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IHP news 606 : Done with Davos

( 29 Jan 2021)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.

Dear Colleagues,

As you might have noted, it was “Davos Agenda week” (25-29 January) this week, virtually at least. No rant this year from my side, I’m done with Davos men & women, their ( mostly fake) solutions to our planet’s intersecting crises, and more in general with Klaus Schwab’s annual High-Level circus. With the moral incentive not having worked much so far, it was probably no coincidence that just this week a report came out on the (massive) economic incentive to avoid vaccine nationalism. And yes, the - as always coinciding - Oxfam report on the “Inequality Virus” was once again spot on. At some point, however, it becomes so blatantly obvious that the strongest shoulders will have to contribute most in this pandemic, that ‘global health’ (enter for example the never-ending ACT-A fundraising saga & laments for more “global solidarity” by Seth et al) risks to lag behind what happens in the broader society. Badly. #LaggingBadlyBehind

By the way, as the Guardian reported, current vaccine supply issues in the "rich" world (we all know what that means in a world run by billionaires and multinationals) could lead to heavy riots and violence in many places, as plenty of people are totally exhausted or angry by now. The situation is probably not much different in some of the heaviest hit LMICs. In any case, the already sky high pressure on policy makers is further increasing, due to the rising threat of political/societal instability, one year into the pandemic. And it’s not the usual WEF blabla on “re-setting” and "stakeholder capitalism" that will change the ugly mood in public opinion, I’m afraid.

A tweet by Sara Pantuliano summed it up well: “The combined wealth of the world’s 10 richest men has increased by half a trillion $ since the pandemic began, warns @Oxfam. More than enough to pay for a vaccine for everyone & ensure no-one is pushed into poverty. That's not the #GreatReset @Davos seeks.” So unless they’re structurally myopic, the brand new G20 High Level Independent Panel on financing the global commons for pandemic preparedness and response knows where to look for the big bucks. So let’s hope the global health world heeds Oxfam’s message in the years to come. In the current pandemic, that probably implies that C-TAP, the Trips waiver proposal, and other new R&D innovation mechanisms to deliver a ‘People’s Vaccine’, should be more strongly supported, in addition to COVAX, given the current dire global vaccination outlook (see a new Economist Intelligence Unit report). (PS: as somebody tweeted, “it’s funny to see how rich countries want the vaccines to be "global common goods" when they need access, but not when others do.” )

World Health Day 2021, devoted to health equity this year, also seems to provide another excellent

opportunity for some paradigmatic breakthrough. Over to you, M Mazzucato 😊!

Enjoy your reading.

Kristof Decoster

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Featured Article

Let’s work towards moral and just mental health systems

André J. van Rensburg

Mental healthcare is fundamentally moral. It is, as Didier Fassin reminds us, “the government of the precarious”. In 2017, Reverend Joseph Maboe set out to find his son Billy, who was kept in a dilapidated institution for people living with severe mental and neurological conditions (PSMN) – serious forms of mental incapacitation – in South Africa’s premiere gold mining strip. Billy was emaciated, was refused water due to his incontinence, and was so hungry that when his father offered him some crisps, he tried to eat it bag and all. Less than a week later, Billy died due to neglect, a direct result of a state-driven deinstitutionalization drive that ultimately led to the deaths of 144 vulnerable people. Billy’s narrative was told as part of an inquest into the Life Esidimeni tragedy in South Africa, yet another chapter in the dark history of mental healthcare reform. Unfortunately, stories like Billy’s remain all too universal.

Human Rights Watch has been monitoring abuses against PSMN, especially in low-and-middle income countries (LMICs). A report launched during 2020’s Mental Health Month, highlighted a range of abuses across 60 LMICs, including arbitrary detention; living conditions with overcrowding, poor sanitation and lack of hygiene; incarceration, restrictions on movement; lack of shelter and denial of food; involuntary treatment; and physical and sexual violence. Importantly, these abuses are not confined to one particular space, and happen in both state and non-state settings, in healthcare institutions, community residential facilities, and in family homes. These abuses certainly are not a feature of LMICs alone – a walk around Vancouver’s Downtown Eastside quickly challenges this perspective. The plight of PSMN caught up in the USA’s prison industrial complex is also well known, as is the homelessness syndemic with severe mental illness, no doubt a feature of many high-income inner city neighbourhoods.

This highlights a key feature of health systems, namely, their ineffectiveness to adequately address the rapidly growing global inequality and inequity. The COVID-19 vaccination roll-out is the latest reflection of these imbalances, and it was fitting that the WHO Director-General called the vast inequity in the first stages of the global roll-out a “catastrophic moral failure”. The current pandemic is both a reminder of structural inequity, and well as a driver of existing and new ones. What then is the scope and responsibility for health systems? Can the failure of most public health systems in realising (often the most basic) care for their most vulnerable beneficiaries be termed immoral?

In Richard Horton’s reflections on the meaning of a moral health system, he shifts our gaze from the well-known structural conceptualisation of health systems, towards one that is much more rooted in social solidarity: “Health systems are not Lego-like “building blocks” of component parts—financing, leadership, workforce, products and technologies, information, and services. They are not even cubes with their three dimensions of population, services, and financial protection. Health systems are a set of moral principles.” Those of us lucky enough to have been part of initiatives such as Health Systems Global (HSG) and EV4GH, have experienced a steady increase in discourses centred on moral values and social justice in health systems reform, both explicitly and implicitly. Though still relatively under-theorised, and even less well operationalised, these discourses have imparted on many of us a lens through which to approach research, development and advocacy.

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For a health system to be deemed moral in its effects on its mental health beneficiaries, there needs to be an explicit and transparent distributive justice, rooted in principles of equality, equity and necessity. John Rawls and Norman Daniels’ contributions are valuable here, helping us to understand that health inequalities are unjust because they are rooted in an unjust distribution of resources and socially controllable factors that affect health. As per Daniels, healthcare holds special moral importance in the protection of fair opportunity (a central principle of justice), because all ill-health cannot be prevented. Applied to severe mental illness, this does not necessarily mean that conditions like schizophrenia are unjust in themselves, but rather, that the result of such conditions – early mortality, multimorbidity, stigma, homelessness and substance dependency – is unjust because these outcomes are preventable. As accounts from the Life Esidimeni case and HRW report illustrate, PSMN in many cases do not have equal access to opportunity. There are innovative and established models of community mental healthcare, but a lack of action, investment and prioritisation has resulted in systems that are unjust and immoral in their effects. Much work remains in developing fair, transparent deliberative processes in different health system levels, especially in how to amplify and formalise the voice of PSMN, their families and caretakers in policy and budgeting processes.

In addition to applaudable efforts to integrate mental health into global pandemic discourses and responses, there is a pressing need to “revisit and underscore the moral and philosophical foundations for health improvement activities”, much like during the infectious disease outbreaks two decades ago. Mental health systems as institutions occupy the space generated at the intersections of the national and the local, which confronts us with particular methodological challenges. It demands pluralism, epistemological flexibility and inclusiveness, but any notable progress will at its heart require a firm adoption of principles of distributive justice. It is only when we consider outcomes such as cost-effectiveness, service efficiency and care continuity as embedded in moral principles, that we can move closer to justice for Billy Maboe and thousands of others in precarious circumstances.

The ideas in this piece have been distilled from the book, The Political Economy of Mental Illness in South Africa, published by Routledge as part of its Health in Africa series.

André J van Rensburg is a senior researcher in health systems at the Centre for Rural Health, University of KwaZulu-Natal, and a research fellow at the Centre for Health Systems Research & Development, University of the Free State. He is an alumnus of EV4GH 2016, and currently an EV4GH Resident at the Institute for Tropical Medicine, Antwerp.

Highlights of the week

Climate Adaptation Summit & other Planetary Health news

On Monday, the Netherlands hosted the Climate Adaptation Summit, the first ever global summit focused solely on adaptation and resilience.

Some news from this summit & other planetary health headlines from this week:

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Guardian - US returns to global climate arena with call to act on 'emergency'

https://www.theguardian.com/us-news/2021/jan/25/us-returns-to-global-climate-arena-with-call-

to-act-on-emergency

“The US has returned to international climate action with a focus on helping the most vulnerable on the planet, Joe Biden’s climate envoy announced at a global climate summit, promising financial assistance for those afflicted by the impacts of climate breakdown….” John Kerry called on countries to “treat the crisis as the emergency that it is” by reducing greenhouse gas emissions, and warned that the costs of coping with the climate change were escalating…”

For some of the concrete (international) US plans on climate change, see IISD - US Announces Plans for NDC and Whole-of-Government Climate Action On the ways in which it will reengage in the international climate change dialogue.

New Global Coalition launched to address impacts of Climate Change

https://www.gov.uk/government/news/new-global-coalition-launched-to-address-impacts-of-

climate-change

Prime Minister Boris Johnson launched the Adaptation Action Coalition, a new international coalition to tackle the impacts of climate change. “Developed by the UK in partnership with Egypt, Bangladesh, Malawi, the Netherlands, Saint Lucia and the United Nations, this new Coalition will work to turn international political commitments made through the United Nations Call for Action on Adaptation and Resilience into on-the-ground support for vulnerable communities.”

Guardian - UN global climate poll: ‘People’s voice is clear – they want action’

https://www.theguardian.com/environment/2021/jan/27/un-global-climate-poll-peoples-voice-is-

clear-they-want-action

“Biggest ever [UNDP] survey finds two-thirds of people think climate change is a global emergency.” And remarkable, intergenerational differences aren’t that big. “…While younger people showed the greatest concern, with 69% of those aged 14-18 saying there is a climate emergency, 58% of those over 60 agreed, suggesting there is not a huge generational divide.”

Virtual WEF forum (aka ‘Zoom Davos’) (25-29 Jan)

Oxfam - Billions will live in poverty for at least a decade due to COVID-19: Oxfam

report

https://www.geo.tv/latest/331601-billions-will-live-in-poverty-for-at-least-a-decade-due-to-covid-

19-says-oxfam

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“Mega-rich recoup COVID-losses in record-time yet billions will live in poverty for at least a decade, new report by Oxfam reveals; The report called 'Inequality Virus’ was published on the opening day of the World Economic Forum’s ‘Davos Agenda’; The report shows that COVID-19 has the potential to increase economic inequality in almost every country at once.”

For the Oxfam report, see The Inequality virus.

For a nice summary of key messages, see F2P blog (Julie Seghers) - Why the Inequality Virus should

be the talk of Davos this week Do check out also the recommendations to get to a more equal and

just world.

TNI - Week of activities: Peoples VS Corporate Power: Stop the capture of global

governance

https://www.tni.org/en/article/week-of-activities-peoples-vs-corporate-power#h2

“In the wake of the COVID-19 pandemic, transnational corporations are seeking to cement their control of global governance, ensuring it serves the interests of business and profits rather than the wellbeing of humanity. From January 25-30, social movements and international civil society will focus on the processes underway at the dialogues at Davos from January 25-30 2021. We have collected here an overview of the main civil society activities during the week of Davos, as well as key resources for everyone interested in learning more about the crisis of global governance, the transnational corporations' false solutions, and the possibilities for new forms of global democratic governance…”

There’s a letter you can sign, and also a recording of a webinar of the past week.

And an infographic on Covax.

WEF - Davos Agenda: What you need to know about the future of global health

https://www.weforum.org/agenda/2021/01/davos-agenda-healthy-futures-healthcare-universal-

health-coverage-uhc2030-infectious-disease-wellbeing-climate-change-air-pollution/

With an overview of what this year’s WEF had foreseen in terms of global health focus and sessions.

In Davos speak: “Getting control of COVID-19 and vaccinating people should be top priorities in recovery plans. A sustainable recovery is also dependent upon improving access to healthcare, preventing the next pandemic and tackling climate change. The Davos Agenda will highlight solutions to ensure healthy futures for all.”

Guess you also have some doubts on these ‘healthy futures for all’, if we (continue to) follow the

Davos agenda (ahum).

PS: You also find the (global) health related sessions here: https://www.weforum.org/events/the-davos-agenda-2021/themes/healthy-futures (do re-watch some of them)

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The Davos Agenda

https://www.weforum.org/events/the-davos-agenda-2021

With some more info, reports, … on the overall ‘Davos Agenda’.

Some snippets perhaps, that caught our attention:

• (see also last week’s IHP news): “The @wef Global Risk Report 2021 is out … “The age of

intersecting crises” is here…”

“…The 16th edition of the World Economic Forum’s Global Risks Report analyses the risks from societal fractures—manifested through persistent and emerging risks to human health, rising unemployment, widening digital divides, youth disillusionment and geopolitical fragmentation. Businesses risk a disorderly shakeout which can exclude large cohorts of workers and companies from the markets of the future. Environmental degradation—still an existential threat to humanity—risks intersecting with societal fractures to bring about severe consequences…..”

• WEF - Fighting systemic racism: 48 companies form global coalition to bring racial justice to

the workplace

• EU to create private-public bio-defence preparedness plan

“The European Union will seek to create a bio-defence preparedness programme in the form of a public-private partnership, to prepare against the next big health crisis, the head of the European Commission Ursula von der Leyen said….”

• Valuable 500 Initiative: With more than 400 committed members driving impact in 35 countries, The Valuable 500 is now the largest global network of CEOs committed to disability inclusion. Launched at Davos 2019.

Lancet series on Women’s and children’s health in conflict settings

Lancet ;

“The Lancet Series on Women’s and Children’s Health in Conflict Settings aims to improve understanding of and address the special requirements of providing sexual, reproductive, maternal, newborn, child and adolescent health and nutrition services in conflict settings. The Series draws upon scholarship from the BRANCH Consortium, providing insights into the nature and dynamics of women’s and children’s health and nutrition in diverse conflict contexts globally. The Series papers articulate a way forward to fill immediate evidence and guidance gaps as well as longer term action to ensure the most effective humanitarian health response for conflict-affected women and children.”

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For a quick overview, see Lancet Series on women’s and children’s health in conflict (Exec summary, 3 p.)

More coverage & analysis of WHO’s EB 148 meeting

With coverage of some of the final days of the EB meeting. Including on the (sustainable) financing of WHO, pandemic preparedness discussions, relationship with non-state actors,….

HPW - Gender-based Violence, Unhealthy Diets & Climate Need Greater Focus In

Light Of COVID-19 Pandemic – WHO Member States

https://healthpolicy-watch.news/who-social-determinants-focus-pandemic/

“WHO needs to focus more work on limiting gender-based violence, increase its programmatic emphasis on healthy diets and lifestyles, and contribute to renewed momentum on climate action, said WHO member states at Friday’s Executive Board session. … The member states were reviewing the WHO Director General’s report on “social determinants of health” – in light of the added health impacts of the ongoing global COVID-19 pandemic….”

HPW - Member States Raise Concerns About Sustainability Of Funding For Polio &

Antimicrobial Resistance Efforts

https://healthpolicy-watch.news/81708-2/

“COVID-19 has led to the suspension of polio campaigns in more than 30 countries, and has underscored the importance of the mission to eradicate it, tackle antimicrobial resistance, and ensure the timely sharing of pathogens, said WHO member states at Monday’s Executive Board session. Throughout the morning and afternoon sessions, member states reviewed and discussed the Director General’s reports on poliomyelitis eradication, polio transition planning, antimicrobial resistance (AMR), and the public health implications of the implementation of the Nagoya Protocol. …”

Devex - Can WHO find a concrete solution to its funding woes?

J L Ravelo; https://www.devex.com/news/can-who-find-a-concrete-solution-to-its-funding-woes-

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(Recommended analysis) “After hours of deliberation, World Health Organization member states agreed on Monday to establish a working group to tackle the issue of sustainable financing of the organization. WHO proposed the creation of a working group led by member states from across WHO regions that would help tackle the following questions: What should be funded sustainably? How much funding should be provided sustainably and why? Who should provide this funding? The working group is to come up with a proposal on how WHO can secure sustainable financing, including an increase in assessed contributions, which would be presented and decided upon on at the 75th World Health Assembly in 2022….”

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PS: Tweet Balasubraniam re the Decision:

“#EB148 adopted the decision to creating an open-ended working group on sustainable financing. As drafted, this decision would cede responsibility to determining the "essential functions" of @WHO to this working group away from the Secretariat.”

And a link: KEI - EB 148: China and the United Kingdom raise concerns over the WHO Foundation and other WHO initiatives

HPW - Interview with Björn Kümmel, Vice Chair, WHO Executive Board

https://healthpolicy-watch.news/interview-bjorn-kummel-who-executive-board/

By Priti Patnaik. On Germany’s view in this financing debate (and broader on WHO). “Discussions on WHO’s state of financing were addressed by member states during the on-going Executive Board meeting. As we reported last week, WHO is keen on defining independence and sustainability of its financing to be better prepared to address emergencies in the future. We spoke to Björn Kümmel, Deputy Head of Unit, Global Health, German Federal Ministry of Health and Vice Chair of the WHO Executive Board, who has been actively involved consistently in raising these issues on the organization’s finances. He was also a part of the consultations on the Open-ended Intergovernmental Working Group on Sustainable Financing at the EB last week….”

NPR - 'Everything Broke': Global Health Leaders On What Went Wrong In The

Pandemic

NPR;

Overall analysis of the pandemic preparedness discussions: “How to make sure the world is never so devastated by another pandemic? Health officials from around the globe have been vigorously discussing that question over the past week at the annual meeting of the World Health Organization's Executive Board. The members, whose nine-day-long, mostly virtual gathering concludes on Tuesday, have heard recommendations from four separate panels. “While the conversations have been wide-ranging, common themes keep emerging. Here are six of them: … “ : Time for fundamental change; Need for speed; Logistics are key (and so are health workers); Money matters; Inequality is a threat for everybody; why this pandemic could be the one that finally prompts action.

HPW - WHO Proposes New Mode Of Engaging With Non-State Actors

https://healthpolicy-watch.news/who-proposes-engaging-non-state-actors/

“The World Health Organization (WHO) aims to make its engagement with non-state actors (non-state actors) more meaningful and efficient with a new proposal to establish a number of NSA fora that would allow exchange with WHO and member state representatives outside of official meetings. The new proposal — which will be tested during the 74th World Health Assembly (WHA), 24 May to 1 June — would offer multiple side events in which non-state (NSA) actors could engage more informally with member state representatives as well as a forum for exchange between NSAs and WHO regional and technical staff. But at the same time, non-state actors will be allotted a

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more limited number of constituency statements in formal governing body meetings – and like-minded groups of actors will be asked to combine their official statements together….”

Annual letter Gates - The Year Global Health Went Local."

https://www.gatesnotes.com/2021-Annual-Letter

Nice title. And well worth a read, this annual letter.

See PR Newswire:

“Today, Bill and Melinda Gates share their 2021 Annual Letter, "The Year Global Health Went Local." In this year's letter, Bill and Melinda reflect on the worldwide impact of COVID-19 and the global collaboration and scientific innovation fueling one of the largest public health efforts in history. They share why they are optimistic the world can emerge from the pandemic stronger, healthier, and more resilient, and discuss two areas they believe are essential to building a better future: prioritizing equity and preparing for the next pandemic….”

PS: “To date, our foundation has invested $1.75 billion in the fight against COVID-19. Most of that funding has gone toward producing and procuring crucial medical supplies….”

Biden repeals Global Gag rule

Devex - Biden repeals the 'global gag rule,' but next steps will be 'huge

undertaking'

https://www.devex.com/news/biden-repeals-the-global-gag-rule-but-next-steps-will-be-huge-undertaking-98954

“President Joe Biden issued a memorandum Thursday that broadly restored United States funding support for women’s reproductive health services and rights, both rescinding the Mexico City Policy and announcing that the country would reinstate funding to the United Nations Population Fund. The memorandum immediately rescinds the controversial policy, widely known as the “global gag rule,” which withholds all U.S. global health assistance from international organizations that provide or even offer information on abortions. Federal agencies are set to shortly follow by issuing guidance to their grantees, according to experts, though a follow-up explaining the practical next steps for foreign NGOs has not yet been made publicly available….”

“…The move will free up at least $7.3 billion in U.S. global health funding, making foreign NGOs and partners again eligible for U.S. global health assistance, even if they engage in abortion-related services or acitivites. For UNFPA, it could mean an additional $69 million each year, as well as the reemergence of one of their largest traditional donors … … But change regarding the global gag rule, in particular, is likely to unfold in a complicated, drawn-out manner that could stretch on for several years. …”

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Other global health governance news & publications

The G20 establishes a High Level Independent Panel on financing the Global

Commons for Pandemic Preparedness and response

https://www.bancaditalia.it/media/notizia/the-g20-establishes-a-high-level-independent-panel-on-

financing-the-global-commons/

“Tuesday 26 January, G20 Members agreed to establish a High Level Independent Panel (HLIP) on financing the global commons for pandemic preparedness and response. The decision was taken by the membership at the first G20 Finance and Central Bank Deputies meetings….”

“…The Panel, proposed by the Italian G20 Presidency, will assess the current financing systems and propose viable solutions for the longer term. The G20 High Level Independent Panel is tasked with: • Identifying the gaps in the financing system for the global commons for pandemic prevention, surveillance, preparedness and response; • And proposing actionable solutions to meet these gaps on a systematic and sustainable basis, and to optimally leverage resources from the public, private and philanthropic sectors and the International Financial Institutions….”

Overview of Members: Members of HL panel.

Lancet Regional Health (Europa)- How a European health union can strengthen

global health

I Kickbusch et al; https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00002-

8/fulltext

“The COVID19 outbreak has had two political consequences for the European Union: it has put closer integration of EU internal health activities on the agenda, and it has pulled the EU in a leading position on global health policy. The present call for a European Health Union by the European Commission brings an important political opportunity for the geopolitics of global health as its internal legal and political capacity for health immediately interacts with the EU's capacity to strengthen global health. It is still the case that the EU can only act externally to the extent that internally it has the competence to do so. Yet given the present geopolitical pull on the EU to play a role in global health, this will also benefit the Member States internally…..”

Geneva Health Files - A pandemic treaty: reforming global health security & TRIPS

Waiver update at WTO

P Patnaik; Geneva Health Files;

With some coverage of the ‘pandemic treaty’ discussions at the EB meeting, as raised by Tedros himself.

The second story is a quick story on the TRIPS waiver talks at WTO from last week (19 Jan). Extremely important in the Covid vaccine access discussion, as you know.

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On the latter, see also this TWN report - Proponents of TRIPS waiver call for text-based negotiations

“As the deaths worldwide from COVID-19 passed the 2 million mark due to enveloping shortages of vaccines, the proponents of a TRIPS waiver for temporarily suspending key provisions in the WTO’s TRIPS Agreement in combating the worsening pandemic have called for text-based negotiations at the WTO so as to ensure an early agreement on the waiver, negotiators told the SUNS. The proponents led by South Africa and India, along with Pakistan, Zimbabwe, Chad on behalf of the least- developed countries, and Venezuela among others, made a strong case on the urgent need to accelerate the discussions at the World Trade Organization….”

Next meeting: Informal Open-ended Meeting of the WTO TRIPS Council — Informal Meeting - 4 February 2021.

And TWN analysis (29 Jan)- COVID-19: Vaccines war underscores need for TRIPS waiver at WTO

“As COVID-19 cases crossed the 100 million mark globally with loss of more than 2 million lives, the European Union and other industrialized countries appear to have entered into a tit-for- tat vaccines war over the dwindling supply of pandemic vaccines developed by their respective companies. The only way to overcome the grim “cascade of crises” is to agree to the TRIPS waiver at the World Trade Organization, said people familiar with the development….”

Winnie Byanyma (UNAIDS) comes to the same conclusion in this op-ed - A global vaccine apartheid is unfolding. People’s lives must come before profit.

Duke (report) - Making the final decade of the Sustainable Development Goals

count: an analysis of donors’ subnational approaches to reaching the poorest

people

Kenny C, G Yamey et al; https://centerforpolicyimpact.org/our-work/aid-targeting-approaches-to-reach-the-poorest/

The authors “conducted a document review and comparative analysis of six of the largest global health donors to better understand the extent to which they incorporate subnational poverty into their allocation decisions and programming. … “

They found “that most donor high-level strategy documentation allude to the relationship between poverty and health by, for example, noting the financial burden of specific diseases targeted or the disproportionate disease burdens that may fall on the poorest people. However, only two of these donors, Gavi and IDA, incorporate any subnational poverty indicators or broader subnational poverty focus that could be tracked and monitored over time. Gavi and IDA also integrate household level wealth or health expenditure data in their routine monitoring processes, though there is limited information about how much this integration influences how these two donors target aid toward the poorest communities. For the other four donors— Global Fund, PEPFAR, USAID, and Japan—subnational poverty is either not addressed or else is invoked in the context of other social or demographic factors that make certain groups of people vulnerable to disease (e.g., sex workers’ vulnerability to HIV). “ They then draw five policy recommendations for how global health donors can more effectively work toward achieving the Sustainable Development Goals

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(SDGs) and leaving no one behind by improving the way they identify, prioritize, and target people living in poverty.”

Covid key news

With focus on key trends & WHO messages.

Cidrap News - Cases drop in main global pandemic hot spots but surge elsewhere

https://www.cidrap.umn.edu/news-perspective/2021/01/cases-drop-main-global-pandemic-hot-

spots-surge-elsewhere

(Jan 27) “In its weekly snapshot of COVID-19 activity, the World Health Organization (WHO) said cases fell for the second week in a row, mainly in the highest-burden countries, but it warned that the pattern masks sharp rises in other countries in some regions. Meanwhile, the world's level of deaths, often a lagging indicator, stayed about the same as the previous week. And more countries reported detections of variants of SARS-CoV-2, the virus that causes COVID-19. In its weekly situation report, the WHO said cases declined 15% from last week. The largest drops were in the European and African regions. … … However, in the Americas, for example, sharp rises were seen in several locations, including Mexico, where cases have tripled over the past weeks in some regions, Caribbean countries and territories, Colombia, Paraguay, and Chile, the WHO's Pan American Health Organization (PAHO) said today at a briefing. …”

See also via Reuters: “Over one million people in the Americas have now died from complications from COVID-19, the head of the Pan American Health Organization said.”

And WHO Afro - New COVID-19 variants fuelling Africa’s second wave

“COVID-19 cases and deaths are surging in Africa as new, more contagious variants of the virus spread to additional countries. Over 175 000 new COVID-19 cases and more than 6200 deaths were reported in Africa in the last week while infections rose by 50% on the continent between 29 December 2020 and 25 January 2021 when compared with the previous four weeks. In the past week, there has been a small dip in cases in South Africa, but 22 countries continue to see their case numbers surge….”

Via HPW - Six African Nations Report SARS-CoV-2 Variants

Reuters - Global COVID-19 cases surpass 100 million as nations tackle vaccine

shortages

Reuters;

Another sad milestone (and no doubt far from the real number).

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“Global coronavirus cases surpassed 100 million on Wednesday, according to a Reuters tally, as countries around the world struggle with new virus variants and vaccine shortfalls. … … The worst-affected countries – the United States, India, Brazil, Russia and the United Kingdom – make up more than half all reported COVID-19 cases but represent 28% of the global population, according to a Reuters analysis. … … It took the world 11 months to record the first 50 million cases of the pandemic, compared to just three months for cases to double to 100 million…”

See also Cidrap News - Vaccine developments at center stage as pandemic total tops 100 million.

“As the world's COVID-19 total passed 100 million cases today amid the threat of more-transmissible variants, anxiety grew over vaccine supplies amid promising news of effectiveness and more production capacity….”

Reuters - Sanofi to help produce 100 million Pfizer/BioNTech vaccine doses

https://www.reuters.com/article/us-health-coronavirus-vaccines-sanofi/sanofi-to-help-produce-100-million-pfizer-biontech-vaccine-doses-idUSKBN29V23Y

“Sanofi will fill and pack millions of doses of Pfizer’s COVID-19 vaccine from July in an effort to help meet the huge demand for the U.S. drugmaker’s shots. The French company will aim to help supply more than 100 million doses of the vaccine this year from its German plant in Frankfurt, CEO Paul Hudson told Le Figaro newspaper on Tuesday….”

Let’s hope this sets a trend and other big pharma companies follow. Could boost global vaccine production.

AP - Relative of virus victim asks to meet WHO experts in Wuhan

https://apnews.com/article/wuhan-china-coronavirus-pandemic-united-nations-

5de25b984d72c79fdcde05ae2b2a351e

“After multiple delays and a 14-day quarantine, WHO investigators charged with uncovering the pandemic’s origins are finally set to begin work in China this week….”

PS: Families of Chinese COVID-19 victims also want their story heard.

PS: via HPW last week Friday: “… Investigation of SARS-CoV2 Virus Origins Will “Follow the

Science””

M Ryan’s take: “With regards to Beijing’s recent media campaign suggesting that the virus may have originated somewhere other than China – just as a WHO-led team begins work in Wuhan to look for virus tracks in the city where the first clusters of infection were reported, Ryan said that it was mistaken to “start any process where the conclusions are at the start, and then we look for the evidence to support them – we’re dealing with a lot of that in the last few days.” But Ryan declined to say whether the international team of independent experts would visit the Wuhan Virology Institute that had been conducting research into coronaviruses before the pandemic began….”

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SCMP - WHO science sleuths set to start Wuhan investigation into Covid-19 origins

https://www.scmp.com/news/china/science/article/3119354/who-science-sleuths-set-start-wuhan-investigation-covid-19

“Quarantine period in China ends on Thursday and team will begin work on the ground looking at earliest known cases; Amid doubts over access, one member reportedly says Chinese scientists have been sharing data that was not previously made public.”

And via the Guardian - Joe Biden’s administration demands ‘robust and clear’ investigation as WHO team visits Wuhan.

And see Reuters – WHO-led team in Wuhan probing COVID origins meet Chinese scientists

“A World Health Organization-led team of experts investigating the origins of the COVID-19 pandemic began meeting with Chinese scientists on Friday, and the WHO said the group plans to visit labs, markets and hospitals in Wuhan….”

UN News - Amidst surging COVID numbers, WHO chief urges: ‘take heart and take

action’

https://news.un.org/en/story/2021/01/1082922

Coverage of WHO mediabriefing on Monday. “The sheer scale of the numbers involved in the COVID-19 pandemic can “make us numb to what they represent”, the UN health agency chief said on Monday, reminding journalists in his latest briefing, that each one stands for “a person, a story”. …”

“Last week, Tedros said that the world stood on “the brink of a catastrophic moral failure” if it does not deliver equitable access to vaccines. Two new studies show that “it wouldn’t just be a moral failure, it would be an economic failure" too, he said. …”

“An International Labour Organization (ILO) analysis released on Monday, found that $3.7 trillion was lost last year in terms of working hours. … …. At the same time, a study commissioned by the International Chamber of Commerce Research Foundation, makes a strong economic case for vaccine equity. “It finds that vaccine nationalism could cost the global economy up to $9.2 trillion, and almost half of that – $4.5 trillion – would be incurred in the wealthiest economies”, the WHO chief said. …”

For more on the latter study, see below.

PS: Tedros also said, the financing gap for the Access to COVID-19 Tools Accelerator this year still

stands at $26 billion.

ICC - Study shows vaccine nationalism could cost rich countries US$4.5 trillion

https://iccwbo.org/media-wall/news-speeches/study-shows-vaccine-nationalism-could-cost-rich-

countries-us4-5-trillion/

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“New comprehensive economic modelling shows advanced economies stand to lose trillions of dollars through vaccine nationalism – more than previously thought; Economic benefits of funding multilateral efforts to ensure equitable access to vaccines dwarf the costs; Advanced economies with international linkages have the most to gain from global collaboration on vaccine access and distribution.”

“A new study commissioned by the ICC Research Foundation has found that the global economy stands to lose as much as $9.2 trillion if governments fail to ensure developing economy access to COVID-19 vaccines, as much as half of which would fall on advanced economies.”

“The study clearly demonstrates the economic case to invest in the Access to COVID-19 Tools (ACT) Accelerator, the global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. … … Strikingly, a US$ 27.2 billion investment on the part of advanced economies – the current funding shortfall to fully capitalize the ACT Accelerator and its vaccine pillar COVAX – is capable of generating returns as high as 166x the investment.”

See also HPW – Cheaper To Fund Global Vaccines Than Suffer Economic Pandemic Fallout, Finds Study.

UN News - New COVID-19 strains ‘poised to unleash’ more severe infections –

Security Council hears

https://news.un.org/en/story/2021/01/1082902

Coverage of a Security Council meeting: “Since September, the devastation wrought by the COVID-19 pandemic has deepened, infecting close to 100 million people, costing more than $3 trillion in lost wages and intensifying obstacles for peace and security around the world, the UN political chief told the Security Council on Monday. “ “And while the pandemic has “hindered diplomatic action and complicated our peacemaking efforts”, Rosemary DiCarlo, Under-Secretary-General for Political and Peacebuilding Affairs said via videoconference that it has “amplified the prevention challenge” and aggravated underlying dynamics of armed conflicts. Moreover, “new strains of the virus are poised to unleash more severe waves of infection at a time when health systems and social safety networks are already on the brink”, she told the meeting on the implementation of the UN Secretary-General’s call for a global ceasefire. … The pandemic’s impact on peace and security is a “pressing concern”, Ms. DiCarlo said. “

“… In assessing the economic effects of the pandemic, Mr. Lowcock highlighted a bleak picture for the most vulnerable, estimating that 235 million people will need humanitarian assistance and protection, “almost entirely down to COVID”. … … while the humanitarian community has managed to scale up assistance, the effort has been outpaced by the growing scale of this crisis, according to Mr. Lowcock. He appealed to the UN Ambassadors for $35 billion to support the Global Humanitarian Overview, which aims to reach 160 million people; strengthen international financial institutes that provide for their most vulnerable; and action for equitable vaccine distribution. “

UN News - Pandemic will not end for anyone, ‘until it ends for everyone’

https://news.un.org/en/story/2021/01/1082762

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“The COVID-19 pandemic “will not end for anyone, until it ends for everyone”, an independent UN human rights expert said [last week] on Friday, advocating for an equitable and globally-coordinated vaccine distribution programme.”

WSJ - WHO Plans Privacy, Security Rules for Covid-19 Vaccine Certificates

https://www.wsj.com/articles/who-plans-privacy-security-rules-for-covid-19-vaccine-certificates-11610706601

“Estonia is testing a blockchain-based digital vaccine certificate that could be accepted in other countries.” “The World Health Organization is working on technical details and privacy standards for digital coronavirus vaccine certificates to give individuals proof of immunization that could be accepted in other countries. The WHO is working with Estonia and a group of around 150 volunteer privacy, governance and other experts to determine how an international system for verifying individuals’ vaccine history could work, said Bernardo Mariano Jr., the United Nations health agency’s chief information officer. He expects specifications to be released by the end of the first quarter. …… Mr. Mariano said he expects countries to more widely adopt digital vaccine certificates this spring, once the WHO’s group of experts agree on technology and privacy standards….”

See also Deutsche Welle - COVID-19: WHO races to develop vaccination card.

HPW – Africa CDC calls for “Common Approach” To International Travel

Restrictions – Based on COVID Testing and Not ‘National Origins’

https://healthpolicy-watch.news/africa-cdc-international-travel-six-variant/

“Dr John Nkengasong issued his call for a rethink of travel policies after several foreign countries, including the United States, are considering or have already banned flights originating from South Africa. Travel restrictions aiming to limit the importation of variants should be based upon a systematic testing policy – and not geographic or national origins, said Nkengasong. “We should not be banning people because of their geographical origin, but we should be encouraging people to travel with negative tests and facilitate the testing process so that people can travel with a negative test,” Nkengasong said….”

The Rockefeller Foundation Announces Grant to Expand Access to Covid-19

Testing and Tracing in Africa

https://www.rockefellerfoundation.org/news/the-rockefeller-foundation-announces-grant-to-expand-access-to-covid-19-testing-and-tracing-in-africa/

“The Rockefeller Foundation has announced a new grant of US$12 million to the Africa Public Health Foundation to help expand the geographic coverage of testing and strengthen contact tracing for Covid-19 in Africa through the Africa Centres for Disease Control and Prevention. … Testing and tracing remain two of the strongest public health interventions for containing Covid-19 on this continent of about 1.3 billion people. Yet, only a little above 29.2 million tests have been reported since the beginning of the pandemic…. … Through the Partnership to Accelerate Covid-19 Testing (PACT), an initiative rolled out in August last year, Africa CDC is establishing partnerships

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across the globe to mobilize technical, material, and financial resources to support its Member States in expanding testing, tracing, and treatment for Covid-19. This grant will contribute to the implementation of PACT across the continent….”

And a link: HPW – Senegal’s Pasteur Institute – At Center Of New Genetic Surveillance Network

Covid science

Science News - Vaccine 2.0: Moderna and other companies plan tweaks that would

protect against new coronavirus mutations

https://www.sciencemag.org/news/2021/01/vaccine-20-moderna-and-other-companies-plan-

tweaks-would-protect-against-new

“Current vaccines likely still work, scientists say, but their power may be declining.”

See also NYT - As Virus Grows Stealthier, Vaccine Makers Reconsider Battle Plans.

FT - Moderna develops new vaccine to tackle mutant Covid strain

Nature News - Are COVID vaccination programmes working? Scientists seek first

clues

https://www.nature.com/articles/d41586-021-00140-w

“Vaccinated people in Israel are less likely to test positive for SARS-CoV-2, but a population-wide effect will take time to become clear.”

WSJ - WHO Recommends Against Moderna, Pfizer Vaccines for Most Pregnant

Women

https://www.wsj.com/articles/who-recommends-against-moderna-pfizer-vaccines-for-most-pregnant-women-11611775138

“Neither Moderna nor Pfizer enrolled pregnant women in their Covid-19 vaccine trials, and both say they plan future study.”

And some links:

• Stat - Novavax says its Covid-19 vaccine is 90% effective, but far less so against one variant (the South-African).

• FT - German authorities recommend blocking use of AstraZeneca vaccine for over-65s

• Reuters - Pfizer vaccine only slightly less effective against key South African mutations - study

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• Stat - Moderna’s vaccine is less potent against one coronavirus variant but still protective, company says

• FT - Johnson warns new virus variant may be deadlier than original strain

“…Boris Johnson has warned that the new variant of coronavirus that emerged in the UK is not only

more infectious but, according to new data, may also be 30 per cent more deadly….”

See also Cidrap News:

“…Patrick Vallance, MD, PhD, the UK's chief science advisor, said during that briefing that the data are not yet strong and that there is a lot of uncertainty, with more work needed to get a precise handle on the variant's impact on mortality, according to the BBC. He said, though, that increased morality is concerning. The new findings come from a study today from by the UK's New and Emergency Respiratory Advisory Group (NERVTAG), which said a preliminary analysis based on relatively few people and settings shows that increased severity may be associated with the variant. …”

And FT - Is Covid variant raging through UK more lethal? “Research suggests B.1.1.7 is more likely to result in death, but fatality rates are still lower than when pandemic began.”

• The Conversation - Risk of severe COVID established early in infection – new study

• Guardian - Scientists liken long Covid symptoms to those of Ebola survivors

• Vox - 4 reasons we’re seeing these worrying coronavirus variants now

• Cidrap News - Variant COVID among triggers for grim surge in Manaus, Brazil (on 4 factors

that might be at play there (see Lancet article).

Covid vaccine access

Heavy section, as usual, with updates on Covax, the (sorry) state of C-TAP, vaccine diplomacy and much more. (PS: on the TRIPS waiver proposal, we already reported above)

Before we start, a quick overview of how the global vaccination campaign is going (via Our World in Data ): Max Roser: “The global vaccination campaign is picking up speed – 80 million vaccinations by now.”

COVAX global supply forecast

https://www.gavi.org/sites/default/files/covid/covax/COVAX%20Supply%20Forecast.pdf

(17 p.) Will be regularly updated. (as of Jan 20) “The COVAX Global Supply Forecast aims to provide an up-to-date overview of the supply of safe and effective vaccines to the COVAX Facility. Our goal is

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to offer economies participating in COVAX as much clarity as possible on when we expect the doses we have secured to start arriving. To this end, we provide both a global overview as well as specific regional forecasts. According to our forecasting and assuming funding availability, we expect as many as ~1.8 billion doses to be available to the 92 economies of the Gavi COVAX Advance Market Commitment (AMC) in 2021, corresponding to ~27% coverage of AMC populations. Our forecasting indicates that we should fulfil the requests for vaccine placed by Self-Financing Participants in the second half of 2021.”

HPW - Pfizer/BioNTech Join Global COVAX Vaccine Facility – In Game-Changer For

WHO Plan To Roll Out Vaccines More Equitably

https://healthpolicy-watch.news/pfizer-biontech-joins-who-cosponsored-covax-vaccine-facility-in-

game-changer-for-global-distribution-plan/

News from last week on Friday and overall update on Covax (as of 22 Jan). See also WHO - COVAX

Announces new agreement, plans for first deliveries

The Pfizer announcement amounted to a psychological turning point for Covax, it was claimed: “… Pfizer/BioNTech will join the WHO-co-sponsored COVAX vaccine facility, providing up to 40 million vaccines at cost to the Facility for use in low-income countries around the world – in what signals a breakthrough for the facility that only a week ago appeared to be teetering on the verse of irrelevance – as more low- and middle-income countries raced to sign bilateral contracts with pharma manufacturers for vaccine supplies. The joint announcement by Pfizer CEO Albert Bourla and WHO’s Dr Tedros Adhanom Ghebreyesus at a WHO press conference on Friday evening puts a bookend on a week of good-news developments for the WHO and its global health partners in COVAX – following on from moves by the new US administration of President Joe Biden to rejoin WHO and join the COVAX facility as well. …”

“While 40 million doses is still a relatively a small initial amount, to begin with, it is also psychologically important to COVAX. It makes a statement that the even the most expensive, cutting edge mRNA vaccine technologies will be a part of the global vaccine pool made available to low and middle-income countries – which has already stocked up pre-orders for 2 billion doses of cheaper, and more conventional COVID vaccines. Together with the AstraZeneca vaccine, the commitment by Pfizer also ensures that at least some vaccine supplies will be ready to roll out almost immediately; other vaccines in the COVAX portfolio include products by Johnson & Johnson, Novavax and Sanofi – which are still in Phase 3 trials and thus haven’t yet been approved by any regulatory agency. The Pfizer move is also important because it provides a signal to other vaccine developers that COVAX has a broad base of industry support. … … Some 150 million doses of the AstraZeneca vaccine will also be available in the first quarter of 2021, said Dr Tedros, speaking at the press briefing. Those doses are primed and ready to go, pending only WHO review and approval of the safety and efficacy of the AstraZeneca vaccine and its production facilities at the Serum Institute in India and in the Republic of Korea. “Together, these announcements mean COVAX could begin delivering doses in February, provided that we can finalize a supply agreement for the Pfizer biotech vaccine and emergency use listing for the AstraZeneca Oxford vaccine,” he said. …”

“… United States Expected to Play Critical Role in COVAX Global Vaccine Rollout…”

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MSF: Only 2 percent of Pfizer’s COVID-19 vaccine supply is going to COVAX Facility

https://www.doctorswithoutborders.org/what-we-do/news-stories/news/msf-only-2-percent-

pfizers-covid-19-vaccine-supply-going-covax

Puts things in perspective on the contribution of Pfizer to Covax : )

But see also HPW: COVAX Deal With Pfizer Is Small But ‘Opens the Door’

“… Meanwhile, WHO Special Advisor Dr Bruce Aylward defended a small 40 million COVAX deal reached with Pfizer, which had been announced on Friday. … Alyward said the small number was “a start”, but that the Pfizer vaccine was already recommended by WHO “so this could be launched very, very rapidly and earlier possibly than some of the other products”. “45 out of 50 of the countries rolling out vaccines are using the Pfizer vaccine,” said Aylward. “Even with a relatively small number of doses … it was clear that we could make a real difference in protecting some of the most highly exposed, highly at risk health care workers, particularly in some of the [low- and middle-income countries (LMICs)] that the facility serves. “The other big advantage by putting the framework agreement in place, is that we can then open the door to donations in a much more potentially seamless manner with other countries that currently have contracts with and substantial quantities of the Pfizer vaccine.”…”

Telegraph - Developing nations ‘on track’ for 2 billion jabs by end of the year

despite ‘feeding frenzy’

https://www.telegraph.co.uk/global-health/science-and-disease/poorer-nations-track-2-billion-jabs-

end-year/

Covax is on track, according to CEPI’s Richard Hatchett.

HPW - COVAX Planning Per-Dose Vaccine Levy To Fund Compensation Scheme

https://healthpolicy-watch.news/

“The global COVID-19 vaccine access platform, COVAX, plans to impose a US 10-cent levy on each vaccine dose to fund a compensation scheme for people who suffer from severe adverse reactions to any of the vaccines it supplies….”

Devex - Humanitarians plan for COVID-19 vaccinations in conflict zones

https://www.devex.com/news/humanitarians-plan-for-covid-19-vaccinations-in-conflict-zones-

98971

“International and regional NGOs operating in conflict zones are beginning to prepare for the first batches of COVID-19 vaccines expected this year. Access is a chief concern but far from the only one, experts say. … … … The Inter-Agency Standing Committee is holding talks on the establishment of a COVAX humanitarian “buffer,” which would ensure that up to 5% of COVID-19 vaccines procured

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by the facility are stored for the most at-risk populations. No decisions have yet been finalized on this plan, according to John Johnson, project lead for vaccination at Médecins Sans Frontières in France….”

Reuters - Africa begins vaccines, sceptical Tanzania told to trust science

Reuters;

“Some African nations have begun administering vaccines against COVID-19, regional health officials said on Thursday, though Tanzania’s dissenting president was singled out for his trust in alternative remedies and God. John Nkengasong, director of the African Union (AU) bloc’s disease control and prevention body, said a few countries had begun vaccinating: Morocco, Egypt, Seychelles and Guinea. “Guinea is very limited, just about 50 to 60 vaccinations have occurred. But these other countries have started mainly with the vaccine from China,” he told an online briefing.

In addition to 270 million doses previously secured, the AU has signed an agreement with India’s Serum Institute for 400 million doses of the Oxford/AstraZeneca vaccine. “Remember, this is spread over this year and to next year,” added Nkengasong, whose Africa Centres for Disease Control and Prevention (CDC) has not yet given allocation details. Health bodies hope to vaccinate about 30-35% of Africans this year.”

“… … Nkesangong said the Africa CDC was reaching out to China, Russia and Cuba to explore obtaining more vaccines, and would work with any partner whose vaccine was safe and effective.”

Reuters - Bill Gates sees 6-8 month lag for poor countries to get COVID-19 shots

Reuters;

Bill Gates’ view on the global access issue, Covax roll-out in the coming months, and more . “ Poorer countries face a best-case scenario of a 6-8 month lag behind richer nations in getting access to COVID-19 vaccines to protect their populations against the pandemic disease, the philanthropist Bill Gates said on Wednesday. …. In an interview with Reuters, Gates called the rollout of the first COVID-19 shots a “super hard allocation problem” that was putting pressure on global institutions, governments and drugmakers….”

PS: and a typical ‘Gates’ paragraph: “Seth Berkley, CEO of GAVI and a co-lead of COVAX, warned on Tuesday of “a sense of vaccine panic” with many countries pursuing biliateral deals with drugmakers to secure limited supplies and some threatening legal action against drugmakers who have said supplies could be delayed. Gates said such pressure was unhelpful, noting that pharmaceutical companies such as Pfizer, BionTech, AstraZeneca and Moderna all developed COVID-19 vaccines in less than a year. “If you’re a pharma company that didn’t make a vaccine, you’re not under pressure. But the ones who did make the vaccine - they are the ones being attacked,” he said. “It’s all very zero-sum.”…”

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Guardian - Most poor nations 'will take until 2024 to achieve mass Covid-19

immunisation'

https://www.theguardian.com/society/2021/jan/27/most-poor-nations-will-take-until-2024-to-

achieve-mass-covid-19-immunisation

Coverage of a new Economist Intelligence report, that is more gloomy than Gates, it seems:

“Forecast predicts handful of developed countries fully vaccinated by late 2021 while others race to catch up.”

“Most poor countries will not achieve mass Covid-19 immunisation until at least 2024 and some may never get there, according to a new forecast, which maps a starkly divided world over the next few years in which a handful of developed countries are fully vaccinated while others race to catch up. Countries such as the UK, US, Israel and those in the EU will probably achieve “widespread vaccination coverage” – meaning priority and vulnerable groups, and almost all of the rest of the population – by late 2021, according to analysis from the Economist Intelligence Unit. They will be followed by a slew of other developed countries by the middle of 2022 and then most middle-income countries by the end of that year. But 84 countries that make up the world’s poorest will not receive enough doses to sufficiently immunise their populations for at least a further year, a global faultline that will run through the first half of this decade, said Agathe Demarais, the unit’s global forecasting director and author of the report….”

See Economist Intelligence report .

HPW - Moderna’s COVID-19 Vaccine ‘Safe’ For Most People WHO Experts Say – But

No Recommendation For Pregnant Women Or Children

https://healthpolicy-watch.news/who-recommend-moderna-emergency-use-not-issued/

“The Moderna COVID-19 vaccine is safe for most people including those with a wide range of underlying medical conditions, according to the World Health Organization’s Strategic Advisory Group of Experts (SAGE) on immunizations. However, the vaccine is not recommended for pregnant women or children as it has not been tested on these groups, according to interim recommendations published today by WHO. …”

“… The WHO approval may also pave the way for Moderna to contribute vaccines to the global COVAX facility, following a final WHO “Emergency Use Listing” approval for the vaccine. Last Friday, Pfizer announced it was contributing 40 million doses of its vaccine to the WHO co-sponsored COVAX, weeks after WHO approved the vaccine. …”

“… The WHO has not yet issued an Emergency Use Listing (EUL) for the Moderna vaccine, but it has undergone review by the European Medical Agency (EMA), which has authorized its use in the European Union. It has also been approved in the United States, Canada, the United Kingdom and Swissmedic. Regardless, the WHO advice is significant as many member states – especially low- and middle-income countries (LMICs) – also rely upon WHO for vaccine recommendations as a global reference point….”

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UCL Policy Brief – Delivering the People’s Vaccine: Challenges and proposals for

the biopharmaceutical innovation system

https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-purpose/files/iipp-pb12_delivering-the-

peoples-vaccine_final.pdf

By Els Torreele, M Mazzucato et al. So you know you better read this 😊. They come with 4

proposals.

Stat - In a major setback, Merck to stop developing its two Covid-19 vaccines and

focus on therapies

Stat News;

“Merck said Monday it will stop developing both of the current formulations of the Covid-19 vaccines the company was working on, citing inadequate immune responses to the shots. Work will continue on at least one of the vaccines, which is being developed in partnership with the International AIDS Vaccine Initiative (IAVI), to see if using a different route of administration would improve how effective it is. These failures are a shocking setback for one of the most storied vaccine makers, and will raise tensions around readouts expected soon from other companies, including Johnson & Johnson and the upstart NovaVax…. “ “…Merck said it remains committed to research on Covid-19 and will focus on two treatments it is developing. One is an antiviral medicine against SARS-CoV-2, the virus that causes the disease. The other is a medicine aimed at helping hospitalized patients by reducing the immune system’s over-response to the virus; it has already shown promise in clinical studies.”

NYT - China Wanted to Show Off Its Vaccines. It’s Backfiring.

https://www.nytimes.com/2021/01/25/business/china-covid-19-vaccine-backlash.html?smid=tw-

share

Slightly biased take on how China’s vaccine diplomacy is going, so far. “Delays, inconsistent data, spotty disclosures and the country’s attacks on Western rivals have marred its ambitious effort to portray itself as a leader in global health.”

PS: “Beijing officials who had hoped the vaccines would burnish China’s global reputation are now on the defensive. State media, meanwhile, has started a misinformation campaign against the American vaccines, questioning the safety of the Pfizer and Moderna shots and promoting the Chinese vaccines as a better alternative. They have also distributed online videos that have been shared by the anti-vaccine movement in the United States….”

But “.. To be sure, the Chinese vaccines have a big appeal to many countries. More than 40 countries have expressed an interest in importing Chinese vaccines, according to China’s foreign ministry. Several world leaders, including President Reccep Tayyip Erdogan of Turkey and President Joko Widodo of Indonesia, have gotten a Sinovac vaccine….”

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CNBC - Countries worldwide look to acquire the intellectual property rights of

Covid-19 vaccine makers

https://www.cnbc.com/2021/01/22/countries-look-to-acquire-the-ip-of-vaccine-makers-to-fight-

pandemic.html

“Soaring demand for the Covid-19 vaccine and limited supply have countries worldwide looking for ways to fast track vaccinating their citizens. Many countries have gone to the World Health Organization requesting compulsory licensing of Covid-19 vaccine patents from drug makers….”

HPW - African Countries Appeal For WHO Support For Expanded Local Production

of Medicines, Diagnostics & Vaccines

https://healthpolicy-watch.news/african-countries-who-local-production-medicines-vaccines/

“Ten African countries, supported by China, have appealed to the World Health Organization (WHO) to support increased local production of medicines, vaccines and other health products – to improve their access and drive down prices, according to a draft resolution presented to WHO’s Executive Board Friday. Ethiopia, supported by nine other African countries – eSwatini, Ghana, Kenya, Namibia, Rwanda, South Africa, Sudan, Togo and Zimbabwe – led the appeal to WHO for support to develop “national policies and evidence-based comprehensive strategies and plans of action for local production”….”

Guardian - WHO platform for pharmaceutical firms unused since pandemic began

https://www.theguardian.com/world/2021/jan/22/who-platform-for-pharmaceutical-firms-unused-

since-pandemic-began

C-TAP, “A World Health Organization program for pharmaceutical companies to voluntarily share Covid-19 related knowledge, treatments and technology so they can be more widely distributed has attracted zero contributions in the eight months since it was established, the Guardian has learned….” “… Another United Nations-backed patent-sharing platform, the medicines patent pool (MPP), widened its mandate last year to include Covid-19 treatments, but it too has so far not negotiated any deals for drugs, data or technology to fight the coronavirus pandemic.;..” PS: for more on the role the MPP could play in this pandemic, see a WEF blog - Are vaccines enough? To end COVID-19 we need more innovation – and more access “Patent pooling seeks a business model that offers a more sustainable solution for increasing access to medical breakthroughs.”

Ellen ‘t Hoen (blog -)- The elephant in the room at the WHO Executive Board

https://medicineslawandpolicy.org/2021/01/the-elephant-in-the-room-at-the-who-executive-

board/

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On the same issue. “ … at the EB, … Tedros left the elephant in the room unmentioned: most pharmaceutical companies refuse to share the know-how and technology needed to produce vaccines on a large scale…” “Despite the fine words of European leaders who, just under a year ago, promised that no one could “own the vaccine,” the WHO Covid-19 Technology Access Pool is empty. 41 countries officially support C-TAP in words but few with action. This failure cannot be bought off with donations to the COVAX facility. COVAX after all, also needs the success of C-TAP to be able to buy affordable vaccines on a large scale….”

‘t Hoen concluded with a glimmer of hope: “… Dr Fauci’s recent comments beg the questions will the Biden administration do the same and put its weight behind making the Covid-19 Technology Access Pool a success?”

Stat - U.S. will have enough Covid-19 vaccines for 300 million Americans by end of

summer, Biden says

https://www.statnews.com/2021/01/26/biden-purchase-doses-300-million-americans/

“President Biden plans to purchase another 200 million doses of coronavirus vaccines from Pfizer and Moderna, which should give the U.S. enough to fully vaccinate 300 million Americans by the end of summer 2021, the administration announced in a press release Tuesday….”

And a related tweet: “…Everyone's for more vaccine but hard not to note that this news comes a week after WHO warned that "vaccine nationalism" was putting the world on the brink of "catastrophic moral failure."…”

Guardian - World's poor need action, not Covid 'vaccine nationalism', say experts

https://www.theguardian.com/world/2021/jan/22/worlds-poor-need-action-not-covid-vaccine-

nationalism-say-experts

“Pharmaceutical companies should do more to transfer vaccine technology to prevent the poorest countries falling behind in the distribution of Covid-19 vaccines, according to an expert….”

“The warning came from Dag-Inge Ulstein, the co-chair of the global council trying to speed up access to Covid vaccines for the world’s poor, known as the Act (Access to Covid-19 Tools) Accelerator. Ulstein, Norway’s international development minister, oversees the drive to ensure vaccines reach the poor – the Covax programme. His remarks were amplified by his global health ambassador, John-Arne Røttingen, who told the Guardian that the battle to create equal access to vaccines was “at a very important turning point”. Other diplomats fear that if the issue of vaccine distribution is not resolved, it will result in years of resentment between rich and poor nations….”

The Continent - Most African countries should get their first vaccine for free

https://bucket.mg.co.za/wp-media/6155ef88-thecontinentissue34.pdf

On a Covax change in policy. “The majority of African countries could get enough Covid-19 vaccine doses to cover at least 20% of their populations for free — marking a major shift in international

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policy. … … Covax initially promised that vaccines would be free for poor countries, but in September Gavi’s board introduced required co-payments of up to US$2 per dose for poor countries. Exemptions to the policy would be on a case-by-case basis. Now, Covax has committed to providing initial doses for free if funding pans out. Late Thursday, the World Health Organisation — a Covax partner — announced that all 54 countries on the continent have expressed interest in joining Covax; and, notably, that lower and middle-income countries will access Covax vaccines at no cost. Speaking to The Continent, a Gavi spokesperson confirmed that the organisation is fundraising to provide 1.3-billion vaccine doses free to poor countries. The deal would apply to all African countries except for eight uppermiddle-income nations that must pay for Covax jabs in full: Botswana, Equatorial Guinea, Gabon, Libya, Mauritius, Namibia, Seychelles and South Africa. “… … “Whilst mindful of uncertainties on vaccine pricing, resource availability and manufacturing supply, Gavi aspires to cover at least 20% of the population of eligible economies with these donorfunded doses – thereby making a very real impact towards stopping the spread of the pandemic by end 2021.” Once donor funding for Covid-19 vaccines doses is exhausted, poor countries will have the chance to purchase further quantities at a subsidised price. So far, Covax has secured two-billion vaccine doses and raised $6-billion in donor funding. “We are not yet where we want to be, but I’m happy to say we are on track,” a Gavi spokesperson told journalists on Thursday.” …”

Lancet Comment – Urgent needs of low-income and middle-income countries for

COVID-19 vaccines and therapeutics

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00242-7/fulltext

By the Lancet Commission on Covid-19 Vaccines and Therapeutics Task force members. They lay out what is needed at all levels (including globally).

And some links:

• Bloomberg - India Has Plenty of Coronavirus Vaccines But Few Takers

“Doctors shun early-stage vaccine, ignore government pleas; India may fall short of plan to vaccinate 300 million by July.”

• Unicef - Getting COVID-19 vaccines to West and Central Africa

“How UNICEF is harnessing decades of expertise to deliver COVID-19 vaccines to the region.”

• Guardian - EU threatens to block Covid vaccine exports amid AstraZeneca shortfall

A telling tweet from Ellen ‘t Hoen: “And so it has come to this”.

• Bloomberg - Zimbabwe Gets Coronavirus Vaccine Offers From China, Russia

“Minimum will be $2.50 per shot, says Health Ministry official.”

Politico on middle income countries ‘s vaccine access situation:

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“… more than a quarter of the world’s countries fall somewhere in the middle: not rich enough to snap up major vaccine supply and not poor enough — at least on paper — to get support. They are what the World Bank calls the upper middle-income countries, where the gross national income per capita ranges from $4,046 to $12,535. Countries as diverse as Argentina, Indonesia and South Africa fall into this category. Many have been hit hard by the virus. The 50 or so countries in this group represent about a third of the 100 million infections reported globally. Just 10 have started vaccinating, and some governments are facing internal criticism for falling behind in the vaccine race. Most of them have scrambled to strike bilateral deals with vaccine makers in the West — Colombia, Costa Rica, Ecuador and Lebanon, among them. Others have opted for those made in the East: Argentina, Brazil, Iran and Turkey….”

Finally, a tweet by Balasubraniam – “The Oxford/AZ vaccine is the backbone of COVAX vaccines

distribution.”

Covid analysis

Lancet Editorial – Health and care workers are owed a better future

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00179-3/fulltext

Linking all the current challenges for health workers in the pandemic with the long term.

“It has been a traumatic and testing year for the health and care workforce globally. In recognition of their contribution and struggles during the pandemic response, WHO has designated 2021 as the International Year of Health and Care Workers. This campaign highlights the need for investment in health workforce readiness, education, and learning to manage the COVID-19 pandemic, to maintain health services, and to prepare for vaccine roll-outs. A call for action on behalf of the health-care workforce is welcome. What must also be considered is a governmental duty to sufficiently protect the health-care workforce, be that protection from infection, protection of mental health, or legal protection. Governments should be asking themselves whether they are fulfilling this duty of care….”

The Telegraph - Global nutrition crisis looms for hungry children locked out of

school, charities warn

The Telegraph;

“Around 1.6 billion pupils have been hit by school closures, with 370 million missing out essential meals. Vulnerable children around the world are being put at increased risk of malnutrition thanks to school closures, Unicef and the World Food Programme (WFP) have warned. More than 39 billion in-school meals have been missed globally since the start of the coronavirus pandemic, new research from the organisations has found. According to their latest report, Covid-19: Missing More Than a Classroom, 370 million children worldwide – many of whom are reliant on school meals as a key source of their daily nutrition – have missed on average 40 per cent of in-school meals since Covid-19 restrictions shuttered classrooms last year….”

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Reuters - New Zealand, Vietnam top COVID performance ranking; U.S., UK

languish

Reuters;

For what it’s worth, another ‘Covid performance’ ranking. See here for the ranking.

“New Zealand, Vietnam and Taiwan rank the top three in a COVID Performance Index of almost 100 countries for their successful handling of the coronavirus pandemic, with Britain and America near the bottom of the pile. The Lowy Institute said its index published on Thursday excludes China, where the first cases were identified in December 2019, due to a lack of publicly available data. Other countries in the top 10 include Thailand, Cyprus, Rwanda, Iceland, Australia, Latvia and Sri Lanka - countries with fewer reported cases and deaths both in aggregate and per capita terms. … The index showed countries in Asia-Pacific proved the most successful in containing the pandemic, while Europe and the United States were “quickly overwhelmed” by the rapid spread of COVID-19. … “Levels of economic development or differences in political systems between countries had less of an impact on outcomes than often assumed or publicised,” the Sydney-based Lowy Institute said in its analysis. … … “In general, countries with smaller populations, cohesive societies, and capable institutions have a comparative advantage in dealing with a global crisis such as a pandemic.”

Guardian - All countries should pursue a Covid-19 elimination strategy: here are

16 reasons why

M Baker & M McKee; https://www.theguardian.com/world/commentisfree/2021/jan/28/all-

countries-should-pursue-a-covid-19-elimination-strategy-here-are-16-reasons-why

The ‘zero-Covid’ strategy seems to gain some momentum in op-eds in a number of countries. Baker & McKee list 16 ideas why it’s the way to go in the second year of the pandemic. (Have my doubts it’s feasible in all countries...)

They conclude: “We hope that all governments, and the World Health Organization, will consider the elimination strategy as they plan year two of our global response to the pandemic.”

See also Richard Horton in his weekly Offline - Offline: The case for No-COVID

“As many countries continue to struggle with a third wave of COVID-19—Hong Kong is suffering its fourth wave and is contemplating a fifth and sixth—all governments and public health authorities will need to remain open to new ideas for controlling the pandemic. This past week, Ilona Kickbusch, founding director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, shared a proposal being widely discussed in Germany. The approach devised by a group of clinicians and academics, which in addition to Kickbusch includes Melanie Brinkmann, Michael Hallek, Matthias Schneider, and others, is a “No-COVID strategy”.

“…There are three elements to their plan, based on the twin objectives of No-COVID and the creation of virus-free green zones. First, a rapid reduction in numbers of infections to zero. Second, avoidance of further virus transmission or reintroduction through rigorous test, trace, and isolate

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systems, together with local travel restrictions. Third, rapid outbreak management if new cases of COVID-19 occur sporadically…”

HPW – Low-Income Countries Can Expect Higher Mortality From ‘Collateral

Damage’ Than COVID-19, Global Fund Head Predicts

https://healthpolicy-watch.news/low-income-countries-can-expect-higher-mortality-from-collateral-

damage-than-covid-19-expert-predicts/

Peter Sands did so at a Davos session. “While very low-income countries have experienced relatively low mortality rates from COVID-19, they can expect higher mortality caused by the knock-on effects of the pandemic on their fragile health systems, according to the Executive Director of the Global Fund to Fight AIDS, TB and Malaria….”

IDC report - Developing countries face disastrous healthcare setbacks, hunger

and huge international debt as covid-19’s ‘final wave’

https://committees.parliament.uk/committee/98/international-development-

committee/news/138597/covid-secondary-impacts-report-publication-19-21

Similar message. In its latest report, the (UK) International Development Committee (IDC) warned

that a legacy of humanitarian and development reversals and crises could be more catastrophic than

the direct impacts of covid-19 in developing countries.

Nature (News) - Why did the world’s pandemic warning system fail when COVID

hit?

https://www.nature.com/articles/d41586-021-00162-4

Must-read analysis. “Nearly one year ago, the World Health Organization sounded the alarm about the coronavirus, but was ignored.”

Among others, on the different connotation of “PHEIC” vs “pandemic”. And the need for reform.

A few quotes:

““The biggest issue to me is that for six to eight weeks after the PHEIC declaration, countries, except for in Asia, sat on their hands,” says Joanne Liu, a former president of Médecins Sans Frontiérs (also known as Doctors without Borders), who serves on the independent panel….”

“Several reports note that politicians and the public mainly ignored the PHEIC declaration and Tedros's corresponding recommendations in January 2020, but started listening when the organization used the unofficial term ‘pandemic’ to describe COVID-19 in March, once it was spreading in multiple continents. Unlike the PHEIC, 'pandemic' is not a defined declaration, and countries haven't agreed to take any actions once it's used. … … Despite the disproportionate

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response to the word pandemic, many scholars argue that changing the name of the WHO’s highest alarm wouldn’t be useful….”

BMJ Collection - Covid-19: The Road to Equity and Solidarity

Collection launched at PMAC last Friday. Some articles have already been put online, among others:

BMJ - Political economy of covid-19: extractive, regressive, competitive

https://www.bmj.com/content/372/bmj.n73

“The political economy of covid-19 reflects longstanding patterns of resource extraction linked to racial discrimination, marginalisation, and colonialism, write Jesse Bump and colleagues.”

BMJ - Solidarity and universal preparedness for health after covid-19

https://www.bmj.com/content/372/bmj.n59

“Göran Tomson and colleagues argue that our ability to control pandemics requires global action to counter inequalities from demographic, environmental, technological, and other megatrends.”

BMJ Analysis - Explaining covid-19 performance: what factors might predict

national responses?

https://www.bmj.com/content/372/bmj.n91

“Fran Baum and colleagues discuss the factors that affected prediction of the success of national responses to covid-19 and will influence future pandemic preparedness.”

“…Ten factors seem to have contributed to the index failing to predict country responses, including overlooking political, economic, and social contexts and the role of civil society. Future assessments of pandemic preparedness need to take these 10 factors into account by adopting a systems approach which enables a focus on critical system components.”

For more articles in this series:

• International collaboration and covid-19: what are we doing and where are we going?

“ The mixed patchwork of achievements and mis-steps in responding to covid-19 show powerful nations are not living up to their commitment to solidarity and equity, argue Jesse Bump and colleagues…”

And: “Addressing these deficits in collaboration is essential to resolving global collective action challenges, including covid-19, climate change, and non-communicable diseases.”

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• Covid-19 pandemic and the social determinants of health

• Covid-19—a rehearsal to build a greener and healthier society

More articles from the BMJ collection will be gradually published online.

Lancet (Comment) - The need for a global COVID-19 maternal immunisation

research plan

A Bardaji et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00146-

X/fulltext

“… There is an urgent need for a proactive, global COVID-19 immunisation plan for the evaluation of COVID-19 vaccines in pregnant women in clinical trials before and after COVID-19 vaccine allocation….”

CGD - COVID-19 is a Gendered Crisis. Here’s What Policymakers Can Do About It.

M O’Donnell; https://www.cgdev.org/blog/covid-19-gendered-crisis-heres-what-policymakers-can-

do-about-it

“The Center for Global Development is building on our initial efforts by launching the COVID-19 Gender and Development Initiative. This new initiative will aim to promote gender equality and long-term prosperity in low- and middle-income countries by informing global and national decisionmakers' policy responses to the current pandemic and future crises….”

Rand corporation (e-book) - COVID-19 and the cost of vaccine nationalism

M Hafner et al ; https://www.rand.org/pubs/research_reports/RRA769-1.html

Another report pointing out the huge cost of vaccine nationalism. “Without a vaccine, the worldwide economic impact of COVID-19 would have been $3.4 trillion a year. But even with a COVID-19 vaccine, unequal allocation could cost the global economy up to $1.2 trillion a year in GDP.”

Devex - Consensus or chaos? Pandemic response hinges on trust, experts say

https://www.devex.com/news/consensus-or-chaos-pandemic-response-hinges-on-trust-experts-say-

98959

“Trust is a key reason for the wide variance in how countries have fared during the COVID-19 pandemic, determining why some have succeeded in containing the virus while others have failed, according to new research on responses across 23 countries. The work, supported by Schmidt Futures and the National Science Foundation and carried out by teams at Columbia, Harvard, and Cornell Universities, studied national responses to COVID-19 based on public health, economy, and politics. It organizes countries into three categories: control, consensus, and chaos. The researchers call the United States the leading example of high levels of polarization, decentralized decision-

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making, and distrust in expertise leading to policy chaos. The category also includes Brazil, India, Italy, and the United Kingdom….”

FT - Forget the ‘beginning of the end’, Covid is a permawar

https://www.ft.com/content/1c7266b1-1fad-458e-8585-12dc3164fdce

“Despite the crop of vaccines, the healthcare industry expects to fight coronavirus for years.”

Movendi (report) - Groundbreaking New Report Shows Lethal Interaction

Between Alcohol and Coronavirus Pandemic

https://movendi.ngo/media-release/groundbreaking-new-report-shows-lethal-interaction-between-

alcohol-and-coronavirus-pandemic/

“Alcohol fuels the coronavirus pandemic in different ways, the alcohol industry exploits the current public health crisis and many governments around the world have largely failed to protect their people by using evidence-based alcohol policy solutions as part of the response to COVID-19 – according to a brand new research report. The groundbreaking analysis provides for the first time a comprehensive picture of the individual, societal and policy dimensions of the interaction between alcohol and the coronavirus crisis….”

FT - IMF warns on financial stability threat from vaccine shortages

https://www.ft.com/content/1a4b40e3-2950-4c54-b9e6-8c2248502a12

“The IMF has warned that emerging markets’ limited access to Covid-19 vaccines poses a risk to global financial stability, saying shortages could exert a drag on economic recoveries in low-income countries. …”

Lancet Comment – SARS-CoV-2 serosurveys in low-income and middle-income

countries

J C Mugunga et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00188-4/fulltext

“Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveys provide crucial information on previous SARS-CoV-2 infections in communities. These surveys are particularly useful in low-income and middle-income countries (LMICs), where limited testing capacity inhibits the ability to monitor COVID-19 burden through routine care and contact tracing. We represent a global group of clinical, programmatic, and research leaders that, through long-term collaborations between Partners In Health and national ministries of health, are supporting COVID-19 response data collection and analysis needs in eight countries. SARS-CoV-2 serosurveys are included in the broad set of activities that we are supporting; however, as our teams began developing core technical documents on the design and analysis of serosurveys, we realised that there were divergent opinions on individual protocols within these serosurveillance activities, specifically as to whether or not to return SARS-CoV-2 antibody test results to the individual

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participating in the serosurvey activity. There are many reasons why this topic is debatable, and we highlight some of our key considerations to help other teams designing SARS-CoV-2 serosurveys in LMICs to think through these issues, and to generate a broader discussion as to the pertinence of returning SARS-CoV-2 antibody test results when done as part of serosurveys in different countries….”

Links:

• Lancet Letter - Preparing for a COVID-19 resurgence in the WHO African region (by B

Impoena, M Moeti et al)

• Lancet Comment - COVID-19 and the moral imagination (by M Patel et al)

“The COVID-19 pandemic offers what Ulrich Beck termed a “cosmopolitan moment”, when the existing order is destabilised to open up a new arena of moral and political responsibility. In this cosmopolitan moment, the global community could come together to create new institutions or mechanisms to address the structural causes of global inequity and promote the wellbeing of people and the planet….”

Covid resources

Wellcome - Covid-19 vaccines: information hub

https://wellcome.org/what-we-do/our-work/covid-19-vaccines-information-hub

Collection of quick and simple resources on how Covid-19 vaccines work, how we know they're safe, and how they can be distributed to everyone around the world.

Covid Variant Tracking Project: tracking the spread of alarming Covid variants

https://public.tableau.com/profile/brooks.miner#!/vizhome/MapVariants/Dashboard

With the world map for the UK variant, South African variant, Brazil variant, … so far.

UHC

WB (blog) - A Decade of the Joint Learning Network: A Vision Realized

https://blogs.worldbank.org/health/decade-joint-learning-network-vision-realized

“Launched over a decade ago, the Joint Learning Network for Universal Health Coverage (JLN) has grown to be a community of practitioners and policymakers from 34 countries around the world who engage in practitioner-to-practitioner learning. Through the network, countries find

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practical solutions to their shared challenges in achieving universal health coverage (UHC). Their g products and tools, which harness the practitioners’ joint expertise and experiences, are equipping countries with the “how” of designing and implementing efficient, equitable, and sustainable healthcare systems, while contributing to global knowledge for achieving UHC….”

Family planning

Guardian - Covid 'imperils family planning in poorest countries', says global

project

https://www.theguardian.com/global-development/2021/jan/26/covid-imperils-family-planning-in-

poorest-countries-says-global-project

Coverage of the FP2020’s final progress report: “Sixty million more women and girls in the world’s poorest countries are now using modern contraceptives, after an eight-year global effort to expand family planning services. But the FP2020 global partnership, launched in London in 2012, warned that the coronavirus pandemic and the resulting financial crisis imperils further progress. According to the FP2020’s final progress report, published on Tuesday, 320 million women and girls are using some form of modern contraception in the 69 focus countries, up from 260 million in 2012. The partnership had hoped to reach a figure of 120 million additional women and girls by 2020, but the increase was almost a third higher than had been projected over that period before the initiative began. The number of users across Africa – which had the lowest uptake in 2012 – has grown by 66%, from 40 million to more than 66 million women and girls. In central and west Africa, users doubled, while in eastern and southern Africa, the number grew by 70%. However, Covid-19 could cast a long shadow on progress. In April, two-thirds of the 103 countries surveyed by the World Health Organization reported disruptions to family planning services. The UN population fund (UNFPA) projected that as many as 47 million women and girls in 114 poorer countries could lose access to contraception….”

See FP 2020.

KFF - Donor Government Funding for Family Planning Remains Steady in 2019

A Wexler et al; “A new KFF analysis finds donor government support for global family planning efforts totaled US$1.5 billion in 2019, matching the previous year’s record level and well above the US$1.1 billion in 2012 since the London Summit on Family Planning that created an international goal of increasing family planning services. …”

Remark: “…these findings reflect political funding decisions made before the COVID-19 pandemic and therefore precede possible effects on donor government spending for family planning….”

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Vaccines & childhood mortality

Lancet – Estimating the health impact of vaccination against ten pathogens in 98

low-income and middle-income countries from 2000 to 2030: a modelling study

Xiang Li et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32657-

X/fulltext

Via the press release:

The Lancet: Study estimates that, without vaccination against 10 diseases, mortality in children under five would be 45% higher in low-income and middle-income countries

• A new modelling study has estimated that from 2000 to 2030 vaccination against 10 major pathogens – including measles, rotavirus, HPV and hepatitis B – will have prevented 69 million deaths in low-income and middle-income countries (LMICs).

• The study estimated that, as a result of vaccination programmes, those born in 2019 will experience 72% lower mortality from the 10 diseases over their lifetime than if there was no immunisation.

• The greatest impact of vaccination was estimated to occur in children under five – mortality from the 10 diseases in this age group would be 45% higher than currently observed in the absence of vaccination, according to the research.

• This is the largest scale modelling study of the impact of vaccination in LMICs to date, assessing vaccination programmes against 10 pathogens within 98 countries. The findings indicate that if the progress in vaccination coverage is sustained, these public health gains will continue to increase in coming decades.

Vaccinations against 10 major pathogens have a substantial impact on public health in low-income and middle-income countries (LMICs), according to new modelling research published in The Lancet. The study estimated that from 2000 to 2019 vaccinations have prevented 37 million deaths, and that this figure will increase to 69 million deaths for the period 2000-2030. Most of this impact is estimated to be among children younger than five years, most notably from measles vaccinations. …”

Related Comment in the Lancet - Vaccines work: a reason for celebration and renewed commitment.

NCDs

SSM - The origins of the 4 × 4 framework for noncommunicable disease at the

World Health Organization

L Schwartz et al ;

https://www.sciencedirect.com/science/article/pii/S2352827321000069?via%3Dihub

Very neat article. “This paper traces the history of noncommunicable disease public health research and programming at the World Health Organization. Specifically, it investigates the origins of the

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now pervasive 4 × 4 framework focusing on four sets of diseases (cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers) caused by four behavioral risk factors (tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity). We have found that the 4 × 4 framework developed as a generalization from strategies to control epidemics of cardiovascular disease and stroke in high-income countries during the second half of the twentieth century. These strategies, which were narrowly focused on interventions to address behavioral “lifestyle” risk factors as well as pharmacotherapy for physiologic risk factors, were ultimately packaged as an integrated approach initially in high-income countries and subsequently extended to low- and middle-income countries, where they have failed to address much of the burden among very poor populations.”

IJHPM - Conceptualising the Commercial Determinants of Health Using a Power

Lens: A Review and Synthesis of Existing Frameworks

B Wood et al ; http://www.ijhpm.com/article_4007.html

“…existing frameworks for analysing corporate strategies and practices that impact on health do not incorporate concepts of power in consistent ways. This paper aimed to review the ways in which corporate power has been incorporated into such frameworks, and to propose a revised framing of the commercial determinants of health (CDoH) that makes concepts of power explicit. … … “

Results: “Twenty-two frameworks were identified, five of which used theories of power. A wide range of contexts that shape, and are shaped by corporate power were discussed, as were a diversity of corporate, social and ecological outcomes. A variety of material and ideational sources of power was also covered. We proposed an integrated ‘Corporate Power and Health’ framework to inform analysis of the CDoH, organised around key questions on power set out by Foucault. The proposed framework draws from a number of well-established corporate power theories and synthesises key features of existing CDoH frameworks.”

Lancet Public Health (Editorial) – Gambling: a neglected public health issue

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30290-5/fulltext

“Today, The Lancet Public Health, … announce(s) the launch of the journal's inaugural Commission on Gambling—a scientific inquiry and response to an urgent, neglected, understudied, and worsening public health predicament. …”

See Lancet PH Comment - The Lancet Public Health Commission on gambling.

And a link: Lancet Comment - High burden of postoperative cancer mortality in LMICs Linked to a new study in the Lancet.

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NTDs

WHO issues new 10-year plan to end suffering from neglected tropical diseases

https://www.who.int/news/item/28-01-2021-who-issues-new-10-year-plan-to-end-suffering-from-

neglected-tropical-diseases

“A new World Health Organization (WHO) road map for neglected tropical diseases (NTDs) proposes ambitious targets and innovative approaches to tackle 20 diseases which affect more than a billion mainly poor people and which thrive in areas where access to quality health services, clean water and sanitation is scarce. Targets include the eradication of dracunculiasis (guinea worm) and yaws and a 90% reduction in the need for treatment for NTDs by 2030. `Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030´ aims to accelerate programmatic action and renew momentum by proposing concrete actions focused on integrated platforms for delivery of interventions, and thereby improve programme cost– effectiveness and coverage. It was endorsed by the World Health Assembly (WHA 73(33)) in November 2020….”

Coverage via HPW - New Roadmap Sets Ambitious Targets To End Neglected Tropical Diseases

2021 Access to Medicines Index

https://accesstomedicinefoundation.org/access-to-medicine-index

“The Index reports how 20 pharma companies make medicines, vaccines and diagnostics more accessible for people in low- and middle-income countries.” 7th index already.

• Excellent coverage via the Guardian - Pharmaceutical giants not ready for next pandemic,

report warns

“Ten of the world’s most infectious diseases identified by the WHO not being catered for by drug

firms.”

Coverage also via Devex - Report spotlights drug firms' supply chain initiatives, hurdles in LMICs

• Devex - Q&A: COVID-19 a 'pivot point' for pharma policy (interview with CEO Jay Iyer)

“…Eight leading pharmaceutical companies are developing access plans for products in their research and development pipelines, according to the 2021 access to medicine index, released today. After years of advocacy for access planning, there has been a shift in pharmaceutical company policy, said Jayasree Iyer, executive director of the Access to Medicine Foundation. …

“The index notes the details of these access plans, and how they will accelerate the speed at which future vaccines and other medicines are accessible in low- and middle-income countries. The release

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of this year’s index coincides with the earnings calls of several pharmaceutical companies, including Johnson & Johnson and Novartis, Iyer said. “It’s not coincidental,” she said in an interview with Devex about the results of the index. “It’s strategic.”…”

See also Jay Iyer's take on the index.

Announcing the Lancet Commission on Medicine and the Holocaust: Historical Evidence, Implications for Today, Teaching for Tomorrow

V Roelcke et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00157-

4/fulltext

Co-chairs of this Commission are announcing “The Lancet Commission on Medicine and the Holocaust: Historical Evidence, Implications for Today, Teaching for Tomorrow” and describe its objectives.

Decolonize Global health

BMJ GH - How global is global health research? A large-scale analysis of trends in

authorship

M Dimitris et al ; https://gh.bmj.com/content/6/1/e003758

« We conducted a large-scale investigation of the contribution of LMIC-affiliated researchers to published global health research and examined whether this contribution differed over time. …”

Some of the results: “…we found that 86.0% included at least one LMIC-affiliated author, while 77.2% and 71.2% had an LMIC-affiliated first or last author, respectively; however, analagous proportions were only 58.7%, 36.8%, and 29.1% among 100 687 publications about low-income countries. Proportions of publications with LMIC-affiliated authors increased over time, yet this observation was driven by high research activity and representation among upper middle-income countries. Between-country variation in representation was observed, even within income status categories. “

Global Health Now - Who Should Lead Global Health?

C Guzman; https://www.globalhealthnow.org/2021-01/who-should-lead-global-health

Carlos Guzman’s take: “…Who should lead global health? Communities. No one else should be able

to claim that right over them. “

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Some other news of the week

WHO highlights progress in accelerating access to hepatitis C diagnostics and

treatment in low- and middle-income countries

https://www.who.int/news/item/27-01-2021-who-highlights-progress-in-accelerating-access-to-

hepatitis-c-diagnostics-and-treatment-in-low-and-middle-income-countries

“Many low- and middle-income countries have reduced suffering from hepatitis C, thanks to increased access to testing and treatment. Some achieved a 20-fold increase in the number of people treated with safe and effective direct-acting retroviral drugs between 2015 and 2018, according to the Global progress report on accelerating access to hepatitis C diagnostics and treatment, released by WHO today. Low- and middle-income countries can now aim to achieve a price as low as US$ 60 per patient for a 12-week course of treatment with WHO-prequalified generic sofosbuvir and daclatasvir. Prices offered by suppliers of WHO-prequalified HCV rapid diagnostic tests ranged between US$ 1 and US$ 8 per test. By 2018, more than 120 countries had adopted a national viral hepatitis strategy, up from 20 countries in 2012….”

HPW - Important Advances in HIV Prevention Unveiled: New PrEP Formulas &

Broadly Neutralizing Antibodies

https://healthpolicy-watch.news/important-advances-in-hiv-prevention-unveiled-new-prep-

formulas-broadly-neutralizing-antibodies/

“While global attention has fixated on the coronavirus, the forty-year long fight against HIV, which has claimed 33 million lives, is seeing new breakthroughs in preventive tools. New discoveries of “broadly neutralizing antibodies” as well as novel regimens of pre-exposure prophylaxis (PrEP), could strengthen the world’s toolbox to prevent the disease, announced the International AIDS Society (IAS) at the opening of the 4th HIV Research for Prevention Conference. The IAS-sponsored Conference, which is taking place virtually over four days, is the only conference in the world that is exclusively focused on research in HIV prevention. …”

Oxford (news) - 21st century crises demand new economic understanding, say top

economists

https://www.ox.ac.uk/news/2021-01-20-21st-century-crises-demand-new-economic-understanding-

say-top-economists

“Leading economists, including Nobel laureate Joseph Stiglitz, Argentina's Minister of Economy Martin Guzman, as well as academics from Oxford, Yale, Columbia, and UCLA, are calling today for a deep shift in how economists understand the overall economy. According to the new thinking, a series of massive economic shocks have left traditional economic theory in pieces and the old macroeconomic paradigm is on its way out. “

“…. Professor Vines and Dr Wills have named the newly-emerging macroeconomic paradigm ‘MEADE’: Multiple Equilibrium and DiversE (in recognition of the Nobel prize-winning economist

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James Meade). The new approach studies how multiple economic equilibria can arise and uses wide range of different kinds of models to understand what policymakers can do. …”

Development Today - Norway and UK block consensus in OECD on reporting

COVID19 vaccine research grants as aid

https://www.development-today.com/archive/dt-2021/dt-1--2021/uk-and-norway-want-to-dip-deeper-into-aid-budgets-to-finance-covid19-vaccine-research

(gated) “As vaccine inequality grows, donors continue to argue over how much of their funding for COVID19 vaccine research via the epidemic response agency CEPI can be financed from their aid budgets. The OECD says only about half of these grants can be reported as aid since vaccines also benefit rich countries. Norway and the United Kingdom want to report more as aid, and are blocking consensus on the issue.”

Guardian - UK diplomats told to cut up to 70% from overseas aid budget

https://www.theguardian.com/global-development/2021/jan/26/uk-cut-overseas-aid-budget-costs

“British diplomats have been instructed to find at least 50% cuts in UK overseas bilateral aid in the next few weeks in advance of the next financial year, the Labour party has said. Sarah Champion, the Labour chair of parliament’s international development select committee, said: “Our ambassadors have today been instructed by the Foreign Office to cut 50-70% from the aid budget.”…”

Via Devex: “That amounts to a cut of £4.5 billion, or $6.2 billion, which could result in 100,000 deaths due to scaled-back immunizations, according to a new analysis by the Center for Global Development….”

See also the Guardian - UK aid cuts of up to 70% a 'gut punch' to world's poorest, experts say

“Decision to reduce overseas aid represents a ‘major challenge’ to partner countries’ Covid responses, FCDO warned….”

Guardian - UK must cancel poor countries' debt or face Covid-19 'financial

tsunami'

https://www.theguardian.com/global-development/2021/jan/26/uk-must-cancel-poor-countries-

debt-or-face-covid-19-financial-tsunami?CMP=twt_a-global-development_b-gdndevelopment

“Billions of dollars of debt owed by poor countries must be permanently cancelled in order to stave off a “looming financial tsunami” caused by Covid-19 and the ensuing global recession, a cross-party committee of MPs has warned. Debt relief will not be enough to help the world’s most vulnerable economies as they face skyrocketing levels of hunger and unemployment, according to an inquiry into Covid-19’s secondary impacts in developing countries, published on Tuesday by the House of Commons international development committee (IDC)….”

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New Humanitarian - How advertisers defund crisis journalism

https://www.thenewhumanitarian.org/analysis/2021/01/27/brand-safety-ad-tech-crisis-news

“In the pursuit of avoiding risk, ad tech might have created a new headache.” “Hard news about humanitarian and social issues is being treated as toxic by overzealous ad technology, undermining corporate social responsibility and effectively punishing publishers for reporting on international crises, researchers say.”

Excerpt: “Franaszek’s findings confirm that mainstream brands don’t just avoid mention of violence, misery, and pornography in ad placement, but also of racial groups, religions, and sexual orientations. Adding to the political and human rights questions that raises, humanitarian advocates may object on principle at the inclusion of “refugee” and the “World Health Organization” on the lists of words apparently blocked by key advertisers….”

Devex - Africa's attempt to regulate traditional medicine fails to gain traction

https://www.devex.com/news/africa-s-attempt-to-regulate-traditional-medicine-fails-to-gain-traction-98999

“… In a bid to enhance research and development of traditional medicines like CVO, the World Health Organization and the Africa Centres for Disease Control and Prevention established a Regional Expert Committee on Traditional Medicine for COVID-19 in July 2020, hoping to test traditional therapies and provide independent advice about their safety and efficacy. But six months after its formation, it appears that this attempt to regulate has failed to gain traction: None of the proposed remedies has yet progressed beyond phase II clinical trials. WHO estimates that more than 80% of Africans rely on traditional medicine for their health care needs. …”

Wellcome Leap Establishes Global Network Dedicated to Accelerated

Breakthroughs in Human Health

https://wellcomeleap.org/leap-establishes-global-network/

“Charter group of 21 world-class institutions representing a network of over 150,000 researchers across six continents sign agreement that sets new bar for fast-paced research and development….”

“Wellcome Leap (Leap), a U.S.-based non-profit organization founded by the Wellcome Trust to accelerate innovations that benefit global health, today announced the first 21 participants in the Leap Health Breakthrough Network, a global group of leading academic and research institutions committed to solving the world’s most serious health challenges — such as cancer and infectious diseases — at record speed….”

Reuters – Chad becomes first country to ask for debt overhaul under G20 common

framework

https://www.reuters.com/article/us-chad-debt/chad-becomes-first-country-to-ask-for-debt-overhaul-under-g20-common-framework-idUSKBN29X0Q5

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“Chad has officially requested a debt restructuring, the first country to do so under a new common framework agreed by Group of 20 major economies last year, the International Monetary Fund said on Wednesday….”

Some papers and reports of the week

Journal of Health Organization & Management -What theories underpin

performance-based financing? A scoping review

E Paul, V Ridde et al ; https://www.emerald.com/insight/content/doi/10.1108/JHOM-04-2020-

0161/full/html

The study aims to explore the theoretical bases justifying the use of performance-based financing

(PBF) in the health sector in low- and middle-income countries (LMICs).

“… Economic theories were predominant, with the principal-agent theory being the most commonly-used theory, explicitly referred to by two-thirds of included studies. Psychological theories were also common, with a wide array of motivation theories. Other disciplines in the form of management or organizational science, political and social science and systems approaches also contributed. However, some of the theories referred to contradicted each other. Many of the studies included only casually alluded to one or more theories, and very few used these theories to justify or support PBF. No theory emerged as a dominant, consistent and credible justification of PBF, perhaps except for the principal-agent theory, which was often inappropriately applied in the included studies, and when it included additional assumptions reflecting the contexts of the health sector in LMICs, might actually warn against adopting PBF. … Overall, this review has not been able to identify a comprehensive, credible, consistent, theoretical justification for using PBF rather than alternative approaches to health system reforms and healthcare providers' motivation in LMICs.”

“…The theoretical justifications of PBF in the health sector in LMICs are under-documented. This review is the first of this kind and should encourage further debate and theoretical exploration of the justifications of PBF….”

WHO - Quality of care in fragile, conflict-affected and vulnerable settings

https://www.who.int/teams/integrated-health-services/quality-health-services/quality-of-care-in-

fragile-conflict-affected-and-vulnerable-settings

WHO technical package on quality of care in fragile, conflict-affected & vulnerable settings. The document outlines a practical approach to action planning and implementation of quality interventions in FCV settings and is accompanied by a curated compendium of tools.

IJHPM - Feasibility of Good Governance at Health Facilities: A Proposed

Framework and its Application Using Empirical Insights From Kenya

T Pyone & T Mirzoev ; http://www.ijhpm.com/article_4005.html

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The authors explored the feasibility of embedding good governance at healthcare facilities in Kenya.

HP&P- COVID-19 and the proliferation of urban networks for health security

M Boyce & R Katz; https://academic.oup.com/heapol/advance-

article/doi/10.1093/heapol/czaa194/6118440?searchresult=1

“Recent years have witnessed cities establishing themselves as major players in addressing global issues, often taking collective action through international city networks and organizations. These networks are important, as they amplify the voices of municipal officials, who are often excluded from high-level decision-making, and can also provide a platform for officials from low- or middle-income nations to participate in higher-level political forums. The global response to the COVID-19 pandemic has included traditional public health stakeholders—including supranational organizations, international non-governmental organizations and national authorities—but has also featured mayors and city networks, in an unprecedented fashion. Existing networks without an explicit focus on health have shifted their focuses to prioritize pandemic response and several new networks have been created. These developments are significant, not only because they represent a shift in health governance and policy, but also because cities and urban networks more broadly have exhibited a nimbleness and pragmatism unmatched by higher levels of governance….”

Blogs & op-eds of the week

IHP - Launch of the India Health Policy and Systems Research (HPSR) fellowship

programme: a promising start for the Indian HPSR community in 2021

IHP;

On a recently launched India HPSR fellowship programme by a consortium of Indian and global

health institutions.

CGD (blog) - Build Back. Worry About Better Later

C Kenny; https://www.cgdev.org/blog/build-back-worry-about-better-later#.YBBuUC5bPxU.twitter

Provocative. “The slogan “build back better” has become widespread during the COVID-19 pandemic, and to the extent it is used to promise a recovery that ensures less risk of a repeat, greater equality and more opportunity, that’s a wonderful thing. But the term comes with a history—and not a great one.”

Sandro Galea launched “The Healthiest Goldfish”

https://sandrogalea.substack.com/welcome

His new long-form newsletter. Subscribe here for weekly essays exploring the forces that shape health.

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Guardian Long read - Cash injection: could we cure all disease with a trillion

dollars?

R Hooper; https://www.theguardian.com/news/2021/jan/28/could-we-cure-disease-with-trillion-dollars-coronavirus?CMP=Share_iOSApp_Other

“Could such a large amount of money end the Covid pandemic? Eradicate disease? Provide universal healthcare and fund vaccine research?” Based on a book by the same author. “How to Spend a Trillion Dollars: Saving the World and Solving the Biggest Mysteries in Science.”

Some tweets of the week

Zain Rizvi

“Pfizer says it will provide *2%* of the vaccine doses it produces in 2021 to low-and middle income countries through COVAX. WHO held a press conference to celebrate the announcement. COVAX called it a "major step forward for equitable access." Seriously. twitter.com/AlbertBourla/s…”

Adam Kamradt-Scott

“Academic #globalhealth systems are broken. University fee structures, research incentives, publishing arrangements, lack of diversity & inclusion, list goes on. So, as we’re talking about #WHOreform let’s also redesign #academic global health #AcademicTwitter #phdchat.”

Geoffrey York

“The COVAX vaccine program still needs billions of dollars in funding. "The finance ministers of Norway and South Africa have called on fellow ministers of the G20, the OECD and Covax member countries to meet on Jan 29 to discuss plugging the funding gap."”

Mukesh Kapila

“A forensic reading of the article also raises concerns: India is bypassing rather than supplying via #COVAX even as it benefits from its bulk orders. Vaccine diplomacy to further one’s own image is not solidarity - it’s an extension of vaccine nationalism #politvirus #COVID19”

Gavin Yamey

Re this Alliance call: https://www.who.int/alliance-hpsr/callsforproposals/Alliance-RFP-transitions-

from-external-assistance-web.pdf?ua=1

“A call for research proposals from @AllianceHPSR @WHO in which 85% of the funding must go to health researchers in low- or middle-income countries, and at least 50% of the research team must be women. This is the future of global health research.”

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Ellen ‘t Hoen

“I guess the European Commission is discovering that you cannot create global common goods by giving billions to pharma without strings attached.”

Ilona Kickbusch

“Serum Institute of India: “The endgame solution is to have some dedicated pandemic facility on standby forever. Finding a financial model to keep that going is where I will need outside funding.” Fascinating article - and a vision to fight #pandemics.”

Global health events

PMAC 2021 is ongoing this weekend. ( 28 Jan - 3 Feb ) With lots of virtual sessions!

Global governance of health

John Nkengasong - Building a new public health order for Africa—and a new

approach to financing it

https://www.brookings.edu/essay/support-for-public-health-preparing-for-the-next-pandemic/

Chapter in Brookings book, “Support for Public Health: Preparing for the next pandemic.”

“ …. To address this multidimensional threat, Africa requires a new public health order, including:

1. A strengthened Africa CDC and national public health institutions (NPHIs). … 2. Local production of vaccines, therapeutics, and diagnostics that contributes to supply security, drives down procurement costs, and increases the speed of response to a local threat. Such initiatives should be driven by strong private sector partners, with public support for the required capability building and other enablers, but also for the negotiation of contracts that are sufficiently large and long-term for the initiative to attract the required funding. … 3. Investment in public health workforce and leadership programs. … 4. Action-oriented partnerships—including between the public and private sector, donors and governments, and with public health institutions. Respectful partnerships are those that respect African-originated and defined health priorities and solutions and ensure health programs are aligned with continental priorities such as the Agenda 2063. … This new public health order requires more predictable, long-term funding overall, joint priority setting, and stronger mechanisms to manage the allocation of funds in line with continental aspirations….”

Global Fund - 15 Years of (RED)

https://www.theglobalfund.org/en/specials/2021-01-26-15-years-of-red/

“Partnering with the Global Fund since 2006, (RED) harnesses the power of people and the world’s most iconic brands to fight AIDS. Profits from the sale of (RED)-branded products and experiences

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have generated more than $650 million for Global Fund grants to date, benefiting more than 180 million people in Africa. “ On (RED)'s 15th anniversary.

Seeing that picture of Bono & Klaus Schwab, I’m not sure there’s that much to celebrate.

Global Justice - Healthcare for all? How UK aid undermines universal public

healthcare

https://www.globaljustice.org.uk/resources/healthcare-all-how-uk-aid-undermines-universal-public-

healthcare

“The UK government is at the forefront of a trend to invest large amounts of development funding in private healthcare. Over half a billion pounds of UK public funds have been invested in private healthcare in the global south in the past decade alone. What’s more, this figure is likely to increase in the years to come as the UK seeks to expand its post-Brexit economic role as a key exporter of health services. Our research has found that the UK development bank, CDC Group, has a private healthcare portfolio of £420 million. This includes financial support for a series of highly questionable projects …”

“In this new report, we set out how these investments fit into the UK's wider development strategy which, in recent years, has prioritised supporting private, for-profit businesses over services which reach the world's most marginalised communities….”

CGD (blog) - Five Points for MPs in the UK’s Planned Aid Cut, and an Alternative

Proposal for the Government

https://www.cgdev.org/blog/five-points-mps-uks-planned-aid-cut-and-alternative-proposal-

government#.YA7VxYrbLmI.twitter

“The UK government plans to reduce its aid budget from 0.7 percent of its gross national income (GNI) to 0.5 percent. Today we publish a note that provides an analytical overview of the proposed cuts and potential impacts.

Chatham House - Global Britain, Global Broker: A Blueprint for the UK’s Future

International Role

R Niblett; https://www.chathamhouse.org/2021/01/global-britain-global-broker

“In this paper, Chatham House Director Robin Niblett sets out a proposed blueprint for Britain’s future foreign policy. Rather than reincarnate itself as a miniature great power, he argues that the country has the chance to remain internationally influential if it serves as the broker of solutions to global challenges. The paper lays out six international goals for the UK that offer the best points of connection between its interests, resources and credibility. These are: protecting liberal democracy; promoting international peace and security; tackling climate change; enabling greater global health resilience; championing global tax transparency and equitable economic growth; and defending cyberspace.”

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Globalization & Health - A call to advance and translate research into policy on

governance, ethics, and conflicts of interest in public health: the GECI-PH network

R Nakkash et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-

00660-0

“… Globalization, trade and investment agreements, and privatization, amongst other factors, have facilitated the growing influence of private sector actors on public health at both national and global levels. Protecting and promoting public health from the undue influence of private sector actors is thus an urgent task. With this backdrop in mind, we launched the “Governance, Ethics, and Conflicts of Interest in Public Health” Network (GECI-PH Network) in 2018. Our network seeks to share, collate, promote and foster knowledge on governance, ethical, and conflicts of interest that arise in the interactions between private sectors actors and those in public health, and within multi-stakeholder mechanisms where dividing lines between different actors are often blurred….”

Bloomberg - U.S. Delays Effort to Restore WTO’s Key Decision-Making Power

https://www.bloomberg.com/news/articles/2021-01-25/u-s-delays-effort-to-restore-wto-s-key-

decision-making-power?sref=0klsF1YE

“The U.S. signaled it’s not yet ready to engage in a debate over how to revive the World Trade Organization’s dispute resolution system, which has been hobbled since 2019, until Washington works through President Joe Biden’s transition….”

Global Policy - Academic Research on the 2030 Agenda: Challenges of a

Transdisciplinary Field of Study

A Sianes; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12912

“…. since the adoption of the 2030 Agenda, academic research on the topic has blossomed. However, most academic research has focused on specific topics within the Agenda, with a bias towards the 17 Sustainable Development Goals (SDGs) settled on it. The aim of this study is to contribute to the comprehension and delimitation of the 2030 Agenda as a field of study. … …The results highlight the transdisciplinary nature of the 2030 Agenda, which has gathered attention from a wide range of disciplines and authors, especially in the sustainability and green sciences. At the same time, it points out some weaknesses in the development of a deeper comprehension of the 2030 Agenda from disciplines such as political and international sciences, which could hinder its governance, efficacy and impact.”

And a link:

All Africa - Africa: Former U.S. Officials Call on Biden to Back WTO Selection for Okonjo-Iweala

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UHC

Université de Montréal (thesis- The unintended consequences of a complex

intervention combining performance-based financing with health equity

measures in Burkina Faso

https://papyrus.bib.umontreal.ca/xmlui/handle/1866/24272

by A-M Turcotte-Tremblay. The government of Burkina Faso tested an innovative intervention that combines PBF with health equity measures. … … This thesis aimed to increase the scientific knowledge on the unintended consequences of PBF combined with health equity measures in a low-income setting.

Planetary health

Guardian - Rating agency S&P warns 13 oil and gas companies they risk

downgrades as renewables pick up steam

https://www.theguardian.com/business/2021/jan/27/rating-agency-sp-warns-13-oil-and-gas-

companies-they-risk-downgrades-as-renewables-pick-up-steam?CMP=Share_iOSApp_Other

More evidence of a tipping point on renewables. “Firms including Woodside, Chevron, Shell and

Exxon Mobil, told they could be downgraded within weeks…”

Guardian - Helping poorest tackle climate crisis will boost global growth, says IMF

head

https://www.theguardian.com/environment/2021/jan/25/helping-poorest-tackle-climate-crisis-will-

boost-global-growth-says-imf-head

“Kristalina Georgieva says investing to create resilient economies is a ‘win-win-win-win’ scenario.” Georgieva was at the Climate Adaptation Summit, hosted by the Netherlands on Monday.

It’s a pity the IMF still has it upside down.

Guardian - Global ice loss accelerating at record rate, study finds

https://www.theguardian.com/environment/2021/jan/25/global-ice-loss-accelerating-at-record-

rate-study-finds

“Rate of loss now in line with worst-case scenarios of the Intergovernmental Panel on Climate Change.”

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Climate and Development -Health system resilience to extreme weather events in

Asia-Pacific: a scoping review

V Rameshanker et al;

https://rsa.tandfonline.com/doi/abs/10.1080/17565529.2020.1870425?scroll=top&needAccess=tru

e&journalCode=tcld20#.YA6ILshKhPZ

“Increasingly severe extreme weather events (EWEs) threaten population health in Asia-Pacific. Resilient health systems can minimize health risks by improving EWE preparedness, response, and recovery. However, how health systems demonstrate resilience is less understood in the emerging resilience literature. The objective of this scoping review was to describe how peer-reviewed and grey literature has operationalized health system resilience to EWEs in Asia-Pacific…”

Global Policy - Clash of Geofutures and the Remaking of Planetary Order:

Faultlines underlying Conflicts over Geoengineering Governance

D McLaren et al ; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12863

“Climate engineering (geoengineering) is rising up the global policy agenda, partly because international divisions pose deep challenges to collective climate mitigation. However, geoengineering is similarly subject to clashing interests, knowledge‐traditions and geopolitics. Modelling and technical assessments of geoengineering are facilitated by assumptions of a single global planner (or some as yet unspecified rational governance), but the practicality of international governance remains mostly speculative. Using evidence gathered from state delegates, climate activists and modellers, we reveal three underlying and clashing ‘geofutures’: an idealised understanding of governable geoengineering that abstracts from technical and political realities; a situated understanding of geoengineering emphasising power hierarchies in world order; and a pragmatist precautionary understanding emerging in spaces of negotiation such as UN Environment Assembly (UNEA). …Technology assessments should recognise that geoengineering will not be exempt from international fractures; that deployment of geoengineering through imposition is a serious risk; and that contestations over geofutures pertain, not only to climate policy, but also the future of planetary order.”

Infectious diseases & NTDs

WHO recommends the dapivirine vaginal ring as a new choice for HIV prevention

for women at substantial risk of HIV infection

https://www.who.int/news/item/26-01-2021-who-recommends-the-dapivirine-vaginal-ring-as-a-

new-choice-for-hiv-prevention-for-women-at-substantial-risk-of-hiv-infection#.YBBSQrbU8SY.twitter

“WHO today recommended that the dapivirine vaginal ring (DPV-VR) may be offered as an additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches….”

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Devex - GSK grants India's Bharat Biotech licensing rights to malaria vaccine

https://www.devex.com/news/gsk-grants-india-s-bharat-biotech-licensing-rights-to-malaria-vaccine-

98992

“GlaxoSmithKline is granting Indian company Bharat Biotech all licensing rights to its malaria vaccine, a move that not only ensures the long-term supply of an essential tool in the fight against malaria, but also has the potential to ensure the vaccine’s accessibility and affordability for lower-income countries. The vaccine, the world’s first vaccine for malaria, is currently being implemented in Ghana, Kenya, and Malawi, as part of a four-year pilot program to assess the feasibility of administering the vaccine and its safety as part of routine immunization in the pilot countries, as well as its potential in reducing child mortality from malaria…”

Homeland Preparedness News - Global Health Security Act reintroduced to House

to address U.S. global health needs

https://homelandprepnews.com/stories/61999-global-health-security-act-reintroduced-to-house-

to-address-u-s-global-health-needs/

“In an attempt to address U.S. global health security staffing and to provide a permanent designated official for coordinating interagency health response, 57 House members supported the reintroduction of the Global Health Security Act this week….”

BMJ GH - Improving National Intelligence for Public Health Preparedness: a

methodological approach to finding local multi-sector indicators for health

security

N Erondu et al ; https://gh.bmj.com/content/6/1/e004227

“The COVID-19 epidemic is the latest evidence of critical gaps in our collective ability to monitor country-level preparedness for health emergencies. The global frameworks that exist to strengthen core public health capacities lack coverage of several preparedness domains and do not provide mechanisms to interface with local intelligence. We designed and piloted a process, in collaboration with three National Public Health Institutes (NPHIs) in Ethiopia, Nigeria and Pakistan, to identify potential preparedness indicators that exist in a myriad of frameworks and tools in varying local institutions…”

WHO - Meeting report of the WHO expert consultation on the definition of

extensively drug-resistant tuberculosis

https://www.who.int/publications/i/item/meeting-report-of-the-who-expert-consultation-on-the-

definition-of-extensively-drug-resistant-tuberculosis

“The World Health Organization (WHO) consultation meeting on the definition of extensively drug resistant (XDR) tuberculosis (TB) was held on 27, 28 and 29 October 2020…” This is the report of the meeting.

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JAMA Viewpoint - Revised UNAIDS/WHO Ethical Guidance for HIV Prevention

Trials

https://jamanetwork.com/journals/jama/fullarticle/2775959

“This Viewpoint summarizes updates to the UNAIDS/WHO document on ethical guidance for HIV prevention trials, emphasizing the importance of collaboration among trialists, sponsors, participants, and community members if the world is to reach a target of fewer than 200 000 new infections per year by 2030.”

AMR

Link:

Plos One - High global consumption of potentially inappropriate fixed dose combination antibiotics:

Analysis of data from 75 countries

NCDs

Globalization & Health - Market strategies used by processed food manufacturers

to increase and consolidate their power: a systematic review and document

analysis

B Wood, O Williams et al;

https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00667-7

“… this paper aimed to systematically review and synthesise the market strategies deployed by dominant processed food manufacturers to increase and consolidate their power.”

Results: “…The market strategies (n=21) and related practices of dominant processed food manufacturers identified in the documents were categorised into a typological framework consisting of six interconnected strategic objectives: i) reduce intense competition with equivalent sized rivals and maintaining dominance over smaller rivals; ii) raise barriers to market entry by new competitors; iii) counter the threat of market disruptors and drive dietary displacement in favour of their products; iv) increase firm buyer power over suppliers; v) increase firm seller power over retailers and distributors; and vi) leverage informational power asymmetries in relations with consumers….”

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Sexual & Reproductive / maternal, neonatal & child health

Open Democracy - Will Trump’s anti-abortion Geneva Consensus fall apart?

K Cullinan; https://www.opendemocracy.net/en/5050/will-trumps-anti-abortion-geneva-consensus-

fall-apart/

“The pro-choice Biden administration is very unlikely to support the declaration, signed just two weeks before the 2020 US elections.”

HP&P - The effects of performance-based financing on neonatal health outcomes

in Burundi, Lesotho, Senegal, Zambia and Zimbabwe

A Gage et al ; https://academic.oup.com/heapol/advance-

article/doi/10.1093/heapol/czaa191/6118441?searchresult=1

The authors assessed the impact of PBF on early neonatal health outcomes and associated health

care utilization and quality in Burundi, Lesotho, Senegal, Zambia and Zimbabwe.

BMJ GH (Commentary) – Unveiling respectful maternity care as a way to address

global inequities in maternal health

A Asefa; https://gh.bmj.com/content/6/1/e003559

“…Addressing maternal mortality from a rights-based approach is exercising leadership up to the expectations of women’s rights to live and enjoy quality, culturally sensitive and respectful health services. To hasten the ever-prevailing maternal health inequities globally and nationally, acting on the missing link—RMC—from the perspectives of health system strengthening helps not only to improve maternal health services and meet the maternal mortality target of the sustainable development goals, it also augments the progress to achieving universal health coverage…”

UN News -Shining a light on sexually exploited women and girls forced into crime

https://news.un.org/en/story/2021/01/1082532

“Trafficked and sexually exploited woman and girls can find themselves facing prosecution and conviction for those very same crimes, in some countries, a new UN report shows. The study aims to help prosecutors to better handle these complex cases, and protect the genuine victims.”

African Development Review - Governance, health expenditure and infant

mortality in sub‐Saharan Africa

Z Langnel et al ; https://onlinelibrary.wiley.com/doi/10.1111/1467-8268.12470

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“The paper examines the effect of governance and health expenditure on infant mortality with a panel data of 32 sub‐Saharan African (SSA) countries from 2000 to 2015….”

And a link:

NYT - Near-total abortion ban takes effect in Poland, and thousands protest.

Access to medicines

BMJ GH (Commentary) - Strengthening regulatory systems for medicines in a

changed world: where do we go from here?

J O’Brien et al ; https://gh.bmj.com/content/6/1/e004680

“Strengthening regulatory systems for medicines in low-income and middle-income countries is critical to ensure fit for purpose, future-proofed and efficient regulatory systems that facilitate access to safe and effective medicines for patients; this holds true before, during and after the COVID-19 pandemic….”

WHO Bulletin - Supply chain transparency and the availability of essential

medicines

C Ardal et al ; https://cdn.who.int/media/docs/default-source/bulletin/online-

first/blt.20.267724.pdf?sfvrsn=ea1c5d04_5

“…The supply of medicines could be improved by increasing the transparency of the complicated and fractured supply chain, starting upstream at the sources of active pharmaceutical ingredients. …”

Stat - U.S. drug prices were more than double those in dozens of countries in 2018

https://www.statnews.com/pharmalot/2021/01/28/drug-prices-rand-oecd-generics/

“As debate intensifies over the cost of medicines, a new analysis found that prescription drug prices

were on average 2.5 times more expensive in the U.S. than in 32 other countries. That gap widened to 3.4 times costlier when looking specifically at brand-name medications. At the same time, prices for generic drugs were slightly lower in the U.S. than in most other nations….”

Extra Covid section

Beware of Mashup Indexes: How Epidemic Predictors got it All Wrong

B Milanovic; https://www.globalpolicyjournal.com/blog/28/01/2021/beware-mashup-indexes-how-

epidemic-predictors-got-it-all-wrong

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“Branko Milanovic argues that the World Health Preparedness Report and Global Health Security Index fell short when confronted with the reality of countries' responses to the COVID19….”

Guardian - Covid-19 has cost global workers $3.7tn in lost earnings, says ILO

https://www.theguardian.com/business/2021/jan/25/covid-19-workers-lost-earnings-ilo-job-losses

“Women and young workers bearing brunt of job losses and reductions in hours, says UN labour.”

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CSIS - New Variants Rattle the World

A McCaffrey & J S Morrison; https://www.csis.org/analysis/new-variants-rattle-world

Focus on US in this piece, but obviously also a question for many other countries now.

“The emergence of new SARS-CoV-2 variants should come as no surprise. Yet, one year into the Covid-19 pandemic, world leaders are rattled as several new variants have taken hold in the United Kingdom, South Africa, Brazil, and now the United States. They confer a new competitive edge to the virus and threaten to change the pandemic game fundamentally, at the very moment when many countries are facing runaway outbreaks and worsening economic and social crises. … … Research on the new variants is just beginning and the full implications of their emergence remain unclear. One thing is clear: these new variants are generating new levels of anxiety and threatening to upend the best laid plans for Covid-19 prevention and control. They have created a sense of urgency and a renewed focus on the basics: expand genomic surveillance; achieve greater compliance in masking, social distancing, and avoidance of congregate settings; accelerate vaccination campaigns; and communicate to an anxious and skeptical public to win higher trust and confidence.”

Frontiers in Nutrition - The Burden of Malnutrition and Fatal COVID-19: A Global

Burden of Disease Analysis

https://www.frontiersin.org/articles/10.3389/fnut.2020.619850/full

By ITM colleagues Elly Mertens & José Penalvo. They note the convergence of multiple forms of

malnutrition and higher rates of fatal COVID19 in Africa, particularly across the Sahel.

Guardian - Covid vaccine acceptance rising across Europe but falling in parts of

Asia

https://www.theguardian.com/world/2021/jan/22/covid-vaccine-acceptance-rising-across-europe-

but-falling-in-parts-of-asia

“Covid vaccine acceptance is rising across Europe as inoculation programmes slowly advance, according to a survey, with the proportion of people saying they are willing to have the jab improving sharply over the past two months. YouGov tracker data shows double-digit percentage

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point increases in coronavirus vaccine acceptance rates in eight of the nine European countries surveyed since mid-November, with one country, Sweden, recording a rise of 21 points. The picture was less positive outside of Europe, however, with people in several countries in Asia appearing no more willing now – and in some cases even slightly less willing – to get vaccinated than when they were asked late last year….”

WB (blog) - COVID-19 Vaccines – A Path for Recovering Human Capital

https://blogs.worldbank.org/health/covid-19-vaccines-path-recovering-human-capital

COVID-19 threatens to reverse hard-won human capital gains of the past decade. … “The development and deployment of vaccines is key to helping countries recover from setbacks in human capital outcomes. The emergence of new, more transmissible variants has led to further large-scale shutdowns and redoubles the urgency of vaccination. Recovering from setbacks in human capital outcomes will depend greatly on the successful deployment of vaccines. The re-opening of early childhood development services and schools is essential to a recovery in learning and years of schooling, and to caregivers’ return to work. Restored access to health services and relief to overburdened health systems are needed to restore preventive health services and control infectious diseases and non-communicable diseases. …”

Global Public Health - Primary care perspectives on pandemic politics

F Goodyear-Smith et al; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1876751

“An international survey of primary care experts’ perspectives about their country’s national responses was conducted April to early May 2020. This mixed method paper reports on whether they perceived that their country’s decision-making and pandemic response was primarily driven by medical facts, economic models, or political ideals; initially intended to develop herd immunity or flatten the curve, and the level of decision-making authority (federal, state, regional)….”

FT (op-ed) - Vaccines have been oversold as the pandemic exit strategy

https://www.ft.com/content/17c44c96-39f2-4ada-badd-d65815b0a521

“Covid will be around for a long time — virus suppression is the right policy.” Interesting piece on current state of affairs (cfr threat of variants etc).

Excerpts: “… One source of gloom emerged at a briefing last week. Academic researchers warned vaccination alone might not induce sufficient herd immunity to stamp out the virus. An unhappy combination of imperfect vaccine efficacy, suboptimal take-up and super-infectious variants could derail attempts to reach the herd immunity threshold, when R falls below one and the virus begins to dissipate. Modelling from the University of East Anglia corroborates this unpalatable possibility. Another major worry is that countries with poorly controlled transmission might be acting as production lines for dangerous new variants … Researchers have previously suggested that immunocompromised patients who suffer lengthy infections might act as Petri dishes for such irrepressible strains. But there may be a plausible alternative hypothesis, according to Tulio de Oliveira, a bioinformatician at the University of KwaZulu-Natal. He co-authored the paper on the South African variant and contributes to the World Health Organization’s Virus Evolution Working

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Group. His tip-off led UK scientists to more fully investigate the B.1.1.7 variant. “We had an open discussion in the group recently about why these variants were emerging independently in so many places,” Prof de Oliveira says. “We noticed a common factor about London, the Eastern Cape [South Africa] and Manaus [Brazil], where these three variants appeared: they were very heavily affected in the first wave of infection.” … … If regions with raging transmission do act as breeding grounds for resistant variants, then failing to control spread will prolong the pandemic. Prof de Oliveira stresses that Taiwan, China, Australia and New Zealand, which have chased elimination, are the role models to follow. “… That means not just vaccinating but fast testing, accurate and quick contact tracing, quarantine and isolation. In short, vaccination must go hand-in-hand with virus suppression, not become a substitute for it….”

For a somewhat similar read – NYT - Why vaccines alone will not end the pandemic. (focus on the US)

NYT – Covid-zero is an idea gaining momentum: could it work in Canada?

https://www.nytimes.com/2020/11/21/world/covid-zero-is-an-idea-gaining-momentum-could-it-work-in-canada.html

“… Some physicians and scientists are saying that to address the crisis, Canada should aim to not just contain the spread of the virus but outright eliminate new infections. It’s an idea known on social media as #COVIDzero, and it is gaining momentum around the world. The big question is how aggressive countries need to become. Australia provides one example. …”

Reuters - WHO issues new clinical advice on treating COVID-19 patients

Reuters;

“The World Health Organization (WHO) issued fresh clinical advice on Tuesday for treating COVID-19 patients, including those displaying persistent symptoms after recovery, and also said it advised using low-dose anti-coagulants to prevent blood clots. “The other things in the guidance that are new are that COVID-19 patients at home should have the use of pulse oximetry, that’s measuring the oxygen levels, so you can identify whether somewhat at home is deteriorating and would be better off having hospital care,” WHO spokeswoman Margaret Harris told a U.N. briefing in Geneva….”

BMJ Editorial - Universal basic income and covid-19 pandemic

S Patel et al ; https://www.bmj.com/content/372/bmj.n193

“Evidence backs up health benefits and may show the way forward.”

CGD (blog) - Is Africa Wasting the Pandemic-Induced Economic Crisis?

D Sembene; https://www.cgdev.org/blog/africa-wasting-pandemic-induced-economic-crisis

“In many African countries, the economic response to the crisis so far appears to have been broadly less consistent than the health response. For mitigation measures to be stronger and more effective, and for sustained recovery to take place, governments, central banks, and regional

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institutions will need to make tough policy choices, promote coordinated and collaborative policy implementation, and embrace bold and innovative reforms….”

F2P blog - Imagining the world anew: the pandemic and gender equality

https://oxfamblogs.org/fp2p/imagining-the-world-anew-the-pandemic-and-gender-equality/

“The pandemic has eroded women’s rights – but there is a way forward, says Nikki van der Gaag.”

Devex - USAID is trying to track down its ventilators, GAO reports

https://www.devex.com/news/usaid-is-trying-to-track-down-its-ventilators-gao-reports-99019

“The United States Agency for International Development is trying to locate ventilators it sent to other countries to help them respond to COVID-19 and to verify that they have been put to effective use. One section of a wide-ranging report published Thursday by the Government Accountability Office found that USAID spent $200 million on its global ventilator push, which saw 8,722 of the breathing assistance machines sent to 43 different countries through Sept. 30, 2020. Former President Donald Trump’s administration rolled out the ventilator distribution effort with significant publicity and coordinated it through the National Security Council, but it has been criticized for lacking a clear plan for matching resources with needs….”