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IHP news 590 : COVAX momentum & UNGA75 high-level week

( 25 Sept 2020)

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

Dear Colleagues,

As you no doubt already noticed, everything seems in flux these days. That clearly also pertains to the shifting dominant discourse. Earlier this week, Klaus Schwab (WEF), of all people, declared

“Neoliberalism dead”. Now we’re just waiting for Davos to suffer a similar fate 😊 (that this year’s WEF location has been moved to another Swiss city, doesn’t really count).

The terms we use to describe the climate crisis are also changing rapidly, in line with its frightening acceleration. In ten years, we’ve gone from ‘global warming’ and ‘climate change’ to a ‘climate emergency’, a ‘climate breakdown’, and ‘locked-in climate disruption’. Some are already warning we better hurry up if we still want to avoid a full-blown ‘climate lockdown’.

And lately, ‘a World Woefully Underprepared’ seems to have taken over as “the” high-level event/report “buzzword” par excellence from ‘ a Decade of Delivery’, whether it’s on pandemic preparedness, the climate, biodiversity, … you name it. Last year’s UN High-Level political declaration on UHC, unanimously endorsed, already feels like a long time ago now, even if UHC remains more relevant than ever. Meanwhile, pandemic fatigue is becoming an all too common phenomenon in many countries (while we can’t afford it), and tragically, there’s even a certain pandemic numbness emerging in some of the worst affected ones.

It’s against that dark global backdrop that UN SG Guterres and other world leaders addressed UNGA75 this week, most of them virtually (or in recorded messages). In spite of its 75th anniversary, this is a difficult time for the United Nations, and for multilateralism. Guterres was one of many hoping for some added momentum on (financing for) the ACT-Accelerator ( which includes Covax, the main mechanism of global solidarity on vaccine access, in spite of all its flaws), during UNGA speeches. While COVAX engagement (by 2 thirds of the world!) looks very promising, after last week’s deadline, and COVAX clearly is ‘in business now’ (in the words of Seth Berkley), the massive funding gap for the ACT-Accelerator remains, for the time being. That tells you a lot.

In the current circumstances, I’m thus not sure Guterres’ call for a New Social Contract (in countries) and a New Global Deal (globally), will find fertile ground. Yet, in one respect, Guterres was certainly spot on: “Public appetite for transformative change is growing”. Global polls indeed seem to confirm this statement made by the UN SG at the SDG Moment 2020.

Guterres immediately added a caveat, though, in the rest of his sentence: “'But one critical ingredient is still missing: political will. Without it, neither public appetite nor stakeholder action will be sufficient'. Speaking of political will, in the very week that saw the US pass the sad ‘milestone’ of

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200.000 Covid-19 casualties, Trump gave himself an "A+" on the his job performance on the coronavirus. Congrats, Donald. Here in Europe we all crave for a great leader like you.

Still, not all hope is lost. Earlier this week, one of our contributors triangulated astrological predictions which indicate that we will begin to experience relief from COVID-19 towards the end of the year as Jupiter and Pluto move apart (they are doing so at a glacial pace we’re informed). And guess what, that seems to ‘align’ with Dr. Fauci's estimates of a vaccine being proved effective only

around November or December 2020 😊.

Enjoy your reading.

Kristof Decoster

Featured Article

Regulation of the for-profit private healthcare sector in India: Whose voices are being heard in policy making?

Shweta Marathe (Shweta Marathe works with SATHI (Support for Advocacy and Training to Health Initiatives), Pune India, as a health system researcher.) Indian civil society networks and health professionals are urgently demanding better regulation of the for-profit private healthcare sector. India’s health system is dominated by the for-profit private healthcare sector, which accounts for around 75% of outpatient care. In 2016-17, the hospital industry in India was already worth around Rs. 4 trillion ( 54.34 billion USD). It is expected to almost double to Rs 8.6 trillion (116 billion USD) by 2022, which shows the pace at which the private healthcare sector is growing in India. Within the private sector, the proportion of larger providers (e.g., corporate hospitals) has been growing while the share of smaller providers (e.g., independent doctor’s offices) has been reducing over the last two decades, illustrating a shift from simple commercialisation to deep corporatisation of healthcare. Today, the private healthcare sector lacks effective mechanisms for its regulation. The Clinical Establishment Act, which sets standards around quality, transparency and accountability, was passed in 2011 but has been adopted by only 11 of India’s 36 states and territories. Moreover, in the states that have adopted the act, its implementation is not in good shape. Medical professionals’ bodies like the Medical Council of India and the Indian Medical Association also seem to be ineffective. Thousands of cases are pending with them waiting for justice. Current mechanisms for grievance redressal against patients’ rights violation in private healthcare sector are reported to be non-transparent and biased. The consequences of this rapidly growing and nearly unregulated private sector are painfully visible with all kinds of negligence, malpractices, and exploitation of patients. The average cost of healthcare in India has tripled from 2005 to 2015, due to unregulated private healthcare expenditure. Research studies have also reported serious issues like denial of care, unnecessary procedures, and fraud, including when the private sector has been involved in implementing publicly funded insurance

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schemes. And yet, despite this lack of regulation and clear failure to behave in the best interests of the public, the governmental health sector is increasingly partnering with the private sector for the provision of healthcare. Despite calls to strengthen states’ capacity to regulate the private sector and provide better stewardship, the government appears to lack power and motivation when it comes to regulation of this sector. Over the last few years, the regulation of the private sector has been high on the agenda of civil society networks, health activists and public health professionals. Demand for regulation of the private healthcare sector and adoption of a patients’ rights charter have been raised persistently through a range of actions including: a national campaign by the People’s Health Movement for the Clinical Establishment Act; a public hearing organised by the National Human Rights Commission in 2016 on cases of violation of patients’ rights; an online petition for adopting a patients’ rights charter in mid-2019; a huge (national-level) protest in Delhi in February 2019; and a patients’ satyagraha (non-violent civil resistance) in October 2019 for demanding immediate implementation of the patients’ rights charter. Despite raising voices at multiple levels through action, research and advocacy, government policies seem to be going in a different direction. The national health policy (2017) includes an objective to align the growth of private healthcare with public health goals through strategic purchasing. The government promptly implemented this objective with the launch (in 2018) of Pradhan Mantri Jan Arogya Yojana (PMJAY), touted as the world’s largest insurance scheme. The private sector is “aggressively” involved in the implementation of the scheme, without much consideration of its regulation. Despite serious issues with insurance schemes engaging with the private sector and extensive critique of using public funds for private benefit, insurance-based schemes are being promoted in a major way under the rubric of Universal Health Care. The National Institution for Transforming India (NITI Aayog) is the Government of India’s premier policy think tank, providing both directional and policy input. A 2019 report by NITI Aayog, called ‘Building Blocks’, emphasised risk pooling, strategic purchasing, health service provisioning and digital health. This report does mention the need for a regulatory framework for commercial insurance. However, it does not comment specifically on the profit-centred private sector in India, its implications and the need for its regulation before engaging with it. In 2020, NITI Aayog announced a public-private partnership model to link the new and existing private medical colleges with functional district hospitals in the country. The thinktank’s rationale for the launch of this scheme is wilfully ignorant of decades of research on achieving primary healthcare, eagerly dismissive of the potential for public sector strengthening, and blind to the flaws of private-for-profit healthcare, stating: “India has a dire shortage of qualified doctors. It is practically not possible for the Central/State Government to bridge the gaps in medical education with their limited resources and finances. This necessitates formulating a Public-Private Partnership (PPP) model by combining the strengths of public and private sectors.” Criticising several noxious points in this document is a topic for a separate write up. However, the concern is that the PPP model is being pushed across the country without taking cognisance of strong evidence on its failures. From the above, two critical questions emerge: Whose voices are being heard in the policy making? And who really influences policy making? Campaigns, consultations, expert committees, … all their reports and research studies demand strengthening of the public health system, bringing in patients’ rights, and implementing the Clinical Establishments Act, … They also underscore the dominant presence of an overwhelmingly commercialised private healthcare sector, while pointing to the need for developing a social accountability framework for the private sector along with the public health sector. However, it seems recent policies do not recognise and engage with these demands. Instead, they are prepared in line with proposals and recommendations by certain experts from national or

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international level, favoring the growth of the health industry with corporate healthcare providers. In short: does policy formulation involve multi-stakeholder members with civil society representation? Or it is settled only with a particular set of experts who support a flourishing private healthcare sector with government backing? The COVID pandemic has underscored some of the major failures of the private healthcare sector in India, but has also offered reason for modest hope. Maybe at last the demand for more regulation can get a receptive ear, including in government circles. Moreover, while people with COVID have experienced (and continue to experience) denial of care and high bills, some states have also rapidly introduced and enforced rate regulation, so let’s hope this will trigger a momentum. In any case, it is high time to move towards public-centered Universal Health Care based on a blend of a robust public health system and regulated private healthcare providers. Healthcare setups should be viewed as a social institution and not as an arena for revenue generation. But only when civic voices are provided due space and heard in policymaking, such pro-people health policies will become a reality.

Highlights of the week

UNGA 75 High-level week (mostly virtual)

Last week we already reported on the numerous reports published, ahead of UNGA75. Below you find some of the virtual highlights of the sessions & high-level meetings, as well as some of the key messages by UN SG Guterres et al.

We’ll try to cover things, at least to some extent, chronologically.

Launch of Civil society’s Spotlight report (18 Sept)

https://www.2030spotlight.org/en

We recommend you certainly read the first chapter (by Jens Martens) in full: Global Civil Society Report on the 2030 Agenda and the SDGs - A world in turmoil needs fundamental change.

Great overview of the current (dire) situation.

With among others, in terms of a way forward: “We offer as an alternative an “8 R”-agenda for systemic

change.” Do check out what this neat agenda involves.

SDG moment (18 Sept)

The first SDG moment of the Decade of Action was held virtually on Friday, 18 September.

See also last week’s IHP news.

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IISD -Presidents and Prime Ministers Appeal for Big Ideas, Solidarity to Restart SDG Progress

IISD;

Coverage. “The high-level week of UNGA 75 began with the first-ever SDG Moment, aiming to set the stage for the UN75 commemoration, other high-level events during the week, and the Decade of Action for the SDGs. Many speakers took the opportunity to highlight the critical importance of multilateralism and intergenerational solidarity to achieve any of our shared goals. In the view of the Earth Negotiations Bulletin, the speeches of the 21 Heads of State and Government who spoke at the SDG Moment betrayed a deep concern for the current, weakened state of multilateralism.”

IISD - Civil Society Groups Introduce People’s Scorecard on Fifth Anniversary of SDGs

http://sdg.iisd.org/news/civil-society-groups-introduce-peoples-scorecard-on-fifth-anniversary-of-

sdgs/

“The “people’s scorecard” model was introduced to enable comparative analysis at the fifth anniversary of the SDGs’ adoption, to assess SDG progress in 20 countries. Economic opportunity and fairness emerges as a particular weakness.”

For the scoreboard, see here.

Devex - How off track are the SDGs, exactly? We don't know, but it might not matter

https://www.devex.com/news/how-off-track-are-the-sdgs-exactly-we-don-t-know-but-it-might-not-

matter-98125

“….Insufficient official data sources and continued social distancing requirements make it challenging to capture, in real time, a detailed and accurate picture of the SDGs, development experts say. But an exact answer might not be necessary, since the backsliding trend is clear, and solutions for regaining momentum remain unchanged, development experts explained….”

75th anniversary High-Level meeting (21 September)

On Monday the UN marked the 75 years of the Organization with a High-level meeting featuring many world leaders.

The theme wass, “The future we want, the United Nations we need”. There was a strong focus on the role of youth, and ensuring the UN remains relevant for future generations.

AP - Born to prevent war, UN at 75 faces a deeply polarized world

https://apnews.com/413677c173065d408a86582e2647fea5

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Coverage. “The United Nations marked its 75th anniversary Monday with its chief urging leaders of an increasingly polarized, go-it-alone world to work together and preserve the organization’s most important success since its founding: avoiding a military confrontation between the major global powers. Secretary-General Antonio Guterres’ appeal for a revival of multilateralism — the foundation of the United Nations — was echoed by leaders of countries large and small, rich and poor.”

Excerpt: “Appealing for a new multilateralism that draws on civil society, cities, businesses, local

authorities and young people, Guterres said “no one wants a world government — but we must

work together to improve world governance.”

“Diplomats from the U.N. member nations managed to agree after sometimes difficult negotiations on a declaration to mark the U.N.’s anniversary, which was adopted Monday. It recalls the body’s successes and failures and vows to build a post-pandemic world that is more equal, works together and protects the planet. … … Richard Gowan, U.N. director for the Crisis Group, a Brussels-based think tank, said the declaration was weakened by the U.S. opposing strong language on climate change and Britain and others objecting to China trying to insert language including its hallmark phrase, “win-win.” … … President Xi used it Monday in speaking about “Cold War mentality,” declaring “what we need to do is to replace conflict with dialogue, coercion with consultation and zero-sum with win-win.” … Gowan said the dispute over the declaration was minor but “captures the real question that has emerged over the U.N. in 2020, exacerbated by COVID, which is: How is this organization going to navigate an era of U.S.-China tension?”

Annual meeting of world leaders (22 September)

Except Guterres, no world leaders were physically present. They (and unfortunately, it were mostly

men), sent recorded messages & speeches.

UN News - UN chief appeals for global solidarity at General Assembly, warns COVID is ‘dress rehearsal’ for challenges ahead

https://news.un.org/en/story/2020/09/1072972

“In his centerpiece address to the historic and unprecedented 75th session of the UN General Assembly, Secretary-General António Guterres on Tuesday appealed for global solidarity to overcome the COVID-19, and again call for a global ceasefire during the pandemic, by the end of the year.”

Excerpt:

“For the Secretary-General, recovering from COVID-19 must lead to a better future for all, anchored by inclusive, sustainable and resilient societies. He emphasized the need for what he labelled a New Social Contract, at the national level, and a New Global Deal, applicable internationally. Mr. Guterres explained that the New Social Contract has several components, such as ending exclusion, discrimination and racism, and establishing Universal Health Coverage and even a possible Universal Basic Income. It also entails having fairer tax systems, providing education for all, harnessing digital technology, and ensuring human rights as well as opportunities for women and girls. …”

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In general, it was a fairly grim ‘state of the world’ speech. And it didn’t get much better afterwards,

see AP - World powers clash, virus stirs anger at virtual UN meeting

“As Secretary-General Antonio Guterres opened the first virtual “general debate” of the U.N. General Assembly, the yawning gaps of politics and anger became evident. China and Iran clashed with the United States — via prerecorded videos from home — and leaders expressed frustration and anger at the handling of the COVID-19 pandemic, which the U.N. chief has called “the number one global security threat in our world today.”…”

See also Devex - Leaders juggle blame and calls for solidarity in first virtual UNGA

Focus on in this nice analysis on some of the key messages of the HL-session: a fifth horseman? Blame game (Trump); Covid-19 vs development; the high road (Xi Jinping); the people’s vaccine (with an unlikely though slightly dodgy ‘starring role’ for Putin & Russia); a new multilateral order (Macron)).

Excerpt: “‘A fifth horseman’: Guterres added the COVID-19 pandemic to his list of “threats that endanger our common future,” alongside “geostrategic tensions”, an “existential climate crisis,” “deep and growing global mistrust,” and “the dark side of the digital world.” “Since January, the COVID-19 pandemic has galloped across the globe — joining the four other horsemen and adding to the fury of each,” Guterres told the General Assembly.”

On Russia’s proposal, see also Reuters - Russia's Putin wants stronger WHO, proposes conference on

coronavirus vaccine. I suggest we let Charité in Berlin host it 😊.

Some more analysis, reports & other news snippets from UNGA 75

Devex - Can António Guterres lead a broken United Nations?

https://www.devex.com/news/can-antonio-guterres-lead-a-broken-united-nations-98071

On Guterres’ track record so far, in arguably different circumstances.

Guardian - UN warns of lost decade without Covid economic recovery plan

https://www.theguardian.com/business/2020/sep/22/un-covid-economic-recovery-austerity-unctad

“Austerity policies will choke off recovery and risk a double-dip recession, says Unctad.”

“The global economy faces a lost decade after the Covid-19 pandemic unless policymakers spurn austerity measures in favour of a comprehensive recovery plan built on investment in sustainable growth, the United Nations has said. In its annual trade and development report, the UN’s economic arm said a repeat of the cost-cutting conducted by governments after the financial crisis of

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2008-09 would choke off recovery and risk a double-dip recession in 2022. The UN Conference on Trade and Development (Unctad) said that, despite a better than expected growth performance in recent months, the global economy was on course to shrink by 4% this year. The turnaround from the near-3% growth predicted before the pandemic struck would cost $6tn (£4.7tn) in lost output, it added, with international trade down by 20%, foreign direct investment dropping by 40% and remittances cut by more than $100bn. While the biggest falls in growth rates would be in developed countries, the UN body said the greatest economic and social damage would be felt in poorer countries. As a result of the pandemic, between 90 million and 120 million people would be pushed into extreme poverty in the developing world, with close to 300 million facing food insecurity.”

IISD - In Interim UN75 Report, One Million Respondents Unified on Natural Environment, Diversity and Inequalities

http://sdg.iisd.org/news/in-interim-un75-report-one-million-respondents-unified-on-natural-

environment-diversity-and-inequalities/

“The Office on the Commemoration of the UN’s 75th Anniversary issued an update on the results of a global consultation on people's fears and hopes for the future. For immediate pandemic recovery, participants want improved access to basic services and greater support to the places hardest hit. Looking to the future, respondents overwhelmingly called for the UN to be "more inclusive of the diversity of actors in the 21st century" and more innovative, including with stronger leadership.”

Guardian - Lack of Covid help for poor countries will haunt west, says UN aid chief

https://www.theguardian.com/business/2020/sep/22/lack-covid-help-poor-countries-haunt-west-

un-aid-chief-mark-lowcock

“The west will be haunted for decades to come by its failure to do more to help poor countries cope with the economic and social impact of the Covid-19 crisis, the United Nations humanitarian chief has warned. Writing for the Guardian, Sir Mark Lowcock, the former top civil servant at the UK’s Department for International Development, said rich nations had acted decisively to deal with their own problems but failed to show the same vigour in response to the growing international crisis. Lowcock, the UN under-secretary for humanitarian affairs, said that in the world’s most fragile countries starvation was set to double, life expectancy would fall and girls removed from school would never go back. “All this will fuel grievances, and in their wake conflict, instability and refugee flows, all giving succour to extremist groups and terrorists. The consequences will reach far and last long.”…”

“He called on developed countries to use their voting power at the International Monetary Fund and the World Bank to beef up the multilateral response to the crisis by: (1) Giving the go-ahead for the IMF to create and distribute the reserve assets known as special drawing rights.(2) Putting in place a more comprehensive plan for debt relief. (3) Pressurising the World Bank to exploit the strength of its balance sheet to lend more to struggling countries.”

See also Devex - COVID-19 effects could deteriorate into 2021 and beyond, UN’s Mark Lowcock says

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WHO & Funding gap ACT-Accelerator

See also last week’s IHP news & WHO’s three messages for UNGA75.

See Politico on the huge remaining funding gap for the ACT-Accelerator- The World Health Organization says it has raised just a tenth of the funding it needs to help coordinate a global coronavirus response.

See also further in this newsletter.

“Getting more buy-in — and a lot more cash — for the plan, called the Access to Covid-19 Tools (ACT)-Accelerator, is the top goal of the WHO at this year’s virtual U.N. General Assembly, which started this week and continues next week with speeches from national leaders. “The ACT-Accelerator needs $35 billion to fast-track the development, procurement and distribution of 2 billion vaccine doses, 245 million treatments and 500 million tests over the next year,” the WHO said this week. Guterres warned that “there is real urgency in these numbers,” with $15 billion needed immediately to cover the next three months…. … WHO launched the Accelerator in April … but the Accelerator didn’t make any more funding progress over summer. …”

As for Covax: “The COVAX Facility has raised around $700 million to date but is still short of its $2 billion target for seed funding needed by the end of the year to help produce 1 billion doses by the end of 2021.”

HPW - Global Call For Rebuilding Vaccine Networks In Advance Of COVID-19

Vaccine Rollout

https://healthpolicy-watch.news/global-call-for-rebuilding-vaccine-networks-in-advance-of-covid-19-vaccine-rollout/

“A lineup of global health leaders called upon high income countries to join the new global COVID-19 pool, saying that worldwide access to a safe and equitable vaccine is essential to beat the COVID-19 pandemic. Speaking at the virtual UN General Assembly (UNGA) side event on Wednesday, the leaders also said that maintaining essential vaccine services, during the pandemic, would help lay the groundwork for rollout of a COVID-19 vaccine. “The building back of the routine immunization program is the underlying fundamental that creates the infrastructure on which we will deliver [COVID] vaccines,” said Katherine O’Brien, of the World Health Organization. “

“… some $7.5 billion still needs to be recruited by the end of 2020 to finance the 2021 procurement and distribution of 2 billion vaccine doses for 92 low-income countries that already participate in Gavi’s bulk vaccine procurement system, said Seth Berkley, CEO of Gavi. While that is still a huge sum, the $7.5 billion that Berkley cited as immediately needed, is still only about one-fifth of the $35 billion WHO said was the global “ask” for COVID-19 vaccines, tests and treatments. “

Devex - Reaching the world's most vulnerable poses biggest challenge for COVID-19 vaccine, experts say

https://www.devex.com/news/reaching-the-world-s-most-vulnerable-poses-biggest-challenge-for-covid-19-vaccine-experts-say-98157

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“Global health and development leaders expressed optimism during the United Nations General Assembly this week that a COVID-19 vaccine is forthcoming and can end the devastating pandemic. But many warned that equitable distribution will face additional hurdles of financing and misinformation once an effective vaccine is found.”

Global Health Governance

Geneva Health Files – GAVI’s discomfort with civil society on vaccines

This week’s main story from the Geneva Health Files’ newsletter.

One of the reads of the week, no doubt.

“…Why is one of the biggest agencies in global health, wary of activists? Geneva Health Files tried to understand the reasons behind Gavi’s insistence on excluding Civil Society Organizations (CSOs) on COVID-19 vaccines’ discussions. According to several people who work on CSO matters, Gavi has traditionally not engaged with CSOs effectively and the pandemic hasn’t changed that much. It appears this lack of CSO engagement is based on inadequate appreciation, and worse, distrust of what civil society does and can bring to Gavi’s operations, sources say….”

Excerpt: “CSOs have pushed for greater involvement in engaging with the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator (ACT Accelerator), and specifically, the COVAX Facility. But they have not had much success. It makes especially intriguing given that CSOs, have been integrated well into the activities of the others pillars of the ACT Acclerator - on therapeutics, diagnostics and Health Systems Strengthening. Given the tremendous interest on vaccines for the pandemic, it becomes critical to incorporate the voices from the ground that CSOs represent, experts are of the view. It is understood that the top leadership of Gavi, is of the opinion that CSOs already have a representation on its Board and that it is sufficient….”

Do read the whole story! Some other possible reasons are mentioned as well. And there’s a lot more in this article.

1st Meeting Independent Panel for Pandemic Preparedness and Response

(Thursday 17 Sept)

https://www.theindependentpanel.org/meetings

You can find meeting documents, including Remarks from Co-Chairs @HelenClarkNZ and @MaEllenSirleaf , Terms of Reference & Briefing on State of #COVID19 Pandemic here. As well as the first Meeting report. “…The Panel agreed to focus on three main themes of enquiry: an analysis and vision for a strengthened international system ideally equipped for pandemic preparedness and response; a review of the response to the COVID-19pandemic from the initial phase through to the present, including the global alerts, the spread, country responses and wide societal impact; and lessons to be learnt in why

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SARS-CoV-2 spread globally and had its devastating impact, including an understanding of characteristics of the virus and of governmental and institutional responses at all levels. …”

PFIP - When do partnerships make a difference? Interview with Amanda

Glassman, Executive Vice President of Center for Global Development (CGD), CEO

of CGD Europe, and Senior Fellow

https://pfipartners.org/2020/09/22/when-do-partnerships-make-a-difference-interview-amanda-glassman-cgd/ Amanda Glassman was interviewed by Katri Bertram. “In this interview, we discuss whether impact drives the formation of new partnerships, why the aid harmonisation agenda has not lived up to expectations, and why partnerships rarely close down fully.” Well worth a read.

WHO, the pandemic and Europe’s new global health leadership role

http://www.genevasolutions.news/global-health/who-the-pandemic-and-europe-s-new-global-health-leadership-role

Well worth a read. Ahead of Gastein, Ilona Kickbusch discusses, among others, the broken global health funding model, and Europe’s new global health leadership role.

Quote: “Very clearly, $35bn is actually peanuts, if you look at the trillions being discussed by the finance ministers of the G20. Many of the rich countries, if they got their act together, plus some of the middle-income countries could actually contribute, together with the development banks, and maybe even some of the philanthropists. If you look at the amount of money Mark Zuckerberg made during the Covid-19 pandemic, some of these sums pale in comparison. It shows that our whole system of financing is wrong- and bankrupt.”

Book - Health Norms and the Governance of Global Development: The Invention

of Global Health

A Granmo & P Fourie; https://www.routledge.com/Health-Norms-and-the-Governance-of-Global-Development-The-Invention-of/Granmo-Fourie/p/book/9780367625658#.X2sceBgWVKV.twitter

“This book maps the emergence of health in global development discourse and governance since 1990. It argues that health norms have emerged, diffused, and subsequently become internalised through the various direct and indirect negotiation processes that created the global development goals. Covid-19, Ebola, and HIV/AIDS are prime illustrations of the fact that health is supremely political. Governments – whether they are local, national, international, or multilateral – make decisions about their policy responses, coordinate their response, and channel the necessary resources. Such decisions are informed by local and global conditions, as well as sets of values, norms, and standards that determine policy and interventions. As states and regions become more interconnected, the politics of health are increasingly relevant to the sustainable future envisioned by global governance. This book explains how considerations of global health have come to inform and infuse the United Nations Development Agenda. It identifies processes, actors, institutions, and interactions in global health by analysing two related case studies: the Millennium Development Goals, and the Sustainable Development Goals….”

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Planetary Health

Politico - UN chief’s climate gamble pays off and leaves Trump isolated

https://www.politico.eu/article/un-chiefs-climate-gamble-pays-off-and-leaves-trump-isolated/

Some rare positive news on the climate front. “A spate of climate announcements firms up the Paris Agreement.” “There's a sense that there's been significant movement on climate issues in just the last few days….”

Guardian - Few countries living up to Covid 'green recovery' pledges – analysis

https://www.theguardian.com/environment/2020/sep/23/few-countries-living-up-to-green-

recovery-promises-analysis

“Few countries are living up to their promises of a “green recovery” from the coronavirus crisis, with hundreds of billions of dollars likely to be spent on economic rescue packages that increase greenhouse gas emissions, research has found. The US is planning nearly $3tn in spending with few environmental safeguards attached, and little money going to low-carbon efforts, while rolling back regulations that protect nature and the environment. Of the total US stimulus of about $2.98tn, only about $39bn is going towards green projects, according to the analysis. Among the world’s 20 biggest economies, only the UK, Germany and France as individual countries, and the EU as a whole, are planning for a green recovery in which the benefits to the climate and nature outweigh the negative impacts, according to an analysis, entitled the Greenness of Stimulus Index, by Vivid Economics as part of the Finance for Biodiversity initiative….”

Guardian – Carbon storage technologies critical for meeting climate targets – IEA

https://www.theguardian.com/environment/2020/sep/24/carbon-storage-technologies-critical-for-meeting-climate-targets-iea?CMP=share_btn_tw

“Global governments and major polluters must take urgent action to develop technologies which can capture and store carbon emissions or it will be “virtually impossible” for the world to meet its climate targets, according to the International Energy Agency. The global energy watchdog said carbon capture, utilisation and storage (CCUS) projects should play a central role in meeting climate targets as one of four key pillars in reducing emissions….”

Guardian - World's richest 1% cause double CO2 emissions of poorest 50%, says

Oxfam

https://www.theguardian.com/environment/2020/sep/21/worlds-richest-1-cause-double-co2-

emissions-of-poorest-50-says-oxfam

“The wealthiest 1% of the world’s population were responsible for the emission of more than twice as much carbon dioxide as the poorer half of the world from 1990 to 2015, according to new research. Carbon dioxide emissions rose by 60% over the 25-year period, but the increase in emissions from the richest 1% was three times greater than the increase in emissions from the

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poorest half. The report, compiled by Oxfam and the Stockholm Environment Institute, warned that rampant overconsumption and the rich world’s addiction to high-carbon transport are exhausting the world’s “carbon budget”….”

The charity says the world’s fast-shrinking carbon budget should be used to improve lot of poorest.

Guardian - Children urged to strike against lack of action on climate emergency

https://www.theguardian.com/environment/2020/sep/21/schoolchildren-strike-climate-emergency

“Schoolchildren around the world are being urged to go on strike to protest against a lack of action on the climate crisis. Children and their supporters are invited to take to the streets on Friday, if it is safe to do so, or to go online with their protests “in whatever way suits you best”, according to the organisers. This will be the first such action since the coronavirus pandemic struck. Greta Thunberg, the Swedish school strike pioneer and activist, said: “Extreme weather driven by the climate crisis is accelerating around the world, and yet we still don’t treat it as a crisis. We are in a global emergency that affects all of us. However, not everyone is suffering its consequences equally.”…”

“The protests will focus on Mapa, a new term for “most affected people and areas”, which the organisers prefer to older phrases such as “the global south”. Protesters are asked to make the Mapa signal, which is two closed fists pressed together with thumbs up, symbolising strength, solidarity and hope….”

Ecological Economics - A Green New Deal without growth?

R Mastini, G Kallis & J Hickel ;

https://www.sciencedirect.com/science/article/pii/S0921800919319615

“The Green New Deal and degrowth represent two distinct narratives and visions for rapid decarbonisation. Green New Deal and degrowth proposals have synergies and tensions. The Green New Deal does not have to stimulate GDP growth or depend on it for financing. Degrowth policies could be incorporated into a ‘Green New Deal without growth’.”

Project Syndicate - Avoiding a Climate Lockdown

M Mazzucato; https://www.project-syndicate.org/commentary/radical-green-overhaul-to-avoid-

climate-lockdown-by-mariana-mazzucato-2020-09

“The world is approaching a tipping point on climate change, when protecting the future of civilization will require dramatic interventions. Avoiding this scenario will require a green economic transformation – and thus a radical overhaul of corporate governance, finance, policy, and energy systems.”

Excerpts: “As COVID-19 spread earlier this year, governments introduced lockdowns in order to prevent a public-health emergency from spinning out of control. In the near future, the world may need to resort to lockdowns again – this time to tackle a climate emergency. … Under a “climate

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lockdown,” governments would limit private-vehicle use, ban consumption of red meat, and impose extreme energy-saving measures, while fossil-fuel companies would have to stop drilling. To avoid such a scenario, we must overhaul our economic structures and do capitalism differently. …”

“Addressing this triple (economic, climate, health) crisis requires reorienting corporate governance, finance, policy, and energy systems toward a green economic transformation. To achieve this, three obstacles must be removed: business that is shareholder-driven instead of stakeholder-driven, finance that is used in inadequate and inappropriate ways, and government that is based on outdated economic thinking and faulty assumptions.”

Covid key news & updates – close to 1 million deaths

The main news of the week was of course the COVAX milestone (but for more on that, see the next section on ‘access’). Here we offer some other key news & trends.

For visualization of the global trends, see the FT Tracker.

Cidrap News - Steeply rising pandemic activity led by India, surges elsewhere

https://www.cidrap.umn.edu/news-perspective/2020/09/steeply-rising-pandemic-activity-led-india-

surges-elsewhere

(update as of 23 Sept)

“The pace of global COVID-19 cases showed no letup today, with an ongoing surge in India, some Middle East countries logging record numbers, and some European hot spots reporting more worrying developments. In other developments today, global health officials warned that false information about COVID-19 is hampering the response and urged countries to do more to counter it with accurate messaging. The pandemic total today climbed to 31,728,021 cases, and 973,176 people have died from their infections, according to the Johns Hopkins online dashboard.”

Via FT: Latin America now accounts for 38 % of average global deaths.

“Latin America is the current epicentre of the pandemic, with the region accounting for almost 40 per cent of all deaths each day. This has been fuelled by a surge in Covid-19 fatalities in Brazil, Mexico and several other countries in Central and South America. A recent surge in India, however, means it has become the most-affected country by daily average deaths.”

Guardian - Number of new weekly coronavirus cases at record high, says WHO

https://www.theguardian.com/world/2020/sep/22/weekly-number-of-new-coronavirus-cases-at-highest-level-says-who

“With a new seven-day high of just short of 2 million new cases being recorded by the WHO, the latest tally represents a 6% increase over the previous week as well as “the highest number of reported cases in a single week since the beginning of the epidemic”, the UN health agency said.

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That figure is skewed by the fact testing has become much more widespread globally over recent months.”

“… Nearly all regions of the world experienced a rise in new cases last week, the WHO said, with infections increasing by 11% and 10% respectively in Europe and the Americas. Only Africa went against the upward trend, reporting a 12% drop in new cases from a week earlier. The figures, released by the WHO late on Monday, have underlined the huge difficulties countries are facing in attempting to bring the spread of the virus under control without an effective and widely available vaccine…..”

See also Cidrap News (Sept 24) on the declining trend in Africa:

“Africa has seen a steady decline in new COVID-19 cases since Jul 20, according to a news release from the World Health Organization's (WHO's) African regional office. Some of the most affected countries, including South Africa, Ethiopia, Nigeria, Kenya, and Senegal, have seen infections drop every week over the past 2 months, and deaths have remained low in the region. The WHO says low population density and mobility, a hot and humid climate, and a younger population are contributing to the pattern seen in Africa.”

See also CNBC - WHO says the coronavirus is killing about 50,000 people a week: ‘That is not where we want to be’

“Dr. Mike Ryan, executive director of the WHO’s health emergencies program, warned Friday that the coronavirus is “not going away,” noting that it’s still killing about 50,000 people a week. WHO officials said they are beginning to see “worrying trends” in the number of Covid-19 cases, ICU admissions and hospitalizations in the Northern Hemisphere as it enters its colder seasons. Seroepidemiology studies that examine the extent of coronavirus infection in different populations indicate that a majority of the world’s population is susceptible to infection from this virus, they said. “

Guardian - Aid agencies warn of Covid-19 crisis in refugee camps as winter

approaches

https://www.theguardian.com/global-development/2020/sep/23/aid-agencies-warn-of-covid-19-crisis-in-refugee-camps-as-winter-approaches

“Displaced populations across the Middle East, already in cramped, unhygienic conditions, face a health catastrophe as infections rise.”

“It seemed inevitable that the contagion would reach those less able to absorb its impact. And now, as second and third waves of Covid-19 surge around the globe, worst fears are being realised. Several months into the crisis, the virus has crept into the populations of refugees and internally displaced people, where stopping its advance will be close to impossible. Up to 15 million people across the region, many of whom were already at risk of disease, now face a rampant spread through their communities. Numbers of infections in camps across Iraq, Syria, Lebanon and the Palestinian territories have risen sharply throughout September….”

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The Hill - House Republicans blame Chinese cover-up for coronavirus pandemic

https://thehill.com/policy/international/517395-house-republicans-blame-chinese-cover-up-for-

coronavirus-pandemic

Zzzz. “Republicans on the House Foreign Affairs Committee on Monday released their final report investigating China’s actions related to the spread of the COVID-19 pandemic, accusing Beijing of covering up the virus threat and faulting the World Health Organization for failing to push back. The 96-page report builds on interim findings released in June by Republicans, and largely backs President Trump's argument that the COVID-19 pandemic could have been prevented if not for the actions of China….”

Guardian - Coronavirus pandemic has wiped out $3.5tn in work income, says ILO

https://www.theguardian.com/business/2020/sep/23/coronavirus-pandemic-has-wiped-out-dollars-

3tn-in-wages-says-ilo

“UN body figures show people in Americas and lower to middle-income nations hardest hit.”

UN News - Countries urged to act against COVID-19 ‘infodemic’

https://news.un.org/en/story/2020/09/1073302

“The UN and partners have urged countries to take urgent action to address what they have described as the “infodemic” that has surfaced in tandem with the COVID-19 pandemic, both in the real world and online.” At an UNGA side event on infodemic management.

For the joint statement, see here.

Reuters - Airlines call for COVID-19 tests before all international flights

Reuters

“Global airlines called on Tuesday for airport COVID-19 tests for all departing international passengers to replace the quarantines they blame for exacerbating the travel slump.”

UHC 2030 Civil Society Engagement mechanism - For an equitable COVID-19

response, investments in civil society cannot wait

https://www.uhc2030.org/blog-news-events/uhc2030-blog/for-an-equitable-covid-19-response-investments-in-civil-society-cannot-wait-555408/

“Pandemic response plans must adopt a multi-disciplinary approach with multi-stakeholder input that consider the added impact of poverty, gender inequalities, and discrimination among other factors. This is a core message of the Civil Society’s COVID-19 Calls to Action developed by the Civil Society Engagement Mechanism for UHC2030 (CSEM) in consultation with members. Yet even when political leaders align with a rhetoric of “leave no one behind,” many governments are making decisions without community and civil society representatives at the table and missing opportunities

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to truly respond to the needs of vulnerable populations. In a global survey by the CSEM and UHC2030 Social Participation Technical Network (SPTN), more than half of the 200 civil society respondents reported minor or no involvement of CSOs and communities in their governments’ COVID-19 responses. “

… Governments cannot afford to wait until the end of their emergency response modes to engage with civil society and seek their leadership. “

“…Looking forward, WHO is soon to publish a ‘Handbook on Social Participation for UHC’ which will provide specific best practice guidance to policymakers on how to effectively and meaningfully engage with populations, civil society and communities for policy- and decision-making….”

Covid vaccines (& medicines) access: Covax milestone

PS: we already want to flag that later today, as announced in a briefing by Tedros yesterday, “the ACT-Accelerator is set to release its status report and plan, providing an overview of goals, approach, achievements to date and near-term priorities. An investment case will also be released, laying out the economic rationale for investing in the ACT-Accelerator. “

WHO/GAVI - Boost for global response to covid-19 as economies worldwide

formally sign up to covax facility

https://www.who.int/news-room/detail/21-09-2020-boost-for-global-response-to-covid-19-as-

economies-worldwide-formally-sign-up-to-covax-facility

Somewhat jubilant press release (21 September):

“64 higher income economies have now joined the COVAX Facility, with a further 38 economies expected to sign in the coming days. These self-financing economies, which include 29 from ‘Team Europe’ participating as part of an agreement with the European Commission, join 92 lower income economies eligible for financial support through the Gavi COVAX Advance Market Commitment

This means a total of 156 economies, representing nearly two-thirds of the global population, are now committed to or eligible to receive vaccines through the Facility .”

“… With the Commitment Agreements secured, the COVAX Facility will now start signing formal agreements with vaccine manufacturers and developers, which are partners in the COVAX effort, to secure the doses needed to end the acute phase of the pandemic by the end of 2021. This is in addition to an ongoing effort to raise funding for both R&D and for the procurement of vaccines for lower-income countries via the Gavi COVAX AMC….”

As already mentioned in the intro: “COVAX is now in business” (Seth Berkley)

For the full list of countries, see GAVI. ( some have signed commitment agreements to the Covax facility; some have submitted non-binding confirmations of intent to participate in the facility; and then there’s the 92 AMC-eligible countries).

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Some Coverage & analysis

In general, the COVAX Announcement is applauded, but it’s clear that major questions about equitable distribution to the most vulnerable groups (and countries) still remain. PS: It also appears GAVI has agreed to give countries some more time to join Covax.

• the Washington Post - World Health Organization unveils plan for distributing coronavirus vaccine

“The WHO’s answer is a two-phase plan that will be closely studied and assessed. In the first phase, doses will be distributed proportionally, meaning each participating country will get doses for a share of its population: 3 percent to start, then up to 20 percent. If supply is still limited after the 20 percent threshold is met, the allocation method will switch. In Phase 2, Covax will consider each country’s covid-19 risk level, sending more doses to countries at highest risk….”

“The framework makes clear that each participating country can decide whom to vaccinate first, but is based on the idea that doses for 3 percent of a country’s population could be used to vaccinate medical workers first, and then other high-risk groups. Analysts said the framework reflects the political nature of the process, and the fact that the WHO is a member state organization. “It seems like a compromise position,” said Thomas J. Bollyky, a senior fellow at the Council on Foreign Relations and the director of its global health program. “It’s not exactly what you would do if you were driven strictly by public health.” In a policy report this month for the journal Science, critics offered an alternate framework called the Fair Priority Model, which is critical of the country-based approach….”

• Stat - 64 high-income nations join effort to expand global access to Covid-19 vaccines, but U.S. and China do not

“Countries representing about 64% of the world population have signed up to expand global access to Covid-19 vaccines by funding a purchasing pool organized by the World Health Organization and other nonprofit groups, leaders of the effort announced Monday. Not among the countries: the United States, which had previously said it is not taking part in the so-called COVAX Facility, or Russia nor China, both of which have already issued emergency use licenses for Covid-19 vaccines….”

“…Alliance officials said dialogue continued with Beijing….”

• Science - WHO unveils global plan to fairly distribute COVID-19 vaccine, but challenges await

Great analysis by Kai Kupferschmidt. Very much recommended.

PS: on Monday, WHO Chief Scientist Soumya Swaminathan told reporters on Monday that the lower bound for effectiveness for approving a safe vaccine was 30%. (for Covax and in general)

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HPW - Binding Commitments To A Global COVID-19 Vaccine Procurement

Initiative Trickle In, But Massive Infusion Of Funding Still Required

https://healthpolicy-watch.news/binding-commitments-to-the-covax-facility-trickle-in-but-massive-

infusion-of-funding-still-required/

More analysis.

“Some 64 higher income countries have now made binding financial commitments to a precedent-setting COVID-19 global vaccine pool that aims to equitably distribute future vaccines to halt the pandemic raging now. Another 38 countries are expected to commit over the next week, said CEO Berkley, in a WHO press conference Monday that disclosed the landmark agreement formally establishing the COVAX Advance Market Commitments (AMC) mechanism, the first to involve rich as well as poor countries in vaccine pooling. ….”

“However, some US $35 billion is still urgently needed to finance the manufacture and distribution of vaccines to low-income countries that join the COVAX pool, as well as treatments and tests needed to combat COVID-19 even more immediately, said WHO Director General Dr Tedros Adhanom Ghebreyesus at the press conference. He said that US$15 billion is “immediately needed” to “maintain momentum and stay on track for our ambitious timelines… We are at a critical point, and we need a significant increase in countries’ political and financial commitment. Only US $3 billion has been invested so far into financing vaccines for the COVAX faciliaty as well as the other pillars of the broader ACT Accelerator initiative, which aims to scale up development and distribution of COVID-19 treatments and diagnostics, said Dr Tedros.”

Tedros (and Guterres) begin to sound like a broken record on this : (

Some more info on countries vs Covax (as the deadline approached, or beyond the

deadline)

• Reuters - Germany won't buy vaccines through WHO's COVAX scheme - sources

“Germany has joined France in deciding against buying potential COVID-19 vaccines through a World Health Organization (WHO) programme, although it supports the scheme, government sources told Reuters on Friday. The sources said Berlin was not buying supplies through the WHO’s COVAX programme because it was already sourcing potential vaccines through a European Union scheme….” (for more on Germany and Covax, see https://www.auswaertiges-amt.de/en/aussenpolitik/themen/gesundheit/germany-joins-covax/2396914 )

Same like France’s position in other words, see Reuters - France won't buy vaccines through WHO's COVAX scheme - ministry source

• Devex - UK joins COVAX scheme on deadline day

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“While some donors are only contributing funding, the U.K. will also be procuring vaccines through COVAX. … France and Germany are contributing financing but will not procure vaccines through the program, sources told Reuters. … … The European Commission announced its participation at the end of August, along with a donation of €400 million to the facility, but said the conditions of its involvement were still to be decided. Japan followed on Sept. 16, donating $164 million….”

PS: By now, the EU has firmed up its support to COVAX with an initial €230 million in cash to purchase vaccines for lower income countries.

• Latin American nations plan to join COVAX vaccine facility after deadline

“Brazil and Argentina, Latin American nations seeking more time to commit to the global COVID-19 vaccine facility known as COVAX, said they intend to so as soon as possible after missing Friday's deadline. … … A dozen Central and Latin American countries had informed the WHO they would request more time to sign up after the midnight on Friday deadline to formalize legally-binding documents. Brazil's statement would appear to indicate that the GAVI Alliance has agreed to give nations more time to join COVAX.”

Euractiv – Fearing supply shortfall, EU wants to buy more COVID vaccines

https://www.euractiv.com/section/coronavirus/news/fearing-supply-shortfall-eu-wants-to-buy-more-covid-vaccines/

“The European Union wants to raise more money to shore up its supplies of potential COVID-19 vaccines after estimating that the number of shots available next year around the world might fall short of demand, two EU sources said. The possible move by the wealthy EU could weaken a global procurement effort co-led by the World Health Organization and further limit the vaccines available to poorer countries, even though the bloc has publicly championed the sharing of COVID-19 vaccines among the entire global population. The EU executive, the European Commission, told a meeting of EU ambassadors last week that it was “trying to be pragmatic as the total number of vaccines that could be produced globally next year is 2.4 billion,” one of the EU sources told Reuters. The WHO scheme, called COVAX, wants to secure 2 billion doses by the end of 2021 and many countries, most of them wealthy nations such as the United States, are in a race to ensure they have their own supplies of potential vaccines. According to the Commission’s estimate, supply could far outstrip demand next year….”

Nature - Who gets a COVID vaccine first? Access plans are taking shape

https://www.nature.com/articles/d41586-020-02684-9

Nice read from late last week, on the WHO resp NASEM access plans.

“Advisory groups around the world release guidance to prioritize health-care workers and those in front-line jobs.”

“The World Health Organization has released a preliminary plan for globally allocating coronavirus vaccines when they become available. The report urges richer countries to ensure

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that poorer nations receive vaccines in the early days of allocation. The guidance follows a similar draft plan published by the US National Academies of Sciences, Engineering and Medicine (NASEM) earlier this month. The NASEM report recommends that health-care workers and first responders should be vaccinated first, followed by people with underlying conditions and older people and then essential service workers, such as teachers and grocery-store, transit and postal workers. People from hard-hit ethnic groups are over-represented in these jobs. “We really are trying to make sure that people of colour, who have been disproportionately impacted, will also have priority — but for the factors that put them at risk, not highlighting just their racial and ethnic makeup,” says co-chair of the NASEM committee Helene Gayle….”

Washington Post - China and Russia are ahead in the global coronavirus vaccine

race, bending long-standing rules as they go

Washington Post

“China and Russia have begun a mass rollout of their coronavirus vaccines before clinical tests are complete, in what is emerging as an unexpectedly complex geopolitical challenge for the United States. China's Sinopharm announced this week that it would provide emergency doses of one of its two trial vaccines to the United Arab Emirates, prioritizing the U.S. ally over the vast majority of Chinese. China is now the sole supplier of coronavirus vaccine to the Middle East. Meanwhile, Russia's sovereign wealth fund signed a deal this week to supply India with 100 million doses of the Sputnik V vaccine. These moves have thrown Western policymakers off balance. American health-care experts say the United States should not rush out its own vaccine in response. But that leaves China and Russia as the only countries wielding this valuable diplomatic tool for potentially months to come….”

“… The upshot is that by next year, China and Russia may have purchased significant geopolitical power by having bent the rules and rushed out their vaccines. It is also possible their vaccines may fail, at enormous human cost.”

Lancet (Comment) -What can we expect from first-generation COVID-19 vaccines?

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31976-0/fulltext

“Crucially, it will be important to communicate to policy makers and the general public that first-generation vaccines are only one tool in the overall public health response to COVID-19 and unlikely to be the ultimate solution that many expect.”

Stat - Here come the tortoises: In the race for a Covid-19 vaccine, slow starters

could still win out

Stat;

“…Corporate giants Sanofi and Merck, which got a relatively late start in developing Covid-19 vaccines, may seem far behind the frontrunners. But experts say they also have such deep experience developing and testing vaccine candidates, and producing vaccine at commercial scale, that both could well close the gap considerably in the months ahead. Each is developing two vaccines, in partnership with others….”

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Do read about their comparative advantages over Moderna, for example.

AP - As rich nations struggle, Africa’s virus response is praised

AP;

Nice analysis, zooming in on John Nkengasong (and Africa CDC’s important role so far).

“As director of the Africa Centers for Disease Control and Prevention, Nkengasong has helped to steer Africa’s 54 countries into an alliance praised as responding better than some richer countries, including the United States. He's set to be honored as a “relentless proponent of global collaboration” with the Gates Foundation’s Global Goalkeeper Award today.”

(see Global Goalkeeper award )

“With COVID-19 vaccines the next urgent issue, African countries held a conference to insist on equitable access and explore manufacturing to end their almost complete reliance on the outside world. They began securing the late-stage clinical trials that long have been held outside the continent, aiming to land 10 as soon as possible….”

“Nkengasong said Africa needs at least 1.5 billion vaccine doses, enough to cover 60% of the population for “herd immunity” with the two likely required doses. That will cost about $10 billion.”

Now that’s quite far from the current Covax commitment for African countries…

Think Global Health - Vaccine Nationalism and Africa

E A Nelson et al ; https://www.thinkglobalhealth.org/article/vaccine-nationalism-and-africa

“African Union calls for a “People's Vaccine” as African Academy of sciences begins mapping local clinical trials sites.”

HPW - US FDA Commissioner Promises Not To Bow To Political Pressure On

COVID-19 Vaccine Timetable – President Donald Trump Says Any Delay Would

Need White House Approval

https://healthpolicy-watch.news/77055-2/

“United States President Donald Trump told a press conference that any moves by the Food and Drug Administration (FDA) to delay emergency authorization of any forthcoming COVID-19 vaccine for an additional two months to ensure safety concerns are met, “sounds like a political move more than everything else” and such a delay “has to be approved by the White House.””

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Health Affairs - Four Ways To Increase Global Access To Promising Monoclonal

Antibodies For COVID-19

M Feinberg et al ; https://www.healthaffairs.org/do/10.1377/hblog20200915.995263/full/

On the encouraging developments in monoclonal antibodies (mAbs) as potential treatments and preventives for COVID-19, and ways to increase global access. With as a first step a Global Call to action (from IAVI & Wellcome).

CEPI – CEPI survey assesses potential COVID-19 vaccine manufacturing capacity

https://cepi.net/news_cepi/cepi-survey-assesses-potential-covid-19-vaccine-manufacturing-capacity/

“In collaboration with the Bill & Melinda Gates Foundation, The Clinton Health Access Initiative, and PATH, we recently undertook a broad worldwide survey with vaccine manufacturers to work out what global vaccine manufacturing global capacity to produce billions of doses of vaccine looks like. With responses from over 30 countries, data suggests there is the potential to produce at least 2-4 billion doses of COVID-19 vaccine through end of year 2021, supporting our goal to develop, manufacture and equitably deliver 2 billion doses of safe and effective vaccine through COVAX….”

Covid financing, debt relief, social protection, …

Global Coalition for Social Protection Floors - Over 200 civil society organizations

and trade unions unite to call for a Global Fund for Social Protection to protect the

most vulnerable during COVID-19 and beyond

http://www.socialprotectionfloorscoalition.org/2020/09/press-release-cs-global-

fund/?utm_campaign=shareaholic&utm_medium=twitter&utm_source=socialnetwork

“The International Labour Organization (ILO) just published figures that give an idea of the size of the global social protection gap: To guarantee basic income security and access to essential health care for all in 2020 alone, low and middle income countries need to invest about US$1.2 trillion – on average 3.8 per cent of their GDP. The responsibility to ensure social protection lies with governments, but the pandemic has put a spotlight on the need for international solidarity in finally realizing the human right to social protection for everyone, everywhere. Therefore, the Global Coalition for Social Protection Floors (GCSPF), a group of over a 100 civil society organizations and trade unions, is calling on the world’s governments support low-income countries to expand and improve their social protection systems through the establishment of a Global Fund for Social Protection. This Fund will enable low-income countries to implement national social protection systems that ensure income protection for all by providing temporary co-financing and facilitating access to technical support.”

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Guardian - What are we waiting for? We must increase lending to the world's

poorest now

M Lowcock; Guardian;

Mark Lowcock makes this case for the zillionth time now, and suggest three things that need to be

done urgently.

Current situation: “The UN’s global humanitarian response plan, progressively updated as the virus spread between March and July, now seeks $10bn (£7.8bn) to mitigate the damage over the next six months. It is just 25% financed.”

Brookings (blog) - Financing a comprehensive and equitable COVID-19 response

M Mohieldin et al; Brookings;

To be read together with the previous analysis & recommendations from Lowcock.

“…even during this unprecedented crisis, low- and middle-income countries will still be asked to pay a total of $130 billion in debt service this year. Dozens of nations have requested debt service relief. Many of these are in distress and face the possibility of default. Others may be forced to make devastating cuts in public services that are badly needed to bandage their wounded people and economies—just to service their debts. … We previously outlined our case for the SDGs as a guide for the COVID-19 response, but now it is time to implement them—and with adequate financing. So how should we proceed to finance and implement the SDGs during and after the pandemic? There are at least four key steps: … “

So as you can see, plenty of good ideas on what needs to be done to help avert the worst socio-economic damage in LMICs. But so far not many in power are listening – G20, …?

Finally, a link:

FT - Zambia headed for Africa’s first Covid-related debt default

“Zambia has asked investors in its US dollar bonds to accept delays in their interest payments into next year, in what would be the first African debt default on private creditors since the pandemic.”

Covid science

FT - Scientists plead for clarity on AstraZeneca’s Covid-19 vaccine trial

https://www.ft.com/content/06015bd9-ed4b-44ef-a243-2bd67557d2c0

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“Scientists are demanding to know why AstraZeneca’s trial of its Covid-19 vaccine is still on hold in the US while it has been restarted elsewhere, worrying it could damage public trust. … … polls show the public rapidly losing confidence that an eventual vaccine will be safe. The latest poll by Pew Research shows only half of Americans now say they definitely or probably would be vaccinated at this time. That is a 21-point drop from May. …”

See also:

NYT - AstraZeneca, Under Fire for Vaccine Safety, Releases Trial Blueprints

https://www.nytimes.com/2020/09/19/health/astrazeneca-vaccine-safety-blueprints.html?smtyp=cur&smid=tw-nythealth

“Experts are concerned that the company has not been more forthcoming about two participants who became seriously ill after getting its experimental vaccine.”

Guardian - Flu and Covid-19 at same time significantly increases risk of death

https://www.theguardian.com/world/2020/sep/22/flu-and-covid-19-at-same-time-significantly-

increases-risk-of-death

“UK scientists warn co-infection is ‘serious trouble’ and urge those at risk to get flu vaccine.”

HPW - Africa Lagging In COVID-19 Clinical Trials As Global Studies Cross 1000

Mark

https://healthpolicy-watch.news/africa-lagging-in-covid-19-clinical-trials-as-global-studies-cross-

1000-mark/

“Africa is trailing the rest of the world in conducting clinical studies on COVID-19 vaccines and drugs. Less than 70 registered studies for drugs and vaccines are currently taking place in Africa, out of more than 1000 studies being conducted globally….”

“… To increase the number of clinical trials in the poor regions of the world, the DNDi and its partners have formed the COVID-19 Clinical Research Coalition, a global partnership aimed at accelerating clinical research in resource-limited settings.”

Vox - This theory might explain “Covid toes” and other mysteries of the disease

https://www.vox.com/21445038/covid-19-symptoms-treatments-bradykinin-cytokine-storm

“Bradykinin storms are the hottest new hypothesis for why Covid-19 can wreak havoc on the body.”

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CNN - CDC abruptly removes guidance about airborne coronavirus transmission,

says update 'was posted in error'

https://edition.cnn.com/2020/09/21/health/cdc-reverts-airborne-transmission-guidance/index.html

Was a weird story, this. “The US Centers for Disease Control and Prevention on Monday abruptly reverted to its previous guidance about how coronavirus is transmitted, removing language about airborne transmission it had posted just days earlier. "A draft version of proposed changes to these recommendations was posted in error to the agency's official website. CDC is currently updating its recommendations regarding airborne transmission of SARS-CoV-2 (the virus that causes COVID-19). Once this process has been completed, the update language will be posted," Jason McDonald, a CDC spokesman, said in a response emailed to CNN.”

LA Times had reported earlier, CDC says coronavirus spreads mainly in the air, through respiratory aerosols and droplets

Anyhow, WHO’s stance remains the same. See Reuters - WHO says no change to COVID-19 transmission guidance after U.S. draft change

“The WHO’s Ryan said the agency still believes the disease is primarily spread through droplets, but that in crowded closed spaces with inadequate ventilation, aerosol transmission can occur. … … “We still, based on the evidence, believe that there is a wide range of transmission modes,” he said….”

Forbes - Covid-19 Can Spread On Long Airline Flights, Per Two New Studies

Forbes;

These are wickedly fun times for airlines, clearly.

The Conversation - COVID-19 and HIV: so far it seems the outcome is not what

was feared

B Fielding; https://theconversation.com/covid-19-and-hiv-so-far-it-seems-the-outcome-is-not-what-

was-feared-146213

Based on the author’s research in this regard. With a view on the figures in South-Africa, among others, which are a lot lower than expected.

“My laboratory recently reviewed what is known at this stage – and what is still unknown – about

co-infections of HIV and coronaviruses….”

The author concludes: “Concern over HIV-positive patients is understandable. But current data from the COVID-19 pandemic – and past experiences with SARS and MERS – suggest that they do not form an at-risk group. This raises the question of whether HIV serves as an immunological shield against more severe forms of the new disease. What has been quite apparent from the start is

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that old age and co-morbidities such as obesity, hypertension and diabetes are more telling considerations in both general infections and HIV/SARS-CoV-2 co-infections….”

Reuters - Exclusive: Study suggests dengue may provide some immunity against

COVID-19

Reuters;

Not yet published study, though… “A new study that analyzed the coronavirus outbreak in Brazil has found a link between the spread of the virus and past outbreaks of dengue fever that suggests exposure to the mosquito-transmitted illness may provide some level of immunity against COVID-19.” Question: how about Brazil, then? In other words: to be confirmed/continued…

FT - J&J launches first phase 3 trial of single-dose Covid-19 vaccine

https://www.ft.com/content/b23ba7ff-7e2c-4ea2-bc18-e64f7bd23848

“World’s largest healthcare company hopes to catch rivals working on two-jab products.”

“Johnson & Johnson became the first leading pharmaceuticals company to test a single-dose Covid-19 vaccine with the launch this week of a phase 3 trial that will recruit 60,000 participants across three continents. The company’s decision to pursue a single-dose product may help its trials move faster than rivals that need to give two jabs, even though some other vaccine makers began their large studies in May and July. …”

Cfr tweet Laurie Garrett:

“The Johnson & Johnson #COVID19 #vaccine candidate is much more promising than frontrunners from @moderna_tx @pfizer & @AstraZeneca . It requires on 1 dose, it's fairly stable & doesn't require deep-freezing, and it used the same vector model as J&J deployed for its #Ebola vax.”

See also a NYT piece - Johnson & Johnson's vaccine advances, sparking optimism in the race.

Reuters – Fujifilm's Avigan shown to be effective in Japanese Phase-3 trial for

COVID-19

Reuters;

“Fujifilm Holdings Corp said on Wednesday a late-stage study of its antiviral drug Avigan showed it reduced recovery times for COVID-19 patients with non-severe symptoms, boosting expectations for regulatory approval in Japan. … … Former Japanese Prime Minister Shinzo Abe had touted Avigan’s potential as Japan’s contribution to a global race for coronavirus treatments, aiming for domestic approval in May….”

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Wired - Covid-19 Vaccines Could End Up With Bias Built Right In

Wired

“Some of the leading candidates might work better for the richest people in the world, simply on account of how they're made.”

“…The potential issue comes from how they’re made: Each is a viral vector vaccine, which means it uses an engineered version of another, milder virus—here it’s one that causes common colds—as a delivery system. But some people who could end up getting these vaccines will have immunity to the vector. If that’s the case—if their bodies have fought off the relevant cold virus in the past—then their preexisting antibodies may end up hampering (or even neutralizing) the new vaccines. More concerning, this potential problem isn’t evenly spread across global populations: It’s much more common in the developing world….” In countries like Thailand, Brazil or Cameroon, where exposures to these mild viruses is more common.

Science News – Hidden immune weakness found in 14% of gravely ill COVID-19

patients

https://www.sciencemag.org/news/2020/09/hidden-immune-weakness-found-14-gravely-ill-covid-19-patients

“Damaged interferon response helps explain why men get sicker than women.”

And some links:

• the Pan American Health Organization (PAHO) is warning of the increased risk to pregnant women from COVID-19. The organization has recorded 60,458 confirmed cases of COVID-19 among pregnant women, including 458 deaths.

• MIT - A city in Brazil where covid-19 ran amok may be a ‘sentinel’ for the rest of the world

“ So many people have gotten sick in Manaus that researchers say the virus is running out of people to infect.”

• Guardian- Coronavirus continuing to mutate, study finds, as US cases rise

“Experts believe virus is probably becoming more contagious but US study did not find mutations made it more lethal.”

“The new US study analyzed 5,000 genetic sequences of the virus, which has continued to mutate as it has spread through the population. The study did not find that mutations of the virus have made it more lethal or changed its effects, even as it may be becoming more easier to catch, according to a report in the Washington Post, which noted that public health experts acknowledge all viruses have mutations, which are mostly insignificant.”

• NYT Opinion - These Coronavirus Trials Don’t Answer the One Question We Need to Know

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“We may not find out whether the vaccines prevent moderate or severe cases of Covid-19.”

Via Nature News: “Trials of three leading coronavirus-vaccine candidates in the United States are not designed to tell us whether they work against mild or more-severe forms of the disease, write pharmaceutical researcher Peter Doshi and Eric Topol, director of the Scripps Research Translational Institute in California. This is a problem because a vaccine might be deemed to work even if it mostly prevents mild cases in young, healthy people. In that case, it might not reduce the number of deaths. Doshi and Topol argue that the trial protocols released last week for vaccines from Moderna, Pfizer and the University of Oxford–AstraZeneca should be modified to focus on severe COVID-19.”

Covid analysis

Lancet – Offline: COVID-19 is not a pandemic

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32000-6/fulltext

Brilliant analysis from Horton. He argues Covid-19 should be seen as a syndemic, rather than a

pandemic.

“As the world approaches 1 million deaths from COVID-19, we must confront the fact that we are taking a far too narrow approach to managing this outbreak of a new coronavirus. We have viewed the cause of this crisis as an infectious disease. … … But what we have learned so far tells us that the story of COVID-19 is not so simple. Two categories of disease are interacting within specific populations—infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and an array of non-communicable diseases (NCDs). These conditions are clustering within social groups according to patterns of inequality deeply embedded in our societies. The aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease. COVID-19 is not a pandemic. It is a syndemic. … The most important consequence of seeing COVID-19 as a syndemic is to underline its social origins. …”

Lancet Infectious Diseases (Newsdesk) – COVID-19 in Africa: half a year later

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30708-8/fulltext?rss=yes

“With the number of COVID-19 cases decreasing across the continent, it is time to reflect on the first

months of the pandemic in Africa. Munyaradzi Makoni reports.”

Quote: “Reflecting on the COVID-19 pandemic, Nkengasong said that three lessons have emerged so far for Africa: focus on diagnostics, vaccine development, and drugs. “Africa imports 95% of drugs—this is unsustainable for a continent of 1·3 billion”.”

BMJ GH Analysis – Willingness to comply with physical distancing measures

against COVID-19 in four African countries

M A A Ahmed et al; https://gh.bmj.com/content/5/9/e003632

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“Mali, Burkina Faso, Senegal and Guinea, four West-African countries, have put in place several physical distancing measures that made it possible to contain the spread of COVID-19 in Western countries without too much questioning about their acceptability by their populations. We describe these measures and discuss the importance of considering the socio-cultural, economic and political context to choose the most appropriate and effective measures. We propose ways to explore strategies that are potentially better adapted to the African context.”

Guardian - Female voices 'drowned out' in reporting on Covid-19, report finds

https://www.theguardian.com/global-development/2020/sep/24/female-voices-drowned-out-in-

reporting-on-covid-19-report-finds

“Women’s voices have been “worryingly marginalised” in reporting of the coronavirus, partly due to the war-like framing of the pandemic, according to a report analysing stories across six countries. Each woman’s voice in news coverage of the crisis is “drowned out” by at least three men, it said. The report, commissioned by the Bill and Melinda Gates Foundation, and examining the UK, US, Kenya, South Africa, Nigeria and India, said women have been “locked out” of coronavirus decision making at a national level in five of the countries.

… “It is partly to do with the ‘war framing’ of the crisis. The idea that this is an emergency and that men are better equipped to deal with it. Women are being pushed out… …It is the first of two reports to be commissioned by the Gates Foundation, the second of which will look into the causes of underrepresentation of women in the news.”

NY Intelligencer - Bill Gates on the Pandemic: ‘You Hope It Doesn’t Stretch Past

2022.’

D Wallace-Wells; https://nymag.com/intelligencer/2020/09/bill-gates-hopes-covid-19-pandemic-

doesnt-stretch-past-2022-interview.html?utm_source=tw

Starting with some of his Global Goalkeepers report results, but also interesting for other sections, including how Gates ‘reads’ the current global Covid trends.

Excerpt: “Question: Across sub-Saharan Africa, the fatality rate appears to be much lower than in Europe, the U.S., or Asia. Gates: “Ninety percent percent of that is due to the age structure of their population. Their societies are about 20 to 25 years younger on average. These are very young countries. And even though the newspapers highlight the cases of younger people who do get the disease, some of whom die, those are very small numbers. … India isn’t as young, and the density of their slums is such that they’ve actually had a pretty tough epidemic. South America is coming out the worst — they’re old enough to have a lot of deaths, and yet they’re poor enough that their slums have just super-high density. And of course their health system, although they’re better than Africa, they still have been overloaded. So the education and economic damage from this pandemic may not get solved for more than a decade….”

Devex - COVID-19 response a tale of two UNs, UNDP chief says

https://www.devex.com/news/covid-19-response-a-tale-of-two-uns-undp-chief-says-98152

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“The COVID-19 response has, in many ways, been a story of two United Nations — the political and the operational — according to United Nations Development Programme Administrator Achim Steiner. “In a sense, we've seen two U.N.s operate side by side over the last six to eight months. There is the political U.N. — the General Assembly, the Security Council, and all the bodies associated with it — that clearly, in the current struggle to find a collective response, are also a reflection of the state of our world,” Steiner told Devex in an interview. How is COVID-19 affecting progress on the SDGs? Will online meetings mean greater international representation? Our reporters are covering the all-virtual 75th United Nations General Assembly to find out. But then there is also the operational side — the World Health Organization, the humanitarian institutions, and the development system — where the past six to eight months “have been an extraordinary moment of demonstrating how, with agility and the capacity and resilience, we have actually been part of the backbone of a world's response to COVID-19, particularly for those countries who rely on support.”…”

Adjustments in health purchasing as part of the COVID-19 health response:

results of a short survey and lessons for the future

Inke Mathauer; https://p4h.world/index.php/en/who-adjustments-health-purchasing-part-of-covid-

19-health-response-survey-results-lessons-future

“Based on a short online survey covering 31 low- and middle-income countries, this blog summarises how countries have adjusted their purchasing arrangements to respond to COVID-19, outlines challenges and explores what lessons may be drawn from this for the future….”

The following themes were investigated to cover core aspects related to purchasing: 1.Purchasers’ strategies to cope with increased funding needs; 2. Adjustments in benefits and in cost-sharing; 3. Modifications in provider payment methods; 4. Changes in contracting and accreditation arrangements; 5. Alterations in governance arrangements for purchasing; 6.Developments in information management support and; 7. What are the lessons for the future?”

Foreign Policy - The World Is Winning—and Losing—the Vaccine Race

Adam Tooze; https://foreignpolicy.com/2020/09/19/the-world-is-losing-the-vaccine-race/

Must- read. Even if I didn’t like one of the options suggested by Tooze, “a collective capitalist

consciousness”, much 😊.

“Immunization to COVID-19 is supposed to solve our problems—but it's starting to trigger even bigger ones.”

Cfr tweet from Tooze: “A while back I did an essay about U. Beck’s concept of “risk society”. In this new piece for @ForeignPolicy I analyze the vaccine race as a 1st taste of political economy of the future. We may want a black box, but in risk society politics is everywhere.”

Excerpts:

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“What is being exposed is that political interests, big business, and public health are deeply linked. Stable solutions for public crises amid a maelstrom of conflicting interests, invisible risks, and uncertainty are never a quick fix. As the prescient sociologist, Ulrich Beck, warned us in the 1980s, in “risk society,” politics are everywhere. …. …. The powerful actors in this drama are the nation states and their publics, and Big Pharma. The global public health regime is a thin film … The question is whether nation states, politicians, science, business, and the public at large can organize themselves in such a way as to deliver a high-quality vaccine at affordable prices to all of the world’s 7.8 billion inhabitants. … It is a matter of urgent practical necessity. It is a question of legitimacy—of international and domestic order. It is also a decisive question for the future….”

“… Our era, now widely described as the Anthropocene, is one in which we must reckon with the blowback from our comprehensive and destabilizing transformation of the natural environment. This blowback may come in the form of forest fires, parched summers of extreme heat and drought, the battering of mega hurricanes, or, as we have now experienced, the accelerated mutation of zoonotic (ie: non-human to human) viruses. We will need to rearrange the way we live, work, play, travel, feed, and house ourselves. … … Each crisis will demand a combination of far-reaching responses—political, economic, social, cultural, and technical. Some questions we will want to put up for public debate. Others we will want to leave up to expert judgment and technical solutions—without the uncertain intervention of public scrutiny. Seen in these terms, the race to develop a vaccine is a test run for the political economy of the future. … … … Given the huge global publicity accorded to COVID, given the way that it has been defined as a challenge for humanity as a whole, a failure to ensure an equitable distribution of the vaccine will tarnish the reputations of those who monopolize the cure and further shred the legitimacy of the global institutions that are supposed to ensure fair play….”

“But beyond the short term, what matters in the November election is not just the defeat of Trump but the ability of the Democratic Party to harness a politically viable coalition for structural reform. The stakes are now clear: to create a political economy fit for the demands of the anthropocenic era to come.”

Nearly 9 in 10 People Globally Want a More Sustainable and Equitable World Post

COVID-19

https://moderndiplomacy.eu/2020/09/20/nearly-9-in-10-people-globally-want-a-more-sustainable-

and-equitable-world-post-covid-19/

“Nearly 9 in 10 People Globally Want a More Sustainable and Equitable World Post #COVID-19 - @wef survey “We are now at a pivot point where we can use the social momentum of this crisis to avert the next one.”

“In a new World Economic Forum-Ipsos survey of more than 21,000 adults from 28 countries nearly nine in ten say they are ready for their life and the world to change. 72% would like their own lives to change significantly and 86% want the world to become more sustainable and equitable, rather than going back to how it was before the COVID-19 crisis started. In all countries, those who share this view outnumber those who don’t by a very significant margin (more than 50 percentage points in every country except South Korea). Preference for the world to change in a more sustainable and equitable manner is most prevalent across the Latin America and Middle East-Africa regions as well as in Russia and Malaysia.”

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“Next week’s World Economic Forum Sustainable Development Impact Summit will address the achievement of the sustainable development goals and the appetite for transformation which will drive the “decade of delivery”….”

Fortune - ‘The whole world is coming together’: How the race for a COVID vaccine

is revolutionizing Big Pharma

https://fortune.com/longform/covid-vaccine-big-pharma-drugmakers-coronavirus-pharmaceutical-industry/

Hmm. Interesting framing of some sort of “Big Pharma Kumbaya”.

“Drugmakers are teaming up like never before to fight the coronavirus. The benefits could last well beyond the pandemic.”

Lancet (Health Policy) - Lessons learnt from easing COVID-19 restrictions: an

analysis of countries and regions in Asia Pacific and Europe

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32007-9/fulltext

Via the press release:

“The Lancet: Experts compare strategies for easing lockdown restrictions in Europe and Asia Pacific and identify key cross-country lessons

• Experts identify five key factors for strategies to ease lockdown restrictions - knowledge of infection levels, community engagement, public health capacity, health system capacity, and border control measures.

• Analysing the successes and failures of nine high-income countries and regions across these five domains, the authors find an absence of clear and consistent strategies for exiting restrictions and identify key cross-country lessons that can still be learnt.

• Experience with past pandemics in Asia Pacific meant they were more prepared than European countries, where policies of economic austerity have weakened health system in the years leading up to the current crisis.

• An ambition to achieve a ‘Zero COVID’ strategy (eliminating domestic transmission), like in New Zealand, should be considered by other governments, suggest the authors.

Authors of a review of policies, based on the experiences of nine high-income countries and regions’ easing of lockdown measures, published in The Lancet journal, are urging governments to consider five key factors in lockdown exit strategies. The report analyses nine countries and regions’ strategies for easing COVID-19 restrictions from a first wave of infections: five in the Asia Pacific (Hong Kong, Japan, New Zealand, Singapore, South Korea) and four in Europe (Germany, Norway, Spain, the United Kingdom)….”

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Lancet Editorial – COVID-19 in India: the dangers of false optimism

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32001-8/fulltext

Important read on India’s response so far and how it has been communicated, on the instigation of Modi.

Concluding: “Hope is important, and recognising successes is vital, especially during a pandemic. But presenting the current situation in India with a too positive spin not only clouds reality but also hampers vital public health initiatives. Perpetuating unrealistic claims or failing to honestly report negative news creates uncertainty among the public and health-care professionals, discouraging people from taking preventive action or taking public health messages seriously. India has the expertise in medicine, public health, research, and manufacturing to lead the nation through the COVID-19 pandemic. To capitalise on these attributes, the country's leaders must respect scientific evidence, expert commentary, and academic freedom, and not provide false optimism.”

Covid resources

Covid-19 sex-disaggregated tracker: updated

https://globalhealth5050.org/the-sex-gender-and-covid-19-project/

Cfr tweet: “The latest update from the #COVID19 sex-disaggregated data tracker is live. Now covering 175 countries around the world. Explore data & new dashboard. “

See also A new database tracks COVID-19’s effects on sex and gender.

Covid impact on other global health causes and programmes

Lancet Infectious Diseases - Indirect effects of the COVID-19 pandemic on malaria

intervention coverage, morbidity, and mortality in Africa: a geospatial modelling

analysis

Lancet Infectious Diseases;

“Substantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control. … … Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19….”

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See also the related Lancet Inf Diseases Commentary - COVID-19 in malaria-endemic regions:

potential consequences for malaria intervention coverage, morbidity, and mortality.

BMJ blog - Delivering for women, children, and adolescents during and after

covid-19

J Requejo et al ; BMJ Blog;

“A new report argues the decades long efforts to improve health should be shielded from the effects of the pandemic and the response to it.”

“In 2010 the Every Woman Every Child (EWEC) movement was launched by the UNSG to address the major health challenges facing women, children, and adolescents around the world. Since 2015 the movement has been tied to the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) (Global Strategy), which was developed as a concrete roadmap to reach related SDG targets. Since March 2020, when the covid-19 pandemic was declared, the challenges and prospects confronting the EWEC movement have radically shifted. A new report, which we have authored along with other EWEC partners, takes stock of progress and synthesises information on the impact of covid-19 on women’s, children’s, and adolescents’ health. The report, Protect the Progress: Rise, Refocus and Recover, highlights that although minimising the pandemic’s impact should be at the forefront of countries’ planning, other efforts to improve the health of all women, children, and adolescents should not be adversely affected. …”

PS: the report will be launched later today (25 Sept).

Raconteur - The dangers of focussing solely on COVID

https://www.raconteur.net/healthcare/covid-medical-research

Short but interesting analysis on the impact of Covid on research and funding for health care.

“Coronavirus is an all-consuming topic, both in terms of published research and funding. But opinion is split over whether it will reinvigorate healthcare spending or simply divert funds away from other needy causes.”

Devex -ODA influx needed to prevent ‘terrifying’ SDG backslide in fragile states

https://www.devex.com/news/oda-influx-needed-to-prevent-terrifying-sdg-backslide-in-fragile-

states-98126

“With elusive progress on the Sustainable Development Goals in fragile contexts drastically compromised by COVID-19, there is a critical need for effective aid spending, according to the Organisation for Economic Cooperation and Development’s “States of Fragility 2020” report. The annual report examined the most fragile contexts in 2020 in two parts: the global state of fragility before the virus struck, and how the resulting pandemic is dramatically impacting that landscape. It examines fragile state progress on the SDGs, and reviews levels of finance available to support them, calling for urgent action by OECD countries to maintain official development assistance levels,

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support access to other types of financing, and promote policies for fragile contexts. Of those living in extreme poverty globally, 76.5% live in fragile contexts — representing 23% of the world’s population. Only small improvements were found in the 2020 analysis of 57 countries and territories, and they are expected to be jeopardized by COVID-19, which has contributed to mass unemployment, increased poverty, heightened inequalities, political unrest, and rising gender-based violence….”

Borgen - The Rise of Midwifery in Developing Countries Amid COVID-19

Borgen;

The magazine, not the series : )

“…In April, the United Nations Population Fund (UNFPA) reported how the pandemic may lead to 47 million women in low-and-middle-income countries losing access to sexual and reproductive health services such as contraception. Moreover, a rise in COVID-19 cases will likely result in pregnant women becoming increasingly wary of health facilities in fear that they might catch the virus. Expectant mothers unfortunately have to worry about the exorbitant cost of delivering a baby on top of it all. As a result, midwifery in developing countries is becoming popular as a safe and cost-effective solution….”

NCDs

WHO - Tobacco responsible for 20% of deaths from coronary heart disease

https://www.who.int/news-room/detail/22-09-2020-tobacco-responsible-for-20-of-deaths-from-

coronary-heart-disease

Coverage via HPW - Heart Disease Deaths From Tobacco Use Are On The Rise

“Over the past two decades, the number of coronary heart disease deaths resulting from tobacco consumption has risen by 10,000 new deaths every year, warned WHO spokesperson Jaimie Guerra, in an interview with Health Policy Watch.”

Global Public Health - Assessing sector representation of non-state actors within

the World Health Organisation Framework Convention on Tobacco Control

N Sircar et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1823451

“The WHO Framework Convention on Tobacco Control (WHO FCTC) has accomplished much in advancing tobacco control. Non-governmental organisations (NGOs) were critical to the development of the Convention, who aided in mobilising stakeholders and advocated for core provisions of the treaty. NGOs and intergovernmental organisation are well recognised within the Convention and deemed essential to its continued implementation and evolution. Further, the treaty has been understood to be multidisciplinary in its aspiration to improve public health, and the role of

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both health sector and non-health sector stakeholders is an important component for describing the reach and potential for the Convention. In 15 years, however, non-state actors’ participation in the WHO FCTC Conference of the Parties (COP) – where Parties to the treaty engage in discussions that shape the treaty’s implementation and evolution – has been underrepresented in terms of sectoral diversity. We reviewed COP documents and assessed non-state actors’ participation in the COPs since the Convention's entry into force. We conclude that greater inclusion in COPs from health and non-health sector NGOs, intergovernmental organisations and UN Special Agencies would strengthen the global reach and full implementation of the WHO FCTC.”

HPW - Food Product Warning Labels Are A Cost-Effective Obesity Prevention

Strategy, Says New Vital Strategies Report

https://healthpolicy-watch.news/food-product-warning-labels-offer-hope-as-cost-effective-obesity-

prevention-strategy-says-new-vital-strategies-report/

“… Now, national regulatory authorities and food companies can create healthier food environments and combat worrying chronic disease trends through smart, cost-effective and comprehensive obesity prevention policies, based on new guidance from Vital Strategies, a global health NGO. “The guide makes available tools to help countries apply an effective and essentially free-to-government behavioral nudge to promote their population’s health,” said Nandita Murukutla, Vice President of Global Policy and Research at Vital Strategies….”

Access to (other than Covid-19 related) medicines

Stat - Novartis sells bonds tied to expanding access to medicines in poor countries

Stat

“In a first-of-its-kind move by a large drug maker, Novartis (NVS) raised approximately $2.1 billion last week by selling bonds that are tied directly to its progress in making medicines accessible in certain low- and middle-income countries. Specifically, the stated goal is to expand the number of patients who receive its brand-name medicines by at least 200% by 2025, as well as programs that market medicines to combat leprosy, malaria, Chagas, and sickle cell disease by at least 50% over the same period. If the company fails to meet those expanded access goals, however, investors will receive higher interest payments…..”

UHC

As already mentioned in this week’s intro, it’s just one year ago (23 Sept) that the UN HL political declaration on UHC was unanimously endorsed.

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The UHC2030 Related Initiatives are promoting important messages and learning

on health systems and the COVID-19 response.

https://www.uhc2030.org/blog-news-events/uhc2030-news/experiences-and-insights-on-health-

policy-and-systems-responses-to-covid-19-555412/

Must-read overview.

“The COVID-19 pandemic demonstrates powerfully the need for stronger health systems for both universal health coverage (UHC) and health security. This global crisis is a sharp reminder that everyone, everywhere should have access to quality and affordable health services. UHC2030, the global movement for stronger health systems for UHC, has emphasised the inter-connectedness of UHC and health emergencies and called on global leaders to remember their UHC commitments as they respond to COVID-19. Over six months since COVID-19 was declared a pandemic, important evidence and lessons are emerging on how to strengthen health systems to respond effectively to this and future crises, and protect us all. The UHC2030 Related Initiatives are a group of initiatives, networks and platforms that focus on different aspects of strengthening health systems. They have come together to share some of the key messages on health systems and UHC in the context of COVID-19, building on previous work….”

CGD (blog) - Getting to Convergence: How “Vertical” Health Programs Add Up to A

Health System

A Glassman, K Chalkidou et al;“https://www.cgdev.org/blog/getting-convergence-how-vertical-

health-programs-add-health-system

“Historically, donors and multilateral organisations have channelled funding in health through vertical disease programs, typically focussed on one disease area and a set of short- and medium-term objectives. We, and others, have argued that the “convergence” of verticals into a set of essential health benefits with pooled domestic and external funding to support its financing and delivery is the way ahead.”

Authors first give an overview of how, since 2006 the major global health funders have made modest shifts in the financing and delivery of their vertical programs. Still, funding wise, it’s still largely a status quo. Nevertheless, “Whether a consequence of transition from aid eligibility—or reduced revenues and aid alongside the COVID-19 and debt crises, or a change of philosophy amongst global health donors—the pressure to converge vertical programs into a health system approach, has become more pronounced in recent years. In particular there is heightened emphasis on health benefits packages developed as part of UHC policies with predominantly domestic financing. And it’s possible that a shift to budget support in aid in response to the COVID-19 crisis may speed this process….” Yet, there are challenges with convergence.

CGD will focus on the ‘How’ of this convergence: “.. In the coming year, we plan to look to countries that have made further progress towards convergence to offer insights on how they managed or are managing vertical programs and UHC plans. These insights could then be shared with countries considering developing a health benefits package as part of their UHC plans, such as Kenya, Zambia, and Cote d’Ivoire. The findings will help to inform whether incorporating vertical programs into UHC plans is feasible and a necessary key objective for a successful aid transition.”

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Decolonize Global Health

BMJ Global Health - Article processing charges are stalling the progress of African

researchers: a call for urgent reforms

Juliet Nabyonga-Orem, S Abimbola et al; https://gh.bmj.com/content/5/9/e003650

“…In this editorial, based on our collective and diverse experiences as African researchers, editors and funders, we highlight the plight of fellow African researchers whose desire to contribute to global knowledge, progress their careers and gain recognition for their work is hampered by deterring APCs in the face of meagre resources. In addition, to address this pressing challenge, we offer and call for urgent reforms by governments, local and international funders and donors, and the scientific publishing industry. … We offer three sets of urgent and necessary reforms….”

IHP - Developing an Activist Agenda for Health Policy and Systems Research in

Africa

K Munge, L Brady & Salma Abdalla; https://www.internationalhealthpolicies.org/featured-

article/developing-an-activist-agenda-for-health-policy-and-systems-research-in-africa/

Recommended reading ahead of the upcoming Health Systems Global Africa Convening (30 Sep-2 Oct), Decolonial thought and African Consciousness for socially just health systems: An imaginative space, supported by the HSG Africa Regional Network, the Atlantic Institute and Tekano.

This blog shares some of the collective reflections from a session at the Africa Health Economics and Policy Association (AfHEA) 5th Biennial Scientific Conference. “In March 2019 a group of researchers and practitioners met in Accra, Ghana, the first sub-Saharan nation freed from colonial rule, to interrogate what a decolonial lens offers for developing an activist agenda for health policy and systems research (HPSR) on the continent….”

Washington Post (Op-ed) - Africa has defied the covid-19 nightmare scenarios. We

shouldn’t be surprised.

K Attiah; https://www.washingtonpost.com/opinions/2020/09/22/africa-has-defied-covid-19-

nightmare-scenarios-we-shouldnt-be-surprised/

Op-ed on the comparative lack of attention for African success stories in world media.

“This pandemic has coincided with a global movement challenging anti-Black racism and white supremacy. This should have been a moment for media outlets to challenge corrosive narratives about Africa and the idea that Africans are not capable of effective policy-making. We could be learning from the experiences that Africans and their governments have had with pandemics and viral diseases, including Ebola and AIDS. Instead, the media has largely ignored the policy successes out of Africa. In doing so, Western media is reinforcing colonial narratives of Black inferiority and the inability of Black nations to govern themselves at all, much less govern better than resource-rich White nations….”

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Coming up soon -The Health Systems Africa Convening 2020 (Sept 30-2 October)

https://africanhealthfutures.co.za/

“This convening will foreground Africans as experts and highlight our own solutions to the challenges faced on the African continent. This will be achieved within in the area of African Health Policy and Systems Research (HPSR) through making space for scholars and practitioners to build collective capacity and engage in critical decolonial scholarship.”

Main aims: “(1) Become a catalyst for political project/process amongst African HPSR scholars to engage in conversations and deliberations for developing language, theories, methodologies and research priorities for a decolonial HPSR paradigm/orientation. (2) Become a catalyst for political project/process amongst African HPSR scholars to engage in conversations and deliberations for developing language, theories, methodologies and research priorities for a decolonial HPSR paradigm/orientation.”

Tweet Claire Standley

(on the GHS webinar with Seye Abimbola & Sridhar Venkatapuram from this week, on the uses of knowledge in global health)

“What knowledge is important? @seyeabimbola suggest that "thought" pieces and perspectives have been among the most important @GlobalHealthBMJ publications on #COVID19, noting his sense of responsibility to "shift the center" to voices previously at the margins.”

Finally, a link: Medium - The Overwhelming Racism Of COVID Coverage - Western media cannot write Western failure.

Lancet Global Health – October issue

https://www.thelancet.com/journals/langlo/issue/vol8no10/PIIS2214-109X(20)X0011-8

Check out, among others, the following Comments:

• Launching the Kofi Annan Global Health Leadership Programme

By John Nkengasong (African CDC) et al. “On May 25, 2020, as part of the commemorations for Africa Day, the African Union Commission launched the Kofi Annan Global Health Leadership Programme, as a flagship undertaking of the Africa Centres for Disease Control and Prevention (CDC)….”

• Leadership training to accelerate progress in public health in sub-Saharan Africa: time for

action (on the Afya Bora leadership programme)

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« …By moving beyond research capacity strengthening, leadership programmes such as Afya Bora accelerate effective research use, prioritise public health problems, and foster links between ministries of health, non-governmental organisations, and academic institutions. Africa-centric leadership training that rapidly forges a network of young leaders who can identify locally relevant health priorities, scale up evidence-based solutions, and communicate and marshal resources is key to improving public health. …”

And this research article:

The allocation of US$105 billion in global funding from G20 countries for

infectious disease research between 2000 and 2017: a content analysis of

investments

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30357-

0/fulltext#.X2swW0AqNhM.twitter

The authors present research on investments into infectious diseases research from funders in the G20 countries across an 18-year time period spanning 2000–17, comparing amounts invested for different conditions and considering the global burden of disease to identify potential areas of relative underfunding.

Interpretation of the findings: “HIV research received the highest amount of investment relative to DALY burden. Scabies and syphilis received the lowest relative funding. Investments for high-threat pathogens (eg, Ebola virus and coronavirus) were often reactive and followed outbreaks. We found little evidence that funding is proactively guided by global burden or pandemic risk….”

Some papers & reports of the week

Ethics & International Affairs - COVID-19, the UN, and Dispersed Global Health

Security

Sophie Harman; E & IA.

“The response to COVID-19 demonstrates an inclusive and dispersed form of global health security that is less reliant on the UN Security Council or the World Health Organization (WHO). While WHO remains central to fighting the pandemic, the dispersed global health security addressing the crisis is inclusive of the wider UN system, civil society, and epistemic communities in global health. As part of the special issue on “The United Nations at Seventy-Five: Looking Back to Look Forward,” this essay argues that instead of facing crisis or criticism like WHO, this inclusive and dispersed form of global health security provides mechanisms of resilience and support to the UN at the height of global political tensions surrounding COVID-19.”

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New Political Economy - The Wealth Defence Industry: A Large-scale Study on

Accountancy Firms as Profit Shifting Facilitators

L Ajdacic et al ;

https://www.tandfonline.com/doi/full/10.1080/13563467.2020.1816947#.X2iHiIKbf0N.twitter

“Corporations increasingly engage in innovative ‘tax planning strategies’ by shifting profits between jurisdictions. In response, states try to curtail such profit shifting activities while at the same time attempting to retain and attract multinational corporations. We aim to open up this dichotomy between states and corporations and argue that a wealth defence industry of professional service firms plays a crucial role as facilitators. We investigate the subsidiary structure of 27,000 MNCs and show that clients of the Big Four accountancy firms show systematically higher levels of aggressive tax planning strategies than clients of smaller accountancy firms. We specify this effect for three distinct strategies and also uncover marked differences across countries. As such we provide empirical evidence for the systematic involvement of auditors as facilitators in corporate wealth defence.”

But change is at last in the air, if we can believe Klaus Schwab et al: ) See below.

WEF (prepared in collaboration with Deloitte, EY, PwC and KPMG)- Measuring

Stakeholder Capitalism Towards Common Metrics and Consistent Reporting of

Sustainable Value Creation

WEF;

Via Devex: “The Big Four accounting firms — EY, PwC, Deloitte, and KPMG — came together to narrow sustainability metrics to a set of 21 reportable metrics in key areas of governance, people, prosperity, and planet. The World Economic Forum-led project seeks to improve the ways that companies measure and demonstrate their contributions toward more prosperous, fulfilled societies and a more sustainable relationship with the planet. “

On ‘Stakeholder capitalism metrics’. Probably still to be found in the future in the library section ‘fairy tales’. As was the case in the past 50 years of WEF.

Elsevier Report: Mapping research to advance the SDGs

https://www.elsevier.com/connect/sdg-report?_lrsc=cdfa3db2-e92e-4e01-badc-90b30229ccb1

“Elsevier’s analysis reveals gaps and strengths to support the UN’s 2030 Sustainable Development Goals.”

Global Health Promotion – A patchwork approach to gender equality weakens the

SDGs: time for cross-cutting action

R Morgan et al ; https://journals.sagepub.com/doi/full/10.1177/1757975920949735

“…At 5 years into the 2030 agenda, it is clear that many countries are not on track to meet some of the SDGs and targets. There is also fear the COVID-19 pandemic will result in setbacks and

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complacency from governments to commitments previously made. In order to realize women’s and girls’ rights, concerted action on gender equality throughout the SDGs is needed….”

Some blogs and other mainstream news of the week

Lancet World Report - Inappropriate behaviour claims at Stop TB prompt review

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32003-1/fulltext

“An independent external review is under way after allegations of inappropriate behaviour, including by Executive Director Lucica Ditiu. Talha Burki reports.”

See also last week’s IHP news (on a NYT report).

WHO and UNICEF recommit to accelerating health and well-being at all ages

https://www.who.int/news-room/detail/18-09-2020-who-and-unicef-recommit-to-accelerating-

health-and-well-being-at-all-ages

From late last week (18 Sept). “New partnership calls for key actions in universal health coverage, mental health, emergencies and nutrition.”

“The World Health Organization (WHO) and UNICEF [today] signed a new collaborative framework which will accelerate joint public health efforts that put the most marginalized and vulnerable populations first. The new Strategic Collaboration Framework builds on a robust 70-year collaboration between the two organizations, and prioritizes four strategic areas for immediate attention and action at all levels of the organizations: universal health coverage, through a primary health care and health systems approach; mental health and psychosocial wellbeing and development; public health emergencies; and maternal and child nutrition. Additionally, the two organizations signed a new Joint Programme on Mental Health and Psychosocial Well-being and Development of Children and Adolescents….”

Thomson Reuters - World becoming less tolerant of migrants - Gallup poll

Reuters;

“ Seven European countries were ranked the least accepting, while the sharpest downturns in public opinion came in Peru, Ecuador and Colombia…”

“The world is becoming less tolerant of migrants, according to a poll released on Wednesday as Europe prepared to unveil a new asylum plan in the wake of a blaze at an overcrowded camp in Greece that left thousands without shelter. Seven European countries, led by North Macedonia, Hungary, Serbia and Croatia, topped the Gallup index of the world's least-accepting countries. But the sharpest changes in attitudes were in Peru, Ecuador and Colombia, which have seen an influx of Venezuelans fleeing turmoil at home. Canada was the most welcoming country toward migrants,

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followed by Iceland and New Zealand, according to the index based on more than 140,000 interviews in 145 countries and regions….”

HSG blog - Evolving evidence, fake news, and emerging contexts: researchers at

the nexus of EIDM for COVID-19

Daniela C Rodriguez et al ; https://healthsystemsglobal.org/news/evolving-evidence-fake-news-and-

emerging-contexts-researchers-at-the-nexus-of-eidm-for-covid-19/

Report of a recent webinar. “The ecosystem around Evidence-Informed Decision-Making (EIDM) has been growing steadily in Africa over the years. We have seen more individuals, organizations and governments paying attention to evidence for their policies. This seems to have been accelerated – both positively as well as negatively – during COVID-19. … … A webinar ‘Evolving evidence, fake news, and emerging contexts: researchers at the nexus of EIDM for COVID-19‘ co-hosted by the Africa Evidence Network (AEN) and the Translating Evidence to Action Thematic Working Group of Health Systems Global delved into the experiences of three African researchers as they support an EIDM in COVID-19 response in Cote d’Ivoire, Nigeria and Uganda….”

Global Dashboard - We can’t rely on any leader to pull us out of the inequality

crisis: it’s up to us

Ben Phillips; https://www.globaldashboard.org/2020/09/18/we-cant-rely-on-any-leader-to-pull-us-

out-of-the-inequality-crisis-its-up-to-us/

Ben Phillips introduces his new book, providing some key messages.

“My new book, How to Fight Inequality, is published today. I look back at when inequality had been beaten before, and found that inequality was never beaten through the grace of saviour leaders, but was instead beaten by people power. Here, I discuss what it will take beat inequality and to organise that people power once again.”

Excerpt: “… Successful organising to take on inequality is not only about unions, not only about grassroots movements, not only about faith-based groups; it is about all of them, and more. This is why the US Poor People’s Campaign’s Revd William Barber talks of ‘fusion coalitions’: collective power comes unity across differences. …. … Despite the huge hurdles faced in confronting inequality, we’ve seen glimpses worldwide of what is possible, of what progress in the fight against inequality looks like: the mobilisation of a million farmers in Uganda against taxes on agricultural inputs; the ending of VAT on bread in Zambia; the handing back of land illegally acquired in Cambodia; the resurgence of racial justice activism driven by the Black Lives Matter movement in the US; organising by trade unions, which has secured increases in minimum wages in Nigeria, Senegal, and South Africa; the rising movements in response to the COVID-19 crisis worldwide, of people demanding free healthcare for all, better conditions and pay for the workers who have kept society going, and accountability for the pandemic profiteers. “

He concludes: “The record of the past on beating inequality, and the emerging movements to confront it today, point to the basis of transformative change being not great rescuers but us, together.”

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Devex - NGOs accused of hiding misconduct behind gag orders

https://www.devex.com/news/ngos-accused-of-hiding-misconduct-behind-gag-orders-98064

“Whistleblowers are raising concerns about the use of nondisclosure agreements within the global development and humanitarian sector, with some suggesting they are being used to suppress allegations of misconduct. Also known as confidentiality or gag clauses, experts say they are becoming more common in employment contracts with development organizations, and are also sometimes used in termination settlements. However, the secretive nature of such agreements — which prevents signatories from revealing certain information publicly — means little is known about how common they are in the sector or how they are being used. Although there may be legitimate uses of NDAs, some worry the agreements are being used to cover up wrongdoing and reinforce power imbalances, despite promises from organizations to strengthen safeguarding policies and protect those who speak up….”

Brookings (blog) - Doing Business rankings that endanger good regulations

V Thomas; https://www.brookings.edu/blog/future-development/2020/09/21/doing-business-rankings-that-endanger-good-regulations/

“Vinod Thomas argues that the Bank needs to do a lot more than just audit data to correct the issues with the Doing Business report.” Making a lot of sense, this analysis & recommendations.

Excerpt: “To be sure, onerous, unpredictable processes hamper the business conditions in many countries and improving the efficiency of business norms can help economic growth prospects. But at issue is across-the-board deregulation, borne out of a mistaken worldview equating private business interest with social interest, with no accounting for harmful spillovers of business activities such as growth-debilitating climate change. As such, liberalizing regulations alone should not be labeled “reform”: in the analogy of improving “economic cholesterol,” the patient needs to both reduce bad cholesterol and increase good cholesterol. The World Bank ought not to drive development with the one-sided DB indicator when the United Nations promotes a more holistic path of Sustainable Development Goals….”

Tweet of the week

Antoine de Bengyi (tweeting on Kai Kupferschmidt’s analysis in Science of the Covax boost)

“156 countries joined #COVAX for a global approach to a #Covid_19 vaccine. BUT: - Not enough money to implement the plan - Over half of vaccines to be produced already bought by rich countries, according to @Oxfam https://oxfam.org/fr/node/14233 - Big pharma’s business model unchallenged.”

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Global health events

Lancet (Comment) - The Riyadh Declaration: the role of digital health in fighting

pandemics

B A Knawy et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31978-

4/fulltext

“The COVID-19 pandemic has exposed weaknesses in health and care systems and global public health responses, some of which can be addressed through data and digital science. The Riyadh Declaration on Digital Health was formulated during the Riyadh Global Digital Health Summit, Aug 11–12, 2020, a landmark forum that highlighted the importance of digital technology, data, and innovation for resilient global health and care systems. Our panel of 13 experts articulated seven key priorities and nine recommendations (panel) for data and digital health that need to be adopted by the global health community to address the challenges of the COVID-19 pandemic and future pandemics….”

Global governance of health

Reuters - Three women in final five for WTO leadership race

https://www.reuters.com/article/us-trade-wto/three-women-in-final-five-for-wto-leadership-race-

idUSKBN2691EW

Update on the WT leadership race from late last week. “Three women, two of them from Africa, advanced to the second round of selection to become the next director-general of the World Trade Organization as the field was cut from eight to five, the Geneva-based body said on Friday.”

UHC

The UHC2030 Secretariat is looking for new Co-Chairs for the UHC2030 Steering

Committee. Are you interested?

https://www.uhc2030.org/blog-news-events/uhc2030-news/announcement-applications-sought-

for-new-uhc2030-co-chairs-555409/

Some of you might be.

UHC 2030 - Moving together for UHC: listening to civil society on how to

strengthen social participation in policy and decision-making

https://www.uhc2030.org/blog-news-events/uhc2030-news/moving-together-for-uhc-listening-to-

civil-society-on-how-to-strengthen-social-participation-in-policy-and-decision-making-555407/

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“A recent consultation with civil society organizations (CSOs) has reinforced the importance of practical and flexible guidance for meaningful social participation, communicating the benefits of social participation to decision-makers, and widening access of marginalized groups to national policy and decision-making processes.”

For more, see also here.

Axios - If Trump replaces Ginsburg, the ACA really is at risk

Analysis;

Read why.

“The Supreme Court vacancy created by Ruth Bader Ginsburg’s death leaves the Affordable Care Act in much greater jeopardy than it was just a few days ago. …. The big picture: Conventional wisdom had held that Chief Justice John Roberts would likely join with the court’s liberals to save the ACA once again. But if President Trump is able to fill Ginsburg’s former seat, Roberts’ vote alone wouldn’t be enough to do the trick, and the law — or big sections of it — is more likely to be struck down. … … The backstory: This challenge to the ACA argues that the law’s individual mandate became unconstitutional when Congress nullified it in 2017 — and that the rest of the ACA must fall along with it. Where it stands: If Trump is able to replace Ginsburg with a stalwart conservative, the risk to the ACA’s core provisions will grow significantly.”

BMJ GH - The cost-effectiveness of using performance-based financing to deliver

the basic package of health services in Afghanistan

A Salehi et al ; https://gh.bmj.com/content/5/9/e002381

“… There is a dearth of economic evaluations of PBF in the ‘real world’. Afghanistan implemented PBF between 2010 and 2015 and evaluated the programme using a pragmatic cluster-randomised control trial. We conducted a cost-effectiveness analysis of the PBF programme in Afghanistan, compared with the standard of care, from the provider payer’s perspective. The incremental cost-effectiveness ratio of PBF compared with the standard of care was US$1242 per disability-adjusted life year averted; not cost-effective when compared with an opportunity cost threshold of US$349. Incentive payments were the main contributor to PBF financial cost (70%) followed by data verification (23%), staff time (5%) and administration (2%). The unit cost per case of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) services in the standard of care was US$0.96 (95% CI 0.92–1.0), US$4.8 (95% CI 4.1–6.3) and US$1.3 (95% CI 1.2–1.4), respectively, whereas the cost of ANC, SBA and PNC services per case in PBF areas were US$4.72 (95% CI 4.68–5.7), US$48.5 (95% CI 48.0–52.5) and US$5.4 (95% CI 5.1–5.9), respectively. To conclude, our study found that PBF, as implemented in the Afghan context, was not the best use of funds to strengthen the delivery of maternal and child health services. The cost-effectiveness of alternative PBF designs needs to be appraised before using PBF at scale to support health benefit packages. PBF needs to be considered in the context of funding the range of constraints that inhibit health service performance improvement.”

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Journal of Equity in Health - Financial risk protection of Thailand’s universal

health coverage: results from series of national household surveys between 1996

and 2015

Viroj Tangcharoensathien et al ; https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-

020-01273-6

“…this study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002….”

Planetary health

NYT - Climate disruption is now locked in. The next moves will be crucial

https://www.nytimes.com/2020/09/22/climate/climate-change-future.html

Disturbing read.

“America is now under siege by climate change in ways that scientists have warned about for years. But there is a second part to their admonition: Decades of growing crisis are already locked into the global ecosystem and cannot be reversed.”

“… Conversations about climate change have broken into everyday life, to the top of the headlines and to center stage in the presidential campaign. The questions are profound and urgent. Can this be reversed? What can be done to minimize the looming dangers for the decades ahead? Will the destruction of recent weeks become a moment of reckoning, or just a blip in the news cycle? The Times spoke with two dozen climate experts, including scientists, economists, sociologists and policymakers, and their answers were by turns alarming, cynical and hopeful.”

FT - China pledges to be ‘carbon-neutral’ by 2060

https://www.ft.com/content/730e4f7d-3df0-45e4-91a5-db4b3571f353

“Surprise move at UN by world’s biggest emitter increases pressure on US over climate commitments.”

“China, the world’s biggest producer of greenhouse gases, has said it will cut its carbon dioxide emissions to nearly zero by 2060, in a surprise move announced at the virtual UN General Assembly in New York. President Xi Jinping told the UN meeting that China planned to be “carbon neutral” before 2060, adding that the coronavirus pandemic had showed the world needed a “revolution” that would speed up “green development”….”

See also a tweet by Kevin Anderson: “For “well below 2°C” China needs to peak CO2 by 2025 &be zero by 2050, at the v.latest; earlier still for 1.5°C.”

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Science (News) - Plant trees or let forests regrow? New studies probe two ways to

fight climate change

https://www.sciencemag.org/news/2020/09/plant-trees-or-let-forests-regrow-new-studies-probe-two-ways-fight-climate-change

“Both approaches have promise but face perils, researchers find.” Based on two new studies.

Devex - Q&A: Why Africa is the priority for the Global Center on Adaptation

https://www.devex.com/news/q-a-why-africa-is-the-priority-for-the-global-center-on-adaptation-98154

“On Sept. 16, African leaders and development partners came together for a virtual meeting to inaugurate the Africa office of the Global Center on Adaptation, which will be hosted by the African Development Bank in Abidjan, Côte d'Ivoire….”

And a link: Melting Antarctic ice will raise sea level by 2.5 metres – even if Paris climate goals are met, study finds (Guardian)

Infectious diseases & NTDs

WHO – Overview: Progress towards achieving global tuberculosis targets and

implementation of the UN Political Declaration on Tuberculosis

https://www.who.int/publications/m/item/overview-progress-towards-achieving-global-

tuberculosis-targets-and-implementation-of-the-un-political-declaration-on-tuberculosis

“This is a summary review of progress towards global TB targets, and in implementation of the political declaration of the UN High Level Meeting on TB declaration. Overall the report shows that high-level commitments and targets have galvanized global and national progress towards ending TB, but that urgent and more ambitious investments and actions are required to put the world on track to reach targets, especially in the context of the COVID-19 pandemic.”

Link:

NEJM Perspective - Ebola Response Priorities in the Time of Covid-19.

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AMR

BMJ Global Health (Analysis) - Setting the standard: multidisciplinary hallmarks

for structural, equitable and tracked antibiotic policy

https://gh.bmj.com/content/5/9/e003091

“…. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an ‘implementation gap’. At a policy level, the design of internationally salient solutions that are able to address AMR’s interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise ‘good’ antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.”

NCDs

Plos Med - The prevalence of mental illness in refugees and asylum seekers: A

systematic review and meta-analysis

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003337

“In a systematic review and meta analysis, Rebecca Blackmore and colleagues investigate the prevalence of mental illness among adult refugees and asylum seekers in studies undertaken across 15 countries.”

BMJ GH - The cost-effectiveness of hypertension management in low-income and

middle-income countries: a review

D Kostova et al ; https://gh.bmj.com/content/5/9/e002213

“Hypertension in low-income and middle-income countries (LMICs) is largely undiagnosed and uncontrolled, representing an untapped opportunity for public health improvement. Implementation of hypertension control strategies in low-resource settings depends in large part on cost considerations. However, evidence on the cost-effectiveness of hypertension interventions in LMICs is varied across geographical, clinical and evaluation contexts. We conducted a comprehensive search for published economic evaluations of hypertension treatment programmes in LMICs. … …. Although comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score, most interventions that reported cost per averted disability-adjusted life-year (DALY) were cost-effective, with costs per averted DALY not

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exceeding national income thresholds. Programme elements that may reduce cost-effectiveness included screening for hypertension at younger ages, addressing prehypertension, or treating patients at lower cardiovascular disease risk. “

Access to medicines

FT - India and Pakistan ramp up remdesivir production under Gilead deal

https://www.ft.com/content/d1d69573-c3f8-4e6b-b147-2f29e9721c0d

“Both countries have large supplies of generic Covid-19 treatment but distribution to other places has been slow.”

Excerpts: “India and Pakistan have ramped up production of the coronavirus drug remdesivir under a licensing agreement with Gilead Sciences, but onward distribution to other developing countries has been slow. Vamsi Krishna Bandi, managing director at pharma company Hetero, said there was no longer a remdesivir shortage in India — the country with the second-highest number of coronavirus infections in the world — and that the business had delivered about 800,000 doses of the drug domestically since starting production in June. But while doctors in India are prescribing the experimental Covid-19 treatment, the majority of the 127 countries in the Gilead licensing deal have yet to start buying it. Few countries “have actually put in a system for procurement”, said Mr Bandi, adding that few African countries in particular were placing orders. Hetero has exported to 25 countries, while Cipla, another Indian manufacturer, said it had only shipped to South Africa….”

“… Since May, Gilead has signed licensing agreements with nine generic pharmaceutical companies in India, Pakistan and Egypt to supply remdesivir to 127 developing countries, following a model pioneered during the Aids/HIV epidemic. The licences are royalty-free for those countries until the World Health Organization declares the end of the Public Health Emergency or a Covid-19 treatment other than remdesivir, or a vaccine, is approved. The drug, which costs $390 for one dose in the US, costs as little as Rs2,800 ($38) in India. “Currently, our licensees have made remdesivir available to patients in need in more than 40 countries, and we expect this number will continue to grow over the coming months,” Gilead said, adding “we are pleased by the rapid progress made by this effort”.

Stat - Public funding underwrote much of the development of J&J’s drug for TB,

analysis finds

https://www.statnews.com/pharmalot/2020/09/23/tuberculosis-jnj-drug-prices/

“Amid ongoing debate over taxpayer dollars used to generate medicines, a new analysis contends that public investments contributed up to five times more than what Johnson & Johnson (JNJ) spent to develop Sirturo, its groundbreaking drug for tuberculosis. Public sector funds worth an estimated $455 million to $747 million were used to pay for clinical trials, tax credits, administration of a tax-deductible donation program, and a redeemable regulatory voucher, according to the analysis, published in PLoS One. By comparison, the health care giant was estimated to have invested anywhere from $90 million to $240 million on getting the tuberculosis drug to market….”

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Human resources for health

Family Medicine & Community Health - Reformulation and strengthening of

return-of-service (ROS) schemes could change the narrative on global health

workforce distribution and shortages in sub-Saharan Africa

S A Mabunda et al ; https://fmch.bmj.com/content/fmch/8/4/e000498.full.pdf

“Despite policies for addressing shortages and maldistribution of health professionals, sub-Saharan Africa continues to experience shortages and maldistribution of skilled health professionals. Policies such as return-of service schemes or state-funded educational initiatives do not seem to be achieving their intended objectives, potentially due to poor design, implementation; and lack of monitoring and evaluation of the strategies. A focus by global health experts on strengthening and reformulating educational initiatives offers potential for producing, retaining and recruiting health professionals.”

IJEH -Tracking health sector priority setting processes and outcomes for human

resources for health, five-years after political devolution: a county-level case

study in Kenya

https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01284-3

“Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH.”

Miscellaneous

Report of the United Nations Economist Network for the UN 75th Anniversary

Shaping the Trends of Our Time

https://www.un.org/development/desa/publications/wp-content/uploads/sites/10/2020/09/20-

124-UNEN-75Report-2-1.pdf

Cfr tweet Ben Phillips: “The UN Economist Network finds inaction on inequality is “not due to a lack of technical advice or even in most cases adequate capacity. More often, mobilizing support for policy responses to inequality runs into a wall of vested interests.””

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Guardian - Internal displacements reach 15m in 2020 with worst 'still to come' –

report

https://www.theguardian.com/global-development/2020/sep/23/internal-displacements-reach-

15m-in-2020-with-worst-still-to-come-report

“Millions of people were uprooted from their homes by conflict, violence and natural disasters in the first six months of this year, research has found. Nearly 15m new internal displacements were recorded in more than 120 countries between January and June by the Swiss-based Internal Displacement Monitoring Centre (IDMC). Cyclones, floods, bushfires and locust infestations – among other natural disasters – accounted for the vast majority, or 9.8m displacements, according to a report published on Wednesday. Conflict and violence, primarily in Syria, the Democratic Republic of the Congo and Burkina Faso, accounted for another 4.8m displacements, the IDMC found….”

Guardian - Global preparation: how different countries planned for the second

wave of Covid-19

https://www.theguardian.com/world/2020/sep/20/global-preparation-how-different-countries-

planned-for-the-second-wave-of-covid-19

Comparative piece.

BMJ - Covid-19: Experts divide into two camps of action—shielding versus blanket

policies

https://www.bmj.com/content/370/bmj.m3702

This is not just a UK debate, clearly. “Two open letters sent to the UK’s four chief medical officers signal the polarisation of opinion among medical professionals over how the government should tackle the emerging “second wave” of covid-19. One group of doctors and academics is calling for segmentation and shielding of the most vulnerable groups of people rather than local or national lockdown measures. However, another group says that the government should continue efforts to suppress the virus across the entire population….”

Guardian - The Lancet changes editorial policy after hydroxychloroquine Covid

study retraction

https://www.theguardian.com/world/2020/sep/22/the-lancet-reforms-editorial-policy-after-

hydroxychloroquine-covid-study-retraction

“New policy comes after serious quality control questions were raised about the data relied on by a study in the medical journal.” See also last week’s IHP newsletter.

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NYT - A Covid-19 Vaccine for Children May Not Arrive Before Fall 2021

https://www.nytimes.com/2020/09/21/parenting/kids-vaccine-coronavirus.html

“While scientists are rushing to develop an immunization for adults, no one has started the process yet for children.”

Plos Biology - Quantifying and contextualizing the impact of bioRxiv preprints

through automated social media audience segmentation

Plos Biology

Some of the findings: “ We estimate that 96% of the preprints analyzed are dominated by academic audiences on Twitter, suggesting that social media attention does not always correspond to greater public exposure. …” “

“Surprisingly, we also found that 10% of the preprints analyzed have sizable (>5%) audience sectors that are associated with right-wing white nationalist communities. Although none of these preprints appear to intentionally espouse any right-wing extremist messages, cases exist in which extremist appropriation comprises more than 50% of the tweets referencing a given preprint.”

GAVI – 10 reasons why pandemic fatigue could threaten global health in 2021

https://www.gavi.org/vaccineswork/10-reasons-why-pandemic-fatigue-could-threaten-global-

health-2021

“Being in a constant state of high alert and uncertainty is exhausting. But health officials warn that we can’t let our guard down yet and that resisting living with the ‘new normal’ could threaten our health.”

Lancet World Report - Media reports reveal political interference at the US CDC

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32002-X/fulltext

“News accounts say that Trump administration officials wanted to edit and approve COVID-19 studies and publish guidance without the usual scientific review. Susan Jaffe reports.”