19 pandemic”.
“… Gavi, the Vaccine Alliance, has estimated that at least 21 low- and middle-income countries are already reporting vaccine shortages as a result of border closures and disruptions to travel. So far, 14 vaccination campaigns supported by Gavi against polio, measles, cholera, human papillomavirus, yellow fever and meningitis have been postponed, which would have immunized more than 13 million people….”
Tedros also made the link in his speech with GAVI’s goal for the coming years (and upcoming replenishment) – immunize 300 million more children with 18 vaccines by 2025.
Telegraph - More than 13 million children globally missed out routine
“More than 13 million children did not receive any vaccinations in 2018, and millions more are in danger of missing life-saving vaccines this year due to disruption caused by the Covid-19 pandemic, new analysis has found. Even before the coronavirus outbreak shut down vital immunisation programmes, more than 20 million children living in countries with weak health care systems went without measles, polio and other vaccines every year, a Unicef report has warned….”
HPW – COVID-19 Leaves Most Vaccine Campaigns On Hold; More People Could Die
“Routine vaccine campaigns suspended worldwide in the wake of COVID-19, must be resumed immediately or else some countries could face a big surge in deaths from other preventable diseases, said Seth Berkley, CEO of Gavi, The Vaccine Alliance. Speaking at a press briefing on Thursday, Berkley warned that routine immunizations for other infectious diseases such as polio, measles, and rotavirus need to be resumed immediately in low- and middle-income countries, or deaths from these could outweigh COVID-19 fatalities by a factor of 100 to 1, as per findings from a recent London School of Tropical Hygiene and Medicine study. “I can’t emphasize enough [that
halting routine immunization] is going to be a challenge, and we are going to see outbreaks, certainly for polio,” said the GAVI CEO. …”
“Berkley spoke at a GAVI press briefing today that laid out a vision for the organization’s work on vaccines in the coming months and years. … … Along with resuming routine vaccines, Berkley laid out four other key challenges associated with advancing development and rollout of a future COVID-19 vaccine, which said need “global coordination and leadership”, but also “transparency in R&D and manufacturing.” These challenges include : ensuring adequate production capacity of the vaccine; global leadership to identify and prioritize vaccine candidates; deployment of the vaccine; and protecting healthcare workers….”
WB (blog) COVID-19 (coronavirus): Ensuring fair global allocation of vaccines
M A Pate; https://blogs.worldbank.org/health/covid-19-coronavirus-ensuring-fair-global-allocation-
vaccines
“Providing fair and equal access to a future COVID-19 (coronavirus) vaccine is the right thing to do”
Pate focuses his message for World Immunization week clearly on the coronavirus vaccine this year. “ We cannot afford to let high-income countries monopolize the global supply of COVID-19 vaccines, as happened during the 2009 influenza A/H1N1 pandemic. The poorest and most vulnerable countries and populations cannot be left behind. A far better solution would be for the global community to ensure that there is a globally fair allocation system.”
Interestingly, M Pate also sees an important role for the private sector in this.
Other link related to World Immunization week: Edward Parker in the Guardian - A rise in deaths from preventable diseases must not be part of Covid-19's legacy
“The world may be faced with a new foe, but old ones lie in wait if lockdowns disrupt existing vaccination programmes.”
CGD (blog) – Maintaining Essential Services in the Time of COVID-19: Vaccination
Delivery in Low- and Middle-Income Countries
S Ismail et al; https://www.cgdev.org/blog/maintaining-essential-services-time-covid-19-vaccination-delivery-low-and-middle-income
“…This blog considers childhood vaccination delivery in the context of COVID-19, and proposes how to sustain, and ideally expand, delivery in the face of tightening resource constraints….”
“The United Kingdom has pledged to donate the equivalent of £330 million ($410 million) a year to Gavi, the Vaccine Alliance, for the next five years. The government said it will be the largest supporter of Gavi, which works to immunize children against infectious diseases such as measles and polio, as well as supporting the COVID-19 response. Civil society leaders said the announcement, worth £1.65 billion in total, sent a strong signal to other donors ahead of the Gavi replenishment summit on June 4, which will now be held virtually. It was previously set to be held in the U.K. “The coronavirus pandemic shows us now more than ever the vital role vaccines play in protecting us all,” said Anne-Marie Trevelyan, secretary of state for the U.K. Department for International Development….”
Global Fund update
Via the Global Fund Observer:
• The Global Fund publishes requirements for countries to apply for funds from its COVID-19 Response Mechanism
“The Global Fund Board recently established a COVID-19 Response Mechanism endowed with $500 million, adding to a previous $500 million in potential reprogramming flexibilities made available within existing Global Fund grants. Following the general overview given in the initial announcement, on April 22 the Global Fund published instructions on how to access the funding from the new mechanism, including application forms and detailed guidance for countries.”
• Commentary - The Global Fund makes laudable efforts to tackle COVID-19, but questions remain
“The Global Fund has acted promptly to fight COVID-19, and this is commendable. But important questions remain on the source of the funds, the usefulness of previous investments in health systems, and how to uphold the Global Fund’s commitment to safeguarding human rights and gender equality.”
• News - The Global Fund’s upcoming virtual Board meeting features a streamlined agenda to suit the new format (on 14-15 May)
“The Global Fund’s Board will conduct its biannual meeting virtually for the first time in its almost 20-year history, due to global constraints and restrictions imposed by the COVID-19 pandemic. According to the draft meeting agenda, the meeting is scheduled to be shorter than usual – though some constituencies have called for an additional day in order to address more fully the impact of COVID-19.”
Covid-19 key news of the past week (with focus on WHO messages, UN initiatives, and US/WHO/China “relationship” )
Over to the ‘proper’ Covid-19 sections then.
As you have gotten used to, first some of the key news/messages, then funding/initiatives/advocacy; science; analysis and finally resources & collateral damage.
Update on the figures (30 April): “The global total today climbed to 3,255,454 cases from 187 countries, with at least 231,415 deaths, according to the Johns Hopkins online dashboard.”
Cidrap News - WHO reconvenes COVID-19 panel; Africa's outbreaks intensify
Global update as of Wednesday evening. “The World Health Organization (WHO) director-general said today that the COVID-19 emergency committee will meet tomorrow [i.e. Thursday] to review pandemic developments, as cases surge in some African nations and as many past-peak countries take tentative steps to relax their distancing measures. …”
“Pandemic activity is evolving rapidly in Africa, with cases rising 42% over the past week and deaths increasing by 24%, the WHO's African regional office said today in its weekly outbreaks and health emergencies update. Most countries are experiencing local spread, and three countries reported exponential increases last week, including Equatorial Guinea, Nigeria, and Tanzania. So far only two of the region's 47 countries have reported no cases: Comoros and Lesotho. Overall, 10 countries account for 84% of all cases; they include South Africa, Algeria, Cameroon, Ghana, Nigeria, Ivory Coast, Guinea, Niger, Senegal, and Burkina Faso. So far in the region, 325 healthcare workers from 22 countries have been infected, with Niger reporting the most at 126. Six countries have recorded very high case-fatality rates, ranging from 4.4% in Niger to 12.6% in Algeria. The others include Liberia (9.7%), the Democratic Republic of the Congo (6.1%), Mali (6.6%), and Burkina Faso (6.6%)….”
For another view on the current situation in Africa, see also Devex - Low coronavirus testing in Africa leads to blind spots: Africa CDC chief (interview with John Nkengasong)
“The African region continues to have the lowest number of confirmed coronavirus cases, at over 36,000. But John Nkengasong, director of the Africa Center for Disease Control, says it’s possible they may not be seeing the full impact of this virus in the region yet. “It’s very possible that we’re not seeing everything that is there, and maybe blinded to certain things because of the insufficient testing,” he told Devex. This is why Africa CDC’s focus at the moment is to help ramp up testing in the region….”
Via the Guardian - Matshidiso Moeti, the WHO’s director for Africa region said: “We are very concerned about West Africa where we are seeing some community spread in a significant number of countries compared with others.”
See also UN News - World health experts will meet Thursday to assess COVID-19 pandemic
“… the Emergency Committee meeting will mark three months since members agreed that the new coronavirus disease was an international global health emergency. “In the three months since the Emergency Committee last met, WHO has worked day in, day out to sound the alarm, support countries and save lives”, he said….”
Yet again, Tedros also gave a very detailed timeline starting end of December on WHO’s actions & initiatives to raise the global alarm. On that front (warning early enough), I quite agree now: “It’s game, set and match for WHO. “
Some more news from Tedros: “… Later this week WHO will launch its second Strategic Preparedness and Response Plan, with an estimate of the resources needed for the next stage of the global response. … … We’re also grateful to the more than 280,000 individuals, corporations and foundations who have contributed to the Solidarity Response Fund, which has now generated more than US$200 million. …”
Cidrap News - World's COVID-19 total tops 3 million cases
From earlier this week. “The global COVID-19 total passed 3 million cases today, and with trends in flux in different parts of the world, the World Health Organization (WHO) director-general today warned that the pandemic is far from over. … …. WHO continues to be concerned about the increasing trends in Africa, Eastern Europe, Latin America, and some Asian countries." And he warned that in many regions, the number of COVID-19 cases and deaths are underreported because nations don't have enough testing capacity. Tedros also said the WHO is worried about the pandemic's secondary effects on other groups, such as children who face interruptions in routine vaccination programs against other diseases and populations at risk for malaria who may be affected by delays in public health measures, such as prophylactic treatment, to keep disease levels low.
“…In another WHO development, health officials over the weekend clarified its recent scientific brief about "immunity certificates" and antibody testing. On Twitter yesterday, the WHO said it expects that most people infected with the COVID-19 virus will develop an antibody response that provides some level of protection. "What we don't yet know is the level of protection or how long it will last," the WHO said. "We are working with scientists around the world to better understand the body's response to COVID-19 infection. So far, no studies have answered these important questions."…”
For the scientific brief, see here (24 April) - “Immunity passports” in the context of COVID-19
“Based on a review of scientific data, the agency said there's not enough evidence on immunity to guarantee the accuracy of immunity passports, and that people who test positive on serology might have a false sense of security and increase the risk of transmission….”
See also the Telegraph - World Health Organization cautions against 'immunity passports' route out of lockdown
Great news from late last week (and important in view of the upcoming pledging event (4 May). “In a striking display of multi-lateral unity, launch of the new ‘Access to COVID-19 Tools’ (ACT) Accelerator was made in a WHO public webcast featuring UN Secretary General Antonio Guterres, Melinda Gates, 11 heads of state, including Germany’s Angela Merkel, France’s Emmanuel Macron, and South Africa’s Cyril Ramaphosa, as well as other leaders across Africa, Asia, and the Americas, and Europe. Strikingly absent were the United States and China, which have been locked in bitter dispute with each other over the management of the COVID-19 crisis. … … As new COVID-19 cases continue to rise in newly affected hotspots, and some states begin to weigh the risks of a resurgence as cases plateau, there was wide agreement among the leaders that developing and deploying an effective COVID-19 vaccine was the priority. Von der Leyen and Chancellor of Germany Angela Merkel called for such a vaccine to be treated as “a universal public good.”..”
“… The Coalition for Pandemic Preparedness and Innovation (CEPI), which has been supporting three of the six vaccine candidates that have entered clinical trials around the world, is still facing a US $1 billion shortfall to bring a successful vaccine candidate to market. … … … But while the search for a vaccine dominated the discussion, other speakers reaffirmed the importance of supporting a holistic COVID-19 response, focusing on providing equitable access to diagnostics, therapeutics, and strengthening the public health system for future pandemic threats. The standing president of the G20 group of most called pandemic preparedness the “smartest investment for us to make today.” … … Under the ACT Accelerator, 11 major global health agencies, organizations, and pharma industry representatives made five major commitments in a statement released Friday…”
The programme and its €7.5bn (£6.5bn) fundraising effort will be officially launched on 4 May.
(PS: Saudi Arabia has already pledged $2 billion.)
(PS: like the US & China, India also hasn’t joined the effort (yet)?)
WHO press release - https://www.who.int/news-room/detail/24-04-2020-global-leaders-unite-to-ensure-everyone-everywhere-can-access-new-vaccines-tests-and-treatments-for-covid-19
See also Cidrap News - WHO, partners unveil massive COVID-19 vaccine, treatment effort
And: “The cooperation pledge, made at a virtual meeting, was designed to show that wealthy countries will not keep the results of research from developing countries.”
Meanwhile (Reuters) – the U.S. said it will not take part in WHO global drugs, vaccine initiative launch.
See also Stat - WHO launches ambitious global project to develop Covid-19 medical products
Excerpt: “…For now, though, details were not discussed. Instead, the announcement amounted to a high-level statement of intent rather than a primer on how things will get done. For instance, it remains unclear about the extent to which the project will include a so-called voluntary pool to collect patent rights, regulatory test data, and other information that could be shared for developing drugs, vaccines, and diagnostics….”
Washington Post - Trump expands battle with WHO far beyond aid suspension
Washington Post
“President Trump and his top aides are working behind the scenes to sideline the World Health Organization on several fronts as they seek to shift blame for the novel coronavirus pandemic to the world body, according to U.S. and foreign officials involved in the discussions. Last week, the president announced a 60-day hold on U.S. money to the WHO, but other steps by his top officials go beyond a temporary funding freeze, raising concerns about the permanent weakening of the organization amid a rapidly spreading crisis.”
“At the State Department, officials are stripping references to the WHO from virus fact sheets, and Secretary of State Mike Pompeo has instructed his employees to “cut out the middle man” when it comes to public health initiatives the United States previously supported through the WHO. The United States will now attempt to reroute the WHO funds to nongovernmental organizations involved in public health, according to interviews with U.S. officials and an internal memo obtained by The Washington Post. … … WHO officials initially hoped they could stave off a halt in U.S. funding and a messy public confrontation by making a symbolic concession to Trump, but discussions between the organization and the U.S. ambassador to the WHO, Andrew Bremberg, failed to ease tensions. … … … The Trump administration’s moves could prove far more damaging to the WHO than the temporary halt in funding, said experts who reviewed the State Department memo and tracked U.S. actions. … … “A 60-day pause to U.S. funding is a headache for the WHO but not necessarily an existential crisis. That said, if State starts giving funds to other implementers to carry out health programs the WHO would have overseen, there is a risk that the U.S. starts spreading resources out in an inefficient, fragmentary fashion,” said Richard Gowan, a senior fellow at the International Crisis Group….”
Bloomberg – Pompeo seeks exceptions to WHO funding halt for seven countries
Bloomberg;
“@secpompeo is recommending exceptions to President Trump's WHO funding stop for polio and coronavirus campaigns in 7 countries: Afghanistan, Egypt, Libya, Pakistan, Sudan, Syria and Turkey.”
Guardian - Trump says China could have stopped Covid-19 and suggests US will
“The Senate Republican campaign arm distributed the 57-page strategy document to candidates.” The main reason why Trump is going all out for WHO (in his anti-China narrative for the elections in November).
‘The World Should Have Listened To WHO’ Says Director General Tedros;
Arthritis Drug Shows Promising Results Against COVID-19 In Early Trials
(report of the 27 April briefing by Tedros) As already mentioned, in the match WHO-US, WHO wins hands down. “When the World Health Organization sounded the alarm by declaring a ‘public health emergency of international concern‘ on 30 January, “the world should have listened,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, in his strongest response to date, to repeated allegations by the United States that WHO failed to act quickly enough in the early days of the coronavirus pandemic….”
BBC News – Coronavirus: China rejects call for probe into origins of disease
BBC News;
“China has rejected calls for an independent international investigation into the origin of the coronavirus.” A top diplomat in the UK, Chen Wen told the BBC the demands were politically motivated and would divert China's attention from fighting the pandemic.”
See also Sky News - WHO 'not invited' to join China's COVID-19 investigations
“China has refused repeated requests by the World Health Organisation to take part in investigations into the origins of COVID-19, the WHO representative in China has told Sky News. "We know that some national investigation is happening but at this stage we have not been invited to join," Dr Gauden Galea said….”
FT - US, China researchers collaborate in hunt for virus origin
“US scientists are working with China to investigate the origin of coronavirus, despite criticism from the Trump administration that Beijing is failing to co-operate with outsiders to stem the disease. Ian Lipkin, director of the Center for Infection and Immunity at the Mailman School of Public Health at Columbia University, said he was working with a team of Chinese researchers to determine whether coronavirus emerged in other parts of China before it was first discovered in Wuhan in December. The effort relies on help from the Chinese Center for Disease Control and Prevention. …”
(PS: if I’m correct, the Donald has personally stopped this now, this week…)
“… The US CDC offered help to China in the early stages of the outbreak, but has not made a formal request to its Chinese counterpart for research sharing.“ CDC has asked China CDC to engage on better understanding the outbreak investigation findings but not on formal research collaboration,” CDC told the FT. It added that it was essential that countries and jurisdictions talked and shared information on effective strategies. Chinese CDC declined to comment. The US-China research team is also studying blood samples of various wild animals that the team thought might be the origin of the virus, Prof Lu said. “We want to understand how animal-to-human transmission happened,” he said, adding he worked with Prof Lipkin because he was a leading expert in identifying and diagnosing unknown viruses….” “… A separate international group of scientists, including from the US and China, is also working with WHO to pool research in support of developing a vaccine. “…”
Guardian - US gives G7 countries a list of reforms it wants WHO to undertake
But with the Donald, you never know. “The US has presented its G7 partners with a list of reforms Washington would like carried out at the World Health Organization in the wake of the coronavirus pandemic. The proposals, which were shared on Friday by the health and human services (HHS) department with health ministries in the six other member states, suggested organisational changes intended to reinforce the WHO’s independence and transparency.”
Not clear whether they are agreed administration-wide, though.
“The generally moderate tone of the proposals is at odds with the strident allegations made against the WHO by the president and state department. … … The US reforms presented to the G7 would strengthen the independence of the WHO director general and its emergency committee of international experts, which gives advice on when or whether to take the critical step of declaring a public health emergency of international concern.”
UN News - UN leads bid to help 135 countries get vital COVID-19 medical kit, amid
severe global shortages
https://news.un.org/en/story/2020/04/1062802
“A major UN-led initiative is under way to secure supplies of key medical equipment for 135 low to medium-income countries facing down the COVID-19 pandemic, the World Health Organization (WHO) said on Tuesday.” “The COVID-19 taskforce initiative follows a direct request to WHO from UN Secretary-General António Guterres to coordinate the Organization’s response to the new coronavirus….”
UN News - Coronavirus and human rights: New guidance highlights support for
persons with disabilities
https://news.un.org/en/story/2020/04/1062912
“New guidance issued on Thursday sets out key actions, to counter what the UN High Commissioner for Human Rights has called the “double risk” faced by persons with disabilities in the COVID-19 pandemic.”
Reuters - U.N. raises alarm about police brutality in lockdowns
“The U.N. human rights office voiced concern on Monday about more than a dozen countries that have declared states of emergency due to the COVID-19 pandemic where police have arrested or detained hundreds of thousands of people and killed others….”
UNAIDS and MPact are extremely concerned about reports that LGBTI people are
being blamed and abused during the COVID-19 outbreak
“For at least a year after the Covid-19 vaccine becomes available, it is very likely that there’ll be insufficient supply to meet the global demand of billions of doses.” … The threat of export bans on vaccines is clearly a concern. “
Reuters - African nations to get ventilators from Jack Ma foundation, stress need
From late last week. “African nations that lack ventilators to treat COVID-19 patients will receive some from the Jack Ma Foundation, an African Union official said on Thursday, as Nigeria stressed Africa’s dependence on a properly-funded World Health Organization (WHO)to help it fight the pandemic….”
Bloomberg - Vaccine Could Potentially Be Available Later This Year, Coalition Says
Bloomberg
Some optimistic (bullish?) news/messaging from CEPI’s head, Hatchett, on vaccines, this week.
“Group head hopes to deliver shots sooner than 12-18 months. Oslo-based CEPI has raised about $1 billion for vaccines.”
“A vaccine to halt the coronavirus pandemic could be available as early as this year for vulnerable groups such as health-care workers, even faster than initially thought, according to a key group at the heart of the global development effort….” (in September?)
PS: WHO still thinks it’ll take 10-16 months, though, according to a media briefing on Wednesday.
“Funding bodies face a choice between established manufacturers and biotech upstarts”.
Excerpts: “In the aftermath of the September 11 terror attacks, President George W Bush guaranteed that the US would pay $5.6bn for the production of vaccines and other countermeasures against bioterrorism. That funding model, which led to the development of novel smallpox and anthrax prophylactics, will soon be deployed in the fight against Covid-19, as organisations including the World Bank and the Bill & Melinda Gates Foundation rush to underwrite the enormous costs of vaccine efforts. But with more than 80 coronavirus vaccine candidates being developed around the globe, billions of dollars will have to be spent on preparing manufacturing facilities for several candidates, including some that will never make it to market. “We’re making some fairly substantial investments even before having phase-one clinical trial results,” says Richard Hatchett, a veteran of the Bush and Obama administrations who now leads the Coalition for Epidemic Preparedness Innovations (Cepi). Making investment decisions at such an early stage, adds the head
of Cepi, which is co-ordinating funding for several international Covid-19 efforts, is fraught with financial risk. Gavi, which raises funds from public and private donors for vaccine development, estimates that the bill for manufacturing hundreds of millions of doses of a single product will range from $50m for companies with existing facilities and trained personnel, to about $700m for those starting from scratch. This sum may be even higher if the vaccine requires novel technology platforms, and is on top of an estimated clinical development cost of at least $500m per vaccine candidate. … … The so-called “filling and finishing”, the last stage in vaccine development, in which the drug is formulated and put it into a vial or syringe, is where the bottlenecks are most likely to occur, according to Cepi. For clinical trials, which require thousands of doses at most, that work is done by small, specialist companies. …”
Economist- An Indian rm starts mass-producing an unproven covid-19 vaccine
“It is gambling that one created in Oxford will work and be approved”.
On the links between the Serum Institute of India, one of the world’s largest producers of vaccines, and the Oxford vaccine efforts (Jenner institute).
Excerpt: “…agreed that the Serum Institute would start mass-manufacturing the vaccine ChAdOx1 nCoV-19 created by Jenner. Moreover they would do so on such a large scale they will have 40m-50m doses by September. … … By September, the Serum Institute plans to have a stockpile of cheap covid-19 vaccine available for India and many other low- and middle-income countries. Dr Hill says the institute is looking for a “distributed model” of manufacturing around the world in order to get to the billions of doses that are needed. “ …”
See also the Guardian - AstraZeneca partners with Oxford University to produce Covid-19 vaccine
(if successful) “The Anglo-Swedish firm intends to work with international partners to distribute the vaccine, including making it available in low- and middle-income countries.”
“The Trump administration is organizing a Manhattan Project-style effort to drastically cut the time needed to develop a coronavirus vaccine, with a goal of making enough doses for most Americans by year’s end. Called “Operation Warp Speed,” the program will pull together private pharmaceutical companies, government agencies and the military to try to cut the development time for a vaccine by as much as eight months, according to two people familiar with the matter. As part of the arrangement, taxpayers will shoulder much of the financial risk that vaccine candidates may fail, instead of drug companies. The project’s goal is to have 300 million doses of vaccine available by January, according to one administration official….”
“In 2020 and 2021 alone, developing countries’ repayments on their public external debt alone will soar to between US$2.6 trillion and $3.4 trillion. Calls for international solidarity have so far delivered little tangible support. An international body is needed to oversee developing country debt relief programmes.”
Oxford Poverty and Human Development Initiative (Briefing) - Threat of Covid-19
“Nearly half a billion of the world’s poorest people, who live with three deprivations - lack of access to clean drinking water, under-nutrition and a lack of clean cooking fuel - are at ‘high risk’, according to @ophi_oxford”.
Guardian - Half of world’s workers ‘at immediate risk of losing livelihood due to
“1.6 billion people face economic hit from Covid-19, says UN labour agency.”
“Almost half the global workforce – 1.6 billion people – are in “immediate danger of having their livelihoods destroyed” by the economic impact of Covid-19, the International Labour Organization has warned. Of the total global working population of 3.3 billion, about 2 billion work in the “informal economy”, often on short-term contracts or self-employment, and suffered a 60% collapse in their wages in the first month of the crisis. Of these, 1.6 billion face losing their livelihoods, the ILO warned on Wednesday. “It shows I think in the starkest possible terms that the jobs employment crisis and all of its consequences is deepening by comparison with our estimates of three weeks ago,” the UN agency’s director general, Guy Ryder, told a briefing, foreseeing a “massive” poverty impact….”
And some more news links:
• WP - American touting covid conspiracies probably posted WHO, Gates Foundation
passwords online, report says
“An American touting conspiracy theories about the spread of the coronavirus was the likely source of an incident in which nearly 25,000 credentials from the World Health Organization, the Gates Foundation and other institutions fighting the pandemic were posted to the Internet last week, new research concludes. The research, by the SITE Intelligence Group, which revealed the incident in a report last week, concluded that the emails and passwords posted online were not from
a recent hack. Rather, the credentials came from a larger set of hacked materials originally put online in 2016….”
• New Humanitarian - US adds restriction on foreign aid funding for COVID-19 supplies
“Hundreds of millions of dollars of US international aid funding for COVID-19 may no longer be used to buy medical masks and gloves without specific approval, according to a new directive from President Donald Trump’s administration, The New Humanitarian has learned. Using a new clause in its grant agreements, the US Agency for International Development (USAID) will require aid agencies to get prior approval to buy key items of personal protective equipment (PPE) or ventilators….”
Covid-19 funding/debt relief updates & new initiatives/advocacy
Above, we already provided the main (funding related) news, related to the upcoming pledging
(kickstart) event (4 May). Some more reads:
BMJ blog - Covid-19 vaccines: global access means having enough
Seth Berkley; BMJ blog;
Ahead of the pledging kickstart event on 4 May, Seth Berkley advocates for “a covid-19 Advance Market Commitment (AMC), to make sure that when vaccines are licensed the capacity is in place to rapidly manufacture and distribute the billions of doses needed.” “An AMC is the cheapest option for the health and economic security we all need.”
“The ultimate aim of a covid-19 vaccine AMC would be to increase the chances of success, accelerating the availability of the most suitable candidate vaccines by sharing the risks associated with investing in some vaccines that may end up not making it. The best way is if there is a global political commitment to set aside national vaccine strategies and treat covid-19 vaccines as a global public good….”
KFF - Donor Funding for the Global Novel Coronavirus Response
K Moss; https://www.kff.org/global-health-policy/issue-brief/donor-funding-for-the-global-novel-
coronavirus-response/
Very neat overview (update as of 23 April).
“As of April 21, 2020, donors (including governments, multilateral organizations, and private funders) have pledged or distributed an estimated $19.3 billion in overall financial support for the COVID-19 response. This includes donor assistance provided directly to countries as well as their contributions to the World Health Organization (WHO). The vast majority (85%) was provided by donor governments (including the U.S.), the World Bank, and other multilateral organizations. The
remainder (15%) came from non-profits, foundations, and businesses. The largest donor to date is the World Bank3 ($6 billion), followed by the Asian Development Bank ($4.87 billion), the United States ($2.39 billion), Start Small LLC/Start Small Foundation (up to $1.21 billion), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (up to $1 billion). This makes the U.S. the largest donor government...”
Reuters - World Bank pandemic bonds will funnel $196 million to 64 poor
countries
Reuters;
Guess what, at least this sorry “innovative financing’ story has come to an end…
See also the proud WB press release - PEF Allocates US$195 Million to More than 60 Low-Income
Countries to Fight COVID-19
“This funding is in addition to the World Bank Group’s commitment of up to US$160 billion to fight COVID-19.”
F2P blog - Where have we got to on Covid and debt relief?
Fabulous overview. Must-read by A C Arendar. She discusses the current state of affairs re three types of debt. Debt that is owed to governments (bilateral debt); debt that is owed to the IMF, World Bank and other multilateral creditors; and debt owed to private creditors like banks and hedge funds.
AP – UN: $90 billion could protect 700 million poor in pandemic
AP;
"The U.N. humanitarian chief said Monday that $90 billion could provide income support, food, and a health response to the coronavirus pandemic for 700 million of the world's most vulnerable people -- a price tag just 1 percent of the $8 trillion stimulus package the 20 richest countries put in place to safeguard the global economy. Mark Lowcock told a video briefing most experts agree that the peak of the COVID-19 pandemic hasn't reached the poorest parts of the world, but may peak in the next three to six months" .
Brookings (blog) - Funding the development and manufacturing of COVID-19
vaccines: The need for global collective action
M Schäferhoff, M Yamey et al; https://www.brookings.edu/blog/future-
“In February 20, the World Bank and the Coalition for Epidemic Preparedness Innovations (CEPI), which funds development of epidemic vaccines, cohosted a global consultation on funding the development and manufacturing of COVID-19 vaccines. We wrote a working paper to guide the consultation, which we coauthored with World Bank and CEPI colleagues. The consultation led to the launch of a COVID-19 Vaccine Development Taskforce that is now working on how to finance the development and manufacturing of vaccines for global access. Developing and manufacturing a COVID-19 vaccine at global scale in 12-18 months requires urgent collective action from governments, industry, academia, foundations, multilaterals, and global health partnerships. This endeavor cannot afford any delays. All stakeholders involved should do everything feasible to reduce vaccine development timelines and to collectively contribute to ending the pandemic. In particular, there are five key areas in which we need collective action….”
Health Workers for all Coalition - Invest in health workers: for the present COVID-
“The Health Workers for All Coalition joins an urgent request from 143 civil society organisations to major global health funders to invest in recruitment of health workers in resource limited contexts. The organisations ask commitments and contributions to pooled, adequate long-term investments in the health workforce for the short term COVID-19 response, ensuring continued access to primary care but also future health system resilience.”
Human Vaccines Project Launches Global Initiative to Accelerate the
Development of COVID-19 Vaccines for Those Most Vulnerable
Press release 23 April “The Human Vaccines Project (HVP), a non-profit global consortium, is launching the COVID Vaccine Initiative (CVI), with the goal to ensure the development of safe, effective, accessible vaccines for those most vulnerable to COVID-19. The focus will be on accelerating vaccine development for aging populations and those living in low- and middle-income countries….”
Bipartisan group of 105 members of congress call for $ 1 billion for Global Fund
Covid-19 response mechanism
Global Fight
[US] “Reps. Barbara Lee (D-CA) and Martha Roby (R-AL) led a bipartisan letter to House Leadership signed by 105 members of Congress calling for an emergency $1 billion for the Global Fund COVID-19 Response Mechanism. The Global Fund COVID-19 Response Mechanism is designed to protect progress on AIDS, TB and malaria and is one part of what should be a multi-faceted approach by the U.S. to address COVID-19 around the world….”
And see Devex – “A group of U.S. lawmakers wants to see $12 billion for the global coronavirus response included in the next supplemental spending bill, which Congress is currently negotiating. “
WB (blog) - COVID-19 (coronavirus): Universal health coverage in times of crisis
By I Kickbusch & G Gitahi. “With the crisis expected to deepen before it improves, there are some foundational issues relating to health systems and people’s access to health services that, from our position as co-chairs of the International Partnership for Universal Health -Coverage 2030 (UHC2030), we want to highlight. UHC2030 is the global movement to build stronger health systems in order to achieve universal health coverage (UHC). Right now, health systems and UHC are what will make the difference to each country’s response to COVID-19. They affect whether all or only some receive treatment, as well as rates of recovery and the level of protection afforded to health workers….”
Covid-19 Science
Not our niche, so as usual just (in steno-style) some reports & coverage of scientific studies (& debate) that caught our attention this week:
First an announcement, via the Lancet:
Lancet Comment - A COVID-19 conference at AIDS 2020: Virtual
A Pozniak, R Horton et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31026-6/fulltext
“… The platform IAS is building for AIDS 2020: Virtual offers a unique and timely opportunity to host and support a global virtual conference on COVID-19 itself. As the largest global health conference worldwide, we must address the COVID-19 pandemic and the IAS is compelled to offer our platform to the global health community. In this spirit, we announce that the IAS will host the IAS Virtual COVID-19 Conference, a virtual conference on breaking COVID-19 research, policy analysis, and front-line experience on the final day of AIDS 2020: Virtual. The IAS Virtual COVID-19 Conference at AIDS 2020: Virtual will be the first international gathering on COVID-19 for all the many stakeholders, including affected communities, in the emerging response.”
Bloomberg - Coronavirus Lingers in Air of Crowded Spaces, New Study Finds
Bloomberg;
“The new coronavirus appears to linger in the air in crowded spaces or rooms that lack ventilation, researchers found in a study that buttresses the notion that Covid-19 can spread through tiny airborne particles known as aerosols. At two hospitals in Wuhan, China, researchers found bits of
the virus’s genetic material floating in the air of hospital toilets, an indoor space housing large crowds, and rooms where medical staff take off protective gear. The study, published Monday in the journal Nature Research, didn’t seek to establish whether the airborne particles could cause infections….”
The Guardian - Coronavirus detected on particles of air pollution
Coronavirus detected on particles of air pollution
This reports on a study in Bergamo, Italy. “Coronavirus has been detected on particles of air pollution by scientists investigating whether this could enable it to be carried over longer distances and increase the number of people infected.”
Stat - Gilead says critical study of Covid-19 drug shows patients are responding to
treatment
Stat;
“A government-run study of Gilead’s remdesivir, perhaps the most closely watched experimental drug to treat the novel coronavirus, showed that the medicine is effective against Covid-19, the disease caused by the virus. Gilead made the announcement in a statement Wednesday, stating: “We understand that the trial has met its primary endpoint.” The company said that the National Institute of Allergy and Infectious Diseases, which is conducting the study, will provide data at an upcoming briefing. The finding — although difficult to fully characterize without any data for the study — would represent the first treatment shown to improve outcomes in patients infected with the virus that put the global economy in a standstill and killed at least 218,000 people worldwide….”
Let’s see in the coming days/weeks whether this will indeed be real (treatment) progress. The Gilead
study was not an RCT (unlike the new Lancet study, see below).
And see also Stat News (from earlier this week) - The world wants answers on Gilead’s Covid-19
drug. Experts worry next studies may increase uncertainty
Lancet - First randomised trial of remdesivir suggests antiviral drug is not
associated with significant clinical benefits, more research needed
The Lancet Paper: Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-
controlled, multicentre trial
Press release:
• Study stopped early by data safety monitoring board because of difficulty recruiting patients after COVID-19 outbreak in Wuhan, China brought under control, so the true effectiveness of antiviral drug remdesivir remains unclear.
• Treatment with remdesivir did not speed recovery or reduce deaths from COVID-19 compared with placebo in hospitalised patients in the trial.
• While not statistically significant, pre-specified secondary outcomes found that time to clinical improvement and duration of invasive mechanical ventilation were shorter in people treated with remdesiver within 10 days of showing symptoms, compared to standard care.
• The authors say that future studies of remdesivir are needed to better understand its potential effectiveness.
Related Lancet Comment - Remdesivir for COVID-19: challenges of underpowered studies
“Absence of statistical significance in an underpowered trial means that the findings are inconclusive. The particular challenges of delivering pandemic trials underline the importance of data sharing, allowing rapid curation of relevant datasets…”
Coverage in HPW - First Remdesivir RCT Shows No Significant Clinical Benefit For Severe COVID-19 Patients; But Experts Urge For More Research
“A new study published Wednesday in the Lancet found that remdesivir did not significantly speed recovery or reduce deaths in patients suffering from severe COVID-19….”
“…The formal publication in the Lancet confirms initial reported findings that were accidentally leaked on the World Health Organization’s clinical trials registry last week.”
PS: On Wednesday, a WHO official declined comment on reports that Gilead Science’s remdesivir could help treat Covid-19, but said that further data was needed.
Fauci’s take for now (via the Guardian) on the current remdesivir state of affairs - Remdesivir: early findings on experimental coronavirus drug offer 'quite good news'
“Preliminary results of US government trial show patients who received drug recovered faster than others.”
See also Science News - Large trial yields strongest evidence yet that antiviral drug can help COVID-19 patients
HPW – Conflicting Remdesivir Trial Results Released; Experts Urge More
“With politicians touting the potential benefits of malaria drugs to fight COVID-19, some people are turning away from clinical trials of other therapies.”
Stat News - Closely watched arthritis drug disappoints as a Covid-19 treatment,
studies show
Stat;
“An arthritis drug that was seen as a promising treatment for some Covid-19 patients delivered disappointing results in clinical studies, its makers, the drug firms Regeneron and Sanofi, said Monday. The result could have an impact not only for their treatment, Kevzara, but also for a similar drug from Roche, Actemra, that is being used off-label in many hospitals. It also may lower the odds that other repurposed medicines used against autoimmune diseases like rheumatoid arthritis will benefit Covid-19 patients….”
Devex - Scientists caution against premature use of TB vaccine to combat COVID-
“While controlled trials are underway to investigate the use of the most commonly used tuberculosis vaccine to protect people against COVID-19, scientists are cautioning against using it before there is evidence to prove it works, because it could lead to stock-outs that would limit access to those who need it to combat TB. Health workers have vaccinated children with the bacille Calmette-Guérin vaccine for a century, primarily for the prevention of life-threatening forms of TB….”
Bloomberg - Virus Likely to Keep Coming Back Each Year, Say Top Chinese
Scientists
Bloomberg;
Like Freddy Krueger basically.
“Chinese scientists say the novel coronavirus will not be eradicated, adding to a growing consensus around the world that the pathogen will likely return in waves like the flu. It’s unlikely the new virus will disappear the way its close cousin SARS did 17 years ago, as it infects some people without causing obvious symptoms like fever. This group of so-called asymptomatic carriers makes it hard to fully contain transmission as they can spread the virus undetected, a group of Chinese viral and medical researchers told reporters in Beijing at a briefing Monday. … … “This is very likely to be an epidemic that co-exists with humans for a long time, becomes seasonal and is sustained within human bodies,” said Jin Qi, director of the Institute of Pathogen Biology at China’s top medial research institute, the Chinese Academy of Medical Sciences. … … A consensus is forming among top researchers and governments worldwide that the virus is unlikely to be eliminated, despite costly lockdowns that have brought much of the global economy to a halt….”
Cidrap News - Study: Contact tracing slowed COVID-19 spread in China
“Isolation and contact tracing—which are now key topics as US officials discuss plans to open up the country—helped control the spread of COVID-19 in Shenzhen, China, according to a study published yesterday in The Lancet Infectious Diseases.”
Nature - The race for coronavirus vaccines: a graphical guide
“As scientists at the Jenner Institute prepare for mass clinical trials, new tests show their vaccine to be effective in monkeys.”
“…Most other teams have had to start with small clinical trials of a few hundred participants to demonstrate safety. But scientists at the university’s Jenner Institute had a head start on a vaccine, having proved in previous trials that similar inoculations — including one last year against an earlier coronavirus — were harmless to humans. That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works. … … The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective….”
Guardian - Study of twins reveals genetic effect on Covid-19 symptoms
“Scientists find genetic factors explain 50% of differences between people’s symptoms.”
Science – Survivors’ burden
Science;
“ What happens after you survive ? For those people who recover from a severe bout of COVID-19, both the illness and the treatment can have lingering effects. Clinicians are learning lessons from other diseases about the physical, cognitive and mental-health problems that might be in store.”
Guardian – More cases of rare syndrome in children reported globally
“Doctors around the world have reported more cases of a rare but potentially lethal inflammatory syndrome in children that appears to be linked to coronavirus infections. Nearly 100 cases of the unusual illness have emerged in at least six countries, with doctors in Britain, the US, France, Italy, Spain and Switzerland now reported to be investigating the condition….” A condition known as ‘Kawasaki disease’.
Vox - Why summer likely won’t save us from the coronavirus
State of affairs on the heat/humidity impact debate.
“…We have early evidence the weather has an effect, but we also have early evidence that it won’t be enough. The problem: Other factors, besides the weather, play a role in the spread of diseases. In the case of coronavirus, these other factors seem to play a much bigger role than weather….”
Travel Medicine and Infectious Disease - Prevalence and fatality rates of COVID-
19: What are the reasons for the wide variations worldwide?
Coverage via Cidrap News - Puzzling global differences in cases and deaths
“A review of WHO data reveals wide geographic differences in the COVID-19 prevalence and death rates, researchers from Johns Hopkins, Italy, and Saudi Arabia reported today in a letter to Travel Medicine and Infectious Disease. They said differences in diagnostic efforts, case definition, and reporting don't seem to explain the variations. And though cooler and less humid conditions have been suggested as more conducive to COVID-19 spread, other factors such as greater commercial or tourist travel might play a role, they wrote. For example, they noted that confirmed cases per million population varies widely, from 57 in China to 168 in Saudi Arabia to 2,732 in Italy. They noted that mortality rates vary greatly and are highest in Italy (13.1%) and lowest in Bahrain and Singapore (0.3% to 0.4%). Social habits, greater susceptibility, and superspreading events might play a role, as could response measures, the team wrote. For deaths, older age and lack of critical resources in overwhelmed health facilities may also be factors….”
Scientific American – Widely Used Surgical Masks Are Putting Health Care
Workers at Serious Risk
Scientific American;
“Health workers forced to wear the less protective face covers are “almost certainly” fueling the rise in #COVID19 cases, according to leaders in the field of occupational safety.”
And via the Guardian, on mutations:
“Scientists have found evidence for mutations in some strains of the coronavirus that suggest the pathogen may be adapting to humans after spilling over from bats. The analysis of more than 5,300 coronavirus genomes from 62 countries shows that while the virus is fairly stable, some have gained
mutations, including two genetic changes that alter the critical “spike protein” the virus uses to infect human cells. Researchers at the London School of Hygiene and Tropical Medicine stress that it is unclear how the mutations affect the virus, but since the changes arose independently in different countries, they may help the virus spread more easily….”
Covid-19 Analysis
Again a wealth of analysis on various aspects of Covid-19. (as mentioned above, we also put some more reads on Covid-19 in the extra ‘Miscellaneous’ section).
BMJ blog - Covid-19 affects everything—more than a disease control plan, we
need a manifesto
BMJ blog;
By David McCoy. “Given that it affects all aspects of social, political, and economic life, a case can be made for governments producing an explicit covid-19 manifesto that outlines their principles and aims for dealing with the epidemic. What might such a manifesto look like? Here’s a suggestion for one built around seven key commitments:..”
Lancet Editorial - COVID-19: remaking the social contract
Concluding paragraph: “…Despite important deficiencies in some responses, in many ways the world is witnessing the setting aside of ideology to address the urgent and fundamental need common to all people—the protection of health. So far, the measures taken have been uneven, short-term, and reactive. But it is hard to imagine that when this pandemic is over, the public will be content to go back to the way things were. That it has taken a crisis of this scale to force the recognition that the basic role of a government is to serve and protect its people—that wellbeing has a higher value than gross domestic product—is a shocking demonstration of how the reciprocal rights and responsibilities that form the basis of so many democratic systems have been hollowed out. The kind of societies that are set to emerge from this pandemic is far from clear, but our interconnectedness and interdependence at local, national, and global levels have never been more undeniable. Nor can the importance of well resourced and well prepared health systems continue to be ignored. A renewed and expanded social contract, one with health at the centre, could well be one legacy of COVID-19.”
Lancet Offline: A global health crisis? No, something far worse
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31017-5/fulltext
“…Those with responsibility for leading us through this emergency have called it “a once in a century global health crisis”. This statement is incorrect on two grounds. First, because we cannot
know what the rest of the century will bring. It is highly probable that this current pandemic will be neither the last nor the worst global health crisis of the present century. But second, and more importantly, this global calamity is not a crisis concerning health. It is a crisis about life itself. We have been tempted in recent years to assume the omnipotence of our species. The idea of the Anthropocene places human activity as the dominant influence on the future of life on our planet. Although this newest of geological eras is supposed to underline the harm our species is doing to fragile planetary systems, paradoxically it also asserts our supremacy. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has revealed the hubris of this view. “
Horton draws upon insights from Didier Fassin to arrive at his final conclusion:
“We must say that it is our task to uncover the biographies of those who have lived and died with COVID-19. It is our task to resist the biologicalisation of this disease and instead to insist on a social and political critique of COVID-19. It is our task to understand what this disease means to the lives of those it has afflicted and to use that understanding not only to change our perspective on the world but also to change the world itself. …”
Devex - 'A scattered mess': Global coronavirus response lacks leadership, experts
“While the COVID-19 pandemic is a global phenomenon, it has yet to be met with a truly global response, according to leading U.S. health and development advocates. The inward focus shown by the U.S. and other governments might not be surprising, given that even wealthy nations have been overwhelmed by the coronavirus and its economic fallout. But this risks allowing the virus to gain traction in other parts of the world, only to return and cause additional waves of infection later on, they warned.
“The concern is that, if the COVID-19 epicenter moves from Europe and the U.S. to countries in Africa and other parts of the global south, the virus could find an environment that would foster mutation. This could lead to a more virulent strain, which might then circulate back through countries that have already experienced a first wave of infections, Dybul said….”
Foreign Affairs - It’s Time for an Independent Coronavirus Review - The World
Health Organization and Its Member States Must Learn From Their Mistakes
T Bollyky & D Fidler ; « … https://www.foreignaffairs.com/articles/china/2020-04-24/its-time-
independent-coronavirus-review
The authors argue it’s time for an independent (interim) review.
“the coronavirus pandemic is perhaps the defining struggle of our era, but the global response to it has stalled over a question of scheduling. The United States and Australia want accountability now: … … China, the United Nations, and the WHO all favor accountability later.”
“Halting the pandemic that is ravaging much of the world should be everyone’s top priority, but delaying an independent review of national and international responses won’t slow the spread of the disease. Waiting to initiate such an inquiry will only deprive the WHO and its member states of valuable feedback that could help them improve their responses and save lives. Waiting will also inhibit international cooperation at the G-7, G-20, and other global institutions whose efforts are needed to develop and equitably deploy COVID-19 drugs and vaccines, remove the export bans and other disruptions to the global supply chain for masks and personal protective equipment, and ultimately, get the global economy growing again. Without a credible independent review at the multilateral level, individual states will likely organize their own inquiries, which could further politicize the pandemic and heighten international tensions.
… the UN secretary-general should establish—with the backing of major regional organizations, such as the African Union, the Association of Southeast Asian Nations, and the European Union—an interim, independent review of the COVID-19 response. The aim should be to establish facts that can aid the fight against this disease and future ones. … An interim assessment of the COVID-19 pandemic response could help the WHO and national governments make important adjustments in real time. Because of concerns about its independence, the WHO should not organize the review, however. As a member-state-driven organization, the WHO is constrained in its ability to assess countries’ responses and publicize their shortcomings. For this reason, the UN secretary-general should authorize a review by an independent, high-level panel of outside experts.”
NYT - ‘Sadness’ and Disbelief From a World Missing American Leadership
“The coronavirus pandemic is shaking bedrock assumptions about U.S. exceptionalism. This is perhaps the first global crisis in more than a century where no one is even looking for Washington to lead.”
“The pandemic sweeping the globe has done more than take lives and livelihoods from New Delhi to New York. It is shaking fundamental assumptions about American exceptionalism — the special role the United States played for decades after World War II as the reach of its values and power made it a global leader and example to the world. … … And in the United States, it has exposed two great weaknesses that, in the eyes of many Europeans, have compounded one another: the erratic leadership of Mr. Trump, who has devalued expertise and often refused to follow the advice of his scientific advisers, and the absence of a robust public health care system and social safety net.
… But critics now see America failing not only to lead the world’s response, but letting down its own people as well….”
IHP - The Coronavirus pandemic and the irrelevance of the SDGs: Time for a new
Jubilee
R van de Pas; https://www.internationalhealthpolicies.org/blogs/the-coronavirus-pandemic-and-
the-irrelevance-of-the-sdgs-time-for-a-jubilee/
“According to (my colleague) Remco van de Pas, SDG3 on health and wellbeing has been irrelevant to address global challenges in this area. The futility of this SDG and limits of the World Health
Organization are today painfully clear in the approach of the covid-19 pandemic. Although the crisis was not unexpected, WHO member states have insufficiently invested and left much scope for charities and private investors. The author scrutinizes global public health policies and advocates the creation of a new Jubilee Campaign for indebted countries.” Provocative analysis.
Think Global Health - Expertise, Coronavirus, and the New Normal C Ebikeme; https://www.thinkglobalhealth.org/article/expertise-coronavirus-and-new-normal
“North–south divide in the time of coronavirus may be a preview of what will to emerge on other side of the pandemic”.
“Among the myriad of things this pandemic is bringing to light is how we must re-evaluate the old tropes of scientific expertise—particularly in global health….”
Quote (on the UK): “To suggest the WHO’s recommendations were, essentially, for “other” countries by invoking the United Kingdom’s developed country status is to assert a sort of health-care exceptionalism—and a dangerous one. Ignoring a global pool of expertise that has already shown to be effective at saving people's lives around the globe—not just for this pandemic, but previous epidemics over the years—may be putting British lives at risk….”
What International Relations Tells Us about COVID-19
Interesting analysis. “… From China’s initial reluctance to allow World Health Organization (WHO) experts into the country to G7 fights over what to call the virus to President Trump’s hold on funding for the WHO, the global response has been shambolic and largely uncoordinated, in contrast to the adequate if not exceptional cooperation during the last major global crisis, the 2008 financial crisis. What can we learn from theories of international relations about why the response has thus far been so ineffective?...”
(at three levels) Drawing upon “Kenneth Waltz’s classic images of analysis, with first image theories focusing on the role of individuals, second image theories on the attributes of states, and third image theories the structural properties of the international system.”
“…Early commentary in the West focused on the failings of China’s autocratic system, which hid the severity of Wuhan’s outbreak—at what we now know to be catastrophic cost. The more the epidemic has spread, the more it has become clear that Western liberal democracies have badly mishandled it too, ending up with severe outbreaks that could—perhaps—have been avoided. Yet it makes little sense to view the coronavirus as some kind of perverse vitality test for liberal and authoritarian regimes. Instead we should learn from the countries that responded more effectively—namely, Asia’s advanced technocratic democracies, the group once known as the “Asian Tigers.” In the West the virus exposed creaking public services and political division. But Hong Kong, Japan, and South Korea have managed better, while Singapore and Taiwan have kept the disease almost entirely under control, at least for now.”
“… Only last October, the Economist Intelligence Unit produced a lengthy report ranking nations by global epidemic preparedness. The US came top, followed by Britain and the Netherlands; Japan and Singapore were 21st and 24th, respectively. However this league table was compiled, it seems to have proved entirely wrong. … … The thread uniting the countries that did well was that, whether democratic or not, they were strong, technocratically capable states, largely unhampered by partisan divisions. Public health drove politics, rather than the other way around.
… What matters instead is a new divide between two kinds of countries: those with states that can plan for the long term, act decisively, and invest for the future, and those that cannot.”
Nature - Whose coronavirus strategy worked best? Scientists hunt most effective
“Researchers sift through data to compare nations’ vastly different containment measures.”
“… Efforts to tackle these questions will get a boost in the coming weeks from a database that brings together information on the hundreds of different interventions that have been introduced worldwide. The platform, being prepared for the World Health Organization (WHO) by a team at the LSHTM, gathers data collected by ten groups already tracking interventions — including teams at the University of Oxford, UK, the Complexity Science Hub Vienna (CSH Vienna), and public-health organizations and non-profit organizations such as ACAPS, which analyses humanitarian crises….”
CFR - Is It a Crime to Mishandle a Public Health Response?
D Scheffer; CFR;
“The COVID-19 pandemic is likely to spark a wave of new laws intended to hold governments and businesses accountable for their public health responses during outbreaks.”
See also a tweet by S Venkatapuram – “I am not joking. I think there should be crimes against public / global health. ' Is intentional public health malpractice a crime against humanity? ' “
“Even as the COVID-19 curve begins to flatten in the Northern Hemisphere, the developing world is just starting to feel its onslaught. Just as in the United States, where some of the most effective responses to the global pandemic are generated locally, the success of developing countries will also be determined by the actions of local leaders, citizens, and organizations—including fiscal responses….”
Quote : “Donors have played an important role in bringing together citizens and local government to develop mutually beneficial tax policy that increased revenue and built social cohesion. Now donor facilitation is particularly relevant as local actors are already stretched in responding to the pandemic. Consulting with citizens shouldn’t be considered a luxury. In contrast to the positive examples above, we’ve also found that when tax and budget policies are implemented in developing countries without consultation—or transparency—they can lead to violent uprisings and societal disruption….”
UH2030 - Insights for health systems strengthening in the COVID-19 response
“UH2030 Related Initiatives share their insights, guidance and learning about country responses to COVID-19 in relation to stronger health systems.” Nice overview.
Among others:
“The Alliance for Health Policy and Systems Research has convened an international Network on Health System Responses to COVID-19 (NHSC-19), a group of international research collaborators with a common interest in understanding how health systems have shaped country responses to COVID-19.”
From early this week. “Mortality statistics show 122,000 deaths in excess of normal levels across 14 countries analysed by the FT.” (including visualizations)
“Mortality statistics show 122,000 deaths in excess of normal levels across these locations, considerably higher than the 77,000 official Covid-19 deaths reported for the same places and time periods. If the same level of underreporting observed in these countries was happening worldwide, the global Covid-19 death toll would rise from the current official total of 201,000 to as high as 318,000. … … … “If we want to . . . [understand] the ways different countries have responded to the surging pandemic and how [it] has affected the health of the population, the best way is to count excess deaths,” said David Leon, professor of epidemiology at the London School of Hygiene & Tropical Medicine….”
One Earth (Commentary) - COVID-19: Lessons for an Urban(izing) World
M Acuto; https://www.cell.com/action/showPdf?pii=S2590-3322%2820%2930155-X
“The COVID-19 crisis has changed the face of many of our cities and questioned how we should manage urban life in the wake of a pandemic. This Commentary points to the need to learn urban governance lessons and to the potential value of urban experimentation in crisis.”
For more on urbanisation and Covid-19, see also The Conversation - Cities are at centre of coronavirus pandemic – understanding this can help build a sustainable, equal future
“…We have a unique opportunity to work towards fairer, more sustainable cities in the wake of coronavirus. Emergency government economic support packages must be used proactively. Global plans such as the New Urban Agenda, endorsed by the United Nations in 2016, can steer a shift to green, circular economies.”
Science News - Reopening puts Germany’s much-praised coronavirus response at
A too brisk reopening could jeopardize Germany’s coronavirus response. Interesting piece, certainly also with a view on other countries currently also lifting some of the restrictions.
WB (blog) - COVID-19 (coronavirus): Panic buying and its impact on global health
supply chains
E K Besson; https://blogs.worldbank.org/health/covid-19-coronavirus-panic-buying-and-its-impact-
“Panic buying is one of the top headlines of the COVID-19 (coronavirus) pandemic. This international phenomenon threatens health systems’ ability to prevent and treat the coronavirus with shortages of hand sanitizers, masks, and pain relievers. Panic buying of potential treatments may also deplete medicines for patients with chronic diseases – chloroquine and hydroxychloroquine remain unproven for COVID-19, but are vital medicines for autoimmune conditions such as lupus.”
“The pandemic has led to a market failure where high demand meets limited supply. It is now a “seller’s market,” in which suppliers and distributors have established new terms and conditions for buyers, including: Payment terms with high financial risks, such as 50% upfront payments, with balances due once the merchandise leaves the warehouse. Delivery delays, due to practices such as filling orders out of sequence and moving the highest-paying customers to the front of the line. Excessive mark-ups, with distributors accused of stockpiling goods to create perceived shortages and selling later at inflated prices. Reduced access to known, quality-assured manufacturers, with national governments limiting or banning exports to protect national supplies.”
“This new economic model offers a significant advantage to the wealthiest economies on the global pharmaceutical market. It is exacerbated by panic buying from high-income countries, which further reduces access to affordable and quality-assured medicines for low- and middle-income countries (LMICs)….”
BMJ (Analysis) - Mitigating the wider health effects of covid-19 pandemic
response
https://www.bmj.com/content/369/bmj.m1557
“Health inequalities are likely to widen without action to support those most vulnerable to the economic and other effects of social distancing measures, argue Margaret Douglas, M McKee and colleagues.”
With a full-blown framework 😊! “ Several groups may be particularly vulnerable to the effects of both the pandemic and the social distancing measures (box 2). Table 1 summarises several mechanisms through which the pandemic response is likely to affect health: economic effects, social isolation, family relationships, health related behaviours, disruption to essential services, disrupted education, transport and green space, social disorder, and psychosocial effects…”
By Winnie Byanyma. Very powerful piece. “Covid-19 is a disease killing people. However, the scale and consequences of the pandemic are man-made. The thousands of lives already lost and the millions of livelihoods that have been destroyed were not inevitable. They are the result of the extreme inequality that is hard-wired into our global economy.”
HPW - COVID-19: Exposing & Exacerbating Global Inequality
Short report on the first webinar in the ‘Global Pandemics in an Unequal World’ series.
“As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.”
… “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.”
“But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. …”
Guardian - Covid-19 pandemic shines a light on a new kind of class divide and its
inequalities
R Reich; https://www.theguardian.com/commentisfree/2020/apr/25/covid-19-pandemic-shines-a-
One of our favourite analyses of the week. Robert Reich on 4 emerging classes. “The Covid-19 pandemic is putting the deepening class divide in America into stark relief. Four new classes are emerging.” Focus on the US, but quite recognizable in many other countries as well.
He concludes: “The Remotes among us should be concerned, and not just because of the unfairness of the Covid-19 class divide. If the Essentials aren’t sufficiently protected, the Unpaid are forced back to work earlier than is safe, and if the Forgotten remain forgotten, no one is secure. Covid-19 will continue to spread sickness and death for months, if not years to come.”
Guardian - 'Heads we win, tails you lose': how America's rich have turned
“The pandemic might be devastating countries, the people and their livelihoods, but is good for some companies and their stockholders, like the ones that hold patents for N95 masks, lifesaving medicines or vaccines….”
Telegraph - Pakistan's low death rate could indicate coronavirus is less virulent
“South Asian countries were thought ripe for a devastating wave of infection, yet death rates have so far been surprisingly low.”
“… The planning minister's comments come as Pakistan tries to balance the risks of the disease versus the economic pain from lockdown precautions in a country where a quarter live in poverty. “On the one hand what we are seeing the data that is emerging is clearly showing that the health impact is less disastrous than it has been in developed countries, and the economic impact is far more disastrous than the developed countries,” he said. His remarks also come amid debate among international health officials over whether some countries might genuinely be seeing less virulent outbreaks, or whether the low figures only reflect a lack of testing and incomplete death data. If that is the case, then countries risk easing lockdowns based on dangerous underestimates of the damage Covid-19 is really doing….”
FT - Low coronavirus death toll raises hopes Africa may be spared worst
Must-read. “Continent has limited confirmed virus fatalities but experts warn it is too early to draw conclusions.”
“Africa has just over 32,000 official cases of the virus that has infected almost 3m people around the world, and suffered fewer than 1,400 deaths. Given the limited testing capacity, the numbers may greatly underestimate the true burden, although Mr Odede, like others, said there was little evidence of unexplained outbreaks of the virus. At face value, the figures suggest that a continent of 1.2bn people had suffered fewer Covid-19 deaths than the US was recording each day. “People are very cautiously beginning to breathe a sigh of relief, although it is too early to say that we’ve dodged a bullet,” said Murithi Mutiga, a Nairobi-based analyst with the Crisis Group think-tank….”
“John Nkengasong, director of the Africa Centers for Disease Control and Prevention, warned it would be wrong to draw any firm conclusions. There was, he said, no hard evidence that any factors specific to Africa — whether a younger population, warm weather or even the prevalence of BCG vaccinations against tuberculosis — had any impact on the disease’s spread. “I would be extremely cautious at this point to make any statement that we are moving slowly and that there are special factors,” he said, adding that confirmed cases have risen by more than 40 per cent in a week. That suggested Africa might simply be behind the curve, with the pandemic picking up speed now. “Our testing level is extremely low,” he said, implying many cases might have gone undetected. Some 415,000 tests meant only 400 per million had been carried out, which is much lower than in Europe. Rather than speculate about unproven factors retarding the disease’s spread, Mr Nkengasong said
he preferred to praise the decisive action taken by governments. “African countries took very radical steps very early on by shutting frontiers and doing lockdowns,” he said.
Includes some scholars’ views on hypotheses why Covid-19 hasn’t gone as “viral” (yet?) in Africa.
BBC - Coronavirus: The different approaches to lockdowns in Africa
BBC;
“ Lockdown measures can help prevent the virus spreading, yet [African] governments have taken very different approaches to imposing restrictions on their populations….”
And a quote: “Are lockdowns the right response in Africa? The Africa Centres for Disease Control and Prevention, the body that co-ordinates pandemic responses across the continent, told the BBC that lockdowns have played a role in reducing new cases. "Without the lockdown we would have seen a more explosive outbreak," says director John Nkengasong. He adds that it's not just the lockdown itself, but also what else you do during that period. "You intensify your testing, your isolation and your contact tracing so that when you unlock the system at least you have created a huge impact on the virus spread."…”
NPR - 6 Solutions To Beat COVID-19 In Countries Where The Usual Advice Just
Won't Work
NPR Goats & soda;
Check them out.
Lancet Global Health (Comment) - Limiting the spread of COVID-19 in Africa: one
size mitigation strategies do not fit all countries
S Mehtar et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30212-6/fulltext
“On March 11, 2020, when coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by WHO, there were comparatively few cases reported from Africa. Our Comment draws on early imported COVID-19 cases in South Africa, Senegal, Democratic Republic of the Congo, and Egypt as case studies to discuss important mitigation strategies of COVID-19 in Africa….”
African Arguments - COVID-19: An open letter from African intellectuals to
“100 leading academics and writers call on leaders to govern with compassion and see the crisis as a chance for a radical change of direction.”
“The coronavirus pandemic lays bare that which well-to-do middle classes in African cities have thus far refused to confront. In the past ten years, various media, intellectuals, politicians and international financial institutions have clung to an idea of an Africa on the move, of Africa as the new frontier of capitalist expansion; an Africa on the path to “emerging” with growth rates that are the envy of northern countries. Such a representation, repeated at will to the point of becoming a received truth, has been torn apart by a crisis that has not entirely revealed the extent of its destructive potential. At the same time, any prospect of an inclusive multilateralism – ostensibly kept alive by years of treaty-making – is forbidding. The global order is disintegrating before our very eyes, giving way to a vicious geopolitical tussle. The new context of economic war of all against all leaves out countries of the Global South so to speak stranded. Once again we are reminded of their perennial status in the world order in-the-making: that of docile spectators. Like a tectonic storm, the COVID-19 pandemic threatens to shatter the foundations of states and institutions whose profound failings have been ignored for too long….”
Nature - Let Africa into the market for COVID-19 diagnostics
“Africa is boosting its capacity to respond to COVID-19, but lack of solidarity will cost lives, warns Africa CDC head John Nkengasong.”
“The collapse of global cooperation and a failure of international solidarity have shoved Africa out of the diagnostics market. … … Lack of access to diagnostics is Africa’s Achilles heel. When SARS-CoV-2 was first reported, genome sequences were made available within weeks and several groups in Asia and Europe started producing in-house tests. Africa lacked this capacity and had to wait for the tests to be introduced, a tardy ‘trickle-down’ of diagnostics. The situation has now become worse: a race is on by the powerful to acquire whatever COVID-19 tests are available. … … Instead of global solidarity, global protectionism has prevailed, with more than 70 countries imposing restrictions on the export of medical materials. …”
Guardian - Africa's Covid-19 research must be tailored to its realities – by its own
scientists
Guardian;
“Trust is essential in the pandemic and scientists here can set the priorities that make the most sense for our people.”
Effective States and Inclusive Development (ESID) - Two great blogs on the
politics of responding to Covid-19 in developing countries
Part 1 “In this first part of a two part blog, ESID’s senior team outline what matters most and what a
politically attuned response might look like.”
Part 2: “ Discussion of what the political settlement type is likely to mean for Covid-19 response.”
A few excerpts:
“Our research has tried to go beyond the characterisation of developing country politics in terms of democratic versus authoritarian forms of rule and to focus instead on how the underlying balance of power (or what has been termed the ‘political settlement’ shapes how institutions actually work in practice).
There are early signs that this kind of approach might be useful in understanding how different countries are responding differently to the crisis: according to a Carnegie Endowment analysis of the response to Covid-19 amongst high- and middle-income countries, democracies and authoritarian regimes are amongst both the best- and the worst-performers. Francis Fukuyama has also argued that whether a country is democratic or authoritarian is not emerging as the primary dividing line when it comes to responding to the current crisis. What seems to matter more is the degree of state capacity and the ability of states to learn from previous outbreaks, the trust that citizens have in the state and the role of political leadership in devising, communicating and guiding the implementation of a coherent and effective response. These key characteristics do not break down easily by regime type as shown by Afrobarometer data on levels of trust in African governments. … … In this blog we discuss whether ESID’s findings on the relationship between politics, power and a country’s commitment to broad-based development can help us understand how countries are currently responding to the growing spread of covid-19 and what kinds of responses could be mounted within different types of political settlement.”
Must-read. “All hopes are pinned on the development of a COVID-19 vaccine. But there are going to be huge political challenges to overcome if and when an effective vaccine does become available”.
“In this post, we sketch out some of the problems with existing vaccine markets, and the specific political economy challenges that are likely to emerge around production and distribution of a COVID-19 vaccine. …”
Stat - The success of a Covid-19 vaccine will hinge on its delivery
Stat;
By Johns Hopkins researchers. “It won't be enough to just have an effective Covid-19 vaccine — it's also going to be about how well the vaccine is delivered to those who need it. “
“… All of these issues can be addressed, but the work must start immediately, not the day the vaccine is licensed. The keys are to: project demand to secure market commitments; develop heat-stable and self-administered vaccines; ensure it is effective in older populations; establish the capacity to track changing immunity; and contribute to trust in vaccines by monitoring vaccine safety after it is deployed.”
Gates Notes - What you need to know about the COVID-19 vaccine
Bill Gates’ view (as of 30 April). “On how to speed up the COVID-19 vaccine timeline to ~18 months; On how a vaccine that is merely "good enough" may be OK for now; On how low-income countries should be among the first to get it.”
FT - Nations look into why coronavirus hits ethnic minorities so hard
“… Norway is far from the only country where people from black and minority ethnic (Bame) groups have been disproportionately affected. People from a Bame background make up about 13 per cent of the UK population but account for a third of virus patients admitted to hospital critical care units. Black Americans represent around 14 per cent of the US population but 30 per cent of those who have contracted the virus. Inquiries into why racial minorities are so heavily over-represented among those suffering from Covid-19 are under way, although few expect simple answers. Health experts and academics are now searching for clues among the multiple medical, socio-economic, behavioural, cultural, environmental and biological factors that could be driving the association between Covid-19 and ethnicity….”
PS: “…While genetics has been mentioned as a possible contributing factor that makes some ethnic groups more susceptible to the virus, this explanation was ruled out by Ewan Birney, the director of the European Bioinformatics Institute, part of the European Molecular Biology Lab.”
Speri blog series - Pandemic and Precarity: rethinking what it means to be
“Our new SPERI blog series examines the COVID-19 pandemic through the lens of precarity; illustrating how pre-existing inequalities shape and extend risk.”
Lancet World Report - Travel restrictions hampering COVID-19 response
From last week’s Lancet issue. “Many countries are limiting travel to stem the pandemic, but these measures are restricting the movement of vital equipment and personnel. Sharmila Devi reports.”
“…One of WHO's reasons for counselling against travel bans is that restrictions might interrupt the delivery of needed aid and technical support, as well as the risk of giving a false sense of security to countries. Member states are instead urged to focus on preparing health systems and ensuring disease surveillance. In response to the global shutdown, extraordinary steps are now having to be taken to mitigate the unintended effects of the travel restrictions. … … WHO said that travel restrictions in Africa are affecting the delivery of equipment and personnel vital for the COVID-19 response. “There are 47 countries not allowing any airlines to land and we need to support them with equipment, especially as we cannot send any experts to give technical support, for example, with contact tracing or analysis”, Michel Yao, head of WHO's emergency operations in Africa, told The Lancet. … … As a result of the restrictions, the World Food Programme (WFP) is planning an ambitious network of air bridges that will act like a humanitarian airline for fighting COVID-19 around the world. WHO is the lead partner for sourcing medical supplies and personnel…”
HHR - Applying Siracusa: A Call for a General Comment on Public Health
Emergencies
N Sun; https://www.hhrjournal.org/2020/04/applying-siracusa-a-call-for-a-general-comment-on-public-health-emergencies/
“… The Siracusa Principles are a foundation on which to build—in emergencies—state restrictions on rights. … … however, because these principles are meant to apply broadly to all public emergencies, they are difficult to operationalize in public health crises. This is especially true because public health crises are diverse: the dynamics of transmission, the severity of illness, the availability of treatment, and control measures all vary immensely. For new disease outbreaks, uncertainty around all these factors make assessing the degree to which responses are evidence-based or arbitrary extremely challenging. Recognizing this gap, some global institutions—including UNAIDS and the Global Fund—have issued guidance on human rights and COVID-19. While these documents are useful in highlighting key human rights concerns, overall legal guidance on human rights is needed is from the authoritative body on the interpretation of the ICCPR: the Human Rights Committee….”
Global Policy - Immunity Passports: A “New” Old Idea With Baggage
“Emilian Kavalski and Nicholas Ross Smith, from the University of Nottingham Ningbo China, take the proposed introduction of immunity passports to remind of the hundred-year-old relationship between pandemics and travel documents.”
BMJ Editorial - Donald Trump: a political determinant of covid-19
G Yamey & G Gonsalves; https://www.bmj.com/content/369/bmj.m1643
Still sounds like a euphemism, actually. “ He downplayed the risk and delayed action, costing countless avertable deaths”.
These BMJ authors call for a new social movement in the USA, inspired by the AIDS movement of the last 40 years, and a new “politics of care” to pressure political leaders in the post-pandemic recovery.
Politico – Officials probe the threat of a coronavirus bioweapon
“The Pentagon and the intelligence community are more forcefully investigating the possibility that adversaries could use the novel coronavirus as a bioweapon, according to defense and intelligence officials, in a shift that reflects the national security apparatus’ evolving understanding of the virus and its risks….”
Guardian - Malicious forces creating 'perfect storm' of coronavirus disinformation
“Russia and China among state and other actors spreading fake news and disruption, say experts”.
“…while the rise in malign online activities reflected often different behaviours and interests, together they amount to a “perfect storm” of disinformation….”
Lancet GH Correspondence - Use of the Demographic and Health Survey
framework as a population surveillance strategy for COVID-19
S V Subramanian et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30213-8/fulltext
« …In the absence of universal testing, a random-sample-based population surveillance framework is urgently needed. We propose using the well established Demographic and Health Survey (DHS) framework as a solution to ascertain the true prevalence of COVID-19. We use as an example the National Family Health Survey (NFHS), India's version of the DHS that is led by the International Institute of Population Sciences under the Ministry of Health and Family Welfare …”
• 4th information information sheet Equinet on Covid-19
“It summarises information from and provides links to official, scientific and other resources as of end April 2020 on 1: Developments in the COVID-19 epidemic; 2: Rolling back lockdowns- when and what next? ; 3: What COVID-19 has meant for the risks and returns from migration; 4: An update on access to medicines and vaccines, and 5: Resources, COVID-19 and the creative economy .”
• COVID-19 Research Project Tracker by UKCDR & GloPID-R
“UKCDR and GloPID-R have developed a live database of funded research projects on COVID-19 that will help funders and researchers identify gaps and opportunities and inform future research investments or coordination needs.”
• Resource on AMR & Covid-19: Secondary infections, antibiotic chemotherapy and antibiotic
resistance in the context of COVID-19
“While the numbers of people with COVID-19 continue to increase globally there is more appreciation of the role of secondary infections, the use of antibiotics during COVID-19 patient treatment and the consequences of this for antimicrobial resistance. We have compiled details of peer reviewed publications, preprints, other resources, blogs and commentaries on these topics in the hope that it will be of use to the scientific community during the pandemic….”
• Solidarity and Care during the Covid-19 pandemic
“Solidarity and Care during the COVID-19 Pandemic is a public platform supported and produced by The Sociological Review that documents and reports on the lived experiences, caring strategies and solidarity initiatives of diverse people and groups across the globe during the COVID-19 pandemic.”
• UNDP resource –Covid-19 and human development: Exploring global preparedness and vulnerability
Cfr a tweet Kent Buse: “New dashboards from @HDRUNDP on inequalities that fuel #COVID19 socio-economic vulnerabilities #Data4HumanDev.”
• Building back better - Gender and post-conflict health systems Exploring how issues of gender can be incorporated into the post-conflict or post-crisis agenda.
Covid-19 Collateral damage
Just some more examples of the massive (and fast increasing) ‘collateral damage’ of Covid-19:
UN News - COVID-19 could lead to millions of unintended pregnancies, new UN-
backed data reveals
https://news.un.org/en/story/2020/04/1062742
“Ongoing lockdowns and major disruptions to health services during the COVID-19 pandemic could result in seven million unintended pregnancies in the coming months, according to data released on Tuesday by the UN Population Fund (UNFPA) and partners.
“Globally, around 450 million women across 114 low and middle-income countries use contraceptives, according to UNFPA and partners. They project that if health services remain disrupted and lockdowns continue for six months, some 47 million in these countries may not be able to access modern contraceptives, resulting in around seven million unintended pregnancies….”
Guardian - Polio campaign in Africa put on hold during coronavirus
“Vaccinations for up to 12 million children to prevent the spread of polio in Africa will be delayed, in a major redeployment of polio eradication resources to fight the spread of the Covid-19 pandemic. Polio prevention campaigns, which are vital to avert outbreaks, will be suspended until at least the second half of 2020, said Dr Pascal Mkanda, the head of polio for World Health Organization Africa. The decision will inevitably lead to a rise in polio cases…” And outbreaks.
Guardian - 'Calamitous': domestic violence set to soar by 20% during global
“British government urged to plug shortfall as Oxfam and Christian Aid reveal huge financial impact of Covid-19 outbreak.” (it’s probably a similar story for NGOs in many other countries)
“Charities are calling on the UK government for greater support as they report the loss of millions of pounds as a result of Covid-19. Oxfam said it is losing £5m a month from the closure of its shops alone, while Christian Aid last week said it expected a £6m drop in its funds this financial year. Others
said they were still calculating the impact. Bond, the UK international development network, wants the government to establish a stabilisation fund so organisations can survive and continue to deliver aid to people living in refugee camps or in extreme poverty.”
UNICEF (paper) - COVID-19 and children, in the North and in the South
New Unicef paper. “This paper aims to document the likely direct and indirect impacts of the COVID-19 crisis in developed and developing countries. It also aims to identify potential urgent measures to alleviate such impacts on children….”
Guardian – Demand for coronavirus tests raises concerns over HIV and malaria
“Some firms shifting production away from malaria, HIV and TB, which kill millions…. …. Now there are fears that the rush to supply wealthier countries pressing for more tests may destabilise the fight against HIV, malaria and tuberculosis, illnesses that kill millions, mostly in low- and middle-income countries. “Some companies are planning to reduce or stop malaria, HIV and TB test production,” said Dr Catharina Boehme, the chief executive of the Foundation for Innovative New Diagnostics (Find) and an adviser to the World Health Organization. “They are shifting their production to Covid-19 tests.” Boehme said companies could get about 18 cents for a rapid malaria test and $10 for a Covid-19 test. The Global Fund to fight Aids, Tuberculosis and Malaria said it was concerned about “any action that might reduce the availability of tests or treatment for HIV, TB or malaria”….”
PS: “Diagnostics are finally having their moment. On Monday there will be an international pledging conference for donor countries to promise funds for vaccines and work on epidemic preparedness. This time, it will include diagnostics. There is recognition of the crucial part they play in controlling a global pandemic, and acknowledgement that most countries have been very ill-prepared.”
On the Covid-19 picture: “…As the world's most advanced economies struggle to repurpose state and private sector capacity to meet the growing demands on health services, the spotlight is shifting to countries without formal social safety nets or the massive monetary injections needed to bolster their economies. COVID-19 is yet to establish a firm foothold in low-income nations, but African countries
are already feeling the economic impact of the stall in global demand for oil, gas, and commodity products. … … But with many borders closed and wealthy nations increasingly looking inwards, we are reminded of the asymmetrical power structures that still dominate the largely high-income-country concept of global health and development, and the dangers of the poorest countries being left in the dark as traditional powers shift their focus to the overwhelming problems at home. “
“… Territorial colonialism may have ended long ago but this contemporary global health crisis can serve as a reminder that the colonisation of medicine, economics, and of politics, remains alive. We must reflect on practices that have their origins in 19th century imperialism and replace them with new systems that are rooted in values of recognition, reciprocity, and respect.”
PS: for some concrete recommendations on how to decolonize global health, see this new BMJ blog - “Using my Voice” to Decolonize Global Health (by Tia Palermo)
• Lancet GH Comment - Recognising the burden of maternal infection worldwide
“Maternal mortality is unacceptably high worldwide, with an estimated 300 000 women dying in 2017, of which around 200 000 deaths were in sub-Saharan Africa. Maternal infection, leading to sepsis, is a leading contributor to these deaths. Yet data for the incidence and cause of maternal infection are scarce. In The Lancet Global Health, Mercedes Bonet and colleagues report findings from a study of maternal infection in 52 countries. …”
• Lancet GH Comment - A new vehicle to accelerate the UN Sustainable Development Goals (by L Sherr et al)
Excerpts: “Achieving a range of global goals for adolescents in Africa would have widespread effects, but a new vehicle is needed to implement these goals. Use of development accelerators might be this fundamental change in approach. Promoted by the UNDP, accelerators are conceptualised as pragmatic actions that have a simultaneous cumulative effect across a range of goals. Emerging evidence shows that accelerators can be a reality for adolescents—for example, in South Africa, cash transfers to poor households reduced sexual risk behaviour in adolescents (SDG 5) as well as a range of other SDGs. … … Evidence suggests even greater potential for beneficial effects by use of accelerator synergies (combinations of two or three accelerators that deliver greater reach and resonance) compared with singular accelerators.”
… The next global priorities are to find accelerator synergies for the SDGs, appraise cost-effectiveness, provide pragmatic objectives with high value for money, and feed directly into country-level strategies for implementing the SDGs. The UK Research and Innovation Global Challenges Research Fund Accelerate Hub has been set up to achieve these priorities. The hub is a shared research initiative across UN agencies, the African Union, non-governmental organisations, and donors, with joint south–north academic leadership. “
• Lancet GH Health Policy - Effective coverage measurement in maternal, newborn, child, and
adolescent health and nutrition: progress, future prospects, and implications for quality
health systems (A Marsh et al, on behalf of the Effective Coverage Think Tank Group)
“ Intervention coverage—the proportion of the population with a health-care need who receive care—does not account for intervention quality and potentially overestimates health benefits of
services provided to populations. Effective coverage introduces the dimension of quality of care to the measurement of intervention coverage. Many definitions and methodological approaches to measuring effective coverage have been developed, resulting in confusion over definition, calculation, interpretation, and monitoring of these measures. To develop a consensus on the definition and measurement of effective coverage for maternal, newborn, child, and adolescent health and nutrition (MNCAHN), WHO and UNICEF convened a group of experts, the Effective Coverage Think Tank Group, to make recommendations for standardising the definition of effective coverage, measurement approaches for effective coverage, indicators of effective coverage in MNCAHN, and to develop future effective coverage research priorities. Via a series of consultations, the group recommended that effective coverage be defined as the proportion of a population in need of a service that resulted in a positive health outcome from the service. The proposed effective coverage measures and care cascade steps can be applied to further develop effective coverage measures across a broad range of MNCAHN services. Furthermore, advances in measurement of effective coverage could improve monitoring efforts towards the achievement of universal health coverage.”
• Lancet GH Letter - Public Health and Big Alcohol
“The main message of the corporate social responsibility initiatives is that both the regulators and society need the alcohol industry to come forward and take on a pivotal role in addressing alcohol-related harm. However, as much as bringing people together for a better world sounds good, the financial motivations of Big Alcohol do not align with evidence-based public health initiatives to reduce alcohol harm. On the contrary, Big Alcohol's involvement in public health is indisputably one of the most serious conflicts of interest in the field of global health.”
Some papers and reports of the week
IJHPM - Transnational Networks’ Contribution to Health Policy Diffusion: A Mixed
Method Study of the Performance-Based Financing Community of Practice in
Africa
L Gautier et al ; http://www.ijhpm.com/article_3796.html
« Transnational networks such as Communities of Practice (CoPs) are flourishing, yet their role in diffusing health systems reforms has been seldom investigated. Over the past decade, performance-based financing (PBF) has rapidly spread in Africa. This study explores how, through the PBF Community of Practice’s attributes, structure, and strategies, PBF diffusion was fostered in sub-Saharan Africa (SSA). »
Findings: “CoP members’ attributes included: representation systems anchored in clinical and economic sciences, strong expectations that the CoP would boost professional visibility and career, and significant health systems knowledge and social resources. The CoP’s core group, dominated by high-income country (HIC) members, critically matched PBF principles to major health systems issues in Africa. The broad consensus in online PBF thematic discussions created a strong sense of community, a breeding ground for emulation among CoP members. The CoP also sought to produce and promote experiential knowledge exchanges about PBF amongst African practitioners. Findings
from network analyses showed that the promoted Africa-driven community was led by HIC members, although their prominence tended to decrease with time. »
IJHPM - Community Health Workers as Influential Health System Actors and not
“Just Another Pair Of Hands”
S Kane, B McPake et al; http://www.ijhpm.com/article_3797.html
“Over the last 20 years, community health workers (CHWs) have become a mainstay of human resources for health in many low- and middle-income countries (LMICs). A large body of research chronicles CHWs’ experience of their work. In this study we focus on 2 narratives that stand out in the literature. The first is the idea that social, economic and health system contexts intersect to undermine CHWs’ experience of their work, and that a key factor underpinning this experience is that LMIC health systems tend to view CHWs as just an ‘extra pair of hands’ to be called upon to provide ‘technical fixes.’ In this study we show the dynamic and evolving nature of CHW programmes and CHW identities and the need, therefore, for new understandings….”
“A qualitative case study was carried out of the Indian CHW program (CHWs are called accredited social health activists: ASHAs)….”
UNCTAD report - From the Great Lockdown to the Great Meltdown: Developing
(16 p.) “…Following a brief discussion of current debt vulnerabilities in developing countries, this update of UNCTAD’s Trade and Development Report 2019 lays out a series of steps that the international community will need to take if there is to be any hope of salvaging the Agenda 2030 and moving to a more resilient and sustainable future for all countries. A new ‘Global Debt Deal’ for developing countries…”
What does such a new Global Debt Deal for developing countries involve? “… Argentina’s recent approach to its negotiations with its private and multilateral external creditors sets out some basic principles required to overcome these shortcomings (Box 2). A new “global debt deal” for developing countries should take note of these principles and, more generally, incorporate the following three basic steps…”
BMJ Global Health (Commentary) - The Global Health Security Index: what value
does it add?
A Razavi et al ; https://gh.bmj.com/content/5/4/e002477
Good question, many of us think, especially in the US now 😊. (you recall the US was ranked number
one on this index)
“The Global Health Security Index (GHSI) is a new tool that can be used to assess a country’s global health security. It uses open-source information to establish how each of the 195 International
Health Regulations signatory countries meet 85 subindicators across six categories. The process is comprehensive; however, questions remain over the skew of indicators towards the priorities of high-income countries, the validity of some indicators, the scoring system and its weighting, and how the GHSI adds value to existing assessments of global health security. We recommend avoiding using the scoring to determine priorities and compare countries with one another. “
“Amidst the several other existing global health security assessment tools available, we critically review whether the GHSI adds value to the existing suite of tools for improved global health security….”
They also look forward to further refinement of the process and suggest closer integration with the JEE process and IHR.
Graduate Institute (Global Health Centre) (Working paper) – Towards a
“The Global Health Centre published a new working paper in which Ilona Kickbusch and Christian Franz highlight an urgent need to reframe and refocus the role of the European Union in global health.”
“…Rooted firmly in the European values, norms, and its commitment to human rights, the Member States should work towards a “synergistic” strategy for global health that takes into account three major questions: (1) How can EU global health policy deliver on improving and protecting the health and wellbeing of the people living in the EU through strengthening global health cooperation? (2) Where can global health policy contribute to the strategic goals of the EU and its Member States? (3) How can global health policy support the EU and Member States to fulfill the Sustainable Development Goals and global commitments (both, outside and within the EU)? In close cooperation with the incoming EU Commission, Member States should answer these questions and – based on new Council Conclusions – adjust institutions and instruments, policy priorities, EU coordination processes, and forge new partnerships in global health. Ilona Kickbusch and Christian Franz argue that such a comprehensive approach will allow the EU to take a global leadership role in global health and contribute to the creation of global goods supporting the values of the Union.”
WHO Bulletin (May issue)
https://www.who.int/bulletin/volumes/98/5/en/
Among others, with an Editorial on Medical certification of cause of death for COVID-19 and another Editorial on Simulation of the effects of COVID-19 testing rates on hospitalizations.
“…Presented as a ‘digital longform’, the multimedia story provides an in-depth look at how Ghana’s embedded research programme has evolved and it outlines five steps that were important for its development. The story was jointly produced with the Ghana Health Service and supported by the Doris Duke Charitable Foundation.”
Priority Setting for Better Health: The international Decision Support Initiative
C Nemzoff et al ; https://www.cgdev.org/blog/priority-setting-better-health-international-decision-
support-initiative
“iDSI is a global network of health, policy, and economic expertise that works to directly strengthen priority-setting methods, capacity and processes, and respond to demand for knowledge diffusion and translation. Learn more about iDSI and CGD's priority setting work.”
Development Initiatives - Transforming aid into GPI could help achieve social
“Gorik Ooms, human rights lawyer and global health scholar, suggests that Global Public Investment (GPI) could transform aid and achieve global social justice.”
Who wants some more old wine in new bottles? Why the Sustainable
“Jan Orbie and Sarah Delputte (Gent University) are of the opinion that the SDGs do not tackle – and may even strengthen – global injustice. Delays and failures in achieving the SDGs may easily be blamed on the global disruptions following the covid-19 pandemic. However, there have always been fundamental problems with the SDG approach. SDGs do not contain any structural reforms and further legitimise the existing world order, as evidenced by the role attributed to (free) trade. “
Guardian - Record 50 million people internally displaced in 2019, study finds
“A total of 50.8 million people around the world were recorded as internally displaced last year, forced from their homes by conflict and disaster. This is the highest number ever, and 10 million more than in 2018. Annual statistics published by the Norwegian Refugee Council’s Internal Displacement Monitoring Centre (IDMC) calculated that by the end of 2019, 45.7 million people were internally displaced – effectively becoming refugees in their own country – as a result of violence in 61 countries. An additional 5.1 million people in 96 countries had been displaced by disasters….”
“Alexandra Bilak, the IDMC director, said she had hoped internal displacement would receive more global attention this year, following the launch in October of a UN high-level panel to address the problem and find long-term solutions. The panel held its first meeting in February. However, Covid-19 was expected to shift focus away, she said. “We were so hoping this year would be really the wake-up call to the international community, with the new high-level panel on internal displacement. We thought this year would be the year of internal displacement,” said Bilak. She said it was too early to assess the full impact of the coronavirus on displacement and the efforts to address it, but was worried about future funding….”
The Lily - Women academics seem to be submitting fewer papers during
coronavirus. ‘Never seen anything like it,’ says one editor.
“Six weeks into widespread self-quarantine, editors of academic journals have started noticing a trend: Women — who inevitably shoulder a greater share of family responsibilities — seem to be submitting fewer papers. This threatens to derail the careers of women in academia.”
Devpolicy blog - The new Chinese aid agency after its first two years
D Zhang et al ; https://devpolicy.org/the-new-chinese-aid-agency-after-its-first-two-years-20200422-
2/
Recommended short analysis. “In April 2018, China established its stand-alone aid agency – the China International Development Cooperation Agency (CIDCA). This was a milestone event in Chinese aid history and signalled China’s ambition to reform its aid management to achieve better coordination and greater impact of its aid programs. On CIDCA’s two-year anniversary, we take a look at what has changed and what remains the same, and implications for external stakeholders who engage with China on development cooperation….”
Blog series “Health For All? Critical Perspectives on UHC”
This blog is from Ruth Prince (University of Oslo). Lovely title by the way – “Utopian aspirations in a dystopian world: Health for All and the UHC agenda – an introduction”.
The blog critically explores global moves towards #UHC and its language of rights to #Health, #equity, #SocialJustice & the public good.
( commenting on ramification on polio campaigns in Africa)
“The secondary impacts of #COVID-19 could well be worse than the primary with situations like this. Heartbreaking. “
Simon Rushton
– on the FT article on the Gates Foundation refocus
“Now read it, and I still can't work out why this move is being so widely lauded. Gates is explicit about the costs: “We’ve taken an organisation that was focused on HIV and malaria and polio eradication, and almost entirely shifted it to work on this "
“Exactly my thinking. Of course we need more resources for COVID-19, but don't take it from current spending on other diseases/health issues! Also, strategically, I would think that govts more likely to find resources for COVID than backfill Gates' work on HIV, polio, malaria.”
Seye Abimbola
“Editorial wish @GlobalHealthBMJ : discourse analysis of the last 5yrs of #decolonizeglobalhealth — on the tensions, the mutually reinforcing & exclusive visions, the preoccupations of different groups: elite, non-elite, HIC, LMIC, women, men, minorities, students, practitioners...”
IMF Managing Director @KGeorgieva
“For the first time in the history of the IMF, we made projections for growth based on dual modeling: epidemiological and macroeconomic.” http://ow.ly/8ATs50zpXUB #ACFrontPage #COVID19”
Global governance of health
JAMA Forum - COVID-19 Reveals Urgent Need to Strengthen the World Health Organization
L Gostin; https://jamanetwork.com/channels/health-forum/fullarticle/2765615
“…Out of the COVID-19 pandemic, the WHO could be reimagined as a stronger, more responsive international agency. Among the most crucial reforms are funding, member state compliance with norms, and political support.”
One of his suggestions: Move the WHO Headquarters to Africa
“Although high-income countries used their own resources to respond to COVID-19, the pandemic is poised to affect low- and middle-income countries. The WHO’s historic value-added has been primarily in low- and middle-income countries. The location of the WHO headquarters in Geneva, Switzerland, the epitome of a rich country in the heart of Europe, sends the wrong signal. If its headquarters were moved to sub-Saharan Africa, the WHO would be in a better position to respond rapidly where its technical assistance is needed most. Whatever the challenges, moving its headquarters to Africa would be a powerful symbol of the WHO’s commitment to the world’s poorest communities, making the organization seem less aloof and more relevant in the modern world.”
New Humanitarian - WHO’s members owe it more than $470 million
“Two countries account for over half the unpaid membership dues at the World Health Organisation: on 31 March, the United States owed $196 million, while China’s outstanding bill stood at $57 million. They’re not alone: 151 members collectively owed $473 million in unpaid dues – about 20 percent of the WHO’s annual budget – and a quarter of it was more than a year late. But the size of the US and Chinese debts highlight the WHO’s reliance on its largest members….”
Devex (Op-Ed) – World Bank needs to make fragility a central priority in the COVID-19 era
IDS (blog) - China and the future of global health governance
G Bloom; https://www.ids.ac.uk/opinions/china-and-the-future-of-global-health-governance/
“The Covid-19 pandemic is the latest – though most significant – in a series of disease outbreaks and we can expect others in the future. Rapid changes in the global economy, major population movements, environmental exposure to health risks and climate-related shocks are likely to require major public health responses in the coming years. The inadequate global coordination and leadership in the response to Covid-19, as manifested in the lack of an agreed standard diagnostic test and the competition for necessary supplies, has highlighted the need for new approaches to health governance.”
“ … I can see three alternative directions for global health governance: (1) continuing the current situation with substantial national autonomy and ad hoc arrangements for bilateral and multi-lateral cooperation; (2) creating barriers between countries and regions and a reliance on parallel arrangements for global health security between blocs; or strengthening global governance arrangements that include China and other countries as equal partners. (3) The recent action of the United States in suspending its financial support for the WHO suggests a discontent with the first option and a tendency towards the second. It is difficult to envisage how either of the first two options would provide adequate protection. That means that some form of global cooperation will be necessary. The challenge is that there is no blueprint for how to manage a change towards this goal, which must involve the active participation of China….”
Southern Voice - A global action plan for developing countries to address the coronavirus crisis: Southern perspectives
L A Valdivia, D W te Velde et al ; http://southernvoice.org/a-global-action-plan-for-developing-
“The health pandemic has highlighted the importance of a quality health sector in making the world a better and more resilient place.”
Key messages : “Developing countries face the deepest recession in a generation. Complying with lockdown guidance in developing countries will be very challenging, given the level of informality and the state of poverty and health capacities. The G20 and UN need to address shortcomings to enable inclusive, collective and coherent global leadership. Urgent actions required to address the health and socio-economic costs include global actions plans on aid and finance, trade and food security, and free flows of knowledge.”
Quote: “…Given its limited membership, the G20 needs to create access windows in its decision making process for the poor and vulnerable countries. The G20 needs to contribute towards strengthening multilateralism in these difficult times. A concrete manifestation of that would be developing a shared architecture (beyond GPEDC, beyond ODA) of international development cooperation that explicitly takes into account the perspectives and priorities of recipient countries.”
Global military expenditure sees largest annual increase in a decade—says SIPRI—reaching $1917 billion in 2019
In case you’re wondering where some of the very big bucks are (not going to global health).
“Total global military expenditure rose to $1917 billion in 2019, according to new data from the Stockholm International Peace Research Institute (SIPRI). The total for 2019 represents an increase
of 3.6 per cent from 2018 and the largest annual growth in spending since 2010. The five largest spenders in 2019, which accounted for 62 per cent of expenditure, were the United States, China, India, Russia and Saudi Arabia. This is the first time that two Asian states have featured among the top three military spenders.”
Chatham House - IMF Needs New Thinking to Deal with Coronavirus
D Lubin; https://www.chathamhouse.org/expert/comment/imf-needs-new-thinking-deal-
coronavirus
“The IMF faces a big dilemma in its efforts to support the global economy at its time of desperate need. Simply put, the Fund’s problem is that most of the $1tn that it says it can lend is effectively unusable.”
“…in the end the IMF and its shareholders face a huge problem. It either lends more money on easy terms without the 'collateral' of conditionality, at the expense of undermining its own balance sheet - or it remains, in systemic terms, on the sidelines of this crisis….”
Devex - A look at how UN development funds are recalibrating SDG funding
“Coronavirus funding will likely impact the long-term financing prospects of the Sustainable Development Goals, experts say. For now, U.N. development funds are relaxing restrictions so agencies can join COVID-19 with SDG work.”
IISD - A Bold Call for Action Needed on Measuring SDG Indicators
P Gennari et al; IISD
“When the UN Statistical Commission met in March 2020 for its annual session, it missed an important opportunity to urge countries to monitor the global SDG indicators. The Commission’s open invitation for countries to use “alternative” indicators may have serious consequences for global SDG reporting, blurring the boundaries between the roles of legislator and statistician. With a little over ten years left until the end of 2030, and an unenviable track record so far, half-hearted efforts and mixed messages will not get us to the finish line….”
IISD - Draft Resolution Provides HLPF Themes, SDGs, Areas for Acceleration in 2021-2023
IISD;
“The zero draft under consideration contains proposed themes for ECOSOC and HLPF for 2021, 2022, and 2023. It also specifies sub-sets of SDGs and areas of acceleration to be reviewed at each of those sessions. The areas for acceleration correspond to six "entry points" for transformational change - or systems that underlie the SDGs - identified in the 2019 Global Sustainable Development Report.”
Looks like 2021 will be important for health SDG 3:
“In 2021: The thematic focus would be ‘Human well-being and the SDGs: Recovering after the COVID-19 crisis.’ The SDGs under review would be: 1 (no poverty), 2 (zero hunger), 3 (good health and well-being), 4 (quality education), 5 (gender equality), 6 (clean water and sanitation), 8 (decent work and economic growth), 16 (peace, justice and strong institutions), and 17 (partnership for the Goals)….”
Foreign Affairs - Chinese Debt Could Cause Emerging Markets to Implode
“… China signed on to the G-20 pledge but added caveats that make a mockery of it. China is effectively excluding hundreds of large loans extended through its Belt and Road Initiative (BRI) for infrastructure development. “Preferential loans,” such as those made by the Export-Import Bank of China (EximBank), “are not applicable for debt relief,” declared the Beijing mouthpiece Global Times the day following the G-20 announcement. EximBank has financed over 1,800 BRI projects in dozens of countries. By continuing to demand interest payments on the loans, China will force poor nations to choose between servicing debts and importing essential goods such as food and medical supplies….”
WHO Appoints Okonjo-Iweala as COVID-19 Special Envoy
“The World Health Organisation (WHO) has named Nigeria’s two-term former Minister of Finance and former Managing Director (Operations) of the World Bank, Dr. Ngozi Okonjo-Iweala, as a Special Envoy for its newly inaugurated Access to COVID-19 Tools (ACT) Accelerator. WHO’s
Director-General, Dr. Tedros Ghebreyesus, disclosed this during the launch of the ACT Accelerator, through an online conference that took place in Geneva. Okonjo-Iweala, who is the Board Chairperson of GAVI Alliance, is to serve together with British Business Executive, Andrew Witty, in the same capacity. They are expected to mobilise international commitment to the initiative. The initiative is an international collaboration aimed at accelerating the development, production, and equitable distribution of COVID-18 drugs, tests kits, and vaccines around the world….”
IPS - The COVID-19 Cash Crisis: Will the UN Cease to Exist?
“The coronavirus pandemic has set off an unprecedented institutional crisis at the United Nations – funds are drying up, key meetings are cancelled and the world body is fighting for its future. The chief management officer of the world body, Catherine Pollard, wrote a dire memo on 1 April, setting out the breadth of the crisis, the depth of the financial shortfall, and the emergency steps to be taken immediately to head off ruin. This UN emergency comes as no surprise, since the pandemic has brought so many governments and institutions to the brink of collapse. …”
Thread L Gostin from last weekend (on IHR)
Re @WHO unable to verify China #COVID data. Key post-SARS reform enabled @WHO to use unofficial data sources (indep scientists/civil society) to improve accountability & transparency. But it didn't work w/ China. How can we empower @WHO to speak truth to power? 1X
IHR arts 9-10 gives @WHO power to use non-state info sources. But now, before taking any action, WHO must verify info w/ govt state party. @WHO must coop w/ govt in assessing info. Only if state refuses coop “may” WHO share info globally. This ties WHO's hands. 2X
“If a state wanted to hide #Covid19 info it would stall, like China did, losing valuable time. And WHO not required (“shall”) to share info with other states, much less the public. This is a recipe for no transparency. That is exactly what happened w/ China. 3X”
“WHA should strengthen IHR arts 9-10 like this: @WHO shd actively seek unofficial data sources, & have power to keep source CONFIDENTIAL WHO shd have on-call experts to indep assess official data. If non-govt info is deemed credible, @WHO should share w/ other states & public 4X”
“Giving WHO power to indep investigate official reports could overcome lack of transparency. It would enable WHO to pierce the veil of secrecy in authoritarian or non-open regimes like China. It would be a bold reform coming out of #COVID crisis. 5/5”
“There is no doubt that this reduction — something we will likely see from other donors, too — will be taking away a lifeline for some of the poorest and most vulnerable people. I
Planetary health
CGD (blog) How Do Development Agencies Support Climate Action?
R Calleja; https://www.cgdev.org/blog/how-do-development-agencies-support-climate-action
“This blog undertakes an initial analysis to map the ways that development agencies are integrating climate objectives into their development programs.”
“April 28th 2020 marks 20 years since the inception of the Global Outbreak Alert and Response Network (GOARN). For 20 years GOARN has facilitated and promoted partners to work together in tackling disease outbreaks across the world and by doing so, ensuring that the response can be greater than the sum of its parts. …”
BMJ Global Health - The promise and pitfalls of social science research in an emergency: lessons from studying the Zika epidemic in Brazil, 2015–2016
M J Passos et al ; https://gh.bmj.com/content/5/4/e002307
“Social science generates evidence necessary to control epidemics. It can help to craft appropriate public health responses, develop solutions to the epidemic impacts and improve understanding of why the epidemic occurred. Yet, there are practical constraints in undertaking this international research in a way that produces quality, ethical and appropriate data, and that values all voices and experiences, especially those of local researchers and research participants. In this paper, we reflected on the experience of undertaking social science research during the 2015/2016 Zika epidemic in Brazil…”
“The key findings highlight practical issues in the achievement of three goals: the conduct of high-quality social science in emergencies and efforts towards the decolonisation of global health in terms of levelling the power between Brazilian and UK researchers and optimising the role of patients within research….”
Lancet Infectious Diseases - Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000–17: a financial modelling study
Y Su et al ; https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30124-
9/fulltext#%20
“Estimates of government spending and development assistance for tuberculosis exist, but less is known about out-of-pocket and prepaid private spending. We aimed to provide comprehensive estimates of total spending on tuberculosis in low-income and middle-income countries for 2000–17.”
Findings : « Total spending on tuberculosis in 135 low-income and middle-income countries increased annually by 3·9% (95% CI 3·0 to 4·6), from $5·7 billion (5·2 to 6·5) in 2000 to $10·9 billion (10·3 to 11·8) in 2017. Government spending increased annually by 5·1% (4·4 to 5·7) between 2000 and 2017, and reached $6·9 billion (6·5 to 7·5) or 63·5% (59·2 to 66·8) of all tuberculosis spending in 2017. Of government spending, $5·8 billion (5·6 to 6·1) was spent on notified cases. Out-of-pocket spending decreased annually by 0·8% (−2·9 to 1·3), from $2·4 billion (1·9 to 3·1) in 2000 to $2·1 billion (1·6 to 2·7) in 2017. Development assistance for country-specific spending on tuberculosis increased from $54·6 million in 2000 to $1·1 billion in 2017. Administrative costs and development assistance for global projects related to tuberculosis care increased from $85·3 million in 2000 to $576·2 million in 2017. 30 high tuberculosis burden countries of low and middle income accounted for 73·7% (71·8–75·8) of tuberculosis spending in 2017.”
Lancet Letter - Malaria eradication – Authors' reply
BMJ Global Health - The potential health and revenue effects of a tax on sugar sweetened beverages in Zambia
P Hangoma et al ; https://gh.bmj.com/content/5/4/e001968
“The global burden of non-communicable diseases (NCDs) has been rising. A key risk factor for NCDs is obesity, which has been partly linked to consumption of sugar sweetened beverages (SSBs). A tax on SSBs is an attractive control measure to curb the rising trend in NCDs, as it has the potential to reduce consumption of SSBs. However, studies on the potential effects of SSB taxes have been concentrated in high-income countries with limited studies in low-income and middle-income countries. Using data from the 2015 Zambia Living Conditions Monitoring Survey (LCMS) data, the 2017 Zambia NCD STEPS Survey, and key parameters from the literature, we simulated the effect of a 25% SSB tax in Zambia on energy intake and the corresponding change in body mass index (BMI), obesity prevalence, deaths averted, life years gained and revenues generated…”
“…We conclude that an SSB tax in Zambia has the potential to significantly decrease the amount of disability-adjusted life years lost to lifestyle-related diseases in women, highlighting important health equity outcomes. Women have higher baseline BMI and therefore are at higher risk for NCDs. In addition, an SSB tax will provide government with additional revenue which if earmarked for health could contribute to healthcare financing in Zambia….”
Sexual & Reproductive / maternal, neonatal & child health
Guttmacher institute - The Unprecedented Expansion of the Global Gag Rule: Trampling Rights, Health and Free Speech
Guttmacher;
“…New research from the Guttmacher Institute demonstrates that the expanded global gag rule has already had a detrimental impact on clinical providers, community health workers and critical public health partners around the world….”
You might also want to read (in Plos One) - Investigating the early impact of the Trump Administration’s Global Gag Rule on sexual and reproductive health service delivery in Uganda.
UN News - COVID-19: New women-led UN initiative aims to save lives and protect livelihoods
https://news.un.org/en/story/2020/04/1062692
“Against the backdrop of the unprecedented global crisis caused by the COVID-19 pandemic, the deputy UN chief briefed journalists on Monday about a new women-led initiative that mobilizes support to save lives and protect livelihoods. Deputy Secretary-General Amina Mohammed highlighted that collectively, we are dealing with “an especially severe blow” to developing countries, particularly those in humanitarian or conflict settings. “In the face of a sweeping threat of such historic magnitude, our collective response must be equally historic and urgent”, she said, launching Rise for All – a social and economic recovery initiative that brings women leaders together in calling the world to action and in support of the UN Response and Recovery Fund and Framework….”
This state says it has a ‘feminist economic recovery plan.’ Here’s what that looks like.
Interesting ‘best practice’ – from Hawaii. “The state wants ‘to build a system that is capable of delivering gender equality’” “…The plan, produced by the state’s Commission on the Status of Women, is designed for “deep cultural change” by explicitly incorporating the unique needs of indigenous and immigrant women, caregivers, elderly women, femme-identifying and non-binary people, incarcerated women, unsheltered women, domestic abuse and sex trafficking survivors, and women with disabilities….”
Nature Medicine - Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017
LBD Double Burden of Malnutrition collaborators; https://www.nature.com/articles/s41591-020-
0807-6
“A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million)
children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria…..”
And a link (CGD blog) - Examining Uncertainties in Global Health Aid through the Lens of Family Planning: A Tale of Three Countries in Three Figures
“In the months before the current crisis, CGD’s global health policy team partnered with Pharos Global Health Advisors to understand competing fiscal and programmatic pressures across the health sector. It aimed to drill down on challenges, risks, and opportunities associated with transitions from different global health financing mechanisms.”
Access to medicines
Stat - China has near-total control of the world’s antibiotic supply. Is America at risk as a result?
STAT;
(gated) "... frontline health workers at hospitals from New York to San Francisco have been left unprotected and overwhelmed because of a shortage of masks, gloves, hospital gowns, and ventilators. As harmful as these shortages are, there is widespread confidence that they can be solved, if not in weeks, then months. But there is one major challenge to U.S. readiness that no government simulation has reckoned with, where the gap cannot be closed this year, and probably not even next year: China's near-total control of the world's antibiotic supply..."
Emerging Voices
Lancet Public Health - COVID-19 in Yemen: preparedness measures in a fragile state
New Elsevier journal. Check out the Editors’ note. “an international refereed scientific journal dedicated to encouraging and advancing knowledge on the health of migrants worldwide. This includes analysing migrants’ health and wellbeing, their social determinants of health, and understanding how migrants’ health intersects with other economic, social and political processes of human mobility. It aims to be geographically diverse and adopt a multidisciplinary approach….”
And as promised, for the Covid-19 diehards among you, some more links & reads on Covid-19:
Plos Med (Editorial) - Pandemic responses: Planning to neutralize SARS-CoV-2 and prepare for future outbreaks
“The coronavirus pandemic and its devastating economic impact on developing countries could fuel fresh interest in so-called diaspora bonds that allow migrants to support their countries of origin, experts from the World Bank and other groups say. Dilip Ratha, the World Bank's lead economist on migration and remittances, told Reuters that diaspora bonds could generate about $50 billion a year in total for developing countries, potentially helping to offset a sharp drop in foreign direct investment that is slated to fall by 37% this year. However, such claims have met with scepticism in some quarters, given the plight of many migrants who have lost jobs and income during the crisis and as direct transfers of wages to their home countries - known as global remittances - decline sharply….”
Guardian – Germany's Covid-19 expert: 'For many, I'm the evil guy crippling the economy'
Guardian
On Germany’s “prevention paradox”.
“Virologist Christian Drosten, who is leading Germany’s response to the COVID-19 pandemic, says that the country’s success in mitigating the outbreak has caused some people to think the government has overreacted — and could lead to a second wave. “The ‘prevention paradox’ has set in,” says Drosten. “
New Yorker - Jeffrey Sachs on the Catastrophic American Response to the Coronavirus
Interview with Sachs “about the coronavirus and the challenges that the crisis poses to international coöperation and the world economy. His upcoming book is “The Ages of Globalization.” In our conversation, we also discussed the root causes of American decline, why some poorer countries have so far avoided large outbreaks, and how Donald Trump has failed to meet even the low expectations that internationalists have for the United States….”
With some very damning quotes, among others, on the Donald.
BMJ Blog - Pandemic parlance: public health needs new language for the coronavirus pandemic
BMJ Blog;
“Words matter. If officials want people to buy into lifestyle changes, they need to use more inviting terminology say Joanne Silberner and Howard Frumkin.”
BMJ (Editorial) - Global regulatory agility during covid-19 and other health emergencies
T Mak et al ; https://www.bmj.com/content/369/bmj.m1575
“Enhanced collaboration among authorities is key to ensuring timely access to high quality health products worldwide.”
“… Given the extreme unmet medical need, weighed against the heightened risk of covid-19, regulators recognise that affected communities generally have a greater risk tolerance and are more open to medical interventions based on fewer initial clinical data. Such “regulatory agility” in a time of complex, rapidly evolving science is an essential component of every health system’s effective emergency response. Each regulatory authority should now examine if its emergency regulatory mechanisms are fit for purpose and how they can benefit from wider international regulatory experience. … … Covid-19 is an unprecedented challenge, testing our health systems and institutional responses. Regulatory authorities play a critical role and must be empowered by governments to engage in effective, agile regulation during a health emergency. Such agile approaches must be implemented now and be “interactive, flexible, and fast—but contextually rigorous” to ensure that we have reliable covid-19 diagnostics and high quality medical interventions for every country.”
WB (blog) - Urban Density Is Not an Enemy in the Coronavirus Fight: Evidence from China
W Fang et al; https://blogs.worldbank.org/sustainablecities/urban-density-not-enemy-coronavirus-
fight-evidence-china
Based on evidence from 284 Chinese cities.
“Making a link between a city’s density and its vulnerability to epidemics may seem like an obvious connection. But it may, in fact, be off the mark. Since the outbreak of the coronavirus (COVID-19) and its spread across the globe, places with high urban population density have seemed to be especially at risk to some observers. A common argument is that high population density makes cities more vulnerable to epidemics because of the possibility of frequent interpersonal contacts. New York City is often cited as a prime example. This argument may sound straightforward, but on
examination, its premise is not well-grounded. If you look around the world, some extremely dense cities, such as Singapore, Seoul, and Shanghai, have outperformed many other less-populated places in combating the coronavirus. …”
Stat - We need the real CDC back, and we need it now
Stat;
By A Jha. Focus on the US.
Forbes - A Skeptic’s Guide To Ecologic Studies During A Pandemic
M Pai; https://www.forbes.com/sites/madhukarpai/2020/04/22/a-skeptics-guide-to-ecologic-
studies-during-a-pandemic/#52ea1ce56894
Insightful read.
Global Policy - Covid-19 as a Critical Juncture and the Implications for Advocacy
“This Essay discusses the possible longer-term impacts of the Covid-19 outbreak on political, economic and social systems. To shape the discussion, I use the concept of ‘critical junctures’ as moments of change. I then explore the potential impact on the aid sector, and the implications for progressive advocacy, whether by civil society organizations or others, in defending past gains, building on new opportunities or heading off new threats.”
Economist – for people with dementia, the coronavirus pandemic is a nightmare
