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Dear Colleagues,
It’s early days in 2021, and some of you are probably not fully awake yet after some heavy “Corona proof” partying yesterday, but let us already wish you a splendid new year anyhow. Can’t be worse than the previous one 😊!
In this newsletter you’ll find a re-cap of the past three weeks (since 12 December, UHC Day, more or less). In steno-style, as “global health” continued over the past few weeks, not unlike the pandemic, sadly.
As usual, IHP has just one (knowledge management) resolution to kick off the new year: once more we’ll make a relentless effort to let the ‘Highlights of the week’ section truly live up to its label 😊. Which implies: we’ll ruthlessly put more stuff in the other (extra) sections, and less in the ‘Highlights’ section. For the foreseeable future, we will also provide an extra Covid section from now on, further down the newsletter, as the Covid related news and papers more or less ‘cannibalized’ the IHP newsletter ‘Highlights’ section in 2020. To “Build Back Better and Fairer” in this newsletter, we thus invite the Covid-news diehards among you to also have a proper look at this extra Covid section. For which you’ll have to scroll down. And down. And down 😊.
To get in the mood for a more or less normal life again, hopefully somewhere later this year, we recommend you listen to “The rhythm of the night” (Corona), especially when that pumping beat starts. It will surely make you long for the better times that are coming, sooner or later.
Happy New Year!
Enjoy your reading.
Kristof Decoster
(17 December)
Press release GAVI after its Board meeting. “Gavi Board approves more than US$ 600 million in new funding to help accelerate efforts to reach ‘zero-dose’ and under-immunised children in the face of the COVID-19 pandemic. The Board also made several key decisions related to the COVAX Facility, including the approval of a package of support for India. The Board approved a Risk and Assurance report and discussed risk strategies for the COVAX Facility, ensuring key risks associated with this unprecedented global effort are fully assessed and mitigated ahead of time.”
“COVAX now has agreements in place to access nearly two billion doses of several promising vaccine candidates, and laid the groundwork for further doses to be secured through contributions from donors. These agreements mean that all COVAX’s 190 participating and eligible economies will be able to access doses to protect vulnerable groups in the first half of 2021. At least 1.3 billion donor-funded doses will be made available to 92 economies eligible for the Gavi COVAX AMC, targeting up to 20% population coverage by the end of the year….”
Also with some funding updates.
Coverage Reuters - COVAX programme doubles global vaccine supply deals to 2 billion doses
https://healthpolicy-watch.news/covax-vaccine-2021-2-billion/
Key analysis of this encouraging news on Covax from Mid-December.
“The WHO-led COVAX Facility announced Friday that it has now secured some 2 billion vaccine doses and distribution of vaccines will begin in the first quarter of 2021 – ensuring that at least some vaccines will begin to reach the 92 low-income countries that are largely dependent on global philanthropy to access sufficient vaccine supplies. That would be roughly enough vaccines to immunize a little more than one-eighth of the global population: most of the vaccines procured so far require two doses. At least 1.3 billion of the 2 billion donor-funded doses secured will be distributed in the poorest economies, said the heads of Gavi, the Vaccine Alliance and the World Health Organization (WHO) at a press conference on Friday. They said that the COVAX facility – co-sponsored by WHO and GAVI – would push ahead to acquire more doses, so that all countries worldwide could reach 20% population coverage of the highest risk groups by the end of next year. “We have secured access to the first 2 billion vaccines and these will be delivered in the first quarter of next year,” said Seth Berkley, head of Gavi, The Vaccine Alliance, at the press conference on Friday….”
Some more excerpts: “…. “The idea [is] to be ready to start sharing vaccines as early as possible, that is what we are considering … in conformity with the sharing principles that COVAX and WHO issued today,” said Seydoux. … Their announcement coincided with the release of a WHO paper on Principles for Dose-Sharing. Under this, higher-income economies could donate surplus doses they have procured through direct deals with manufacturers to the COVAX facility’s low-income countries. The framework “opens another potential source of vaccines – supporting the overall goal of equitable access”, WHO said in a press release. “France will rely on this framework to consider sharing doses, as early as possible to enable vaccination against COVID-19 low priority populations,” said Seydoux, encouraging countries belonging to the G7 and G20 to follow suit. It remains to be seen if other countries will indeed choose to donate surpluses to the global COVAX initiative – or share directly with other close neighbors and allies. …”
“… The Pfizer and Moderna vaccines – which have been the first to secure regulatory approvals in the United Kingdom and by the United States Food and Drug Administration (US FDA) – do not appear in the COVAX vaccine portfolio. Moderna’s absence is even more striking, since it received funding for Phase 3 of its clinical trials from the Oslo-based Coalition for Epidemic Preparedness Initiative (CEPI), which is funded by a number of governments as well as philanthropies and other public partners.” But negotiations are ongoing, apparently.
P Patnaik; Geneva Health Files;
Must-read analysis on the GAVI Board meeting, and the current situation (and challenges) re Covax.
Make sure you read the feature story – “Covax in 2021: Will the pieces come together? What Gavi’s Board documents say.”
“…. The Board documents give a glimpse of Gavi’s response to the pandemic which suggest that it is planning for administering vaccines for COVID-19 for several years….”
“Our story this week looks comprehensively at the many dimensions of this operation including on issues of governance, financing, liabilities; and what all these could mean for many countries that have signed up to the Facility. ….”
“….Failure to deliver on COVAX could translate into risks which could threaten Gavi’s overall core immunization programmes, in addition to increasing reputational risks for Gavi that could have implications among its donors, documents say. … …. To raise funds for its activities, Gavi plans to intensify private sector engagement and to cash in on the emerging global health security agenda high on the priorities of donor countries, according to recent documents which were considered by its Board…..”
Some very welcome news from the US, before the end of the year. Part of a larger omnibus funding package, approved by Congress (and in the end, also by the Donald).
“The United States has approved US$ 4 billion for Gavi, the Vaccine Alliance to ensure lower-income economies have equitable access to safe and effective COVID-19 vaccines on the same urgent timeline as wealthier countries. These funds will help end this acute phase of the pandemic. The United States also approved its Fiscal Year 2021 contribution of US$ 290 million for Gavi’s routine immunisation programmes. This funding is part of the multi-year pledge made to Gavi at the Global Vaccine Summit in June and will help provide life-saving vaccines to nearly half the world’s children…..”
See also HPW – US Congress Allocates $4B To Support Gavi Vaccine Equity Plan
(23 Dec) “The virtual 47th meeting of the UNAIDS Programme Coordinating Board (PCB) has concluded with important decisions relating to the HIV response, the COVID-19 epidemic, and the ongoing transformation of UNAIDS.”
We bet you’re more than happy 2020 is ‘history’ now, but if not, below you find some reads reviewing 2020 from a Covid & other global health (policy) angle.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32710-0/fulltext
“While one health issue has dominated the news in 2020, Farhat Yaqub looks back at some of the year's most important non-COVID-19 stories in health and medicine.”
https://www.who.int/news-room/spotlight/a-year-without-precedent-who-s-covid-19-response
Pretty extensive overview by WHO of everything it has done re Covid in the past year.
https://www.economist.com/leaders/2020/12/19/the-year-when-everything-changed
“Why the pandemic will be remembered as a turning-point.” One of many similar analyses.
Yanis Varoufakis ; https://www.project-syndicate.org/commentary/seven-secrets-revealed-by-2020-by-yanis-varoufakis-2020-12?
Must-read. “This year has resembled a rapidly receding tide, forcing us to confront submerged truths. One lesson we learned in 2020 is that national governments had been choosing not to exercise their enormous powers so that those whom globalization had enriched could exercise their own.” Check out the seven exposed truths, this year.
Links:
· Ellen ‘t Hoen : Wrapping up 2020 with some noteworthy medicines, law and policy events
Pretty detailed listing of noteworthy medicines, law and policy events in 2020. Recommended.
· Devex - Global health breakthroughs — other than for COVID-19 — in 2020
There’ll no doubt be plenty more of these pieces in the weeks to come. But here are a few already:
https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021
Check them out, and what WHO’s activities will be related to them.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32751-3/fulltext
This Lancet Editorial lists what the Lancet has in store (in terms of Commissions, Series, …) in 2021. All with as overriding aim: “….For a long time, health has been considered by politicians as secondary to other aspects of governing: an added bonus that can be moulded, a budget that can be reallocated, a policy that can be sidelined, instead of the driving force of a functioning economy. In 2021, The Lancet will continue to put social justice at the centre of our work, and we will strengthen our commitment to argue for health as a foundational value and outcome for all other aspects of society.”
https://www.statnews.com/2020/12/29/global-health-2021-covid-who-polio/
Helen Branswell’s take.
Quote: “The coming year will also see the start of the process for determining if Director-General Tedros Adhanom Ghebreyesus will serve a second term. Tedros took office in July of 2017; his term ends Aug. 15, 2022. He is eligible to run for another five-year term. The process of filling the director-general’s job begins a year before the incumbent’s term ends. The 2021 World Health Assembly — the annual meeting of WHO’s member states which is held in mid-May — will issue a call for nominations. The nomination period will close in September 2021 and the list of nominees will be revealed in October. If Tedros runs and is opposed, the World Health Assembly will hold a vote when it meets in May 2022. The director-general has not yet indicated if he plans to seek a second term…..”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32752-5/fulltext
“Sharmila Devi looks ahead to the most overlooked humanitarian issues that will arise in 2021.”
https://uk.reuters.com/article/health-coronavirus-who-idUKKBN28P1CG
(Dec 15) Update on the (still rather problematic) ACT-A fundraising. The latest “idea” seems another “financialization of global health” disaster waiting to happen:
“The World Health Organization is looking at new financial instruments to help to fill a $28 billion funding shortfall for tools to fight COVID-19, a senior official said on Tuesday. The WHO and GAVI vaccine alliance aim to provide poor and middle-income countries with diagnostic tests, drugs and vaccines through a fund known as the Access to COVID-19 Tools (ACT) Accelerator, set up last April.
Bruce Aylward, a senior WHO adviser and its ACT coordinator, said that new financing mechanisms - including concessional loans and catastrophe bonds - were discussed at a meeting of the ACT facilitation council on Monday, co-chaired by Norway and South Africa….”
See also UN News - To end the pandemic, WHO says $28 billion ACT project is ‘the best deal in town’
Looks like Duterte is making the covid vaccine a strategic game changer in the Philippines–US relationship. “President Rodrigo Duterte (pic) told the United States that he would push through with his plan to terminate the Visiting Forces Agreement (VFA) unless it was able to provide the Philippines with vaccines against the new coronavirus….”
PS: the Chinese vaccine diplomacy vs Turkey also seemed a bit “rough”, according to reports.
(11 Dec) “Exclusive: document intended to help prevent future deaths allegedly pulled from website after request.”
See also more analysis via HPW:
“… the involvement of an influential Italian official in censoring a WHO report that was critical of his country – sets a bad precedent for the much broader WHO investigations that are just getting underway into the global pandemic response and the origins of the SARS-CoV-2 virus. ….”
M Knipper et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32546-0/fulltext
Focusing on how Germany’s new global health strategy neglects migrants.
“…the neglect of migration, one of the most pressing global health issues, means these pledges ring hollow: migration is not even mentioned once in the 44-page document. A global health strategy that leaves out migration is not suited to adequately respond to the health opportunities and challenges of “a world on the move”—in Germany, Europe, or globally….”
(12 Dec) Coverage of the Climate Ambition Summit.
“The world is still not on track to fulfil the 2015 Paris climate agreement, the UK’s business secretary Alok Sharma warned, after a summit of more than 70 world leaders on the climate crisis ended with few new commitments on greenhouse gas emissions. …. … He said progress had been made at the Climate Ambition Summit, co-hosted by the UK, the UN and France, marking five years since the Paris accord was adopted. More than 80 world leaders including China’s Xi Jinping, the European commission president Ursula von der Leyen, and Pope Francis urged swifter action on the climate crisis. But while Xi reaffirmed China’s target of net-zero emissions by 2060, he gave few new details of reductions in the next decade. India also disappointed observers when the prime minister, Narendra Modi, vowed to “exceed expectations” in curbing carbon dioxide by the centenary of Indian independence in 2047, but made no pledge on coal production…..”
And some links:
· Reuters - U.N. chief urges leaders of every country to declare 'climate emergency'
· Guardian - US to hold world climate summit early next year and seek to rejoin Paris accord
https://healthpolicy-watch.news/uk-court-air-pollution-cause-death/
“Global health and air pollution advocates have hailed a landmark court case which has recognized air pollution as a factor into the 2013 death of a 9 year-old girl – for the first time in history…..”
(15 Dec) Coverage of a new UNDP report.
“Unless leaders make the right choices on recovering from the pandemic to avoid entrenching environmental problems and social inequalities, the world faces a future of lurching from crisis to crisis, reversing gains made in recent decades in health, education, social freedom and combating poverty, the UN has warned. The unprecedented impacts of the coronavirus pandemic, combined with the environmental crises the world is facing, threaten to wind back human progress and development, leaving societies around the world vulnerable and more unequal, according to a new report from the UN development programme (UNDP)….”
See also HPW - Climate Measures Now Included In UN Human Development Report – Reflecting Countries’ Progress On Emissions Reductions
“Nearly all countries’ development rankings have been shaken up, following the addition of new climate and environmental metrics in a UN global index designed to measure human progress, with the greatest decline in ranking position occurring among high income and developed countries. The 2020 Human Development Report, published by the United Nations Development Programme (UNDP), details the myriad of challenges posed by climate change and poverty, which have been exacerbated by the ongoing pandemic. But it also includes a new generation of human development metrics to reflect countries’ progress in lowering climate emissions and making more efficient use of natural resources, in what UNDP describes as an attempt to better visualise and measure the effectiveness of countries’ climate and environmental policies. The two new metrics – measuring national carbon dioxide emissions and material footprint, per capita – have been added to UNDP’s Human Development Index (HDI), as part of its ‘planetary pressures’ adjustments…..”
Robert Marten et al ; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czaa165/6042985?searchresult=1
The authors highlight three interlinked reasons, which should motivate the HPSR community to prioritize a focus on climate change.
Nice article. Should’ve been ‘climate crisis’ or ‘climate breakdown’, though, in the title.
Links:
· Climate Home News - - 10 myths about net zero targets and carbon offsetting, busted
“Carbon neutrality targets are often not as ambitious as they sound, relying on problematic carbon offsets and unproven technologies.”
Quote: “We must shift focus from mid-century net-zero targets to immediate, real emissions reductions in our own high-income countries. Reductions of at least 10% per year are needed. This massive transformation of our societies is our only way to fulfil the Paris agreement without relying on risky and unproven, large-scale deployment of negative emission technologies…..”
At a virtual event, WHO’s Operational framework for primary health care was launched. Its relevance for strengthening PHC both in the COVID-19 pandemic context and as part of building better, were also discussed.
The new WHO UHC Compendium of Health Interventions was also launched at this event. That’s a global repository of interventions for UHC.
“The UHC Compendium is a database of health services and intersectoral interventions designed to assist countries in making progress towards Universal Health Coverage (UHC). It provides a strategic way to organize and present information and creates a framework to think about health services and health interventions. The database for the Compendium spans the full spectrum of promotive, preventive, resuscitative, curative, rehabilitative, and palliative services, as well as a full complement of intersectoral interventions. The Compendium will provide rapid one-stop access to supporting evidence, associated human and material resource inputs, and feedback on cost impact as interventions are selected. Version 1.0 of the Compendium focuses on clinical health services and includes a list of over 3500 health actions across different health areas, available here. The health actions can be grouped dynamically into categories such as health programmes, life-course stage, and SDG goals. ….”
See WHO - New WHO tool to help countries advance towards universal health coverage
“…Basically a toolbox for countries to build packages of essential services, the Compendium offers national health authorities and decision-makers a database of over 3500 health actions across all health areas from which they can choose when planning and budgeting their health programmes…..”
https://www.who.int/publications/i/item/9789240017801#.X9nWk93IBDk.twitter
“This document provides detailed advice in support of implementation of version 2.0 of the Health Financing Progress Matrix (HFPM) released in December 2020. The HFPM is WHO’s standardized qualitative approach to assessing country health financing systems, and comprises two stages. Stage 1 provides a descriptive landscape of the different coverage schemes and programmes in the health system, including how the health budget is organized. Stage 2 comprises thirty-three questions which look in detail at the way health financing institutions and policies are organized, and how they are implemented. For each question, the guide discusses why it is important to ask, and what progress looks on the issue looks like. Specific criteria are identified to support the assessment process; these criteria also signal the type of policy directions and implementation strategies which support progress. Ideas are also provided on information sources and quantitative indicators which can support the assessment.”
With three main messages: “…. First, global guidance on COVID-19 response strategies should be adapted to context-specific and evolving needs in fragile settings. This may mean that actions to safely protect and restore other essential health services need to be prioritized, alongside feasible and proportionate COVID-19 control measures. Second, an urgent call to protect funding for health in fragile settings. Third, despite many unknowns in fragile settings, important practical lessons are emerging about how to enhance COVID-19 response and recovery. The brief includes six emergent lessons based on evidence and approaches to date. The policy brief is based on a series of discussions of the UHC2030 Fragile Settings Technical Working Group from July to December 2020, and analysis and evidence contributed by group members…..”
Myria Koutsoumpa, Rosana Lescrauwaet and Mariska Meurs* http://www.healthfinancingafrica.org/home/uhc-time-for-really-innovative-health-financing
Must-read blog. “Ten years after the WHO’s report on Universal Health Coverage (UHC), most African low- and lower-middle income countries are not able to raise enough resources to achieve UHC. And however important, domestic efforts for resource mobilisation alone will not be enough to bring us there. The world has a collective responsibility to address tax injustices and high indebtedness, which have a huge potential to free resources for health.”
“The Elders …. launched a new report, “Building Back Better for Universal Health”, setting out three key pillars to inform the leadership needed from governments and policymakers in response to the COVID-19 pandemic at a national and global level: • Prepare public health systems for future pandemics; • Prioritise Universal Health Coverage at a national and global level; • Promote healthier societies via holistic polices and social development “
“Launched ahead of Universal Health Coverage (UHC) Day on 12 December, the wide-ranging report sets out specific recommendations based on lessons learned thus far from the pandemic, and the wider progress made towards UHC as part of countries’ commitments under the UN SDGs. …. …. The steps required include defining pandemic preparedness and response as a “global public good” that necessitates a multilateral approach, with states and global institutions pooling resources, capacity and expertise to deliver durable responses that reach all of humanity…..”
We’ll focus here on the key WHO messages of the past weeks, pandemic trends, … Clearly the mutations/”variants” (UK, SA, Nigeria, …) also featured prominently in the news over the past weeks. But most links on them you’ll find in the extra Covid section (scroll down….).
(Dec 29) “The WHO said in its weekly situation report that 4 million cases of COVID-19 were reported last week, with a 12% decline that should be interpreted with caution due to the end-of-year holiday season. The Americas region accounted for the highest percentages of new cases, and though cases in the European region are still high, illnesses and deaths declined compared with the previous week. Other regions saw increases, including Africa and the Western Pacific…..”
“…The global COVID-19 total has climbed to 81,746,514 cases, with 1,784,105 deaths, according to the Johns Hopkins online dashboard….”
Coverage of WHO’s ‘end of the year’ media briefing.
“Experts tell end of year media briefing that virus is likely to become endemic and the world will have to learn to live with it.”
See also UN News - Vaccination no guarantee of virus eradication: WHO officials
And Sydney Morning Herald - WHO warns vaccinated travellers could still need to be quarantined.
See also Reuters - WHO, marking year since COVID-19 began, urges fair vaccine distribution to all
“The head of the World Health Organization, marking a year since the first cases of the novel coronavirus were reported by China, urged countries on Wednesday to ensure that vaccines are made available to people at risk everywhere, not just in rich nations. Tedros Adhanom Ghebreyesus, WHO director-general, appealed for $4 billion to buy COVID-19 vaccines for distribution in lower and middle-income countries through the COVAX vaccine facility….”
(Dec 28) Global anxiety has been rising over the mutations. “Over the holiday weekend, more than a dozen countries reported cases involving the UK SARS-CoV-2 variant, with a few reporting their first cases of a similar but distinct South African variant…..”
Consensus so far is that the variants (especially the SA & UK variants) are more transmissible but don’t cause more severe illness (see for example FT ).
Unfortunately, the statistics of ‘being more transmissible’ (see Twitter thread Adam Kucharski ) implies: health systems can get even more under pressure than they already were…. As can be seen in the UK, and SA, for the moment. As for the impact of the variants on vaccines, that should become clearer in the weeks ahead.
See also UN News - New COVID-19 variants under the microscope as travel bans mount over UK mutation
PS: “…As part of the hundred-hundred initiative – a major sprint by WHO, the UN Children’s Fund (UNICEF) and the World Bank to support 100 countries in conducting rapid readiness assessments and develop country-specific plans within 100 days for vaccines and other COVID-19 tools – 89 countries have already completed assessments and teams are working round the clock to ensure that governments and health systems are ready for the global vaccine rollout. ….”
https://www.economist.com/leaders/2021/01/02/what-the-new-variants-of-covid-19-mean-for-human-health
“Between now and when vaccines are widely available countries will face some hard choices.”
Hope the Economist’s assessment is a bit too dark. But unfortunately, it could well turn out the truth in the months ahead, in many countries. Concluding: “Countries in Europe and beyond will be forced to deal with this fast-changing reality by reassessing the trade-offs between the benefits from the harsh lockdowns needed to stop a more contagious virus and their long-term costs to schooling, health and livelihoods. There is still light at the end of the tunnel. But the road through it has become a lot more treacherous.”
https://healthpolicy-watch.news/africa-covid-second-wave-denial/
One of a number of pieces in the media hinting at the potential of a worse second wave in (Sub-Saharan) Africa. “As South Africa records over 930,000 COVID-19 cases and its scientists race to understand whether a new variant is driving the country’s second wave of infections, countries across the African continent are reporting an increase in cases. But there is widespread anecdotal evidence that many African countries are massively under-reporting their COVID-19 caseloads, primarily because not enough tests are being performed. The threat is that this is giving citizens a false sense of complacency. …. …. According to the latest report from Africa Centers for Disease Control and Prevention (CDC), the countries with the highest caseloads on the continent are South Africa, Morocco, Egypt, Tunisia and Ethiopia, with Libya and Kenya not far behind. Nigeria, Zambia and the Democratic Republic of Congo are also reporting rising infections…..”
See also NYT - As Virus Resurges in Africa, Doctors Fear the Worst Is Yet to Come
WHO Afro - Stronger action needed as African countries see steady COVID-19 rise ( 17 Dec)
And for the latest update (WHO Afro – 30 Dec): WHO urges greater surveillance as new COVID-19 variants emerge “With the recent emergence in the African region of new COVID-19 variants which seem to have higher transmissibility, the World Health Organization (WHO) calls on countries to boost genomic surveillance and analysis through the African genome sequencing laboratory network to detect any new mutations and strengthen the efforts to curb the pandemic…. …. The new variants have emerged as COVID-19 infections are on the rise in the 47 countries in the WHO African region, nearly reaching the peak seen in July. In the past 28 days, Algeria, Botswana, Burkina Faso, Democratic Republic of the Congo, Ethiopia, Kenya, Namibia, Nigeria, South Africa and Uganda have reported the highest number of new cases, accounting for 90% of all the infections in the region….”
“The mission will start work in January and will examine medical samples and animals to see where and when Covid-19 began.”
See also AP - WHO to sift Chinese samples, data in hunt for virus origins
And Reuters - WHO says Beijing welcomes COVID-19 investigators trip to China
But see AP - China clamps down in hidden hunt for coronavirus origins. And the clampdown seems to come from the very top. “…an AP investigation shows the Chinese government is strictly controlling all research into its origins, clamping down on some while actively promoting fringe theories that it could have come from outside China….”
(11 Dec) “The World Health Organization expects to make decisions on whether to give emergency use approval to COVID-19 vaccines from Pfizer, Moderna and AstraZeneca in the coming weeks, its chief scientist said on Friday….. Soumya Swaminathan said the global health body could decide on Pfizer’s vaccine candidate in the next “couple of weeks”, and later said it could also review Moderna’s and AstraZeneca’s candidates in a few weeks. WHO approval could allow a vaccine to be deployed in some countries where national medical regulators have not yet been able to evaluate it….. “
And just in (31 Dec): WHO - WHO issues its first emergency use validation for a COVID-19 vaccine and emphasizes need for equitable global access
“ The World Health Organization (WHO) today listed the Comirnaty COVID-19 mRNA vaccine for emergency use, making the Pfizer/BioNTech vaccine the first to receive emergency validation from WHO since the outbreak began a year ago. The WHO’s Emergency Use Listing (EUL) opens the door for countries to expedite their own regulatory approval processes to import and administer the vaccine. It also enables UNICEF and the Pan-American Health Organization to procure the vaccine for distribution to countries in need….”
And some links:
· Time - Time magazine announces the world's #healthworkers and Dr Fauci as 'Guardians of 2020'
· WHO - Call for Action: Managing the Infodemic Manifesto Join the “ global movement to promote access to health information and mitigate harm from health misinformation among online and offline communities”.
· Reuters - How COVID-19 may result in one million excess deaths from other diseases in Africa
“The pandemic has hit Africa's overburdened health services and left many unable to access treatment - raising fears of up to one million excess deaths from other illnesses. “Mostly from HIV, TB & malaria.
· Guardian - Oxford/AstraZeneca Covid vaccine approved by UK regulator “Vital vaccine needs only normal refrigeration and is easily transportable.” Also encouraging news for (future) vaccine access in LMICs, in other words.
As you know, this was a key section last year (and that will remain so this year).
There was already some encouraging news on Covax (see the section on the GAVI Board meeting), and also the approval of the Oxford/AstraZeneca vaccine (in the UK), sounds promising news for access in LMICs in the South, later in 2021. But it’s early days, and for the time being, ‘vaccine apartheid’ is still a huge risk. With funding perhaps less an issue than the sheer availability of vaccine doses (most are bought up by rich countries).
PS: and as HPW notes (contrasting for example the US and Switzerland with Israel’s vaccine roll-out): “…even if you have secured an adequate vaccine supply – that is still only the beginning of the journey….” “In the United States Lack of Public Health Infrastructure Inhibits Vaccine Delivery…”
Some reads from the past few weeks:
(18 Dec) With an update on the TRIPS & WTO process, after the last General Council meeting at WTO:
“The General Council at WTO, the organization’s highest level decision-making body, this week, discussed the TRIPS waiver proposal first put forward by South Africa and India in October this year. With this, the proponents successfully pushed this crucial proposal for political consideration before the world’s trade policy makers. The stage is now set for further deliberation in the coming weeks early in 2021. South Africa has also requested for an extraordinary General Council meeting to take this forward. The significance of the discussion of this proposal at the General Council, is not lost, least of all on countries straining the under the mounting casualties of COVID-19 and those without any visibility of access to vaccines. More than 30 countries took the floor to discuss the proposal, WTO officials said at a press briefing today. …. … This story gives a quick update on the proceedings at the General Council this week, and some of the discussions at the TRIPS formal meeting last week….”
Related links:
· Devex - At WTO, a battle for access to COVID-19 vaccines
· And via HPW : … World Trade Organization IP Waiver For COVID Health Products – Opponents Ask Countries To Explore What Are the Barriers In Use Of Current Rules …
· WTO: WTO paper explores role of trade policy in the rapid roll-out of COVID-19 vaccines
“The WTO Secretariat has published a new information note on trade-related issues for COVID-19 vaccine production, manufacturing and deployment. The note, entitled “Developing and delivering COVID-19 vaccines around the world,” explores how trade policy can play its part in ensuring the rapid roll-out of vaccines against COVID-19. The paper goes into further detail on key topics included in two documents previously published on the WTO website: “Infographic: Developing & delivering COVID-19 vaccines around the world” and “Developing & delivering COVID-19 vaccines around the world: A checklist of issues with trade impact”…..”
(from mid-December)
· BMJ - Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis (15 Dec)
Results: “….As of 15 November 2020, several countries have made premarket purchase commitments totaling 7.48 billion doses, or 3.76 billion courses, of covid-19 vaccines from 13 vaccine manufacturers. Just over half (51%) of these doses will go to high income countries, which represent 14% of the world’s population. The US has reserved 800 million doses but accounts for a fifth of all covid-19 cases globally (11.02 million cases), whereas Japan, Australia, and Canada have collectively reserved more than one billion doses but do not account for even 1% of current global covid-19 cases globally (0.45 million cases). If these vaccine candidates were all successfully scaled, the total projected manufacturing capacity would be 5.96 billion courses by the end of 2021. Up to 40% (or 2.34 billion) of vaccine courses from these manufacturers might potentially remain for low and middle income countries–less if high income countries exercise scale-up options and more if high income countries share what they have procured. Prices for these vaccines vary by more than 10-fold, from $6.00 (£4.50; €4.90) per course to as high as $74 per course. With broad country participation apart from the US and Russia, the COVAX Facility—the vaccines pillar of the World Health Organization’s Access to COVID-19 Tools (ACT) Accelerator—has secured at least 500 million doses, or 250 million courses, and financing for half of the targeted two billion doses by the end of 2021 in efforts to support globally coordinated access to covid-19 vaccines. Conclusions This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines but that access for the rest of the world is uncertain…..”
Results: “Target population sizes for covid-19 vaccination vary markedly by vaccination goal and geographical region. Differences in demographic structure, presence of underlying conditions, and number of essential workers lead to highly variable estimates of target populations at regional and country levels. In particular, Europe has the highest share of essential workers (63.0 million, 8.9%) and people with underlying conditions (265.9 million, 37.4%); these two categories are essential in maintaining societal functions and reducing severe covid-19, respectively. In contrast, South East Asia has the highest share of healthy adults (777.5 million, 58.9%), a key target for reducing community transmission. Vaccine hesitancy will probably impact future covid-19 vaccination programmes; based on a literature review, 68.4% (95% confidence interval 64.2% to 72.6%) of the global population is willing to receive covid-19 vaccination. Therefore, the adult population willing to be vaccinated is estimated at 3.7 billion (95% confidence interval 3.2 to 4.1 billion)…..”
And related coverage (of the first BMJ paper) via Stat News: One-quarter of the world may not get a Covid-19 vaccine until 2022, experts warn
“nearly a quarter of the world’s population — mostly in low and middle-income countries — will not have access to a shot until 2022, according to a new analysis. As of mid-November, high income countries, including the European Union bloc, reserved 51% of nearly 7.5 billion doses of different Covid-19 vaccines, although these countries comprise just 14% of the world’s population. Meanwhile, only six of the 13 manufacturers working on Covid-19 vaccine candidates have reached agreements to sell their shots to low and middle-income countries. The analysis, which was published in the BMJ, noted that access “varies markedly” across these countries. ….”
PS: meanwhile, things seem to be moving too, on ‘donations’ (via Covax or otherwise): “…Earlier this week, the Canadian government committed to provide $380 million to various global initiatives designed to provide equitable access to Covid-19 diagnostics, therapies, and vaccines. Canada has reportedly been in talks to donate excess vaccine doses as well, but no commitment or details have been made public. …. “How and at what point will it share effective Covid-19 vaccines it has procured with those faring worse in the pandemic or in greater need of receiving even the first round of doses? The same question may face a number of other high-income countries that have entered into bilateral agreements with vaccine manufacturers: scale-up at home or share abroad. “Investing and coordinating globally through COVAX an help address this challenge, but the U.S. and Russia have declined to participate,” he continued. “So Canada’s commitment to developing a mechanism for equitably reallocating vaccine doses — through COVAX, by exchange or donation — sets an important first step for the global community to follow.”
Whether donating ‘excess doses’ is ‘global solidarity’ is another question, though….
See also Reuters - EU weighs donating 5% of its COVID-19 vaccines to poor nations- document
(14 Dec) “The European Union could donate 5% of the COVID-19 vaccines it has secured to poorer nations, an internal document seen by Reuters shows, in a move that risks undercutting a distribution scheme co-led by the World Health Organization. The plan, drafted by the French government, sets for the first time a clear target for EU vaccine donations which so far had only been considered as an option if the bloc ended up with surplus doses. The move could however deal a blow to the global procurement scheme co-led by the WHO, known as COVAX, which has the goal of delivering 2 billion shots by the end of next year to at least 20% of people most in need anywhere in the world. Under the French plan, which still needs to be agreed among the 27 EU states, up to 65 million doses of COVID-19 vaccines could eventually be donated by the EU to poor nations….” “That would be the 5% of 1.3 billion doses the EU has so far secured under six advance purchase agreements sealed with Pfizer/BioNTech, Moderna, Johnson & Johnson, AstraZeneca/Oxford, Sanofi/GSK and CureVac, the document shows.”
“Professor Ken Shadlen discusses the global politics of vaccine allocation, and how universal vaccination is stymied by global power asymmetries.”
Nice analysis of how Covax has ‘adjusted’ (or had to adjust) over time to the changing situation (i.e. rich countries buying up most of the vaccines).
https://www.sciencemag.org/news/2020/12/covid-19-vaccines-emerge-global-waiting-game-begins
Analysis by Jon Cohen & Kai Kupferschmidt (15 Dec).
https://www.devex.com/news/adb-launches-9b-covid-19-vaccine-facility-98765
Not just the World Bank, also other Development Banks are going to fund vaccine roll-out. “The Asian Development Bank launched a $9 billion vaccine facility on Friday. The announcement comes amid global interest and demand for COVID-19 vaccines, one of which has received regulatory approval from a few high-income countries. The Asia Pacific Vaccine Access Facility will help the bank’s low- and middle-income member countries in the procurement and delivery of COVID-19 vaccines…..”
“….the Inter-American Development Bank (IDB) announced that it will mobilize $1 billion to help Latin American and Caribbean countries acquire and distribute COVID-19 vaccines…..”
(31 Dec) “The world risks a “moral catastrophe” if COVID-19 vaccinations are delayed in Africa while wealthier regions inoculate their entire populations, the head of the continent’s disease control body said on Thursday…. The Africa Centres for Disease Control and Prevention (CDC) hopes significant vaccination campaigns on the continent will begin in April, its head, John Nkengasong, told reporters. “That’s a long way to go given that this virus transmits very quickly,” he said, adding that in Africa, “the second wave is here with a vengeance”. Cases of the new coronavirus increased by nearly 19% since last week and deaths increased by 26%, according to Africa CDC data. Africa has recorded 2.7 million coronavirus infections and 64,000 deaths as of Thursday, it says. … “We cannot delay, we need those vaccines and need them now,” Nkengasong said. The major blockers to vaccinations beginning in Africa are global availability of doses and financing, he said. … …. The African Union is in talks with the European Union, Canada, and pharmaceutical companies to secure doses, he said, to secure vaccines in addition to what Africa has been promised by the World Health Organization’s COVAX programme. … “This would easily become a moral catastrophe if we should not come together as one to address going forward as early as possible in 2021 and meet Africa at its point of need.” Approval processes for various vaccines will likely be fast-tracked through a central African Union process, he said….”
https://www.ft.com/content/d8d9a691-831f-4942-a8f2-9b6f80f43b0b
Over to the Chinese vaccines then, including the country’s vaccine diplomacy.
“Experts worry that doubts about data threaten to undermine immunisation efforts.”
“…. China has promised coronavirus vaccines to parts of the world struggling to access western jabs, even as concerns emerge over Beijing’s deviation from international standards for transparency during drug development. This month, Bahrain and the United Arab Emirates’ separate announcements that they had approved a vaccine developed by Chinese state-owned pharmaceutical group Sinopharm raised further questions about the inoculation. In both instances, the Gulf states released only brief statements declaring that initial analysis of Sinopharm’s vaccines had shown them to be 86 per cent effective. Neither underlying data nor details of analysis carried out by Sinopharm or the regulatory bodies were released. International experts worry that the opacity of the process and allegations of short-cuts taken by China risk undermining global immunisation efforts. “I think this is a mistake and can easily backfire,” said Suerie Moon, co-director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva. …. …. Zhang Tong, analyst at Kaifeng Investment in Shanghai “If any of the vaccines turn out to have safety problems, or not to be as efficacious as hoped or expected, this will be a big blow to public willingness to be vaccinated and efforts to control the pandemic.” As part of a diplomatic charm offensive, China has pledged deliveries of its four leading Covid-19 vaccines — two developed by Sinopharm, one by Beijing-based Sinovac and another from CanSino Biologics — to nations across the developing world…..”
Link: Nature News - Arab nations first to approve Chinese COVID vaccine — despite lack of public data (14 Dec)
“... Sinopharm’s vaccines are expected to be part of national rollouts in Egypt, Morocco, United Arab Emirates and Bahrain. Both UAE and Bahrain granted emergency approval for their use on frontline workers before clinical trials ended…..”
https://www.ft.com/content/f3f4052b-2582-4602-a0ba-63d672e7490a
(29 Dec) “Pharma company will seek approval from regulator as it looks to distribute jab more widely.”
“… Chinese vaccine developer Sinopharm said interim results from final stage trials of one of its coronavirus vaccines showed a 79 per cent efficacy rate, moving the group closer to large-scale rollout in China and overseas. The Beijing-based branch of China National Biotec Group, a unit of Sinopharm that is developing the vaccine, published the results on its website on Wednesday. The result clears the minimum requirements for Chinese regulators and the group has applied for market approval, it added. …. The lack of transparency around data reviews and regulatory approval for Chinese vaccines has caused international experts to question whether best global standards are being met. China’s foreign ministry on Monday defended the vaccines against the criticisms and reiterated that the country planned to offer the jabs as a “global public good” once development had concluded. Sinopharm’s two vaccines, both of which use a chemically inactivated version of the Sars-Cov-2 virus to spark an immune response, are leading contenders to be distributed both in China and to countries across the developing world…..”
And Reuters - China gives conditional approval to Sinopharm COVID-19 vaccine
“China approved a COVID-19 vaccine developed by an affiliate of state-backed pharmaceutical giant Sinopharm on Thursday, making it the country’s first approved shot for general public use, as it braces for increased transmission risks over winter….”
Analysis of the predicament countries like South-Africa are facing (in terms of vaccine access).
Excerpts: “…. countries like South Africa are in a singular bind because they cannot hold out hope for charity. Although its government is nearly insolvent and half of its citizens live in poverty, South Africa is considered too rich to qualify for cut-rate vaccines from international aid organizations. …. … South African medical advisers say the Covax system is vital but also deeply frustrating. Governments must pay up front without knowing what vaccine they will receive or getting any guarantees on when the doses will arrive. Covax estimates the price per dose but offers little recourse if the cost is ultimately much higher. Countries must assume all of the risk if the vaccine fails or if anything goes wrong. …. … Mr. Berkley and other officials declined to reveal their arrangements with drug companies, describing them as company secrets. They also did not make public the deals they have struck with individual countries. ….. “They’re agreeing to buy something with public money, and we won’t have any influence on pricing,” said Fatima Hassan, a human rights lawyer. “Covax is saying the pricing is fair, but we don’t know. Where’s the transparency?” …. Those trade-offs might be palatable for countries receiving the medicine nearly free. But South Africa is paying about $140 million for its Covax doses to vaccinate roughly 10 percent of its population, including health care workers and some high-risk people. The government hopes to cover the country’s remaining 50 million people through private deals with drug companies….”
Links:
· Via HPW (on the Astra-Zeneca/Oxford vaccine approval in the UK):
“… The UK regulatory approval of the AstraZeneca vaccine also marks an important milestone for low- and middle-income countries – as the vaccine’s modest cold-chain requirements permit storage in a conventional refrigerator making it easier to administer in resource-constrained settings. Some 3 billion doses of the AstraZeneca vaccine are due to be manufactured in 2021 including in India and Brazil – with some supplies also being procured and distributed even more widely through the WHO co-sponsored COVAX facility…..”
· Science News (30 Dec) - ‘It’s crazy.’ Upbeat COVID-19 vaccine news from China and U.K. leaves scientists wanting more details
“Sinopharm efficacy news [see below], British dosing schedule leave questions.”
· Reuters - the pope on vaccine access
“Pope Francis in his Christmas message said political and business leaders must not allow market forces and patent laws to take priority over making Covid 19 vaccines available to all, condemning nationalism and “the virus of radical individualism”.”
· Guardian - Scheme to get Covid vaccine to poorer countries at 'high risk' of failure
Analysis of the troubles Covax faces (from mid-December), based on an internal report. “Risk assessment documents say cost, delays and shortages could lead to billions not vaccinated until 2024.” The picture looks a bit more encouraging now, though, after the GAVI board meeting.
· Reuters - WHO sees "strong commitment" from Pfizer on affordable COVID vaccine
"A World Health Organization senior official said on Tuesday that the agency was in talks with Pfizer to include its COVID-19 vaccine as part of an early global roll out..”
Coverage of the new Oxfam report (15 Dec), Shelter from the Storm
“The COVID-19 pandemic and the lockdown measures to contain it have hit millions of people hard, with poverty set to increase sharply in almost every country for the first time in decades unless action is taken now, according to a new report by Oxfam. Hundreds of millions of people have lost their jobs and income, and 2.7 billion people have not received any public financial support to deal with the economic devastation caused by the coronavirus pandemic, Oxfam said in the report published on Tuesday. … … The report was compiled by Oxfam, a United Kingdom-based nonprofit, and consulting firm Development Pathways, which works with governments and organisations in developing economies. The organisations analysed social protection cash transfers in 126 low- and middle-income countries between April and September 2020….”
https://www.who.int/publications/i/item/9789240017948
“The World Health Organization and the Organization for Economic Co-operation and Development describe, in their joint publication, a decision framework to assist countries as they continue to calibrate social and movement measures until there is widespread population coverage with the vaccine…..”
https://csemonline.net/wp-content/uploads/2020/12/CSEM_Health-And-Economic-Impacts-Of-Covid-19.pdf
“The Health and Economic Impacts of COVID-19 Containment Strategies on the Most Left Behind: Recommendations for how we can build back better, strong and more resilient health and economic systems. A new paper from the Civil Society Engagement Mechanism for UHC2030 (CSEM), in partnership with Equal International, presents the health and economic impacts of COVID-19 policies and containment measures on populations who are most at risk and marginalized along with six recommendations for governments, addressing the negative effects of containment measures on people’s health and economies….”
T Bollyky & Chad Bown ; https://www.foreignaffairs.com/articles/world/2020-12-29/vaccine-nationalism-will-prolong-pandemic
“A Global Problem Calls for Collective Action.” Interesting broad ranging analysis by T Bollyky & Bown.
Excerpt: “….The new era in global health has brought antiviral drugs, insecticide-treated mosquito nets, and pediatric vaccines to millions of people in poor nations and has saved many lives. But it has also shifted the focus of global health away from cooperation among nations, rich and poor alike, on common threats to health and toward aid-driven initiatives and public-private partnerships to solve the problems of other people—mostly in low-income countries. The shortcomings of this approach have long been evident in the failure of global health institutions to mobilize effectively against many of the collective action problems that constitute the world’s biggest health threats. Over the last two decades, no more than one percent of annual global health aid has ever been devoted to preparing for pandemic threats like the coronavirus. Even less aid goes to reduce smoking and the other lifestyle factors that have helped make heart disease, cancers, and other chronic diseases the leading killers of people under age 60 worldwide. Pollution and climate change also rate low on the global health agenda, despite daily evidence of their devastating health effects, from the brown skies of Delhi to the record wildfires on the West Coast of the United States to the floods in Dhaka. The emerging crisis over access to vaccines against the coronavirus is the latest example of a collective action problem that aid and public-private partnerships are ill equipped to solve on their own….”
A Mol et al ; https://gh.bmj.com/content/5/12/e004375
“…. Different disciplines operationalise COVID-19 in different ways, propose diverging interventions, and, added to that, also use contrasting parameters of success. Interdisciplinarity should not be treated as a matter of adding the pieces of a puzzle together, but rather as a mediation process in which no discipline has to submit to either object definitions or criteria for good research of any other. Policy-makers, funders and research institutions should foster diversity in academic ecosystems just as is the case for biological ecosystems…..”
M Marmot on this new report, focusing on the UK, but no doubt with broader relevance as well.
“A fair distribution of health and wellbeing have to be at the heart of building back fairer, say Michael Marmot and colleagues.”
““Build Back Better” has become the mantra for what we should aim for post covid. Important, no doubt, but we also need to Build Back Fairer. The levels of social, environmental, and economic inequality in society are damaging our health and wellbeing…..”
“Our new report, Build Back Fairer: The COVID-19 Marmot Review revisits our 10 Years On report. …”
Coverage for example via the Guardian - Covid exposed massive inequality. Britain cannot return to 'normal'.
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32754-9/fulltext
Horton argues here the time is now to remind ourselves of Raymond Aron’s notion of ‘a universal era for mankind’ now, already decades ago put forward by the French intellectual.
Indeed, “….Every dichotomy in global health has been challenged by this pandemic. Communicable disease versus non-communicable disease. Biological versus social determinants of health. Global health security versus universal health coverage. Developed countries versus developing nations. Democratic governments versus authoritarian regimes. This era is truly one marked by a universal experience, a universal predicament, and the need for universal solutions. One consequence of a universal era, Aron argued, was that “In a humanity on the way to unification, inequality between nations takes on the significance that inequality between classes once had”. Indeed, inequality is one of the most important risks for premature death from COVID-19. Our response to this pandemic, this syndemic, must address inequality as well as the virus itself….”
This brings Horton to Marmot’s ‘Building back fairer’ agenda, in his final paragraph.
https://ourworldindata.org/covid-vaccinations
Tracking COVID-19 vaccination rates, globally. With a great world map.
https://www.unicef.org/press-releases/unicef-launches-covid-19-vaccine-market-dashboard
“As the designated COVAX procurement coordinator and procurement agent, UNICEF has launched the COVID-19 Vaccine Market Dashboard – an interactive tool for countries, partners and industry to follow the developments of the rapidly evolving COVID-19 vaccine market and the efforts of the COVAX Facility to ensure fair and equitable access for every country in the world. In this first release, the dashboard provides a regularly updated overview of the global research and development pipeline, the projected production capacity, publicly announced bilateral and multilateral supply agreements, as well as reported price points. Once the ongoing joint UNICEF-PAHO tender on behalf of the COVAX Facility is complete, the dashboard will be expanded to provide visibility on progress towards the goal of the COVAX Facility to secure 2 billion vaccine doses by the end of 2021. In 2021, the dashboard will provide an update on the status of procurement by UNICEF and other buyers participating in the COVAX Facility. It will also track the status of deliveries by UNICEF and other participating national and institutional buyers. ….”
https://www.social-protection.org/gimi/ShowWiki.action?id=3417
Interactive dashboard.
“The first ever International Day of Epidemic Preparedness, being held on 27 December 2020, was called for by the United Nations General Assembly to advocate the importance of the prevention of, preparedness for and partnership against epidemics…..”
See also UN News - World must be ready for the next pandemic, UN says on first International Day of Epidemic Preparedness
“Senior Sage scientist and others say vaccines for all major pathogens could be prepared ahead of time with proper planning and investment. A vaccine for the next pandemic could be ready within “100 days or less” of a new pathogen emerging given the right planning and investment, according to a senior member of the government’s Scientific Advisory Group for Emergencies (SAGE)….” …. “Scientists around the world are scrambling to prepare for what some fear could be a “new pandemic era” and believe the timeline for vaccine development - squeezed from 10 years to just 11 months for Covid-19 - could be cut much further.
Excerpts: “The fact that the first Covid-19 vaccines are based on a new technology, RNA, is a real breakthrough”, said Sir Jeremy Farrar, director of the Wellcome Trust and leading member of SAGE. …. Now scientists like Sir Jeremy and others believe new innovations could again cut the development timeline by a factor of about ten. These include: Creating prototype vaccines for the 50-100 most likely known animal pathogens with pandemic potential ahead of time and stockpiling them Conducting phase one and two human trials speculatively in advance of an outbreak, so that only phase three trials remain; Signing up tens of thousands of phase three trial participants ahead of time, so those trials can start the moment a new outbreak is detected; Establishing new vaccine manufacturing capacity, spread evenly across the world.”
“… Prof Krammer estimates that the cost of each vaccine would be in the region of £15- £22m, meaning you could get more than ten of them for the £190m price tag of a F-35 fighter jet. … Richard Hatchett, chief executive the Coalition for Epidemic Preparedness Innovations (CEPI), the organisation whose early investment from 2017 helped speed the development of Covid vaccines, says a 100-day vaccine is “not pie in the sky or fantasy”. He told The Telegraph the total investment required would run to billions but that remains small change compared to staggering £21.5 trillion in lost production the International Monetary Fund estimates Covid-19 has cost the world…..”
https://www.weforum.org/agenda/2020/12/funding-global-health-security-systems/
“…New analysis suggests a widening gap between the amount of foreign aid that has been committed, and the amount that has been disbursed…..” For health security.
“…. the Center for Global Health Science and Security at Georgetown University and Talus Analytics created the Global Health Security Tracking Site (GHSTS) to trace the flow of funding for health security around the world. According to GHSTS data, close to 80,000 projects have been funded since 2014 to support health security endeavours through global initiatives. As of September 2020, we recorded 456 projects engaged in efforts to counter COVID-19 globally. Total committed funds to support health security systems have increased (11%) this year compared to 2019. However, disbursed funds have declined significantly (34%), even after adjusting for projected disbursement for the rest of the year. In fact, the gap between committed funds and actual disbursed funds has been increasing over the last few years, as shown below in figure 1, indicating that there are barriers to committed funds being spent…..”
Robert Marten et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30485-X/fulltext
Robert Marten was clearly on an ‘end of the year’ publication spree. Well, that’s one way to say goodbye to a horrible year, I guess 😊.
In this Comment piece, Robert & co-authors list three reasons why implementation research is crucial for NCDs.
“Country becomes only the third in South America to permit elective abortions.”
See also the Economist (Daily chart) - Argentina legalises abortion, joining a small Latin American group
(14 Dec) “Around 1.8 billion people are at heightened risk of COVID-19 and other diseases because they use or work in health care facilities without basic water services, warn WHO and UNICEF. “
“…. The report, Fundamentals first: Universal water, sanitation, and hygiene services in health care facilities for safe, quality care, comes as COVID-19 is exposing key vulnerabilities within health systems, including inadequate infection prevention and control…..”
See also HPW - 1.8 Billion People Struggling To Access Basic Water Services, With Countries “Significantly” Behind Goals, WHO Report Finds.
And via Devex:“A total of $3.6 billion is needed between 2020 and 2030 to establish basic water services in health care facilities in the 47 least developed countries, according to a report by the World Health Organization and UNICEF — marking the first time a price tag has been put on the issue, according to Bruce Gordon, unit head of WASH at WHO…..”
https://www.who.int/news/item/14-12-2020-decade-of-healthy-ageing-a-new-un-wide-initiative
(14 Dec) “The United Nations General Assembly today declared 2021-2030 the Decade of Healthy Ageing….”
As some noted on Twitter, the timing could have been better ☹.
See also WHO - Decade of Healthy Ageing:
“The Decade of Healthy Ageing seeks to change how we think about age & ageing; facilitate the ability of older people to contribute to society; provide health care to older people that is in line with their needs.”
“Edwine Barasa helps guide the government’s response with data—and quiet persistence.”
“Despite the “enormous” contributions that migrants have made to society, they still face discrimination, social exclusion, and struggle to access health services even years after migrating, especially during the current pandemic, the first survey ever of migrant health during COVID-19 has found. The report, which was led by Ghent University and the University of Copenhagen in collaboration with WHO, highlights an urgent need to include refugees and migrants in countries’ COVID-19 response plans, especially in upcoming vaccination campaigns. These preliminary findings, based on self-reports of 30,000 refugees and migrants around the world, were published on International Migrants Day….”
A Link – WHO: WHO, IFRC sign memorandum of understanding on emergency medical teams
https://news.un.org/en/story/2020/12/1080022
(14 Dec) “A new ground-breaking global youth initiative was launched …. to invest in and scale up youth-led solutions and engagement, in response to the ongoing COVID-19 pandemic. It’s come about through an alliance of the world’s largest youth movements and organizations, together with the UN World Health Organization (WHO) and the UN Foundation…..”
“Generation disrupted” will get a very “disruptive” amount of money (5 million), to get started : )
See also HPW - COVID’s ‘Disrupted Generation’ To Be Supported by $5m Scheme Led By WHO, UN Foundation And More.
“France plans to launch a Fund for Innovation in Development, aimed at testing and scaling new approaches to fighting poverty and inequality. Chaired by MIT economist and Nobel laureate Esther Duflo, the new fund will make grants available to public and private sector institutions, and it will focus on the 19 priority countries for French aid, which are mostly in sub-Saharan Africa. …”
See also a few links :
· Devex - Exclusive: France to launch development innovation fund chaired by Esther Duflo
· Devex - Esther Duflo: Foreign aid at risk of becoming 'irrelevant'
“The Nobel prize winner says health ministers from low-income states taking time to negotiate grants with junior bureaucrats from Western donors "makes no sense."” (gated)
Cfr a tweet: “Highly anticipated World Bank audit report is out. Finding: 9 of 15 staff members on the Doing Business team say management pressured them to manipulate data. 8 complied. “
Oops.
S Swaminathan, K Sheikh, R Marten et al; https://gh.bmj.com/content/5/12/e004684
The authors conclude: “As countries plan massive new COVID-19 vaccination efforts, embedded research will be crucial. Operationalising this agenda requires catalysing local researcher–policymaker collaborations. Mainstreaming learning into the PHC effort requires allocating human and financial resources for embedded research and greater efforts to build capacity for PHC research. External funders can also provide catalytic support for locally produced research as well as strengthen local capacities to undertake and use research. Investing resources in embedded research will contribute relevant, timely and contextual knowledge to improve and inform health policies—this is critical to advance PHC, manage COVID-19 and create a healthier post-COVID-19 future.”
J Parkhurst et al ; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czaa166/6034159
“This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community….”
V Haldane et al ; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czaa169/6034156?searchresult=1
“As countries confront and adapt to the impact of COVID-19, policymakers, public health officials and political leaders have rallied around one word: resilience. Resilience often narrowly focuses on ‘bouncing back’ to normal as quickly as possible, without critically assessing whether the pre-shock normal should be aspired to (Ebi and Semenza, 2008; Houston, 2015). We argue that the COVID-19 pandemic presents an opportunity for health systems to address the long-standing structural inequalities it reinforces, and the environmental sustainability it undermines, to work towards transformative resilience, or ‘transilience’….”
N Seward et al ; https://gh.bmj.com/content/5/12/e003456
“….Inappropriate methods are often used in Implementation Research to address and report on context. This may result in a lack in understanding of how to effectively adapt the intervention to the new setting and a lack of clarity in conceptualising whether there is sufficient evidence to generalise findings from previous IR to a new setting, or if a randomised controlled trial (RCT) is needed. Some of the ethical issues arising from this shortcoming include poor-quality research that may needlessly expose vulnerable participants to research that has not been adapted to suit local needs and priorities, and the inappropriate use of RCTs that denies participants in the control arm access to treatment that is effective within the local context. To address these concerns, we propose a complementary approach to clinical equipoise for IR, known as contextual equipoise. We discuss challenges in the evaluation of context and also with assessing the certainty of evidence to justify an RCT. Finally, we describe methods that can be applied to improve the evaluation and reporting of context and to help understand if contextual equipoise can be justified or if significant adaptations are required.”
E Barasa et al, S Bennett, K Hanson et al ; https://healthsystemsglobal.org/wp-content/uploads/2020/12/COVID-19-Health-financing-research-agenda_22-Nov-2020-final.pdf
“…. In this working paper we outline a broad research agenda that would help countries deal with the health financing challenges they are facing, and emerge from the COVID-19 crisis with stronger health financing systems. While recognising that research priorities must be tailored to the needs of specific countries, we argue there is much to be gained by starting from a common agenda, which could enable a coordinated approach and maximise the potential for cross-country comparative work. Such a body of research will enable lessons to be drawn for (i) managing the current crisis; (ii) ensuring resilience of health systems to future shocks; and (iii) enhancing medium-term progress towards UHC.”
Global Health Technologies Coalition;
Pandemic pressures are weakening global health R&D, according to this new report. Among the takeaways: intense demand for global health expertise is redirecting researchers (guess to what…).
Report on both immediate impact, and what they anticipate long term impact of Covid-19 to be on the global health R&D.
P Mullins, S Gupta et al ; https://www.cgdev.org/publication/domestic-revenue-mobilization-low-income-countries-where-here
“…This paper argues that there is considerable potential for raising more revenues from domestic sources in developing countries to finance development, but this would require strong political leadership to overcome resistance from vested interests. The paper identifies the areas where revenue potential exists and the type of reforms needed to tap this potential.”
https://www.thelancet.com/journals/langlo/issue/current
Start with the Editorial – Enhancing, and protecting, maternal and neonatal health care.
M Schleiff et al; https://www.ijhpm.com/article_3994.html?utm_source=dlvr.it&utm_medium=twitter
“…The purpose of this paper is to identify an agreed set of core competencies for HPSR researchers, building on the previous work by the Health Systems Global (HSG) Thematic Working Group on Teaching & Learning…..” “….Emerging domains included understanding health systems complexity, assessing policies and programs, appraising data and evidence, ethical reasoning and practice, leading and mentoring, building partnerships, and translating and utilizing knowledge and HPSR evidence. The development of competencies and their application were often seen as a continuous process spanning evidence generation, partnering, communicating and helping to identify new critical health systems questions….”
M Pai’s reflections after reading Ben Philips’ new book, ‘How to fight inequality?”
“…Reading the book and listening to Phillips made me realize that the fight against inequality will not be won by powerful people, philanthropists or those in leadership roles. It requires people power. Regular people (like you and me) need to wake up to the inequities that surround us, use our voices, organize, build coalitions and actively work to bring about the changes we want to see. This approach has worked in the past and can work again. But the fight will have to be won; it won’t be conceded by those who benefit from inequality…..”
Aid Re-Imagined; https://medium.com/aidreimagined/where-the-aid-sector-is-stuck-483fc4e10120
Cfr tweet: “There are 3 rules of the aid "game" that I challenge in this article: 1. Competitive grant-making 2. Self-regulation 3. Simple narratives. ”
M Mazzucato; https://www.ft.com/content/9e7b2630-2f67-4923-aa76-0f240a80a9b3?sharetype=blocked
“The pandemic is an opportunity for policymakers to fix the structure of the economic system.” Piece in which M Mazzucato (now also WHO chief economist) gives a hint of her forthcoming book, “Mission Economy”.
“Covid-19 is the moment to do capitalism differently. The pandemic showed our economic system is not simply in crisis, it is structurally flawed. … … In sum, “building back better” requires a fundamentally new relationship between all economic actors willing and able to tackle complexity to achieve outcomes that matter.”
“Emotional coda to final @WHO presser 2020. After an hour reflecting on #COVID19 DG @DrTedros revealed that his family is frm the Tigre region of #Ethiopia that's now in brutal war. He can't find his brother & other relatives: "as if #COVID19 isn't enough, I have that pain, also."
“Gates Foundation on sharing the COVID vaccine urges rich countries to share a slice of the cake (the product) with developing countries. Health advocates saying, share the receipt (the know-how) for making the vaccine, and there will be more to go around.”
“My plan for beating #covid19 after watching this pandemic for one year? Easy: Test like a Korean, track and trace like a Singaporean, sequence like a Brit, crush the curve like a New Zealander, vaccinate like an Israeli - and behave like a human being...”
referring to the AP article: Poor countries face long wait for vaccines despite promises
“What is this ? @WHO staff members are taped in internal meetings and the recording is made available the press „during a recent internal discussion, a recording of which was obtained by the AP“
"The well-informed belief among scientists is now that the virus was circulating in the Wuhan human population earlier, in November of last year at least, and that most likely a human—not a wild animal—carried it into the Huanan market," says @DavidQuammen https://nyti.ms/34fMccI
"At this rate, achieving sufficient vaccination to reach herd immunity and bring the pandemic to a close in the U.S. will take about seven years. In Israel, it will be done by March."
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32713-6/fulltext
For this paragraph in particular:
“…. The coronavirus we are grappling with today is not smallpox. But the implications for COVID-19 seem clear. First, a global effort to control SARS-CoV-2 demands a global coordinating body—WHO. While the agency's reputation was strengthened by its work on smallpox, the attacks by President Donald Trump have damaged WHO's international standing. Countries must now recommit their support to WHO and its Director-General, Tedros Adhanom Ghebreyesus, and boost their investment in the agency. It is WHO that must command the confidence of member states to coordinate the operational response to COVID-19. WHO must mobilise its regional offices. The US Government has a crucial part to play in the renaissance of WHO. Second, WHO should create a special time-bound programme for COVID-19 control. This programme should set clear, measurable objectives. Eradication will not be one of those objectives, but extinguishing community transmission is achievable. Third, countries must prioritise management as much as medicine in their control efforts. Management means a network of trained staff, allocation of sufficient financial resources, investment in logistical capacity, and the development of a realistic operational strategy. Fourth, continued investment in COVID-19 research will be decisive. The first year of the pandemic has revealed the extraordinary contribution of science to our understanding of SARS-CoV-2. Now is not the time to step back from investments in COVID-19 science. And finally, WHO should create an independent accountability mechanism to monitor country responses and to offer remedies when those responses seem to be insufficient. Smallpox eradication was one of the greatest scientific and humanitarian achievements of the 20th century. Henderson's legacy has immediate relevance for Tedros, Walensky, and other national, regional, and global health leaders. Indeed, every health leader would do well to have a well thumbed and annotated copy of Henderson's Smallpox: the Death of a Disease by their bedside.”
Over 300 scientists called for a pan-European strategy with clearly defined goals for the medium and long term to rapidly reduce #COVID19 infections. With open borders across Europe, collaboration is essential and advantageous, they write.
L van Schaik, R van de Pas et al; https://www.tandfonline.com/doi/full/10.1080/07036337.2020.1853118#.X-yGlzPRaKU.twitter
“The Covid-19 pandemic marks a shift in the EU’s approach to the multilateral system. Just at a time when the EU aspires to avoid being crushed between the US and China, the World Health Organization (WHO) became one of the new battlegrounds in world politics. This norm-setting international organization for health was already under pressure due to a plethora of other organizations trespassing its mandate, reduced core funding and weak governance, reinforced by a strongly decentralized structure. This article will use the exit, voice and loyalty approach to analyse how the EU operated in the multilateral system during the first phase of the Covid-19 crisis with the WHO and vaccines race as case studies. A comparison is made with the EU’s positioning on global health in the previous decade. Is the EU truly committed to upholding multilateralism in global health through the WHO, and has the Covid-19 pandemic made a structural change?”
https://www.devex.com/news/if-covid-19-changes-finance-will-that-help-development-funding-98754
“…As global markets contracted in response to the COVID-19 pandemic, the growth of environmental, social, and governance, or ESG, investing; sustainable investing; and impact investing appears to have accelerated. But whether that potential shift will result in finally unlocking more capital to finance development remains an open question. “
“The ESG market is expected to reach $45 trillion in assets under management this year, though Europe and North America account for more than 90% of the market, according to research released by J.P. Morgan earlier this year…..”
Quote: “There is not necessarily one trigger point but it is important that IMF is now much more focused on health risks than ever before, [Peter] Sands said, adding that before joining the Global Fund he had tried to persuade IMF to take these issues more seriously and had “singularly failed.” That’s an important signal because if IMF takes these issues seriously, then governments and rating agencies will too, and that will start to translate into the financial world beginning to think differently, which will change incentives for governments and companies, Sands said.” “
https://www.devex.com/news/us-state-department-releases-global-fragility-strategy-98823
(19 Dec) “The State Department on Friday released the Global Fragility Strategy, a document detailing how the U.S. administration intends to overhaul the country’s current approach to conflict prevention and stabilization in fragile contexts…..”
Mishal Khan; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32628-3/fulltext
Interesting analysis from M Khan. She examines some ‘truths” about international aid, focusing here on UK aid.
Excerpt: “….evidence abounds that domestic health and development priorities, and also expertise, are side-lined if there are large external funding inflows. Redefining the political priorities of the recipient countries has been described as the core goal of international development, and is evidenced by the fact that many low-income and middle-income countries·each with different political, cultural, and health-system contexts·have introduced similar health policies, aligned with donor priorities, around the same time. A salient example of such influence is the push for a greater role for the private sector, including delivery of health care and education by private organisations. The focus on supporting privatisation was so strong that the UK's own aid watchdog, the Independent Commission for Aid Impact, warned in 2014 that “DfID needs to recognise that the private sector is not a developmental panacea”. Therefore, the energy being directed towards lamenting a decrease in the amount of aid might instead be channelled towards ensuring that aid is based on principles of social justice, the need to redistribute economic and political power, and self-determination…..”
A Rogerson et al ; https://www.cgdev.org/publication/oda-turmoil-why-aid-definitions-and-targets-will-come-under-pressure-pandemic-age-and
See also the accompanying CGD blog - Playing Snakes and Ladders with International Development Aid: When Fragile Accounting Rules and Political Pressures Mix
“In new analysis, we explore the impact of political pressures and fragile accounting rules on aid budgets, and ask: What can be done to ensure ODA remains robust and relevant?”
S Gupta et al ; https://www.cgdev.org/blog/elections-and-political-cohesion-can-promote-tax-reforms
« In a paper and blog we delve into political considerations that influence the implementation of tax reforms in 45 emerging market and low-income economies. »
https://www.ft.com/content/d9bd8059-d05c-4e6f-968b-1672241ec1f6
For what it’s worth, this FT (somewhat preliminary?) analysis of the Belt & Road project: “Chinese overseas lending has fallen sharply amid a reassessment of the Belt and Road Initiative.”
Excerpts: “…But according to data published this week, reality is deviating sharply from Mr Xi’s script. What was conceived as the world’s biggest development programme is unravelling into what could become China’s first overseas debt crisis. Lending by the Chinese financial institutions that drive the Belt and Road, along with bilateral support to governments, has fallen off a cliff, and Beijing finds itself mired in debt renegotiations with a host of countries. “This is all part of China’s education as a rising power,” says Mr Hillman, a senior fellow at Washington-based think-tank CSIS. “It has taken a flawed model that appeared to work at home, building large infrastructure projects, and hubristically tried to apply that abroad.” … …. The data that describes China’s predicament comes from researchers at Boston University who maintain an independent database on China’s overseas development finance. They found that lending by the China Development Bank and the Export-Import Bank of China collapsed from a peak of $75bn in 2016 to just $4bn last year. … …. China’s retreat from overseas development finance derives from structural policy shifts, according to Chinese analysts. “China is consolidating, absorbing and digesting the investments made in the past,” says Wang Huiyao, an adviser to China’s state council and president of the Center for China and Globalisation, a think-tank. Chen Zhiwu, a professor of finance at Hong Kong university, says the retrenchment in Chinese banks’ overseas lending is part of a bigger picture of China cutting back on outbound investments and focusing more resources domestically. It is also a response to tensions between the US and China during the presidency of Donald Trump, when Washington used criticisms of the Belt and Road as a justification to contain China, Prof Chen adds. “In domestic Chinese media, the frequency of the [Belt and Road] topic occurring has come down a lot in the last few years, partly to downplay China’s overseas expansion ambitions,” says Prof Chen, who is also director of the Asia Global Institute think-tank. “I expect this retrenchment to continue.”
;.. Yu Jie, senior research fellow on China at Chatham House, a UK think-tank, says Beijing’s recently-adopted “dual circulation” policy represents a step change for China’s relationship with the outside world. The policy, which was first mentioned at a meeting of the politburo in May, places greater emphasis on China’s domestic market — or internal circulation — and less on commerce with the outside world. …. … All this is leading to a fundamental rethink by China towards both the Belt and Road and its overseas lending profile, analysts believe. Mr Wang says that one strand of a new approach would be to pursue more lending through multilateral bodies such as the Asian Infrastructure Investment Bank. In addition, Chinese financial institutions may co-operate more with international lending agencies, he adds. Such a change would amount to a fundamental reorientation. The Beijing-based AIIB and another multilateral bank in which China is a stakeholder, the New Development Bank, are very different organisations from the two Chinese policy banks. They have lent out a fraction of the policy banks’ annual average and are not directed by Beijing’s policies but by a board of directors who represent the interests of stakeholder countries. …”
(gated) “Only one of the ten developers of COVID19 vaccines that have received funding from the epidemic response agency CEPI has committed vaccine doses for the poorest countries. As concern grows about the unequal global distribution of vaccines, legal experts argue that the lack of transparency in CEPI grant contracts makes it difficult to hold either CEPI or the companies accountable.”
And a link:
· The recent UN General Assembly resolution on Global Health and Foreign Policy
A Agweyu et al ; https://gh.bmj.com/content/5/12/e004553
“Assessing the quality of healthcare services is a priority in low-resource and high-resource settings alike. It is, however, a complex endeavour. Outcome measures are subject to case-mix variation, often require lengthy follow-up periods to manifest, and are generally costly to monitor. Therefore, structure and process measures are routinely considered reliable alternatives under the assumption of a causal link between the provision of care and improved health status. In this edition of BMJ Global Health, Giorgio et al used such structure and process measures—that is, service delivery indicators (SDI)—to assess the quality of healthcare across 10 African countries. The SDI programme was set up to conduct cross-sectional nationally representative surveys that examine service delivery performance in education and health in Africa. The health indicators assess health worker availability, health worker knowledge on the management of common ailments, and availability of selected essential equipment and treatments. These surveys are aimed at providing high-level snapshots of the quality of health services in target countries. In this editorial, we discuss some of the limits of using data from a platform such as the SDI programme to make sense of quality of care and highlight complementary approaches that are aligned with emergent thinking in the field….”
S Leatherman et al; https://jamanetwork.com/journals/jama/fullarticle/2774417
“This Viewpoint proposes a policy framework for thinking about health care quality in low- and middle-income countries, emphasizing the importance of infrastructure, enforceable quality standards, safety practices, guideline-directed clinical care, and patient and family involvement.”
“International convention to stop richer countries exporting contaminated material for recycling could mean a cleaner ocean in five years.”
“From Australian bushfires to Atlantic hurricanes, insurance damages were the highest annual total ever, says Christian Aid study.”
B Büscher et al ; https://www.sciencedirect.com/science/article/pii/S0305750X2030485X
“….. All these dynamics make it vital to urgently start imagining and planning for a post-COVID-19 development paradigm. In this opinion article, we present five research and policy priorities. While it is clear that ‘pluriversal’ designs need to guide the way forward (Kothari et al 2019), defining a set of key pillars can provide direction and purpose across this pluriversality…..”
https://www.nature.com/articles/s41586-020-03043-4
“….Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness….”
“African-led study expected to involve 1,600 people over next three years in Uganda, Tanzania, Mozambique and South Africa.”
C Boeke et al; https://gh.bmj.com/content/5/12/e003767
“…. Seven countries, with support from the Clinton Health Access Initiative (CHAI) and partners, have expanded access to HCV treatment by combining programme simplification with market shaping to reduce commodity prices. CHAI has supported a multipronged approach to HCV programme launch in Cambodia, India, Indonesia, Myanmar, Nigeria, Rwanda and Vietnam including pricing negotiations with suppliers, policy development, fast-track registrations of quality-assured generics, financing advocacy and strengthened service delivery…..”
And some links:
Reuters - China plans set up of new disease control agency in COVID-19 aftermath -Caixin
Reuters - Sanofi renews deal with WHO to fight tropical diseases, sleeping sickness
Globalization & Health - Integrating the social sciences in epidemic preparedness and response: A strategic framework to strengthen capacities and improve Global Health security
https://www.ft.com/content/db57fb35-1ee6-4b45-a53a-67aa1c33984e
“World needs new antibiotics and action to keep existing ones effective.”
Helicopter view analysis on current AMR predicament, and (what needs to be done about) push & pull incentives.
https://tobacconomics.org/research/cigarette-tax-scorecard/
“The Tobacconomics Cigarette Tax Scorecard was written by Frank J. Chaloupka, Jeffrey Drope, Erika Siu, Violeta Vulovic, Michal Stoklosa, Maryam Mirza, German Rodriguez-Iglesias, and Hye Myung Lee. The Scorecard assesses the performance of cigarette tax policies in over 170 countries. It uses data from the WHO Global Tobacco Control Reports to score countries on a five-point scale, thus providing policy makers with an actionable assessment…..”
https://www.who.int/pmnch/media/news/2020/funding-secured-covid19/en/
(10 Dec) “Funding secured to recover health and social services lost to COVID-19.”
“….In a huge effort to restore crumbling services for women, newborns, children and adolescents, a group of high income, low- and middle-income countries and foundations are making pledges of $20.6 billion to protect this group. $7.4 billion (36%) of the total pledge is from money committed by low and middle-income countries themselves, including Afghanistan, India, Kenya, Liberia, and Nigeria. An additional $13.2 billion (64%) is from official development assistance and grants given by Germany, Canada, Sweden, UK, USA and the Bill & Melinda Gates Foundation….”
Sophie Harman et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32727-6/fulltext
Conclusion: “….Debate over COVID-19 vaccines has rightfully focused on discovery and development, vaccine hesitancy, and equitable access. Vaccine delivery depends on the paid and unpaid labour of women around the world in ways that can threaten their economic and physical security. Vaccines are thus both an important component of the gendered nature of pandemics such as COVID-19 and of the relation between gender and global health security.”
https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1849348
by E Besnier.
And some links:
· UN News - Avert ‘dire consequences’ for women's health, UNFPA urges in appeal to prevent maternal deaths
“Within the span of 10 days, regulators in the United Kingdom and the United States granted emergency use authorization for the Covid-19 vaccine made by Pfizer and BioNTech. This vaccine, reported to be 95% effective, is now being rolled out across both countries. And as I write this, the U.S. is poised to approve a second Covid-19 vaccine, this one made by Moderna. It will likely take far longer for this vaccine to be available in sub-Saharan Africa, partly because its use was approved with emergency use authorizations instead of the developers pursing full licenses….” The article has been “updated” now, though.
Just in case you missed this. At last Belgium showed itself a global health “leader”. 😊
https://gatesopenresearch.org/articles/4-16/v3
By K Chalkidou et al.
https://www.statnews.com/2020/12/11/drug-regulator-india-failed-pandemic-stress/
“The Covid-19 pandemic has served as a stress test for drug regulators across the world. India’s has failed.”
This section will provide a mix of Covid news & headlines, Covid Science & analysis. Will be in steno-style though.
“But experts warn a fast-spreading variant of the virus is still a huge challenge.”
“…While it is good news that the new variant does not lead to more severe disease a virus that spreads rapidly is still a huge problem. …. Dr Adam Kucharski, a mathematical modeller at the London School of Hygiene and Tropical Medicine, pointed out on Twitter that “an increase in something that grows exponentially (i.e. transmission) can have far more effect than the same proportional increase in something that just scales an outcome” (that is, leads to more death or disease) because it will affect so many more people. ….”
“The hypothesis that the fast-spreading UK variant of the Covid-19 virus has a transmission advantage has been bolstered by an analysis that suggests it is linked to higher loads of the virus in respiratory samples…..”
With some more info on the South-African variant.
“Rich nations have struggled with one of the most basic and important methods for controlling infectious diseases.”
“The [Dexamethasone] breakthrough demonstrates the power of large-scale randomised trials in pinpointing effective medicines and will be followed, in the next few weeks, with results from another handful of promising treatments being studied as part of the Recovery programme. These medicines, which could be crucial in the fight to contain Covid-19 next year, are: convalescent plasma, taken from recovering Covid patients; monoclonal antibodies, made by Regeneron, that were used to treat Donald Trump; two anti-inflammatory drugs, tocilizumab and colchicine; and aspirin. All are undergoing trials carried out by thousands of doctors and nurses on tens of thousands of patients in hospitals across Britain. First results are expected in January or early February….”
“Oxford and AstraZeneca’s COVID-19 vaccine can be 80% effective when there are three months between shots, an official involved in approving the vaccine in Britain said, but there is insufficient evidence to back a regime involving a half dose….”
https://www.theatlantic.com/health/archive/2020/12/covid-19-sleep-pandemic-zzzz/617454/
“The coronavirus can cause insomnia and long-term changes in our nervous systems. But sleep could also be a key to ending the pandemic.”
“…Melatonin is attracting attention as a potential COVID-19 treatment—with 8 clinical trials underway—as researchers probe the perplexing connections between sleep and the coronavirus….”
Ed Yong; https://www.theatlantic.com/magazine/archive/2021/01/science-covid-19-manhattan-project/617262/
Yong writes on the COVIDization of science. “No other disease has been scrutinized so intensely, by so much combined intellect, in so brief a time. This piece is about both the victories achieved & the weaknesses exposed…. …. The final part of this piece is the most important. It's about how science lost sight of the social side of medicine, focusing on drugs, vaccines, & technofixes while ignoring inequity, trust, & politics. It’s about the pivot that still needs to happen…..”
BBC;
“Researchers have identified genetic variations that could make some people more susceptible to severe COVID-19 symptoms. Mutations in a gene called TYK2 can trigger an excessive immune response to COVID-19 and damage lungs. Mutations in a gene called OAS can keep the protein it encodes from doing its job, which is to stop viruses from replicating. And defects in the IFNAR2 can prevent the body from launching an early immune response, giving the coronavirus time to make a foothold. ….”
https://www.devex.com/news/4-out-of-5-africans-would-take-a-covid-19-vaccine-africa-cdc-survey-98812
“About 80% of Africans surveyed said they were willing to take a COVID-19 vaccine once it's publicly available and deemed safe and effective. Of those that said they would not take a vaccine, safety was the leading concern. The survey conducted by the Africa Centres for Disease Control and Prevention, the London School of Hygiene and Tropical Medicine’s Vaccine Confidence Project, and Orb International, examined perceptions around COVID-19 vaccines in 15 countries….”
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30484-8/fulltext
“Inclusion of pregnant women in COVID-19 clinical trials would allow evaluation of effective therapies that might improve maternal health, pregnancy, and birth outcomes, and avoid the delay of developing treatment recommendations for pregnant women. We explored the inclusion of pregnant women in treatment trials of COVID-19 by reviewing ten international clinical trial registries at two timepoints in 2020. …. …. Inclusion of pregnant women in clinical treatment trials is urgently needed to identify effective COVID-19 treatment for this population.”
Cfr the press release: “The Lancet Global Health: Pregnant women excluded from three-quarters of COVID-19 treatment trials. “
“Wealthier countries will be dealing with coronavirus in 2022 and beyond, says UN humanitarian agency chief…”
Among others on how 16 countries have committed to work with the Gates Foundation to distribute vaccine doses equitably. ….
PS: “….To help ease the manufacturing burden, our foundation helped put together what’s called “second-source agreements.” We paired vaccine companies in rich countries with counterparts in developing countries that specialize in producing safe, high-quality, and affordable doses at a very high volume…..”
https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html
“Scientists initially estimated that 60 to 70 percent of the population needed to acquire resistance to the coronavirus to banish it. Now Dr. Anthony Fauci and others are quietly shifting that number upward…. ….Hard as it may be to hear, he said, he believes that it may take close to 90 percent immunity to bring the virus to a halt — almost as much as is needed to stop a measles outbreak….”
“‘It’s really being treated like a war… and Israel is experienced in battle’”.
See also HPW - While Europe Celebrates – Israel & Bahrain Vaccinate .
“In addition to ushering in a massive economic and public-health crisis, COVID-19 has fully upended longstanding assumptions about effective governance. There are important lessons to be learned from the fact that some of the world's richest countries have fallen on their faces while some of the poorest have shined.” Senegal, Sri Lanka & Vietnam, among others.
https://www.ghspjournal.org/content/8/4/858
“The COVID-19 pandemic has highlighted and exacerbated deficiencies in hospital oxygen systems globally but is also an opportunity to “build back better.” Our collated field experience from African and Asia-Pacific contexts reveal practical strategies whereby hospitals can rapidly improve their oxygen systems. We share guidance documents (all open access) for local use and adaptation.”
Links:
· Devex - What you need to know about ‘active’ and ‘recovered’ COVID-19 cases
· Reuters - Russia signs more deals with India to make 300 million Sputnik V vaccines
· HPW - Death Of eSwatini’s Prime Minister Sends Clear Warning Across Africa
· FT - BioNTech set to become first foreign jab to enter China market
“BioNTech will supply 100m doses of its coronavirus vaccine to Chinese partner Fosun Pharma for use in mainland China next year in the country's first publicly announced order of a foreign jab against the disease”.
“As funders’ Plan S requirements begin, the open-access movement shows progress and faces questions.”
https://www.cgdev.org/blog/better-ways-use-aid-middle-income-countries
“In a paper and blog, the authors examine the distribution of aid among countries at different income levels and focus on the aid going to middle-income countries (MICs).”
Finally, some articles in Development Policy Review you might want to have a look at:
· The New Progressivism and its implications for institutional theories of development
· How earmarking has become self‐perpetuating in United Nations development co‐operation
https://www.researchsquare.com/article/rs-102665/v1
Not exactly unexpected results....
https://gh.bmj.com/content/5/12/e003126
“….here, we describe a participatory approach to modelling that aims to circumvent this gap. Our approach involved the creation of an international group of infectious disease modellers and other public health experts, which culminated in the establishment of the COVID-19 Modelling (CoMo) Consortium. Here, we describe how the consortium was formed, the way it functions, the mathematical model used and, crucially, the high degree of engagement fostered between CoMo Consortium members and their respective local policymakers and ministries of health…..”