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IHP news 577 : Just another germaphobe Monday

( 19 June 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,

While the pandemic leads to a relentless stream of (often downright horrific) tragedies for many people and countries, I hope I can nevertheless cheer you up a bit in these dire times of ours with the story of my (100 km) commute to Antwerp, last Monday - the first time in 10 weeks!

To set the scene, we’re talking about a middle-aged male here, with not much talent for stoicism. There are mitigating circumstances, of course. My IHP job basically requires me to wake up with Covid-19 and go to bed with it, and this already for almost 6 months now. You can describe my

relationship with SARS-CoV-2 thus as “fairly steady” one. I probably also read a few too many horror stories on people with severe Covid-19 by now. Fortunately, the spiked virus still doesn’t pop up in my nightmares ( and I intend to keep it that way).

Anyway, against that overall backdrop, the train journey felt like an Adventure. Yes, with capital letter. (Don’t blame my age for this utter lack of adventurism- I’ve been told two thirds of the people

in age bracket 20-34 now prefer holidays in places “that look good on Instagram”. 😊 )

On Monday morning, I obviously hadn’t seen the new Lancet Global Health Study yet (as it still had to come out), on the presumably 11 categories of underlying conditions that may raise the risk of severe Covid-19. Rest assured, though, I already feel part of the estimated 1.7 billion that are ‘at risk’, since end of January or so. Indeed, risk factors have been piling up lately, both real and imaginary ones: male; middle aged; bald; blood type A plus; hypertension; a history of diabetes in the family; a “chronic neurological disorder” ? (would be weird if I didn’t have one after over a

decade IHP 😊); excessive Zooming probably also doesn’t boost one’s vitamin D level …. Etc. You name it, I have it.

True, I’m doing a lot better in terms of the “underlying risk factors” or social determinants of health (though things could still go rapidly downhill, once my contract expires next year, as they “pave the

road” with people with a political science background in my country 😊 ). Also, the state of our health system and (admittedly, incredibly complicated) governance aren’t the worst in the world, unlike what you might think, when considering the Belgian Covid-19 stats in international perspective. We ain’t Brazil (we mainly let down the elderly people in nursing homes, sadly).

But to come back on the train journey, it was just lovely. Compulsory masks everywhere; hand gel ready in the pocket of my trousers; I deeply contemplated whether it was kosher or not to check my

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smartphone ( my addiction proved too strong); I also obviously preferred others to open the doors (and if nobody was around, there was always “the elbow”), … When we finally arrived in Antwerp, I saw somebody had left something by accident on a seat. Thankfully, the person before me had

noticed as well, as there was absolutely no way I was going to pick that thing up 😊!

After dropping my mask in a dustbin, I then walked to the ITM premises. A couple of chocolate croissants on the way – fuck it, I thought, won’t make much difference anyway anymore for my ‘underlying health conditions’ profile. Good to see the server in the bakery wore gloves, though.

At the institute then, naturally, it was great to see some of my colleagues back in real life, after 10 weeks of Z(zzzzz)-ooming & other virtual communication. Though I have to admit seeing a colleague hug somebody else after such a long time felt almost like a criminal offence.

Sanitizers and liquids are everywhere now, already from the moment you step through the door. When a colleague with a bariton voice addresses you, instinctively you walk back a few steps. When you explain something to another colleague, half a second later you realize that notorious “1.5 m” has vanished into thin air. I also made a promise to myself to stay clear from that coffee machine that everybody uses – I just don’t trust it (still, never having been very consistent in my life, I already made an exception in the afternoon for the chocolate milk).

Thankfully, we had a unit meeting in open air, even lunch in open air! A bearded colleague generously switched places with me, because of the sunshine. Though he was breathing in my neck. Wicked fun, the workplace these days.

In short, all those things that used to be part of ‘normal life’ seem to involve a risk now. Minimal, yes, but hard to completely think (or wish) away.

Finally, let’s not forget the sanitary facilities at ITM. The otherwise somewhat dull and uninspiring room now feels like “Death is awaiting you” , if you don’t follow meticulously the instructions. I also studiously avoided ITM’s clinic. They won’t see me there for months, if all goes well.

At the end of a wonderful germaphobe Monday, on the train journey back home, I felt like I had caught that bloody virus at least 20 times. Yes, you can now officially call me a Covid wussy.

Still, I’m already looking forward to my next Adventure: boarding a plane. Probably somewhere in 2025!

Enjoy your reading.

Kristof Decoster

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Featured Article

Covid-19 and unregulated private hospitals: Lessons for Private Sector Engagement

Sana Contractor and Inayat Singh Kakar (People’s Health Movement and Medical Support Group,

India)

Last week, a “rate” list from a leading for-profit private hospital in Delhi went viral on social media, probably because of the sheer obscenity of the charges that it displayed. The costs for a bed, as per the list, ranged from Rs. 25,000 (about $330) per day in a general ward (no private room, without isolation or ventilator) to Rs. 72,000 (about $950) per day for an ICU bed with ventilator. Given that these rates are grossly unaffordable even by Indian upper-middle class standards, the picture signifies the impossibility of getting affordable quality care for COVID, in India’s capital today. With public hospitals pushed to the brink, COVID patients are being forced to seek private care, and this makes the issue of price regulation critical. A writ petition filed by Advocate Sachin Jain last month in the Supreme Court of India (to which the All India Drug Action Network and the People’s Health Movement (Mumbai) impleaded) is arguing for precisely this.

It is noteworthy that India’s private health sector - one of the largest and most unregulated in the world – was visibly absent in the initial weeks of the COVID pandemic. In April, it was reported that the private sector was handling only one-tenth of the COVID patient load, even though it had two thirds of hospital beds and 80 percent of ventilators in the country. While this was a result of several factors ranging from restrictions placed due to government policy, to “playing it safe”, even in states where no restrictions were placed on private hospitals in treating COVID patients, they remained reluctant to admit such patients. Further, private hospitals also withdrew from providing non-COVID care and this is critical given that a large proportion of healthcare in the country is serviced through private players. In order to correct this, several state governments had to issue special circulars instructing private providers to resume services. As the burden of the COVID response on India’s flailing public health system increases, various state and national governments have called upon private hospitals to deliver care.

Unaffordable costs for COVID care

Cost regulation, however, has remained contentious – while in some states the government is providing free treatment in requisitioned private hospitals by reimbursing them at fixed package rates (West Bengal), and states such as Maharashtra have capped prices on treatment, in others, like Delhi, select private hospitals have been designated to provide COVID-19 treatment without any price regulations. But even in states with price regulation, corporate private hospitals continue to profiteer by charging exorbitant and irrational costs to patients. Components such as high-end medicines, Personal Protective Equipment (PPE), COVID-19 tests, interventional procedures which constitute a significant portion of bills are excluded from the costs capped by governments. For instance, an analysis (by the impleaders) of bills from corporate hospitals in three metropolitan cities shows two distinct ways in which corporate hospital chains are profiteering on PPE- one, patients are being charged inflated costs of PPE; and two, each PPE kit is billed to multiple patients. A common practice which hospitals have used to evade transparency is to bill PPE as a per day cost, without mentioning the number of PPE kits used or per unit cost of each PPE kit. In their petition to

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the court, impleaders also note that typically, COVID treatment at present is largely supportive and does not require surgical intervention. Yet, the costs often surpass that of major surgeries. Even patients with private insurance have borne out of pocket expenses, as insurance companies have refused to cover costs of extended duration of hospitalization, PPEs, biomedical waste disposal charges and other requirements for COVID care such as care and hygiene charges, thermometer and handrub. Private insurance companies in India have gone on record to say that private hospitals are charging unnecessarily high costs of care which insurance companies cannot afford to cover.

Increasing costs for non-COVID care

An ignored facet of overcharging during the Covid-19 crisis has been the increase in costs of non-COVID treatment in private hospitals during the pandemic. As the number of cases has risen, more and more government hospitals have been converted entirely into “COVID hospitals”, leaving many non-COVID patients who are dependent on public hospitals (often due to economic reasons) for essential and lifesaving treatments such as chemotherapy, radiation, dialysis, abortion without continued care. Such patients are being forced to access care in private hospitals where costs of treatment have been inflated to make up for the loss of footfall. Private hospitals have been forcing patients to deposit hefty sums of money (approx USD 2600-3,900) in order to gain access to non- Covid treatment. These deposits act as financial barriers to people in need of essential care. There have been instances where private hospitals have compelled non-Covid patients to pay for a Covid-19 test in order to access services, even in cases where national testing guidelines do not permit a Covid test to be conducted. As an example, a dialysis dependent patient was forced to pay more than 15 times the cost of dialysis treatment in a private facility as the hospital insisted on doing the dialysis only in the ICU.

Response of the Union Government

As the number of cases rise in the country, and more hospitalization is envisaged, the question of costs is likely to become a significant one for patients seeking care, making this writ petition a very significant and timely one. The response of the Union Government in Court, however, suggests that it is not keen to regulate private hospitals. It has argued in the Supreme Court that under the Ayushman Bharat Prime Minister’s Jan Arogya Yojana (AB-PMJAY) scheme which seeks to 'to mitigate the adverse impact of this catastrophic illness on the poor’, costs would be taken care of, and hence pricing caps are unnecessary. However, data shows that only a fraction of COVID testing and treatment is being provided through the scheme as enrollment is still low, and because the scheme only provides for Rs. 5 lakh (approx. USD 6500) coverage for the entire family – an amount far less than some of the costs that have been reported for COVID treatment for a single patient requiring ICU care and ventilator. It has also argued that the Union Government does not have authority to mandate prices for the private health sector and this is in fact the role of the State Governments. However, with the National Disaster Management Act in place, the Union government does have such legislative authority. In general, the responses of the Union Government so far suggest reluctance to take a position on the issue of price ceilings.

Beyond price regulation

Over the past several years, private sector engagement (PSE) is increasingly gaining ground, both within global health policy circles and national health policy making. Strengthening PSE has been flagged as one of the key pathways to achieving Universal Health Coverage, and more recently a coordinated and comprehensive response to the COVID pandemic by the WHO. Indeed, several

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countries globally have been able to effectively involve and regulate the private sector during the pandemic. However, the way that the private sector has acted in India during the COVID pandemic, holds lessons for both global health policy as well as national health policy, on what regulatory frameworks are needed to truly harness any potential that the sector has, and the State’s capacity (and intent) to enforce such regulation. While this article deals only with the issue of pricing in large corporate hospitals, there is a whole diversity of providers who may have different concerns and this needs exploration. Some experts have argued that it is not capping of prices, but in fact “competition” that will truly regulate the private providers. But if there is one thing that the COVID pandemic has made clear, it is that “the market never regulates healthcare in the public interest”; it is the state that must do so. At a truly existential moment, the private health sector has failed to either act rationally or equitably. That said, however, price capping is by no means the only way to address regulation of the private sector and Indian health care more broadly. Most critically, what we have seen in India over the past three months is the deplorable state of its public health services; had the public sector been well-functioning, for-profit private players would not have been able to profiteer in this manner. If this opportunity is not harnessed, we may go back to allowing a predatory private sector to continue functioning as usual, without regard to health as a public good.

Opinions expressed in this article are personal and do not necessarily reflect the position of the groups to which the authors belong.

Highlights of the week

America is How a Civilization Collapses

U Haque; https://eand.co/american-collapse-is-going-to-go-global-7f71e2fb92e2

The read of the week. “Hate. Racism. Violence. Brutality. Poverty. American Collapse Shows Us How Our Civilization Will, Too.”

“….our world has one very large problem. It underinvests massively. In what better economists, like Joe Stiglitz and Amartya Sen, call “global public goods.”…”

Quote: “Without massive investment in global public goods, our civilization is going to begin to come to an end. In rich and poor countries alike. By the 2030s, climate change is going to be so severe that our economic and financial systems can’t handle it, not to mention our utilities, infrastructure and safety nets. By the 2040s, mass extinction will cause everything from famine to flood to rivers turning to mud to forests dying off en masse. By the 2050s, the earth’s great ecosystems will finally begin to die, once and for all. And as they go, human civilization as we know it will simply come to an end. The basics that we take for granted, air, water, food, sustenance, will stop. Just like public health did this year. Those basics not being available will have dramatic knock-on effects. They will cause a lack of public safety, a political dead end, social disintegration. There will be a bitter fight for survival, a retreat to tribalism and superstition, desperate billions clashing for survival in a world that seems now to be ruled only by famine, flood, plague, and pestilence….”

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PS: Let’s hope America also shows the (world the) way in November to turn this around, and avert this dire scenario.

UHC & Covid-19

UHC 2030 (blog) How COVID-19 is reshaping priorities for both domestic

resources and development assistance in the health sector

https://www.uhc2030.org/blog-news-events/uhc2030-blog/how-covid-19-is-reshaping-priorities-

for-both-domestic-resources-and-development-assistance-in-the-health-sector-555362/

Must-read. Joint blog written on behalf of the UHC 2030 Core Team, as well as the partners engaged in the Sustainable Health Financing Accelerator (SHFA).

“… While health security - reducing the vulnerability of societies to pandemics like COVID-19 - is a distinct goal, it is interlinked with efforts to move towards universal health coverage (UHC). Neither UHC nor health security can be achieved without the foundation of common goods for health, produced through strong and resilient health systems. The crisis has laid bare this interdependence. The immediate and comprehensive response to COVID-19 must strengthen universal systems that contribute to both health security and UHC. This will have implications for how both domestic resources and development assistance, currently channelled to the health sector, should be used to protect against future emergencies and sustain essential service coverage.”

Short quote: "Pandemic preparedness and response capacity must become the “step zero” in the UHC agenda"”

Resource - Technical resources for health systems and COVID-19

https://www.uhc2030.org/blog-news-events/uhc2030-news/technical-resources-for-health-systems-and-covid-19-555363/

“A list of useful resources and technical documents developed by WHO and other partners in the context of health systems and COVID-19.”

WHO & global health governance

Globe and Mail - Margaret Chan reshaped the WHO and brought it closer to China

Globe and Mail

Nuanced analysis, on M Chan’s track record & legacy with respect to WHO’s relationship to China: “ … Dr. Chan … led the WHO for a decade, a time in which she reshaped the organization and nurtured its relationship with China, a connection that has come under intense scrutiny in the midst of the COVID-19 pandemic. Loudest among the critics has been U.S. President Donald Trump, who

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pulled funding from the organization and accused it of bending to Chinese dictates to “mislead the world” about the threat of the virus. The WHO has shown “an alarming lack of independence,” Mr. Trump has said. Dr. Chan is no longer at the WHO, and her defenders and former colleagues call her a woman of integrity who showed no bias toward China. But her long-standing role in shaping the WHO and its posture toward China has nonetheless made her a central player in the direction of an organization that has drawn worldwide questions about its praise for China and its willingness to repeat, unquestioned, early Chinese reassurances about the limited dangers of a coronavirus that has become the most acute international health crisis in a century.”

WSJ - U.S. Work With WHO Continues, Weeks After Trump’s Vow to Quit

https://www.wsj.com/articles/u-s-work-with-who-continues-weeks-after-trumps-vow-to-quit-11592307884?mod=e2twp

(16 June) “U.N. agency has received no formal notice of withdrawal, raising hopes U.S. won’t follow through.”

“More than two weeks after President Trump said the U.S. would withdraw from the World Health Organization, his government remains a member of the U.N. agency and continues to coordinate with it, raising hopes among agency officials the U.S. may not follow through….”

Devex – Australia puts WHO, multilaterals under the microscope with new aid

policy

https://www.devex.com/news/australia-puts-who-multilaterals-under-the-microscope-with-new-aid-policy-97485

“Australian Foreign Minister Marise Payne used an address to the Australian National University on June 16 to deliver criticism to the politics of the United Nations and World Health Organization, telling the audience the COVID-19 pandemic had “drawn attention to the strengths and the weaknesses of the U.N. system.” The speech comes shortly after the release of Australia’s new aid policy in May, which has transitioned the aid program to focus capacity on responding to COVID-19 in the Pacific, Timor-Leste, and Indonesia. … … Within Australia, the speech has been seen as cementing the country’s position as a middle power that can have more influence on the global stage. “From this standpoint, it’s possible that we will see Australia emerge as a leader in health diplomacy,” Charlotte Owens, policy manager at Young Australians in International Affairs, told Devex…. “

“According to the new Australian aid policy document, health security is the key pillar of this new program. But Payne’s speech focused on other elements of this pivot in Australia’s engagement post-COVID: an aid program that assesses multilateral institutions and their capacity to deliver on Australia’s aid and foreign policy objectives….”

See also Reuters - Australia says pandemic prompts greater effort to revamp global bodies

“ Australia will take a more activist role in reshaping global bodies such as the World Health Organization (WHO) after the coronavirus pandemic dealt an unexpected blow to international stability, its foreign minister said on Tuesday.”

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Some more reads & analysis related to WHO & GHG

• Sridhar Venkatapuram (on ORF) - A WHO fit for the 21st Century

Interesting & recommended viewpoint. Especially Americans should read it in more detail 😊.

• Ilona Kickbusch - No “Back to Normal” for the WHO

“… This is not the first time the WHO has been mired in great power politics. Given its nature as an intergovernmental organization, geopolitical shifts have always been a feature of its functioning. Yet the WHO was not prepared for the COVID-19 virus to become so deeply politically divisive. Unlike previous outbreaks of coronavirus disease (SARS and MERS), H1N1 (the swine flu), or Ebola, COVID-19 has become a political accelerator — at the national level, the international level and for the WHO….”

After some analysis, she concludes: “Geopolitics will define global health over the next decade, and good use must be made of the new political dynamics to address the most urgent global health governance issues at hand: financing, authority and fragmentation. Maybe geopolitics will propel us toward a “cosmopolitan moment,” a point in time at which the global community comes together and creates new institutions and mechanisms that it has not otherwise been willing to introduce. The global health diplomacy challenge is to bind the centrifugal forces beyond the present narrative of the United States versus China. Global health is not a zero-sum game; there are too many other powers with a strong interest in a multilateral health system and a rule-based international order. China will not “run” the WHO, but global governance will need to change fast to make the WHO strong. There should be no “back to normal” — even if the United States does stay when all the chips are down.”

And a few links:

CNN - Republicans urge Trump not to terminate relationship with World Health Organization

Then again, who cares. Just kick the whole Trump gang out in November, with party and all.

Shock merger in UK

Devex - DFID merged with FCO

https://www.devex.com/news/breaking-dfid-merged-with-fco-97489

“Prime Minister Boris Johnson announced a merger between the Department for International Development and the Foreign and Commonwealth Office on Tuesday — confirming the U.K.’s

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development sector’s widely-held fear that he would do away with a standalone development department. The two departments will become the Foreign, Commonwealth and Development Office. The move has been long advocated for by Johnson, along with other senior Conservative politicians, but was met with widespread condemnation by civil society and opposition politicians, as well as some within Conservative party ranks. Opponents say it marks the culmination of a slow-drain on DFID influence — with the official development assistance budget increasingly doled out to other departments — despite the department being regarded as a world leader in aid and responsible for the U.K.’s status as a “development superpower.”…”

The FCO will be headed by Dominic Raab.

Quote:

“The prime minister said the U.K. was following the examples of Australia, Canada, and New Zealand, which also implement their development programs through foreign ministries. The merger comes just days after parliament’s development watchdog recommended that DFID retain its independence, and warned that any change to government structures would be highly disruptive.”

As for Raab, he sounded fairly reassuring in his first official Q&A - UK will maintain aid-spending levels in poorest countries after merger, Raab says “The proportion of the U.K.'s aid spending on the poorest and most conflict-affected countries will not be reduced, despite the closure of the Department for International Development, Foreign Secretary Dominic Raab said Thursday.”

Some early reactions & more coverage on the shock merger:

• Guardian - Three ex-PMs attack plan to merge DfID with Foreign Office (recommended

analysis)

“Aid organisations accuse Johnson of tying aid to security and diplomatic aims.”

“David Cameron, Gordon Brown and Tony Blair all condemned the shake-up, with Cameron saying it would mean “less respect for the UK overseas”….” “Gordon Brown, who championed debt relief and increased aid spending as prime minister, described the decision as sad, while Tony Blair said he was “utterly dismayed”. “

“The government is to maintain its statutory commitment to spending 0.7% of gross national income on overseas aid, but the blending of the two departments will inevitably require greater linkage between the UK’s aid, security and commercial interests….”

DfID’s £15.2bn budget dwarfs that of the Foreign Office, and diplomats have jealously eyed the scale of the guaranteed DfID spending ever since the two departments were split by the Labour government in 1997. The new department is expected to be formed in the autumn, before the government has completed its integrated foreign and defence security review, which is being carried out by the academic and Downing Street adviser John Bew….”

• Guardian - 'Political vandalism': DfID and Foreign Office merger met with anger by UK

charities

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“Unicef, Save the Children and Christian Aid among organisations warning move will harm those most in need and reduce UK’s power overseas.”

• Devex - 'A real kick in the teeth': DFID staffers speak out on merger

“DFID staff members are left with more questions than answers after the announcement that their department would be dissolved.”

Among others: the timing of the news surprised staff more than the news itself.

And a quote: “…the official now expected some staff to leave DFID and highlighted the fears of many in the development sector: that the U.K. would now pursue aid overtly in the national interest and that the quality of aid — for which the U.K. is renowned — would worsen. “…”

Finally, a link:

The Conversation (M Jennings)- DfID merger with Foreign Office signals shift from using aid to reduce poverty to promoting British national self interest

“DFID-FCO merger: Boris Johnson is destroying a respected tool for persuasive soft power.”

HSG update

Check out the revamped HSG website: https://healthsystemsglobal.org/

And as you might already know, there’s also a new call for COVID-19 specific abstracts. Deadline: 30

July.

International Men’s Week (June 15-21)

• New report (Global Action on Men’s Health) that looks at men’s health policy, mainly at the

global level, and how it could be improved. See: From the Margins to the Mainstream

• Lancet Comment piece on men’s health (linked to the report) Men's health: COVID-19

pandemic highlights need for overdue policy action (by Peter Baker, Rosemary Morgan et

al)

“The COVID-19 pandemic is shining a cruel light on the state of men's health globally. In 38 out of 43 countries for which provisional data were available, as of June 10, 2020, more men than women have died from COVID-19 despite a similar number of confirmed cases in each sex. In several countries, including the Netherlands, Dominican Republic, and Spain, about twice as many men as

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women have died from COVID-19. International Men's Health Week on June 15–21 is an opportune time to focus attention on this issue and the need for a new and systematic approach to improve the health of men generally….”

“…Global Action on Men's Health's new report, From the Margins to the Mainstream, examines why men's health has been overlooked. Although gender has generally been a marginal issue in health policy, where it has been addressed, it has often been incorrectly conflated with women. Other factors include inadequate awareness and knowledge among policy makers of men's health issues and the absence of political will to push men's health issues onto policy agendas. Also relevant are the lack of sex-disaggregated health data and the paucity of research into the economic costs of men's poor health. Thankfully, there has been some progress….”

Covax Facility

As an introduction to the huge Covid 19 related sections (see further), first some more info & analysis on the GAVI Covax Facility, as it’s taking shape.

GAVI Covax Facility: Questions on access, pricing & governance

Priti Patnaik; https://genevahealthfiles.wordpress.com/2020/06/19/gavi-covax-facility-questions-on-

access-pricing-governance/

A first look at Gavi’s COVID-19 Global Access COVAX Facility (Preliminary Technical design)

(document of 11 June). Must-read!!!

“…Gavi’s plan, a work in progress, raises worrying questions on its ability to ensure equitable access, affordable pricing and fundamental questions on governance….”

Quote: “Initial reading suggests that richer countries can secure “wider” access to vaccines and poorer countries’ access will be subject to financing via Official Development Assistance and possibly only for the most needy segments of their populations. This flies in the face of lofty aspirations of vaccines as a global public good. Further, by offering promises of tiered pricing approaches for COVID19 vaccines to keep manufacturers interested, the goal of equitable access may not be met. In addition, rising vaccine nationalism means that countries are striking bilateral deals with companies – this also puts Gavi’s plan which seeks to pool demand to achieve greater scale and negotiating power, at risk. This is worsened by the assumption that shrinking ODA will help pay for access in poorer countries….”

“This blogpost will discuss some important features of this comprehensive document (i.e. preliminary technical design document) and also place it a wider context – where these decisions will actually be shaped….”

See also:

• WHO Member states briefing (11 June) - Briefing on the Covax Facility (5-pager)

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• Preliminary technical design document for the COVID-19 Vaccine Global Access (COVAX)

Facility. (11 June) (no link yet, as far as I can see but check twitter ).

• The GAVI Covax AMC – An Investment opportunity

https://www.gavi.org/sites/default/files/2020-06/Gavi-COVAX-AMC-IO.pdf

Covid-19 key news

Focus on some key WHO messages of this week (not fully chronological, though) and other updates.

We are at over 8 million cases now, and more than 450000 deaths. For the latest global update, see

Cidrap News – (June 18) Beijing COVID-19 total grows; Latin America, Mideast face more cases

Cidrap News - Global total climbs by 100,000 cases a day

https://www.cidrap.umn.edu/news-perspective/2020/06/beijing-battles-coronavirus-cluster-pandemic-hampers-flu-tracking

(June 15) “At a media briefing today, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, alluded to the rapid increase in cases, noting that it took 2 months to reach the first 100,000 cases. "For the past 2 weeks, more than 100,000 new cases have been reported almost every single day," he said. Nearly 75% of the recent cases are from 10 countries, mostly in the Americas and South Asia, but COVID-19 activity is increasing in Africa, eastern Europe, central Asia, and the Middle East….”

HPW - Southern Hemisphere Faces Double Threat of Flu Season & COVID-19

https://healthpolicy-watch.news/who-warns-of-covid-19-resurgences-as-beijing-united-states-

grapple-with-new-outbreaks/

“Influenza surveillance has declined or suspended in several countries since another respiratory disease, COVID-19, gripped the planet, according to Dr Tedros. “Influenza affects every country every year, and takes its own deadly toll. Circulation of COVID-19 and influenza can worsen the impact on health care systems that are already overwhelmed,” said Dr. Tedros on Monday. “There has been a sharp decline in sharing of influenza information and viruses, because of COVID-19. Compare with the last three years, we have seen a dramatic decrease in the number of specimens tested for influenza globally,” he added.

… It’s quite understandable that as countries have fought COVID-19, a lot of the resources that are within the flu network have been… entirely appropriately pushed into COVID surveillance. We now need to find that balance to ensure that we’re also able to track influenza properly during that same period,” said WHO Health Emergencies Executive Director Mike Ryan. … … “The [threat of] influenza is always there; seasonal influenza and also influenza of pandemic potential,” said Wenqing Zhang, director of WHO’s Global Influenza programme. “So when we are entering into the southern hemisphere influenza season, it is a time to prepare for Northern Hemisphere season [as well].””

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See also UN News - COVID-19: Preparations for southern flu season must be a priority: WHO’s Tedros or FT - WHO warns against neglecting flu season.

Cidrap News - Health officials warn about impact on women and children

https://www.cidrap.umn.edu/news-perspective/2020/06/global-covid-19-total-passes-75-million-

health-officials-warn-about-impact

(June 12). “…At today's media briefing, several speakers detailed the effect the pandemic—and its response actions—is having on women, children, and adolescents. The spotlight is part of efforts to recognize the pandemic's secondary impact on a range of other health issues. In earlier briefings, for example, the WHO highlighted the challenges of maintaining childhood immunizations and essential health services. Tedros said overwhelmed health systems in many places have put women at a greater risk of dying from complications of pregnancy and childbirth. He added that the WHO has carefully investigated the risk of COVID-19 transmission from mother to baby during breastfeeding, and based on current evidence, the benefits of breastfeeding outweigh any potential COVID-19 transmission risks. …”

See also HPW - Disruption Of Maternal & Child Health Services Could Cause More Deaths Than

COVID-19

PS: “Most of world still in first pandemic wave”

“At a World Health Organization (WHO) media briefing today, Mike Ryan, MD, director of the group's health emergencies program, said most of the world is very much in the throes of the pandemic's first wave, with some slowly making their way out of it. …”

Guardian - Pandemics result from destruction of nature, say UN and WHO

https://www.theguardian.com/world/2020/jun/17/pandemics-destruction-nature-un-who-

legislation-trade-green-recovery

“Pandemics such as coronavirus are the result of humanity’s destruction of nature, according to leaders at the UN, WHO and WWF International, and the world has been ignoring this stark reality for decades. … … They are calling for a green and healthy recovery from the Covid-19 pandemic, in particular by reforming destructive farming and unsustainable diets.”

BMJ News - Covid-19: Africa’s case numbers are rising rapidly, WHO warns

https://www.bmj.com/content/369/bmj.m2394

(15 June) “Ten African countries account for nearly 80% of all cases of covid-19 in the continent, and numbers are accelerating, the World Health Organization has said. Since the virus was first detected on the continent in Egypt on 14 February, it took 98 days to reach 100 000 cases and only 18 days to move to 200 000 cases. More than 5600 people have died from the illness, 70% of whom were in just five countries: Algeria, Egypt, Nigeria, South Africa, and Sudan. More than half of Africa’s 54 countries are experiencing transmission of covid-19 in the community. This is largely

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concentrated in capital cities, but cases are spreading into the provinces. South Africa is the most affected, accounting for 25% of Africa’s total cases and 1210 deaths, with the Western Cape and Eastern Cape provinces especially affected. … … Matshidiso Moeti, WHO’s regional director for Africa, said, “For now Africa still only accounts for a small fraction of cases worldwide. But the pace of the spread is quickening. Swift and early action by African countries has helped to keep numbers low, but constant vigilance is needed to stop covid-19 from overwhelming health facilities.” …”

PS (via the Guardian) - African countries drop Covid-19 curbs in effort to limit economic harm

“Governments across Africa are abandoning restrictions imposed to prevent the spread of Covid-19 in the hope of limiting damage to their fragile economies, despite a rapid rise in the number of cases of the virus across the continent….”

AP - Aid groups ‘alarmed’ by little US coronavirus assistance

AP;

“More than two dozen international aid groups have told the U.S. government they are “increasingly alarmed” that “little to no U.S. humanitarian assistance has reached those on the front lines” of the coronavirus pandemic, as the number of new cases picks up speed in some of the world’s most fragile regions. The letter obtained by The Associated Press and signed by groups including Save the Children, CARE USA, World Vision and others says that “in spite of months of promising conversations with USAID field staff, few organizations have received an executed award for COVID-19 humanitarian assistance.”…”

WEF - COVID-19 vaccine must be a global public good: WHO briefing

https://www.weforum.org/agenda/2020/06/vaccine-covid19-coronavirus-who-briefing-12-june/

On a media briefing from late last week. “The World Health Organization held a media briefing on 12 June, to update the public on the COVID-19 coronavirus pandemic. Dr Tedros Adhanom Ghebreyesus called on leaders to ensure any vaccine is a 'global public good'….”

Reuters - WHO hopes for hundreds of millions of vaccine doses this year, 2 billion

next year

Reuters

(June 18) “The World Health Organization hopes hundreds of millions of doses of coronavirus vaccine can be produced this year and 2 billion doses by the end of 2021, chief scientist Soumya Swaminathan said on Thursday. The WHO is drawing up plans to help decide who should get the first doses once a vaccine is approved, she said. Priority would be given to frontline workers such as medics, those who are vulnerable because of age or other illness, and those who work or live in high-transmission settings such as prisons and care homes….”

“…Around 10 potential vaccines are now undergoing trials in humans, in the hope that a shot to prevent infection can become available in coming months. Countries have already begun making

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deals with pharmaceutical companies to order doses, even before any vaccines have been proven to work.”

Guardian (live) - EU urges joint efforts by bloc's states to buy Covid-19 vaccines

https://www.theguardian.com/world/live/2020/jun/12/coronavirus-live-news-markets-fall-over-

fears-of-long-us-recovery-as-brazil-cases-top-800000#block-5ee37a018f08969537f78960

“The European commission has received a political mandate from EU governments to negotiate on their behalf advance purchases of promising coronavirus vaccines, the EU’s top health official said, urging states to set aside parallel initiatives. EU health commissioner Stella Kyriakides told a news conference there was “overwhelming” support from EU governments for a commission plan to use a €2.4bn ($2.7bn) fund to buy coronavirus vaccines upfront….”

PS: “Germany, France, Italy and the Netherlands are already in talks with pharmaceutical companies to buy vaccines, a move that could weaken the EU’s joint approach.”

Reuters – AstraZeneca agrees to supply Europe with 400 mln doses of COVID-19

vaccine

Reuters;

(June 13)

“AstraZeneca Plc said on Saturday it signed a contract with European governments to supply the region with its potential vaccine against the coronavirus, the British drugmaker’s latest deal to pledge its drug to help combat the pandemic. The contract is for up to 400 million doses of the vaccine, developed by the University of Oxford, the company said, adding that it was looking to expand manufacturing of the vaccine, which it said it would provide for no profit during the pandemic. Deliveries will start by the end of 2020. The deal is the first contract signed by Europe’s Inclusive Vaccines Alliance (IVA), a group formed by France, Germany, Italy and the Netherlands to secure vaccine doses for all member states as soon as possible….”

Don’t know how these 4 European countries rhyme all this with their ‘global public good’ rhetoric…

• FT - Europeans discuss deal to access potential J&J coronavirus vaccine

“European countries are lining up a deal to secure a possible Covid-19 vaccine from US company Johnson & Johnson, marking the latest move in an intensifying international battle to secure supplies of any coronavirus treatments that emerge. Both the European Commission and a separate quartet of EU member states comprising Germany, France, Italy and the Netherlands have held talks with J&J as the world’s largest healthcare company prepares to start clinical trials of its candidate next month, European diplomats said….”

Anyway, apparently by now, this “Inclusive vaccine alliance” (of the 4 countries) already stopped - after their first (and last) deal. They will join the European Commission’s vaccine programme (see below).

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• Indeed, even if imperfect too, the European Commission is making somewhat better noises, see (17 June) - Coronavirus: Commission unveils EU vaccines strategy

“… Today, to help protect people everywhere, the European Commission is presenting a European strategy to accelerate the development, manufacturing and deployment of vaccines against COVID-19. An effective and safe vaccine against the virus is our best bet to achieve a permanent solution to the pandemic. Time is of the essence. Every month gained in finding such a vaccine saves lives, livelihoods and billions of euros. Today's strategy proposes a joint EU approach and builds on the mandate received from EU health ministers….”

VOA - EU to Host Global COVID-19 Vaccine Summit

https://www.voanews.com/covid-19-pandemic/eu-host-global-covid-19-vaccine-summit

Some more good noises from Ursula et al: “The European Union called on the international community Wednesday to ensure potential coronavirus vaccines are equally available to all nations. In a video statement, EU Commission President Ursula Von Der Leyen called a global vaccine summit on June 27 at which the EU and its partners will solicit countries to pool their resources and reserve future vaccines for low- and middle-income countries. She said high income countries would act as an inclusive international buyers' group, ensuring commercial vaccine makers got the money they needed to develop and produce vaccines, while low income nations had access to the medicine. The plan is part of a wider EU strategy to secure enough doses for both the grouping of nations and the world's poorest countries because it fears lagging behind the United States and China. …”

“The summit will be the last planned virtual fund-raising campaign co-led by the EU to secure money to distribute potential COVID-19 vaccine to developing countries….”

Lancet Editorial - Global governance for COVID-19 vaccines

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31405-7/fulltext

This week’s Lancet Editorial lays out the overall stakes. “The COVID-19 pandemic has uncovered serious gaps in the health-care systems of many nations. In particular, it exposes a fragmented global governance system that does not have the structures to coordinate the pooling and sharing of resources needed to combat pandemics. Since the early days of the pandemic, medical protectionism has emerged as nations scrambled for their own stocks of personal protective equipment and ventilators. COVID-19 vaccines could be the next example. Already there is a danger of a vaccine bidding war, with governments competing for a limited number of doses, well before a vaccine even reaches the market….”

“There is a urgent need for new arrangements at the global level to facilitate the development, finance, production, and equitable distribution of COVID-19 vaccines. Controlling the pandemic demands global cooperation. The nationalist and competitive approaches taken by a few high-income countries to get hold of a small supply of vaccines could result in excessive casualties in other parts of the world. Global solidarity is needed instead, and resources must be pooled and shared. Gavi Covax is a step in the right direction….” “… A pandemic vaccine needs strong global governance behind it….”

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Nature (News) – Latin American scientists join the coronavirus vaccine race: ‘No

one’s coming to rescue us’

Nature;

“Researchers fear that breakthroughs from abroad will be too slow or inequitably shared to benefit the global south.” . So they are forging ahead with their own vaccine-research programmes to fight COVID-19….

JAMA (news) - Latin America and Its Global Partners Toil to Procure Medical

Supplies as COVID-19 Pushes the Region to Its Limit

https://jamanetwork.com/journals/jama/fullarticle/2767350

“This Medical News article discusses Latin America’s critical shortages of medical supplies including personal protective equipment and ventilators during the coronavirus disease pandemic.”

NPR Goats & Soda - Pandemic Perspective: What The 20 Poorest And Richest

Countries Spend On Health Care

NPR;

Excerpt: “…According to a report by the United Nations Commission for Africa, nearly 94 percent of Africa's total stock of pharmaceutical products are imported. And at least 71 nations have already imposed limitations or full bans on exports of essential COVID-19 supplies, forcing many of the poorest countries into bidding wars over highly urgent, highly priced medical products. "What's going to happen to countries having to choose between supporting populations living with malnutrition or starvation or getting personal protective equipment for hospitals?" Tenner says. "…

FT - African business steps up in global scramble for virus test kits

https://www.ft.com/content/9c745615-d0d4-4345-99c3-fd1dbf2f83be

“Ghana’s mPharma have helped countries shut out by suppliers to source vital equipment”.

“… It ended up in negotiations with Sansure Biotech, a Chinese molecular diagnostics company with whom they were able to secure a long-term deal for coronavirus testing equipment. The tests were shipped to Ghana via another Breyer portfolio company, Jetstream, an African logistics firm. In total, Mr Rockson, working with Breyer, was able to secure a supply of 1m Covid-19 test kits and 150 PCR machines, which process the results. mPharma has since distributed the medical supplies to governments, organisations and private labs in Ghana, Gabon, Republic of Congo, Nigeria and Zimbabwe, making it one of the largest suppliers of Covid-19 materials on the continent. …. … mPharma is one of several African companies that have been able to strike deals for critical medical supplies by tapping their global networks, even as their governments have been largely shut out….” The article also discusses Nigeria’s “Flour Mills of Nigeria” efforts in this respect.

“… The Africa Centre for Disease Control estimates Africa will require 10m to 15m testing kits in the next four to six months. It is working to pool government orders for tests and other equipment

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so African countries can compete and secure the essential supplies. The software system is being funded by Zimbabwean billionaire Strive Masiyiwa and, until it is fully operational, the private sector is filling the void….”

Guardian- Covid-19 studies based on flawed Surgisphere data force medical

journals to review processes

https://www.theguardian.com/world/2020/jun/12/covid-19-studies-based-on-flawed-surgisphere-

data-force-medical-journals-to-review-processes

“New England Journal of Medicine and Lancet peer reviewers did not see raw data behind findings

before publication.”

Covid-19 Funding/Advocacy/initiatives

Telegraph - Amid Covid economic crisis, questions swirl around Africa’s giant

debt to China

https://www.telegraph.co.uk/global-health/science-and-disease/amid-covid-economic-crisis-

questions-swirl-around-africas-giant/

On the China-Africa summit on debt relief.

“The continent's governments are demanding that £120bn in loans is cancelled.”

“China hosted a summit with African leaders on Wednesday, amid questions about what the superpower will do with the £120 billion debt it is owed by African governments who are desperately trying to stave off the dual threats of the pandemic and economic catastrophe. … … After mounting pressure, China agreed to suspend all bilateral debt repayments for dozens of developing countries, many of them African, from May 1 until the end of 2020, as part of the G20’s Debt Service Suspension Initiative for Poorest Countries. However, the G20 scheme does not actually cancel any debt and it only applies to debt from the Chinese state. Importantly, it does not cover the myriad of Chinese commercial creditors who own the bulk of the debts. African leaders want China to go much further. The African Union has called for a two-year-long standstill on repayments for both private and bilateral debt and in his opening remarks at China-Africa summit, South African President Cyril Ramaphosa urged China to support this call or at least propose an alternative. The Chinese President Xi Jinping seemed reluctant to make such a grand gesture. Instead, he spoke vaguely about helping ‘relevant’ African countries with interest-free government loans that would mature by the end of 2020 and encouraged African countries to apply for the G20’s relief scheme….”

See also Africa set to get debt relief from China (focusing on Xi’s message).

You might also want to read a new working paper - Debt Relief with Chinese (by the China-Africa initiative)

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Devex -EU pushes COVID-19 marker to track donor spending

https://www.devex.com/news/eu-pushes-covid-19-marker-to-track-donor-spending-97423

“The European Union wants a common metric for donors’ contributions to the global fight against COVID-19, the bloc’s top development civil servant said Wednesday. “We have brought the idea to the [Organisation for Economic Co-operation and Development], which is precisely the institution which has a very solid track record on developing markers,” Koen Doens, director-general of DEVCO, the European Commission’s development department, said in a virtual panel discussion Wednesday. … … … On Monday, development leaders from EU member states welcomed the establishment of a joint monitoring system for their own spending, as well as “a possible COVID-19 marker,” which would cover both European and non-European donors, “to ensure accountability and transparency in the use of resources mobilised and allocated.” … … The OECD-DAC working party on development finance statistics is due to discuss ways of tracking COVID-19 related expenditures at a meeting on June 22. If approved, the tracking system would cover all DAC donors, which as well as the EU includes the United States, Japan, and others. Non-DAC donors, such as China and India, could report their spending on a voluntary basis….”

Devex - World Bank has 'stretched' its capacity in coronavirus response, Malpass

says

https://www.devex.com/news/world-bank-has-stretched-its-capacity-in-coronavirus-response-

malpass-says-97498

“The World Bank has reached the limit of support it can provide to low- and middle-income countries recovering from the coronavirus pandemic, even while acknowledging those nations require more resources than are currently available, the institution’s president said Tuesday. The bank has deployed $14 billion for emergency health response projects in 100 countries and has committed to mobilize $160 billion over the next 15 months, effectively front-loading development investments that would have been made over a longer period of time if the pandemic and resulting economic fallout had not occurred. While some critics have suggested the bank should find ways to leverage its balance sheets and free up even more financing due to the scale of the COVID-19 crisis, the institution’s current efforts have already tested the bank’s finances and its personnel, Malpass said. …”

Economist - Covid-19 has squeezed migrants’ remittances to their families

https://www.economist.com/finance-and-economics/2020/06/15/covid-19-has-squeezed-migrants-

remittances-to-their-families

“A new report highlights the potential gains from digitisation, though”.

“…This year, on June 16th, a task-force led by the UN, World Bank and other multilateral bodies released a report assessing the impact of covid-19 on remittances. The pandemic has taken a heavy toll on the flow of money. The World Bank estimates that total remittances to developing countries could drop by a record 20% this year, to $445bn. In El Salvador and Nepal, where remittances typically amount to more than a fifth of GDP, flows fell by 40% and 51% in April, compared with the same month last year. At the same time—a small consolation of potentially

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great long-term importance—the pandemic has shown the potential benefits, to both workers and their families, of the digitisation of payments….”

Open Democracy - Vultures are circling our fragile economies – we must not let

them feast

A Pettifor; https://www.opendemocracy.net/en/oureconomy/vultures-are-circling-our-fragile-

economies-we-must-not-let-them-feast/

“We should never forget the lesson of the French Revolution: rentiers need the state more than the

state needs rentiers.”

Fabulous read on the global economy’s dominant player – the rentiers. And what needs to be done

to rein them in.

Excerpt: “The rise of the rentiers” “Rentier capitalists make capital gains more or less effortlessly, at the expense of others. They do so by exploiting an existing asset – think of a London or New York property – and make money from ‘renters’ using that asset, or from re-selling the asset at a higher price. … … … daring, buccaneering ‘rocket-men’ billionaires like Musk and Branson are the small fry of the global rentier economy. The big beasts are Private Equity (PE) firms like the Carlyle Group, Kohlberg Kravis Roberts (KKR) The Blackstone Group and Apollo Global Management. …”

“…While the world economy was locked down by coronavirus, with the heavily indebted corporate sector at grave risk of default, PE firms were circling carcasses of bankrupt firms and markets felled by the lethal pandemic. … the sector has raised $1.5 trillion of “dry powder” for acquisitions, while US distressed-debt funds are hoping to raise more than $67 billion – a capital-raising effort that would smash the previous $44 billion record of 2008. These trillions will be used to scavenge bargains in whole sectors of the economy. PE firms intend to profit from the current crisis much as they did after the 2008 financial meltdown. … … And increasingly it is private investors and speculators that have taken ownership of, and are parasitically squeezing rents out of, existing taxpayer-financed assets, like aerospace assets, care homes, railways, health services, prisons; and the energy, electricity and water industries …” “…the taxpayer-backed monetary systems of well organised nation states are increasingly distorted to serve the interests of private, globalised capital, not the interests of society….”

Pettifor then lays out how “private capital markets have to once again be subordinated to the role of servant of economies, not masters”.

Nature – Rebuild the ramshackle global financial system

Ann Pettifor; Nature world view;

“Economic researchers neglect the role of financialization in global existential crises.”

By the same author. “ For decades, the global financial system has become ever-more ad hoc and ramshackle — precipitating crises with increasing frequency — argues economist and government adviser Ann Pettifor. She says that new lines of research into financial globalization are needed to

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manage domestic economies in these challenging times and mitigate the impact of future crises — from pandemics to climate breakdown and biodiversity collapse.” “Among the most important studies will be those leading to the development of a new, better-managed international financial architecture.”

“…Just as we need a sustainable global ecosystem, so do we need a stable, sustainable international financial system — an important public good. The next practical priority, therefore, is to ensure international coordination and collaboration in designing a new architecture.”

Platform for Collaboration on Tax - Facing the crisis: the role of tax in dealing with

COVID-19

Platform;

“A joint blog by Vitor Gaspar, Director, Fiscal Affairs Department, IMF; Navid Hanif, Director, Financing for Development Office, UN; Ceyla Pazarbasioglu, Vice President, Equitable Growth, Finance and Institutions, WBG; and Pascal Saint-Amans, Director, Centre for Tax Policy and Administration, OECD.” Big shots, so you might want to read this. “COVID-19 will change taxation— in at least three important ways, with lasting implications….”

CGD (blog) - Humanitarian Financing Is Failing the COVID-19 Frontlines

J Konyndyk et al; https://www.cgdev.org/blog/humanitarian-financing-failing-covid-19-frontlines

“Longstanding weaknesses in the humanitarian business model are undermining the COVID-19 response in fragile and conflict affected states. Extensive delays, poor mechanisms for tracking disbursement of funds from intermediaries to implementers, and persistent obstacles to financing local actors are preventing funds from reaching organizations on the frontlines of the COVID-19 fight. Donor governments have generously contributed nearly $2.5bn in humanitarian COVID-19 financing.”

But: “'Donors have given $2.5bn, of which 74% went to UN. NGOs received only ~$73m (3%) of the total, of which specified local and national organizations have received $1.7m (0.07%)'.”

Finally, a link: The African Union Covid-19 Response Fund: a new social contract (by E Kalondo et al)

Covid-19 Science

Stat - Major study finds common steroid reduces deaths among patients with

severe Covid-19

Stat;

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Guess you know this by now, as it was all over the world press : “A cheap, readily available steroid drug reduced deaths by a third in patients hospitalized with Covid-19 in a large study, the first time a therapy has been shown to possibly improve the odds of survival with the condition in the sickest patients. Full data from the study have not been published or subjected to scientific scrutiny. But outside experts on Tuesday immediately embraced the top-line results. The drug, dexamethasone, is widely available and is used to treat conditions including rheumatoid arthritis, asthma, and some cancers….” Part of the RECOVERY study.

Touch wood that it will indeed make a difference, and that the study won’t suffer the fate of retraction.

See also the NYT - Common Drug Reduces Coronavirus Deaths, Scientists Report

For a take, see Devi Sridhar in the Guardian - Dexamethasone may be part of the Covid-19 puzzle, but it's no magic bullet

She admits it’s great news, but: “…we should also not think of dexamethasone as a magic bullet. This drug looks only effective in those patients already in a critical state. The real game-changer will be a drug that prevents people transitioning from mild symptoms to a severe state. With such a drug, alongside widespread testing and early detection, patients could be treated in community and outpatient clinics.”

But see also the Telegraph - Analysis: How drug used to treat ‘Delhi belly’ is among the six coronavirus treatments

“Scientists are excited not just because they have found a treatment that works, but because it raises the possibility that more life-saving drugs will soon be discovered.”

“… scientists are excited not just because they have found a treatment that works, but because it raises the possibility that more drugs will soon be discovered that will save more lives, or - if given in combination - may cure Covid-19 entirely. Scientists from the Recovery (Randomised Evaluation of Covid-19 therapy) trial - who released the dexamethasone results yesterday - have ongoing trials into four more treatments which could radically improve survival, including a drug usually used to treat Delhi Belly, or traveller's diarrhea. Two more drugs are also showing promise. Here are the six drugs and treatments currently in British trials:…”

HPW – World Health Organization To Include Dexamethasone In Updated COVID-

19 Care Guidelines; Drops Hydroxychloroquine From Massive Solidarity Trial

https://healthpolicy-watch.news/world-health-organization-to-include-dexamethasone-in-updated-covid-19-care-guidelines-drops-hydroxychloroquine-from-massive-solidarity-trial/

That didn’t take long.

““We will update our clinical guidance to reflect how and when dexamethasone should be used to treat COVID-19,” announced WHO Director-General Dr Tedros Adhanom Ghebreyesus on Wednesday. “WHO has now started to coordinate a meta-analysis pulling data from several clinical trials to increase our overall understanding of this intervention.” The cheap drug could become the ‘standard-of-care’ for patients suffering from more severe forms of the disease, Soumya Swaminathan, WHO Chief Scientist, told the Financial Times. Producers are already poised to ramp up production of the common drug – including Cipla, an Indian generics manufacturer; Aché, the

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biggest dexamethasone producer in Brazil, and Hikma Pharmaceuticals, a large dexamethasone manufacturer….”

PS: “…Meanwhile, the much hyped antimalarial drug hydroxychloroquine seems to be fading from favor, as WHO announced they would stop enrolling new patients into the hydroxychloroquine arm of its multicountry SOLIDARITY trial for COVID-19 treatments. New patient enrollment has also been stopped in the hydroxychloroquine arm of France’s DISCOVERY trial, one of the country arms of the larger WHO trial….”

See also Stat - WHO drops hydroxychloroquine from Covid-19 clinical trial

HPW - One In Five People Could Be More Vulnerable To Severe COVID-19 Because

Of Underlying Conditions, But Only 4% At “High-Risk”, Concludes Lancet Study

https://healthpolicy-watch.news/one-in-five-people-could-be-more-vulnerable-to-severe-covid-19-

because-of-underlying-conditions-but-only-4-at-high-risk-concludes-lancet-study/

Coverage of the new study in the Lancet Global Health. “About 1.7 billion people, or 22% of the world’s population, has at least one underlying health condition that puts them at increased risk of becoming seriously ill with COVID-19, according to a new modelling study published in Lancet Global Health. Based on the new assessment, about 4% of the world’s population, in total, is at high risk of developing severe COVID-19 requiring hospitalization. But the actual risk of serious forms of the disease varies considerably by age – from less than 1% of people under the age of 20 to about 20% of those 70 years and older. The new estimates reinforce findings from previous studies indicating that older people and those with chronic diseases are at higher risk. However, it is the first of its kind to provide national as well as regional and global estimates of people at risk of severe COVID-19 for 188 countries worldwide – based on age, sex and reporting of underlying health conditions. …”

“…It is time to evolve from a one-size-fits all approach to one that centres on those most at risk…It is time to acknowledge that we are not all at equal risk of severe outcomes from COVID-19 and to work together with those most affected to tailor an effective response,” said lead author Nina Schwalbe, of Columbia University’s Mailman School of Public Health in a statement.”

• You find the study here: Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study

• And the must-read Lancet GH Comment by Nina Schwalbe et al - COVID-19: rethinking risk

“In The Lancet Global Health, Andrew Clark and colleagues produce a model-based estimate of populations at increased risk of severe COVID-19. The authors focus on the central role played by 11 predominantly non-communicable disease (NCD) categories in predicting risk and the need to tailor the response accordingly. …” One of the key flaws of the study, she acknowledges: “the model does not consider the role of underlying risks factors or social determinants.”

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FT -The long road to a Covid-19 vaccine

https://www.ft.com/content/f1b25b41-f3cf-4a73-ba8f-582385bc2eeb

“The world is waiting for a breakthrough that will allow a return to normality but there are possible risks attached.”

“…a shadow looms over the global race to develop a pandemic vaccine: a little-known phenomenon called antibody-dependent enhancement (ADE), also known as disease enhancement or immune enhancement…. … It is a rare but not idle concern. The pandemic virus belongs to the same family of coronaviruses that causes Sars (severe acute respiratory syndrome) and Mers (Middle East respiratory syndrome). The hunt for vaccines for these 21st-century diseases — Sars appeared in 2002, Mers in 2012 — has been stymied by evidence of ADE….”

Quote by Anthony Fauci on a possible trade off: “Fauci, who leads the US research response to Covid-19, said as much when interviewed about another eagerly anticipated vaccine, from the US company Moderna. He spoke of the need to balance the lives saved with those that might be endangered by ADE: “So, if for every one that has enhanced illness, you save a thousand lives, I’ll take that, right?”…”

And another quote: “The virus that causes Covid-19 is named Sars-Cov-2, for its genetic similarity to the Sars virus. It is, relatively speaking, still an immunological mystery: it is not entirely clear which parts of the immune system are triggered by the virus for some people, nor why individuals react to it so differently. Why, for example, do some healthy young people succumb while some infected centenarians survive? When I ask Danny Altmann, a professor of immunology at Imperial College in London who co-wrote a Lancet summary on coronavirus, to rate how much we know about the immunological profile of Sars-Cov-2 on a sliding scale of zero to 10, he plumps for five….”

The Conversation - Fast COVID-19 vaccine timelines are unrealistic and put the

integrity of scientists at risk

B Bridle et al ; https://theconversation.com/fast-covid-19-vaccine-timelines-are-unrealistic-and-put-

the-integrity-of-scientists-at-risk-139824

Worth some reflection, at the very least. The authors start like this: “…The average times of the fastest sprinters in the 100-metre dash are in the ballpark of 10 seconds. So, what would you think if someone promised to run the race in one second?...” An AI enhanced hybrid of Lance Armstrong,

Arnold Schwarzenegger & Ben Johnson in their prime, I hear you think 😊.

Telegraph - Coronavirus vaccine: Chinese biotech says jab produced antibodies in

more than 90 per cent of people

https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-vaccine-chinese-

biotech-says-jab-produced-antibodies/

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“A Chinese biotech has announced positive early results of a vaccine against the coronavirus, claiming it induced an immune response in 90 per cent of those who were given it. The vaccine, called CoronaVac, is being developed by the firm Sinovac and is one of the frontrunners among more than 200 other candidates in the race to develop an effective inoculation against the disease….”

FT - Berlin to buy stake in Covid-19 vaccine player CureVac

https://www.ft.com/content/bddf086e-b810-4628-aab3-e2b43d64486e

“Investment of €300m to secure German drug company and potential treatment from foreign

interest.” You remember that Trump story from a while ago, with respect to this company.

Guardian - Coronavirus vaccine trial by Imperial College London begins

https://www.theguardian.com/world/2020/jun/16/coronavirus-vaccine-trial-by-imperial-college-

london-begins

“Researchers at Imperial College London will this week begin clinical trials of a possible coronavirus

vaccine in 300 people…. … Professor says early vaccines may not stop virus being contracted but prevent recipients developing severe Covid-19 illness.”

Science (Perspective) - Can existing live vaccines prevent COVID-19?

Science;

“… Prophylactic vaccination is the most effective intervention to protect against infectious diseases. The commonly accepted paradigm is that immunization with both attenuated virus (live but with substantially reduced virulence) and inactivated (killed virus particles) vaccines induces adaptive and generally long-term and specific immunity in the form of neutralizing antibodies and/or activating pathogen-specific cellular immune responses. However, an increasing body of evidence suggests that live attenuated vaccines can also induce broader protection against unrelated pathogens likely by inducing interferon and other innate immunity mechanisms that are yet to be identified. The stimulation of innate immunity by live attenuated vaccines in general, and oral poliovirus vaccine (OPV) in particular, could provide temporary protection against coronavirus disease 2019 (COVID-19)….”

See also the Washington Post for coverage of this study.

Telegraph - Common cold may make children more resistant to Covid-19

Telegraph;

“Children may be protected from coronavirus because they catch so many colds, scientists have suggested. Figures from the Office for National Statistics (ONS) suggest children are just as likely to pick up the virus, but few ever develop serious disease, or even show symptoms. Now scientists have suggested that children may be resistant because their immune systems are already well primed by

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the common cold. The common cold is caused by four different types of coronavirus which circulate in the community and are largely harmless. But while adults pick up a cold around two to four times a year, school age children catch an average of 12 colds annually, studies have shown….”

Nature News - How deadly is the coronavirus? Scientists are close to an answer

https://www.nature.com/articles/d41586-020-01738-

2?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

“Public-health researchers use the infection fatality rate to gauge how to respond to a new disease, but it’s tricky to calculate.”

“…Data from early in the pandemic overestimated how deadly the virus was, and then later analyses underestimated its lethality. Now, numerous studies — using a range of methods — estimate that in many countries some 5 to 10 people will die for every 1,000 people with COVID-19. “The studies I have any faith in are tending to converge around 0.5–1%,” says Russell….”

Science Daily – Super-potent human antibodies protect against COVID-19 in

animal tests

Science Daily;

“Researchers have discovered antibodies in the blood of recovered COVID-19 patients that provide powerful protection against SARS-CoV-2, the coronavirus that causes the disease, when tested in animals and human cell cultures….”

Science News - HIV and TB increase death risk from COVID-19, study finds—but

not by much

https://www.sciencemag.org/news/2020/06/hiv-and-tb-increase-death-risk-covid-19-study-finds-

not-much

“Data from South Africa show old age and diabetes are far more important risk factors.” Great read on last week’s study (see also a previous newsletter).

Guardian - Scientists report flaws in WHO-funded study on 2-metre distancing

https://www.theguardian.com/science/2020/jun/14/scientists-report-flaws-in-who-study-on-two-

metre-distancing

“Senior scientists have reported flaws in an influential World Health Organization-commissioned study into the risks of coronavirus infection and say it should not be used as evidence for relaxing the UK’s 2-metre physical distancing rule….”

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Scripps research - Mutated coronavirus shows significant boost in infectivity

https://www.scripps.edu/news-and-events/press-room/2020/20200612-choe-farzan-coronavirus-

spike-mutation.html

“COVID-19-causing viral variant taking over in the United States and Europe now carries more functional, cell-binding spikes.”

Cfr tweet Kai Kupferschmidt (Science): “As far as I can tell this is the best evidence yet for a mutation that might have an effect on #SARSCoV2 spread. Important to see data from animal experiments or even better some clinical data to understand how relevant this D614G mutation is in humans.”

Anyway, far from settled.

NYT - Coronavirus Can Set Off a ‘Cytokine Storm.’ These Drugs May Calm It.

NYT;

“At least a dozen treatments are being evaluated for virus patients whose immune systems go on the

attack.”

CNN - Best way to reduce coronavirus transmission is by wearing a face mask,

study finds

CNN;

“The new coronavirus spreads mainly via airborne transmission and wearing a mask is the most effective way to stop person-to person spread, according to a new study. A team of researchers in Texas and California compared Covid-19 infection rate trends in Italy and New York both before and after face masks were made mandatory. Both locations started to see infection rates flatten only after mandatory face mask measures were put in place, according to the study published Thursday in the Proceedings of the National Academy of Sciences. The researchers calculated that wearing face masks prevented more than 78,000 infections in Italy between April 6 and May 9, and more than 66,000 infections in New York City between April 17 and May 9….”

Vox - The emerging long-term complications of Covid-19, explained

https://www.vox.com/2020/5/8/21251899/coronavirus-long-term-effects-symptoms

Horror read.

For the fans of the genre, see also Covid-19 can damage lungs of victims beyond recognition, expert says (Guardian).

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And if you’re sort of a psychopath, FT- Coronavirus could infect human brain and replicate, US study shows.

Telegraph - Covid-19 may trigger the onset of diabetes in previously healthy

people

https://www.telegraph.co.uk/news/2020/06/12/covid-19-may-trigger-onset-diabetes-previously-

healthy-people/

“New-onset diabetes is being observed in patients who have tested positive for the virus.”

BMJ Feature - Hydroxychloroquine for covid-19: the end of the line?

https://www.bmj.com/content/369/bmj.m2378

“Controversies and disappointing trial results have dampened excitement about an established drug touted as a “game changer” for the novel coronavirus. Elisabeth Mahase asks what the future now holds for hydroxychloroquine.”

It’s not the end, yet. “While it seems that hydroxychloroquine is not effective for patients being treated in hospital, it is still being investigated for prevention….”

Lancet Infectious Diseases - Effectiveness of isolation, testing, contact tracing, and

physical distancing on reducing transmission of SARS-CoV-2 in different settings:

a mathematical modelling study

A Kucharski et al; https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30457-

6/fulltext

This new modelling study argues that as long as there’s no vaccine, a combination of self-isolation, household quarantine, and contact tracing could be a good strategy for controlling the pandemic. This combination of measures could reduce transmission of SARS-CoV-2 by 47% to 64%.

And some links:

Telegraph - Government bodies to review if vitamin D can help protect against coronavirus

Covid-19 Analysis

From various angles:

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Global Policy Watch (Briefing) - COVID-19 and the SDGs: The impact of the

coronavirus pandemic on the global sustainability agenda

Jens Martens et al ; https://www.globalpolicywatch.org/blog/2020/06/18/covid-19-and-the-sdgs/

“The COVID-19 pandemic and the policies with which governments have responded to it have had a serious impact on the global sustainability agenda. While the full extent of the pandemic and its impacts cannot yet be assessed, there is an evident risk that the pandemic will jeopardize the achievement of the internationally agreed Sustainable Development Goals (SDGs) in their entirety. Preliminary forecasts by the United Nations, the World Bank and other international organizations warn that the already fragile progress made in reducing poverty and malnutrition over the past decades will be reversed. The inevitable global economic downturn, already begun, does not spare any country. Unemployment has risen dramatically along with new forms of precarious employment. Measures to combat global warming and the extinction of species threaten to move down on the list of political priorities. Falling state revenues and growing debt will limit the fiscal space for policy action from the global to the municipal level. For each of the 17 SDGs, this briefing summarizes preliminary estimates on the actual or likely impacts of the global coronavirus crisis, using a few specific examples. It illustrates that the 2030 Agenda will not be reached and its Sustainable Development Goals will not be achieved if they are not systematically taken into account in all policy responses to the crisis.”

Paper - What Went Wrong: Corona and the World after the Full Stop

Carlo Caduff;

https://www.academia.edu/42829792/What_Went_Wrong_Corona_and_the_World_after_the_Full

_Stop

Not everything is perhaps equally convincing in this paper, but it’s easily one of the reads of the week nevertheless. Also with a number of suggestions how to rebuild the world after the ‘Full Stop”.

Global Health: Science and Practice - Coping With COVID-19: Learning From Past

Pandemics to Avoid Pitfalls and Panic

https://www.ghspjournal.org/content/ghsp/early/2020/06/17/GHSP-D-20-00189.full.pdf

From a different angle, but going more or less in the same direction.

“As we wrestle with how best to mitigate COVID19, it is imperative to concur on the likely main drivers of transmission (notably, infection clusters resulting from prolonged indoor respiratory exposure) in order to clearly explain risk and to determine the most effective, realistic behavioral and other means to reduce illness and mortality. At the same time, we must avoid generating irrational fear and maintain a broader perspective, including assessing the possibility for substantial unintended consequences from the response to the pandemic.”

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Foreign Affairs - The Looming Hunger Pandemic

David Beasley (executive director of the United Nations World Food Programme); (https://www.foreignaffairs.com/articles/world/2020-06-16/looming-hunger-pandemic

“Coronavirus Threatens to Push Millions Into Starvation”.

CGD (blog) Predicting COVID-19 Infection Fatality Rates Around the World

J Sandefur et al ; https://www.cgdev.org/blog/predicting-covid-19-infection-fatality-rates-around-

world

“How is the pandemic likely to evolve as it spreads to poorer countries? In a new working paper, we attempt to answer one piece of that question, predicting the infection fatality rate for COVID-19 for 187 countries based on demography, comorbidities, and the strength of health systems.”

Excerpt: “ … The IFR numbers we report are somewhat higher—sometimes dramatically so—than the figures given for many developing countries in earlier influential studies, including the Imperial College team’s scenarios for the global pandemic and a recent report by the WHO Africa bureau. That difference can be chalked up to how we incorporate two factors: pre-existing health conditions, and the relative strength of health systems….”

CGD (blog) - What Can Policymakers Learn about COVID-19 from Looking at

Different Model Estimates?

Y-Ling Chi et al ; https://www.cgdev.org/blog/what-can-policymakers-learn-about-covid-19-looking-

different-model-estimates#disqus_thread

“Because of the uncertainties that complicate modelling, there is value in different research groups working independently to build models. Different models will employ different methods, data, and assumptions and will seek to answer different policy questions. Here we take a look from an end-user’s perspective at what models can tell us, by looking for one example country, the Republic of South Africa.”

Plos Med - The potential impact of COVID-19 in refugee camps in Bangladesh and

beyond: A modeling study

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003144

“Paul Spiegel and colleagues estimate the potential consequences of COVID-19 outbreaks at refugee camps.” Very concerning.

“…Our results suggest that a large-scale outbreak is very likely in this setting after a single infectious person enters the camp, with 0.5%–91% of the population expected to be infected within the first three months and over 70%–98% during the first year, depending on the transmission scenario, should no effective interventions be put into place….”

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Guardian - Covid-19 outbreaks in New Zealand and China highlight stark choices

https://www.theguardian.com/world/2020/jun/16/outbreaks-in-beijing-and-new-zealand-highlight-

perils-of-relaxing-rules

“To stay coronavirus free, countries face unsustainable social and economic losses.”

“… The [new] outbreaks have brought home the stark choices facing leaders who have successfully stamped out the virus or contained its transmission. If they want to hold on to that coveted status, their countries face months, perhaps years, sealed off from the world in a way unprecedented in modern times. They can maintain containment but doing so will probably require strict observance of quarantines by travellers,” said Prof Lindsay Wiley, director of the health law and policy program at American University Washington College of Law….”

CGD notes- Protecting Community Health Workers: PPE Needs and

Recommendations for Policy Action

https://www.cgdev.org/publication/protecting-community-health-workers-ppe-needs-and-recommendations-policy-action

In-depth note. 12-pager.

Stat - To understand who’s dying of Covid-19, look to social factors like race more

than preexisting diseases

Stat;

“While early studies of who was dying of Covid-19 identified risks such as obesity and having diabetes, there is a growing realization that those initial conclusions might have been misleading, obscuring a more significant explanation. As researchers pull back their lens from individuals to population-level risk factors, they’re finding that, in the U.S., race may be as important as age in gauging a person’s likelihood of dying from the disease. The higher the percentage of Black residents in a county, the higher its death rate from Covid-19 — even after accounting for income, health insurance coverage, rates of diabetes and obesity, and public transit use, finds a new study by researchers at the MIT Sloan School of Management. With those plausible explanations ruled out, “the causal mechanism has to be something else,” said applied economist Chris Knittel, the study’s senior author. “If I were a public official, I’d be looking at differences in the quality of insurance, conditions such as chronic stress, and systemic discrimination.”

JECH (essay) - The COVID-19 pandemic and health inequalities

C Bambra et al ; https://jech.bmj.com/content/early/2020/06/13/jech-2020-214401

“This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing

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inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemic pandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.”

CGD (blog) - Using Military Health Systems in the Response to COVID-19

J Kazibwe et al ; https://www.cgdev.org/blog/using-military-health-systems-response-covid-

19#disqus_thread

“COVID-19 has placed an unimaginable strain on health systems across the world, especially in regions that have been hit hardest. Some countries have utilised their armed forces to assist the civilian response to the COVID-19 crisis. Recognising the important relationship between the military and medical institutions this blog outlines how militaries around the world–but specifically in eight European countries–have been feeding into the COVID-19 response.”

JAMA Viewpoint - The Moral Determinants of Health

https://jamanetwork.com/journals/jama/fullarticle/2767353

“In this Viewpoint, Berwick emphasizes that moral commitment to others, expressed through working for universal health coverage, criminal justice, and housing policy reform, climate change intervention, and more, is necessary if society is to meaningfully address adverse social determinants of health and reduce health inequalities.”

Now we just have to wait for somebody who’s gonna write about the “immoral determinants of health”. Probably far more common.

Science (News) - ‘It’s really complicated.’ United States and others wrestle with

putting COVID-19 vaccines to the test

https://www.sciencemag.org/news/2020/06/it-s-really-complicated-united-states-and-others-

wrestle-putting-covid-19-vaccines-test

“…A Chinese company will turn to Brazil for help. The World Health Organization (WHO) is adopting a strategy forged in a war zone during an Ebola outbreak. And the Trump administration plans to lean on existing U.S. infrastructure for tackling HIV and flu. These are some of the disparate strategies about to be employed in the next and most important stage of the COVID-19 vaccine race: the large-scale, placebo-controlled human trials needed to prove which of the more than 135 candidates are safe and effective….”

BMJ Global Health (Commentary) - Oxygen provision to fight COVID-19 in sub-

Saharan Africa

Felix Stein et al ; https://gh.bmj.com/content/5/6/e002786

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“The adequate provision of medical oxygen is going to make the difference between life and death for the majority of patients with COVID-19 in Africa. Sub-Saharan African countries lack affordable and reliable oxygen supply. There is evidence from sub-Saharan Africa for why medical oxygen provision must be made a regional urgent priority. Efforts being made in some African countries demonstrate how oxygen provision can be scaled up through innovative cheap technologies.”

Open Society - 10 Lessons from HIV for the COVID-19 Response

D Wolfe; Open Society;

“…As the world moves from lockdown to living uneasily with this new coronavirus, here are 10 lessons we can learn from a pandemic we have lived with longer: HIV….”

Telegraph - UK response to coronavirus pandemic one of the worst in the world,

report finds

https://www.telegraph.co.uk/global-health/science-and-disease/uk-response-coronavirus-pandemic-one-worst-world-report-finds/

“The UK's response to the coronavirus pandemic is one of the worst among similarly developed nations, including the United States, according to analysis from a leading think tank. Success in tackling the outbreak is not necessarily linked to wealth, according to a study from the Economist Intelligence Unit's (EIU). For example, Chile's performance is comparable to that of France, and considerably better than the UK's. According to the index, which ranked the quality and effectiveness of the policy response of the 21 Organisation for Economic Co-operation and Development (OECD) countries, Belgium, Spain, Italy and the UK had the worst responses….”

“….The analysis assessed countries' responses against three criteria: number of tests per million people, provision of non-Covid 19 healthcare, and the number of above average excess deaths per million people (rather than just deaths directly attributed to Covid-19). Three mitigating factors were also taken into account: share of older population, obesity prevalence, and number of international arrivals….”

Think Global Health – Commercial Determinants of Health in COVID-19

A Hyder et al ; https://www.thinkglobalhealth.org/article/commercial-determinants-health-covid-19

“Often part of the problem in pandemics, private sector businesses can be part of the solution as well and protect people.”

Not quite sure whether I fully agree with this expansion of the term ‘commercial determinants of health’ but certainly a recommended read.

Guardian - Coronavirus mass surveillance could be here to stay, experts say

https://www.theguardian.com/world/2020/jun/18/coronavirus-mass-surveillance-could-be-here-to-stay-tracking?CMP=share_btn_tw

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“Extensive surveillance measures introduced around the world during the coronavirus outbreak have widened and become entrenched, digital rights experts have said, three months after the World Health Organization declared a pandemic….”

ASTMH (Perspective) - Erroneous Communication Messages on COVID-19 in

Africa

B Seytre; https://www.ajtmh.org/content/journals/10.4269/ajtmh.20-0540

“Adherence of the population to COVID-19 prevention recommendations is crucial to control the epidemic. However, a study of communication messages around COVID-19 in 15 West African countries showed a number of unfounded messages, as well as a lack of communication on critical information to understand the prevention measures being promoted. Incidents of violence that have taken place recently suggest that general mistrust and hostility could grow, similar to the events that occurred during the previous Ebola epidemics. It is therefore urgent to review and revise the COVID-19 communication messages currently used in sub-Saharan Africa.”

WB (blog) - Lives or livelihoods? Global estimates of the mortality and poverty

costs of COVID-19

B Decerf et al; https://blogs.worldbank.org/developmenttalk/lives-or-livelihoods-global-estimates-mortality-and-poverty-costs-covid-19

“… In a recent paper, we propose a simple approach to estimating the welfare costs of the crisis, using life years as a common unit. Our approach covers mortality and poverty costs only, for 150 countries. For each country, we estimate how many years of life have been lost through COVID-19 deaths (“lost years”) as of early June. We also estimate how many additional years are spent in poverty due to the pandemic and the subsequent individual and public policy responses (“poverty years”). …” Check out the three main findings.

Globally, as of early June, the poverty costs of the pandemic are very large relative to the mortality costs; poverty costs relative to mortality costs decline sharply with GDP per capita. And on a counterfactual scenario: “a no-intervention policy would have led to higher welfare losses, particularly in richer countries.”

Covid-19 resources

LSHTM - COVID-19 vaccine development pipeline

https://vac-lshtm.shinyapps.io/ncov_vaccine_landscape/

“This tracker, developed by the Vaccine Centre at the London School of Hygiene & Tropical Medicine, will follow COVID-19 vaccine candidates as they progress through the development pipeline. Updated weekly. An overview of the different vaccine types as well as the phases of clinical development is provided in the Summary tab.”

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cfr tweet A Glassman: “COVID19 vaccine development pipeline @LSHTM - illustrates clearly that the primary completion date of the only phase II/III trial so far is end August 2021. Bottom line: plan for management of this pandemic for the next year or more.”

Stat – Covid-19 drugs & vaccines tracker

Stat;

Also a great resource.

Covid-19 impact on other global health programs & research

How Covid is making it tougher to tackle TB, AIDS, malaria and child health

J Bigio & M Pai; https://theprint.in/health/how-covid-is-making-it-tougher-to-tackle-tb-aids-malaria-

and-child-health/443658/

Check out especially the nice visualization on the wider impact of the covid pandemic on global health (TB, HIV, malaria, maternal & child health; routine immunization; NCDs; reproductive health; poverty).

The authors’ message: “All countries need to urgently tackle coronavirus, but not at the cost of existing health priorities, which have been hit badly by lockdowns.”

HPW - Neglected Tropical Disease Programmes On Pause Due To COVID-19

https://healthpolicy-watch.news/neglected-tropical-disease-programmes-on-pause-due-to-covid-

19/

“As COVID-19 puts the world collectively on pause, essential programmes for neglected tropical diseases (NTDs) are also feeling the cut. NTDs are estimated to impact up to 1.3 billion people around the world, mostly prevalent in poor, marginalized communities with low access to healthcare. “One of the things that’s been severely affected is our neglected tropical disease programmes,” said Mwelecele Ntuli Malecela, director of NTD Control at WHO. “Particularly in Africa, as part of the focus on social distancing, we’ve had to stop most of the mass drug administration programmes.”

“… in the wake of COVID-19, official WHO guidelines have urged countries to put a pause on MDA campaigns. The focus now is on how to improve programmes as countries come out of lockdown, post-COVID-19, said Ntuli Malecela. … … A new, 10-year Roadmap for NTD control will be released in late August by the World Health Organization….”

NYT – Slowing the Coronavirus Is Speeding the Spread of Other Diseases

NYT;

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Update. “Many mass immunization efforts worldwide were halted this spring to prevent spread of the virus at crowded inoculation sites. The consequences have been alarming.” Especially for measles.

“ As poor countries around the world struggle to beat back the coronavirus, they are unintentionally contributing to fresh explosions of illness and death from other diseases — ones that are readily prevented by vaccines. This spring, after the World Health Organization and UNICEF warned that the pandemic could spread swiftly when children gathered for shots, many countries suspended their inoculation programs. Even in countries that tried to keep them going, cargo flights with vaccine supplies were halted by the pandemic and health workers diverted to fight it. Now, diphtheria is appearing in Pakistan, Bangladesh and Nepal. Cholera is in South Sudan, Cameroon, Mozambique, Yemen and Bangladesh. A mutated strain of poliovirus has been reported in more than 30 countries. And measles is flaring around the globe, including in Bangladesh, Brazil, Cambodia, Central African Republic, Iraq, Kazakhstan, Nepal, Nigeria and Uzbekistan….”

“…As the pandemic lingers, the WHO and other international public health groups are now urging countries to carefully resume vaccination while contending with the coronavirus….”

For a similar (and insightful) read, see Vox - The other infectious diseases spreading in the shadow of the pandemic

Global Fund - Global Fund Survey: Majority of HIV, TB and Malaria Programs Face

Disruptions as a Result of COVID-19

https://www.theglobalfund.org/en/covid-19/news/2020-06-17-global-fund-survey-majority-of-hiv-tb-and-malaria-programs-face-disruptions-as-a-result-of-covid-19/

“The latest survey results of Global Fund-supported programs across 106 countries show widespread disruptions to HIV, TB and malaria service delivery as a result of the COVID-19 pandemic, impacting approximately three-quarters of HIV, TB and malaria programs. The results of this qualitative survey indicate challenges to HIV prevention; testing and case finding for HIV, TB and malaria; cancelled or delayed prevention activities; and medical and laboratory staff being reassigned to the fight against COVID-19. Key results from the latest survey, completed 1 June: 85% of HIV programs reported disruption to service delivery (18% with high or very high disruptions); 78% of TB programs reported disruption to service delivery (17% with high or very high disruptions); 73% of malaria programs reported disruption to service delivery (19% with high or very high disruptions)….”

Reliefweb - Amid Pandemic, Abuse of Older People Rising

Reliefweb;

“COVID-19 has amplified the violence, abuse, and neglect of older people around the world, which was already on the rise, says HelpAge International today on World Elder Abuse Awareness Day. Before the COVID-19 pandemic, it was estimated that 1 in 6 older people was subject to abuse. Emerging evidence is indicating that this has sharply increased in many countries as a direct result of the pandemic….” “… Physical, financial, psychological, verbal and sexual abuse of older people was already rising globally. …”

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Guardian - Why coronavirus has placed millions more girls at risk of FGM

https://www.theguardian.com/global-development/2020/jun/16/coronavirus-millions-more-girls-

risk-fgm

“Covid-19 has exposed just how much work remains to be done to wipe out female genital mutilation (FGM) around the world. Two million girls who would otherwise be safe from the practice are believed to be at risk over the next decade as a direct result of the virus. As lockdowns linger and economies tumble, many families have been spurred into action over the fate of their daughters, using school closures to cut them and marry them off, campaigners say. Although the UN has set a 2030 deadline to end FGM, activists claim that seems unlikely, given the mass cuttings in parts of Africa…..”

“…“Being in school is the main reason girls don’t get cut. The girls are safe in school. With the schools closed, there’s no alternative – they are left to the mercy of their parents and communities.”…”

Sustaining Essential Health Services during the Covid-19 Pandemic: A Social

Imperative

P Marquez et al ; http://pvmarquez.com/essentialhealthservices

“For countries that had weaker health systems and less resources, the impact can be both significant and long-lasting. COVID-19 may affect countries’ journey to Universal Health Coverage and the Sustainable Development Goal 3 through several pathways:…”

They distinguish three main pathways, and then give a number of suggestions on what to do.

NYT - The Pandemic Claims New Victims: Prestigious Medical Journals

NYT;

“Two major study retractions in one month have left researchers wondering if the peer review

process is broken.”

LGBTQ+

Guardian (Longread) - How globalisation has transformed the fight for LGBTQ+

rights

https://www.theguardian.com/world/2020/jun/16/how-globalisation-has-transformed-the-fight-

for-lgbtq-rights

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“Much progress has been made in attitudes towards sexual equality and gender identity – but in many places a dramatic backlash by conservative forces has followed.”

Planetary health

Guardian – World has six months to avert climate crisis, says energy expert

https://www.theguardian.com/environment/2020/jun/18/world-has-six-months-to-avert-climate-

crisis-says-energy-expert

“The world has only six months in which to change the course of the climate crisis and prevent a post-lockdown rebound in greenhouse gas emissions that would overwhelm efforts to stave off climate catastrophe, one of the world’s foremost energy experts has warned. “This year is the last time we have, if we are not to see a carbon rebound,” said Fatih Birol, executive director of the International Energy Agency. Governments are planning to spend $9tn (£7.2tn) globally in the next few months on rescuing their economies from the coronavirus crisis, the IEA has calculated. The stimulus packages created this year will determine the shape of the global economy for the next three years, according to Birol, and within that time emissions must start to fall sharply and permanently, or climate targets will be out of reach. “The next three years will determine the course of the next 30 years and beyond…”

Globalizations -Reforming global climate governance in an age of bullshit

H Stevenson;

https://www.tandfonline.com/doi/abs/10.1080/14747731.2020.1774315?journalCode=rglo20

“There is a significant deficit of ‘ecological integrity’ in contemporary climate change governance, defined as explicit recognition of the mismatch between rhetoric, intentions and actions. This deficit is not unique to climate governance: we live in an age of bullshit (indifference to the truth). Philosopher Harry Frankfurt (On bullshit, 2005, Princeton University Press) identifies this as ‘one of the most salient features of our culture’. In this article, I argue that the concept captures the inconsistencies we observe in global climate governance. I begin by conceptualizing it and identifying the various forms it can take. I then provide an overview of the past three decades of global climate governance, before analysing illustrative examples of bullshit. I conclude by proposing reforms to the climate regime’s accountability arrangements to enhance the integrity and limit the harmful effects of bullshit in global climate governance.”

Guardian - Emissions from 13 dairy firms match those of entire UK, says report

https://www.theguardian.com/environment/2020/jun/15/emissions-from-13-dairy-firms-match-

those-of-entire-uk-says-report

“The biggest dairy companies in the world have the same combined greenhouse gas emissions as the UK, the sixth biggest economy in the world, according to a new report. The analysis shows the impact of the 13 firms on the climate crisis is growing, with an 11% increase in emissions in the two years after the 2015 Paris climate change agreement, largely due to consolidation in the sector.

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Scientific reports have shown that consumption of dairy, as well as meat, must be reduced significantly in rich nations to tackle the climate emergency. The report, by the Institute for Agriculture and Trade Policy (IATP) in the US, also says the growth of giant dairy companies has helped force milk prices below the cost of production for the last decade, causing a crisis in rural livelihoods and requiring taxpayer subsidies to keep farmers afloat. The researchers say caps on production should be reintroduced to protect both the climate and small farmers….”

Guardian - Climate worst-case scenarios may not go far enough, cloud data shows

https://www.theguardian.com/environment/2020/jun/13/climate-worst-case-scenarios-clouds-

scientists-global-heating

“Modelling suggests climate is considerably more sensitive to carbon emissions than thought.”

PS: on a side note, I’m happy Lionel Messi also joined the ‘Building back better’ movement, post-

corona, having at last gotten rid of that ugly beard of his 😊.

BLM & systemic racism

JAMA viewpoint - COVID-19 Pandemic, Unemployment, and Civil Unrest -

nderlying Deep Racial and Socioeconomic Divides

S Galea & S Abdalla; https://jamanetwork.com/journals/jama/fullarticle/2767354

“This Viewpoint discusses the inequalities underlying the preferential spread of COVID-19 and of economic hardship in lower-income communities of color in the US, and sees the national protests in support of the Black Lives Matter movement as a natural consequence of those inequities and an opportunity to change the systems that create them.”

UN News - Citing ‘weight of history’, senior UN officials of African descent issue

call to ‘go beyond and do more’ to end racism

https://news.un.org/en/story/2020/06/1066242

“A group of more than twenty senior leaders in the UN, who report directly to Secretary-General António Guterres, and who are African or of African descent, have put their names to a personal and hard-hitting statement published on Friday, expressing their outrage at pervasive and systemic racism, highlighting the need to ‘go beyond and do more’ than just offering condemnation. The signatories include high-profile heads of UN agencies, such as Tedros Ghebreyesus, head of the World Health Organization (WHO), Winnie Byanyima, Executive-Director of UNAIDS, and Natalia Kanem, who runs the UN sexual and reproductive health agency (UNFPA)….”

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VOA - African Countries Call for Debate on Racism at the UN Human Rights Council

https://www.voanews.com/usa/race-america/african-countries-call-debate-racism-un-human-

rights-council

(Last week), “African countries on Friday called on the U.N. Human Rights Council to organize an urgent debate on racism and police violence, in the context of global mobilization after the death of George Floyd in the United States. In a letter written on behalf of the 54 countries of the African Group, of which he is coordinator for human rights questions, the ambassador of Burkina Faso to the United Nations in Geneva, Dieudonné Désiré Sougouri, asked the body to the U.N. to organize an "urgent debate on the current racially-inspired human rights violations, systemic racism, police brutality against people of African descent and violence against peaceful demonstrations."…”

Reuters - U.N. rights body to examine 'systemic' U.S. racism and police brutality

https://uk.reuters.com/article/uk-minneapolis-police-protests-un/u-n-rights-body-to-examine-u-s-

racism-police-brutality-statement-idUKKBN23M12Z

“The top U.N. human rights body agreed on Monday to hold an urgent debate on allegations of “systemic racism, police brutality and violence against peaceful protests” in the United States and elsewhere on Wednesday. The U.N. Human Rights Council’s decision followed a request last week by Burkina Faso on behalf of African countries in response to the killing of George Floyd, an African American, on May 25 under the knee of a white Minneapolis police officer. His death has ignited protests across the nation and worldwide….”

Update via Reuters (17 June) - U.S. "not above scrutiny", urges other states to be open on racism - statement

“The United States is grappling with racial discrimination and implementing police reforms after the killing of George Floyd, but other countries should show the same level of openness, a U.S. envoy said on Wednesday ahead of a U.N. debate on racism.”

“…Activists said that U.S. officials were heavily lobbying African countries to tone down a draft resolution being considered so that it would not name the United States or set up a U.N. commission of inquiry, but rather a fact-finding mission. Wednesday ahead of a U.N. debate on racism. African countries had lobbied to set up a U.N. inquiry into “systemic racism” and “police brutality” in the United States and elsewhere, aiming to defend the rights of people of African descent, the initial draft resolution showed.”

Stat - ‘An obligation’: Doctors and other health workers increasingly see

protesting racial injustice as part of the job

https://www.statnews.com/2020/06/16/doctors-protesting-racial-

injustice/?utm_content=buffer524bb&utm_medium=social&utm_source=twitter&utm_campaign=t

witter_organic

And they’re damned right.

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Women Deliver - Statement from Katja Iversen

https://womendeliver.org/press/statement-from-katja-iversen/

She apologizes deeply and takes full responsibility. For:

“Recently, former Women Deliver employees have come forward on social media to say they experienced a toxic work environment and Black former employees explicitly described how they felt tokenized, abused, and discriminated against during their time at Women Deliver. And in my discussions with staff, it’s clear that the problems still run deep. I was and am shaken, heartbroken, and tremendously angry with myself. I am in charge of this organization, and I apologize and take full responsibility for these experiences and for my role in it. We have not lived up to our own values, and I am deeply sorry for the pain and the trauma experienced by current and former employees….”

See also Devex - Women Deliver launches investigation following staffers' allegations of racism

“Global advocacy organization Women Deliver is undergoing an independent review after former staffers made public allegations of a racist environment last week. Amid accusations of a toxic workplace, Women Deliver CEO Katja Iversen announced Tuesday that she would take a leave of absence until an independent investigation of the organization is complete….”

More in general – see Devex – “Global development leaders are under pressure to confront and address the effects of institutional racism, both within their own organizations and in the design, portrayal, and implementation of their programs….”

Wellcome - Our commitment to tackling racism at Wellcome

J Farrar; https://wellcome.ac.uk/press-release/our-commitment-tackling-racism-wellcome?utm_source=twitterShare

After Peter Piot last week (LSHTM), Jeremy Farrar also made a statement on the commitment of the Wellcome Trust on this issue. A message from Wellcome’s Executive Leadership Team on diversity and inclusion.

And a link, via Think Global Health - White Supremacy in Global Health

Access to Medicines

Devex - Gilead’s closed-door deal sets precedent for COVID-19 drug access

https://www.devex.com/news/gilead-s-closed-door-deal-sets-precedent-for-covid-19-drug-access-

97214

In-depth analysis (and recommended read). “Amid global conversations to ensure equitable access to future drugs and vaccines for COVID-19, Gilead Sciences, Inc. made its own side room deal. Over

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the past month, the U.S.-based company made an agreement with generic pharmaceutical companies in Egypt, India, and Pakistan to allow them to produce its drug remdesivir, an injectable antiviral medication, and currently the most promising drug for the treatment of the coronavirus. The deal allows these generic manufacturers to distribute the drug in 127 countries….” Check out what the implications might be for Covid-19 drug access in general.

GAVI (News) - Pneumonia vaccine price drops dramatically for lower-income

countries thanks to the Gavi Pneumococcal AMC

https://www.gavi.org/news/media-room/pneumonia-vaccine-price-drops-dramatically-lower-

income-countries-thanks-gavi

“Lower-income countries across the world will now be able to access lifesaving pneumococcal conjugate vaccines, which protect against the leading cause of pneumonia, for US$ 2 per dose, thanks to a new supply agreement between UNICEF, Gavi’s procurement partner, and the Serum Institute of India (SII). The new price represents a 43% reduction from the Gavi price of US$3.50 at the start of the AMC. The supply agreement is the eighth to take place under the Vaccine Alliance’s Advance Market Commitment (AMC) mechanism, and the first to include a developing country manufacturer. Under the agreement the Indian manufacturer will provide ten million PCV doses to Gavi-supported countries each year for the next ten years….”

AMR

Plos Med - Antibiotic prescription practices in primary care in low- and middle-

income countries: A systematic review and meta-analysis

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003139

“Giorgia Sulis and colleagues report the prevalence of antibiotic prescriptions in primary care in low-middle income countries in a systematic review and meta-analysis.”

Coverage in Cidrap news - High antibiotic prescribing rates found in lower-resource nations

“A new review and meta-analysis of studies conducted in low- and middle-income countries (LMICs) shows that on average, more than half of all patients seeking healthcare for any reason at primary care facilities receive an antibiotic, researchers reported yesterday in PLOS Medicine. The review, which examined 48 studies reporting on the use of prescription medications in primary care in LMICs over the last decade, found that the pooled prevalence of antibiotic prescribing in primary care was 52%—far higher than the 30% recommended by the World Health Organization (WHO)….”

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WTO leadership contest & public health

HPW - World Trade Organization Faces Leadership Battle In Shadow Of Crisis

Over Organization’s Future

F M Abbott et al ; https://healthpolicy-watch.news/world-trade-organization-faces-leadership-

battle-in-shadow-of-crisis-over-organizations-future/

Recommended analysis. “The early resignation of Roberto Azevedo from the post of Director General (DG) of the World Trade Organization (WTO), sets the stage for a highly politicized competition over his successor – who will face a major challenge in demands to reshape the WTO in the wake of repeated US complaints about its trade dispute rulings and policies with an alleged pro-China tilt….”

“The new Director General will face a range of sharp debates around trade issues that are critical to health – including the need to ensure wide global access to new COVID-19 medicines and vaccines. But beyond the current pandemic, the WTO may also play a lead role on other critical policies that affect health as well as broader economic well-being, including: import and export barriers affecting fragile economies; policies around trade in agriculture and food products; and ever more urgent questions surrounding trade, climate and sustainability.”

And a quote: “…Along with the much-touted WHO-supported voluntary COVID-19 patent pool launched two weeks ago, proposals for compulsory patent pools are in the works, as are suggestions for taking advantage of the TRIPS Article 31bis provision allowing compulsory licensing predominantly for export. So, the mettle of WTO rules regarding intellectual property are likely to be tested again, perhaps even more severely than before, as the current pandemic has touched rich and poor countries alike in the greatest global public health crisis of a century. The new WTO DG will thus be called upon to provide leadership in assuring that TRIPS Agreement and other WTO flexibilities are respected....”

Social protection in Covid times

SDG Lab & ILO - Inequalities & the Informal Economy: How to move from crisis

response to long-term resilience

https://www.sdglab.ch/en/what-we-do/2020/6/12/inequalities-amp-the-informal-economy-how-to-

move-from-crisis-response-to-long-term-resilience

“At an SDG Lab and International Labour Organization (ILO) convened high-level panel focused on inequalities and the informal economy during the COVID-19 pandemic, speakers reiterated the role of governments in providing social protection to informal workers and other vulnerable groups—not only during times of crisis but as established policy measures to build long-term resiliency in support of achieving the 2030 Agenda. Held on June 9, the webcast event “Inequalities during and after COVID-19” offered a timely moment to learn of policies, programmes and approaches that three countries – Jordan, Portugal and South Africa – have taken to help informal workers and

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their communities cope with the coronavirus outbreak, which, globally, is impacting an estimated 1.6 billion workers in the informal economy, nearly half of the world’s workforce….”

Cfr a tweet: “Because of #COVID19 many govt's have adopted social protection schemes that were absent before the virus. How best to preserve such measures as the new norm in the recovery? That's a question we took on this week in an online panel with ILO”

BMJ Global Health – Income security in times of ill health: the next frontier for the

SDGs

K Lönroth et al; nhttps://gh.bmj.com/content/5/6/e002493

“Universal health coverage (UHC) is at the forefront of the discussions on how to achieve the health-related Sustainable Development Goals (SDG). A prominent part of the UHC agenda is to ensure that people are not impoverished due to high healthcare expenditures. While this is crucial, it is not sufficient to protect people from hardship in times of ill health, as illustrated in the ongoing Covid-19 pandemic where lack of income security creates barriers for people to adhere to infection control measures. Social protection systems ensuring income security when unable to work due to sickness are as important as schemes designed to reduce out-of-pocket healthcare expenditure. Yet, this is not part of the UHC framework and not sufficiently visible in the SDG Target on social protection. This contrasts sharply with the high prioritisation of income security in times of ill health when universal social protection systems were built in the last century in many of today’s high-income countries….”

World Refugee Day (June 20)

Telegraph - Almost 80 million people forced to flee their homes in 2019,

according to UN

https://www.telegraph.co.uk/global-health/climate-and-people/almost-80-million-people-forced-

flee-homes-2019-according-un/

“World needs to be 'more accepting' of refugees as displacement is no longer a short-term phenomenon.”

“An unprecedented 79.5 million people were forced to flee their homes last year, according to a new report released by the UN Refugee Agency ahead of World Refugee Day. The number of refugees worldwide has almost doubled since 2010, when there were 41.1 million, and they now make up more than one per cent of the world’s population. Millions are displaced each year as a result of persecution, violence, conflict and human rights violations. An estimated 30-34 million (40 per cent) of the 79.5 million people forcibly displaced in 2019 were children below the age of 18. …” See also the Guardian - Forcibly displaced now account for 1% of humanity – UN report

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Global Status Report on Preventing Violence Against Children 2020

WHO - Countries failing to prevent violence against children, agencies warn

https://www.who.int/news-room/detail/18-06-2020-countries-failing-to-prevent-violence-against-

children-agencies-warn

“Global status report on preventing violence against children calls for more government action and

warns of ‘dramatic impact’ of COVID-19.”

“Half of the world’s children, or approximately 1 billion children each year are affected by physical, sexual or psychological violence, suffering injuries, disabilities and death, because countries have failed to follow established strategies to protect them. This is according to a new report published today by the World Health Organization (WHO), UNICEF, UNESCO, the Special Representative of the United Nations Secretary-General on Violence against Children and the End Violence Partnership. … … The report – Global Status Report on Preventing Violence Against Children 2020 – is the first of its kind, charting progress in 155 countries against the “INSPIRE” framework, a set of seven strategies for preventing and responding to violence against children. The report signals a clear need in all countries to scale up efforts to implement them. While nearly all countries (88%) have key laws in place to protect children against violence, less than half of countries (47%) said these were being strongly enforced. … … The report includes the first ever global homicide estimates specifically for children under 18 years of age – previous estimates were based on data that included 18 to 19-year olds. It finds that, in 2017, around 40,000 children were victims of homicide….”

Lancet Commission on dengue and other Aedes-transmitted viral diseases

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31375-1/fulltext

New Comment in the Lancet.

“…The Lancet Commission on dengue and other Aedes-transmitted viral diseases had its inaugural meeting in November, 2019, in London, UK. This Commission will assess existing and new technologies and platforms, examine how these can be interlinked for effective synergistic disease control, and provide recommendations for countries to strengthen and sustain Aedes-transmitted disease prevention programmes. … … This Commission will propose a global strategy for control of Aedes-transmitted viral diseases through the integration of synergistic disease control tools into regional, national, and local health programmes. The Commission's report, expected to be launched in late 2021, will include key recommendations for countries and international stakeholders to respond effectively to frequent and cyclical Aedes-transmitted viral disease epidemics. Vertical programmes and community-led solutions will be developed in alignment with the Sustainable Development Goals…”

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Lancet Global Health (July issue)

https://www.thelancet.com/journals/langlo/issue/current

As always, start with the Editorial - Publishing in the time of COVID-19

“ It is difficult to imagine an organisation or individual that has not been affected by the COVID-19 pandemic. As we as a journal begin our fourth month of operating from makeshift home workspaces, perhaps it is time to reflect on our own experiences so far and how they might shape the future of this and other journals….”

The editorial concludes: “…So what have we learned from our experience so far? In addition to rapidly rethinking workflows after a sudden surge in submissions, we have also—paradoxically—found a need to slow down. When research, writing, and peer review are rushed, the consequences can be damaging. Yes, editors need to be alert to the imperative to ensure that important health information does not get caught in a web of antiquated processes. But sometimes we need to question our own eagerness to pursue exciting-looking papers on topical subjects. We might need to resist pressure from researchers and their institutions to expedite every step. And we might need to innovate new means of scrutiny in a Big Data era where computing power, money, and access to raw data govern independent validation. A commitment to these actions is a commitment to the best science for better lives.”

Many papers & comments were already published online before.

Of the “new” content, check out also: Physical activity: moving from words to action

And we certainly want to remind you of this article - An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries (by M Kelley et al)

Some papers and reports of the week

BMJ Global Health - Power and politics: the case for linking resilience to health

system governance

S Topp; https://gh.bmj.com/content/5/6/e002891.full

One of the reads of the week. Let’s hope Health Systems Global will globally advocate for this smart view of resilience, at the virtual symposium in November, and beyond.

“Since the watershed moment of the 2014 Ebola epidemic in West Africa and again in the midst of the current COVID-19 crisis, the concept of health system resilience has been a recurring theme in global health discussions. Although most frequently used in the context of epidemic response, resilience has also been framed as a ‘key pillar’ of health, and invoked in high-level calls for countries to ‘lead the work on building health system resilience’. Yet, as the authors of one of several recent reviews observed, the concept of health systems resilience remains ‘highly confusing’ and ‘still polysemic’. What it means ‘depends on one’s perception, one’s discipline, one’s function and what

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one wants to achieve’. In this editorial, I will, from the perspective of a health policy and systems researcher, draw out and reflect on some of these tensions, and make some suggestions about how we might achieve greater clarity.”

Among others, Steph Topp then argues that we should frame resilience as an ability, not an outcome; she discusses the different types and intensities of shock: different forms of adaptation; lays out that health systems are social systems: shot through with power relations; and explicitly links the exploration of health system resilience to health system governance.

PS: do compare with a new policy brief - Strengthening health systems resilience: Key concepts and strategies. (European Observatory on Health Systems and Policies)

BMJ Analysis - Harnessing the power of health taxes

V Jain, K Chalkidou et al ; https://www.bmj.com/content/369/bmj.m1436.full

“Health taxes are a cost effective opportunity for progress in public health. Yet decision making processes on such policies lack the diligence routinely used in appraising other health interventions, and this limits their use, say Vageesh Jain and colleagues.”

“…Many public health interventions are evaluated through HTA and some are included in health benefits packages. But health taxes, though potentially cost effective, are not routinely included in either HTA or health benefits packages….”

Cfr a tweet from K Chalkidou: “…"Health taxes could be a cost effective state investment to improve health. Harnessing HTA for health taxes will require a shift in power and authority, away from central government."”

OECD/WB (report) - Latin America and the Caribbean countries need to spend

more and better on health to be better able to face a major health emergency like

COVID-19 effectively

https://www.oecd.org/health/latin-america-and-the-caribbean-countries-need-to-spend-more-and-

better-on-health-to-be-better-able-to-face-a-major-health-emergency-like-covid-19-effectively.htm

“Health spending in Latin America & the Caribbean (LAC) was about USD 1,000 per person in 2017, only ¼ of what was spent in OECD countries (adjusted for purchasing power). At the same time, health systems’ capacity is also considerably lower, including the ability to provide access to services of good quality to the most vulnerable groups. In addition, much is left to to be done to improve efficiency, effectiveness and targeting of health spending. While the LAC region is struggling to respond to the major challenges of the COVID-19 pandemic, a serious reflection is needed not only on how to secure more funding but also on how to spend resources better, according to a new joint OECD – World Bank report, the first Health at a Glance publication entirely dedicated to the LAC region. Health at a Glance: Latin America & the Caribbean 2020 says that total health expenditure across LAC countries is 6.6% of GDP, lower than the 8.8% in OECD countries. Spending varied from 1.1% in Venezuela to up to 11.7% in Cuba and 9.2% in Uruguay in 2017. Government spending and compulsory health insurance represent an average of 54.3% of total health spending in LAC, significantly lower than the 73.6% in the OECD. This shows that health

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systems in the LAC region are heavily dependent on out-of-pocket expenditures or supplemental private insurance from households. ….”

BMJ Analysis- The economy of wellbeing: what is it and what are the implications

for health?

J Cylus et al ; https://www.bmj.com/content/369/bmj.m1874

“….There is much interest in policy circles in the concept of wellbeing, but to what end? And what might a so called “economy of wellbeing” mean for the health sector? We review evidence on the measurement and determinants of wellbeing and consider how this might be used to set public sector priorities….”

Some key messages: “Interest is growing in wellbeing as an economic and societal objective; It is not clear what this could mean for health and health systems; Although health makes a large contribution to most measures of wellbeing, there is no guarantee that focusing on wellbeing would lead to more resources for health systems; Health policy makers and analysts should consider new approaches that highlight the multiple direct and indirect pathways by which health systems contribute to wellbeing and ensure that these are incorporated into evaluation methods.”

Plos Med (Perspective) - Social determinants of health, data science, and decision-

making: Forging a transdisciplinary synthesis

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003174

“Sandro Galea and co-authors discuss a forthcoming Collection on data science and social determinants of health.”

“…Aiming to accelerate this synthesis, we have recently launched the Rockefeller Foundation-Boston University Commission on Health Determinants, Data, and Decision-Making (the 3-D Commission; see Acknowledgments). The 3-D Commission brings experts from both the fields of social determinants and data science together with decision makers. …”

BMC Health Services - Health systems and services in low and middle income

settings

Resource Section edited by Dina Balabanova, Hengjin Dong, David Hotchkiss and Kaspar Wyss. BMC

Health Services;

“This section aims to publish research on health systems and services with a focus on research relevant to low and middle income settings as defined by The World Bank.”

Global Fund - Removing Human Rights Barriers to Health: Findings and Lessons

https://www.theglobalfund.org/en/updates/other-updates/2020-06-15-removing-human-rights-

barriers-to-health-findings-and-lessons/

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“Programs to remove human rights barriers to HIV, TB and malaria services are essential to increasing the effectiveness of Global Fund grants. Such programs help to ensure health services reach those most affected by the three diseases. The Global Fund Strategy 2017-2022 recognizes and reaffirms this through its human rights objective. As part of attaining this objective, the Global Fund’s Breaking Down Barriers initiative aims to dramatically scale up programs to remove these obstacles. The Global Fund has now published a summary of key findings of the baseline assessments undertaken as part of the initiative:…”

BMJ Global Health - Rapid urban health security assessment tool: a new resource

for evaluating local-level public health preparedness

M Boyce & R Katz; https://gh.bmj.com/content/5/6/e002606

“Urbanisation will be one of the defining demographic trends of the 21st century—creating unique opportunities for sustainable capacity development, as well as substantial risks and challenges for managing public health and health emergencies. Plans and policies for responding to public health emergencies are generally framed at higher levels of governance, but developing, improving and sustaining the capacities necessary for implementing these policies is a direct function of local-level authorities. Evaluating local-level public health capacities is an important process for identifying strengths and weaknesses that can impact the preparedness for, detection of and response to health security threats. However, while various evaluations and assessments exist for evaluating capacities at other levels, currently, there are no readily available health security assessments for the local-level. In this paper, we describe a tool—the Rapid Urban Health Security Assessment (RUHSA) Tool—that is based on a variety of other relevant assessments and guidance documents. ….”

BMJ GH – Innovative financing to fund surgical systems and expand surgical care

in low-income and middle-income countries

Ché Reddy et al ; https://gh.bmj.com/content/5/6/e002375

« Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs….”

BMJ GH - The community health worker as service extender, cultural broker and

social change agent: a critical interpretive synthesis of roles, intent and

accountability

M Schaaf et al; https://gh.bmj.com/content/5/6/e002296

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“This paper is a critical interpretive synthesis of community health workers (CHWs) and accountability in low-income and middle-income countries. The guiding questions were: What factors promote or undermine CHWs as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? …”

BMJ GH – An analysis of International Health Regulations Emergency Committees

and Public Health Emergency of International Concern Designations

L Mullen et al ; https://gh.bmj.com/content/5/6/e002502

“Nine events have been assessed for potential declaration of a Public Health Emergency of International Concern (PHEIC). A PHEIC is defined as an extraordinary event that constitutes a public health risk to other states through international spread and requires a coordinated international response. The WHO Director-General convenes Emergency Committees (ECs) to provide their advice on whether an event constitutes a PHEIC. The EC rationales have been criticised for being non-transparent and contradictory to the International Health Regulations (IHR). This first comprehensive analysis of EC rationale provides recommendations to increase clarity of EC decisions which will strengthen the IHR and WHO’s legitimacy in future outbreaks….”

“There was considerable inconsistency and application of the criteria for a PHEIC as defined by the IHR. … A more standardised and transparent process for ECs is needed to assess the event and determine if a PHEIC declaration is warranted for the public health community to understand the decision-making process. Guidelines that include the standardised definitions and how they should be assessed for each of the three core IHR criteria is necessary for future PHEIC declarations to ensure confidence in the IHR EC process remains.”

Some blogs & other mainstream news of the week

FT - US upends global digital tax plans after pulling out of talks with Europe

https://www.ft.com/content/1ac26225-c5dc-48fa-84bd-

b61e1f4a3d94?desktop=true&segmentId=d8d3e364-5197-20eb-17cf-2437841d178a

The US has blown up BEPS 2.0. “The US has thrown into disarray plans for a new global tax framework for technology companies after suspending talks with European countries — and warning them of retaliatory measures if they press ahead with their own taxes. In a letter to four European finance ministers seen by the Financial Times, US Treasury secretary Steven Mnuchin warned that discussions had reached an “impasse”. He said the US was unable to agree even on an interim basis changes to global taxation law that would affect leading US digital companies. The move dashes international discussions under the auspices of the Paris-based OECD for a more equitable approach to taxing multinational companies. It will also infuriate European capitals desperate to raise revenue after the devastation to public finances wrought by the Covid-19 pandemic….”

And an update, via Euractiv - Europe to push ahead with digital tax despite US ‘threats’

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Or the Guardian - UK and Europe renew calls for global digital tax as US quits talks

“…Almost 140 countries are involved in the talks organised by the Organisation for Economic Cooperation and Development (OECD) to bring global tax rules into the digital era. The aim had been to reach a deal by the end of the year, but the breakdown in talks, and forthcoming US presidential election, makes that timeline look increasingly unlikely….”

Stat - University of California strikes research access deal with Nature publisher,

putting pressure on Elsevier

Stat Plus

(gated) “…The University of California system has struck a deal with publishing company Springer Nature, in what's being billed as the largest ever open-access agreement in North America. The move could put pressure on other academic publishers, including the largest, Elsevier, to also meet the demands of a growing number of institutions calling for fairer open-access agreements. According to the deal, UC researchers will be able to publish open-access articles in paywalled Springer Nature journals, and eventually also in Nature-branded journals, which are part of the publishing group….”

Guardian - Militant crackdown in Sahel leads to hundreds of civilian deaths –

report

https://www.theguardian.com/global-development/2020/jun/12/militant-crackdown-in-sahel-

leads-to-hundreds-of-civilian-deaths-report

From last week already. “Amnesty records 200 state killings and forced disappearances in Burkina Faso, Mali and Niger, state members of internationally-backed G5 group.”

Devex- Is faith-based health care a stopgap, or a long-term partnership?

https://www.devex.com/news/is-faith-based-health-care-a-stopgap-or-a-long-term-partnership-

97399

“In many low- and middle-income countries, faith-based networks and organizations provide a significant share of health service delivery. Should donors view faith-based providers as stopgaps on the road to public health systems, or as long-term partners?”

Quote: “... That concern has led CCIH and other organizations to begin mapping faith-based health providers in their global networks, in order to assemble a clearer picture of both their geographic reach and their qualitative contributions to health service delivery. By gathering and disseminating better data about faith-based health care, they hope to facilitate a more complementary relationship between two health systems — public and faith-based — that have often operated in parallel, but not always in partnership….”

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BMJ GH blog - Who are the peers in peer-review? A call to redefine

A Banke-Thomas; https://blogs.bmj.com/bmjgh/2020/06/13/who-are-the-peers-in-peer-review-a-

call-to-redefine/

Nice one. “… Moving forward, we need to think more broadly about who makes an appropriate peer reviewer. In the current academic landscape, I submit that an ideal peer reviewer should have content and context expertise and be of equal scholarly status with the author that made the most significant contribution to the manuscript….”

Nature (Editorial) - Boosting research without supporting universities is wrong-

headed

Nature;

“By failing to support their universities, countries are undermining their own plans to boost research, argues a Nature editorial. It calls for students and universities to be eligible for the same kinds of temporary emergency funding as other industries are asking for. In the meantime, senior academics need to speak up for staff on short-term contracts. And everyone should look out for students, who are the ‘guinea pigs’ for the new normal.”

Some tweets of the week

FIFA Rahman

“The ACT Accelerator for the *Global* COVID19 response is overwhelmingly white and global north. Going forward - we need to look at balancing representation within the Accelerator. It is not a global response if it is Europeans telling Africans and Asians what to do.”

Bente Mikkelsen

“This is why I feel so proud to work with @drvarghesec and @WHO colleagues dedicated to serving all people, everywhere. After 20 years of piloting we’re about to launch #PEN2020: a set of protocols to integrate #NCDs into #PHC in #LMICs. This will tip the scales. #NextGenNCD”

Bodo Ellmers

“People are not being left behind, they are thrown under the bus by a system that rigged the rules in favor of the rich. Spot on critique by @unctad 's Richard Kozul-Wright @eurodad virtual Policy Forum @gpolicywatch”

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Dr. Tedros

“Today I briefed Member States about the #WHOAcademy, a major new initiative that is part of @WHO ’s transformation. We aim to build one of the world’s largest & most innovative digital learning platforms to enhance the competencies of a large number of health professionals.”

Duncan Green

“'the spread of the pandemic is a key theme for Western observers, while, in contrast, local voices are more concerned about the potential “secondary impact” of food insecurity, poverty and the spread of other diseases such as measles, AIDS and pneumonia.' “ (cfr J Eldebo in Global Policy ).

Global health events

Not quite sure the ‘UN Global Compact virtual conference of business leaders’ qualifies as a ‘global health event’, but here you have it anyway:

Devex - Can business step up on SDGs post COVID-19?

https://www.devex.com/news/can-business-step-up-on-sdgs-post-covid-19-97496

“Companies are still falling short when it comes to embedding the Sustainable Development Goals in their business but there is an opportunity to accelerate action in the wake of COVID-19, according to new data and leaders at the United Nations Global Compact Leaders Summit this week. Over 20,000 business and sustainability leaders from more than 180 countries participated this week in the 26-hour virtual summit that marked the initiative’s 20th anniversary and a leadership transition — Lise Kingo, who has served as UN Global Compact’s CEO for five years, is leaving the post this week and Sanda Ojiambo will be starting in the position. The summit was a moment to take stock of both the initiative and business involvement in the SDGs, and a new report sheds light on both….”

Excerpt: “ UN SG Guterres echoed remarks he made in January when he launched the SDG Ambition initiative, led by UN Global Compact, at Davos. The SDG Ambition initiative aims to give businesses benchmarks, recommendations, and guidance so they can set more ambitious goals and improve the integration of the SDGs into their core business. This week the compact released the first set of benchmarks that all businesses should follow as part of the initiative. They include: 100% of employees across companies should earn a living wage, gender balance in all levels of management, science-based greenhouse gas emissions reductions that align with the Paris Climate Agreement’s 1.5 degree Celsius target, and zero incidences of bribery….”

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Guardian - Covid-19 pandemic is 'fire drill' for effects of climate crisis, says UN official

https://www.theguardian.com/environment/2020/jun/15/covid-19-pandemic-is-fire-drill-for-

effects-of-climate-crisis-says-un-official

“The coronavirus pandemic is “just a fire drill” for what is likely to follow from the climate crisis, and the protests over racial injustice around the world show the need to tie together social equality, environmental sustainability and health, the UN’s sustainable business chief has said. “The overall problem is that we are not sustainable in the ways we are living and producing on the planet today,” said Lise Kingo, the executive director of the UN Global Compact, under which businesses sign up to principles of environmental protection and social justice. “The only way forward is to create a world that leaves no one behind.”…”

“The UN secretary general, António Guterres, said building a fairer society would be essential to the world’s health, as well as to saving the planet from climate breakdown and ecological destruction. “Today, the fabric of society and the wellbeing of people hinge on our ability to build a fair globalisation,” he told the two-day UN Global Compact virtual conference of business leaders, which started on Monday.”

8th Triad 2020 (16-19 June, virtual, Geneva)

https://www.2020yearofthenurse.org/event/global-nursing-midwifery-triad-meetings/

“The International Council of Nurses, International Confederation of Midwives and the World Health Organization brought nursing and midwifery leaders from across the globe together to discuss key topics of interest to the professions and global health.”

Cfr a tweet, by Tedros: “More than 1200 #nurses and #Midwives coming together, closer than ever, at 8th #Triad2020 - responding to #COVID19 and building a strategy for future investment.”

As you know, this year (2020) it’s the year of the nurse and midwife.

WHO Director-General's opening remarks at high-level video conference on Belt and Road International Cooperation - 18 June 2020

https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-high-level-

video-conference-on-belt-and-road-international-cooperation---18-june-2020

Interesting short read – certainly in the current circumstances : )

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“… The Belt and Road Initiative has the potential to act as an accelerator for the achievement of universal health coverage and the Sustainable Development Goals. … … It can foster improvements in health and wellbeing, by supporting economic development and improving the determinants of health in participating countries, and in supporting robust, accessible health systems and public health infrastructure. China’s recent emphasis on the ‘Health Silk Road’ and the ‘Digital Silk Road’ points to the importance of innovative forms of cooperation to deal with the challenges we collectively face. The ‘Health Silk Road’ has the potential to support partnerships to contain COVID-19, to improve infrastructure and access to much needed health services including diagnostics, and treatment, to strengthen health systems under strain because of the pandemic. WHO is committed to work with China and other partners to turn BRI into a true Health Silk Road and help realise and define “community of common health for mankind”.”

Global governance of health

NPR – U.S. Mulls Controversial Foreign Aid Shake-up

https://www.npr.org/sections/goatsandsoda/2020/06/17/878507540/u-s-mulls-controversial-

foreign-aid-shake-up

Looks like the US (at least under the current administration) are also steadily moving into the UK “merge aid with foreign affairs/State dep” direction…

“Efforts are underway in Washington to revamp U.S. foreign aid in the wake of the coronavirus. Proposals from both the White House and the Senate would shift billions of dollars in foreign assistance, consolidate control over U.S. humanitarian aid in the State Department and — according to one former top aid official — undermine the lifesaving work of USAID….”

“…Leaders in Washington want to leverage the billions of dollars in aid various U.S. government agencies spend each year in low- and middle-income countries to make it more likely that the next emerging disease is discovered and contained before it poses a threat to Americans. The idea is that along with building up health systems in developing countries, the U.S. would push for disease surveillance networks in these places….”

“In addition to the President's Response to Outbreaks, a bill introduced in the Senate called the "Global Health Security and Diplomacy Act of 2020" would also restructure some foreign assistance programs in an effort to better prepare the U.S. for another pandemic. It would authorize $3 billion for pandemic preparedness, including strengthening health systems in low-income countries to better detect new emerging diseases. It would shift control of some overseas aid programs run by USAID as well as the National Institutes of Health, the Centers for Disease Control and Prevention and the U.S. Department of Agriculture and put them under a new coordinator in the State Department….”

“The separation of USAID from the overtly political State Department was deliberate. "There's been a gradual attempt over a number of administrations by both parties to absorb A-I-D into State…”

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Zero draft for the proposed United Nations General Assembly omnibus resolution on the COVID-19 pandemic

https://www.un.org/pga/74/wp-content/uploads/sites/99/2020/06/COVID-19-OMNIBUS-

RESOLUTION-1.pdf

Draft as of 5 June.

Reuters – Disagreement on WHO hindering U.N. Security Council conference: RIA

https://www.reuters.com/article/us-health-coronavirus-russia-un/disagreement-on-who-hindering-

u-n-security-council-conference-ria-idUSKBN23O1JP

“Russia said on Wednesday that differences between other nations over the role of the World Health Organization have delayed a video conference being organized between the permanent members of the U.N. Security Council, the RIA news agency reported. The conference aims to discuss the global response to the coronavirus pandemic, but members disagree on how to assess the role of the WHO in their conference communique, Russian Foreign Minister Sergei Lavrov said.”

Evaluation of the WHO transformation: Request for Proposal

https://www.ungm.org/Public/Notice/108933

Deadline: 30 June. For the ones interested. Consulting firms not welcome 😊.

Bill & Melinda Gates Foundation Appoints President of Gender Equality

https://www.gatesfoundation.org/Media-Center/Press-Releases/2020/06/Bill-and-Melinda-Gates-

Foundation-Appoints-President-of-Gender-Equality

“Today the Bill & Melinda Gates Foundation named Anita Zaidi, currently director, Vaccine Development & Surveillance (VD&S) and Enteric & Diarrheal Diseases (EDD), as the first president of Gender Equality. In this new role, Anita will oversee a division comprised of the foundation’s Gender Equality program team and Gender Program Advocacy and Communications team. She will also take on responsibility for the foundation’s broader gender integration agenda, working with and across all program teams to ensure gender is being incorporated in a smart, thoughtful way to increase impact. Anita will report directly to CEO Mark Suzman and will join the Executive Leadership Team (ELT). She will assume her new role effective November 2, 2020.”

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Great initiative. If she now also reflects deeply on all the marvels that global capitalism brings in terms of gender equality, perhaps the world can at last make some progress. Let’s start by asking some of the garment workers in Bangladesh how wonderful this system is.

CEPI CEO: Scarcity, 'vaccine nationalism' biggest barriers for COVID-19 vaccine access

https://www.devex.com/news/cepi-ceo-scarcity-vaccine-nationalism-biggest-barriers-for-covid-19-

vaccine-access-97466

“Global politics and vaccine scarcity are the biggest challenges to ensuring that a future COVID-19 vaccine will be available in the world’s poorest countries, according to Richard Hatchett, CEO at the Coalition for Epidemic Preparedness Innovations. “Managing the scarcity of a vaccine in a context that is highly politically charged is the biggest challenge. The biggest challenge to global access and equity and equitable access for developing countries is a phenomenon that I’ve sometimes referred to as ‘vaccine nationalism,’” he told Devex President and Editor-in-chief Raj Kumar during a virtual event Thursday….”

USAID’s New Partnerships Initiatives (NPI)

https://www.usaid.gov/news-information/press-releases/jun-11-2020-usaid-aa-john-barsa-

announcing-funding-global-health-npi

Here, “USAID Acting Administrator John Barsa announces funding for the New Partnerships Initiative (NPI) to the Americas Foundation as well as new funding opportunities in global health for local partners in five countries — Liberia, Tanzania, Senegal, Mali, and Brazil — to address the COVID-19 pandemic.”

“NPI is shifting the focus of USAID's traditional partners to mentoring, capacity-building, and technical oversight, by using umbrella mechanisms and sub-awards strategically to enable new and underutilized local partners to lead development in their own communities and advance the Journey to Self-Reliance. USAID seeks to expand its network of partnerships with local organizations because they can mobilize quickly and take advantage of long-standing grassroots relationships to bring needed interventions directly to people at risk….”

TGH - Medical Diplomacy—Lessons From Cuba

H Todd; https://www.thinkglobalhealth.org/article/medical-diplomacy-lessons-cuba

“COVID-19 is a chance to design more efficient, equitable, and ethical health care responses during a

crisis.” Lessons for the US in particular, in this piece 😊.

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And a link (Foreign Policy) - China’s Health Silk Road Is a Dead-End Street (by a former CIA staff

officer, among others 😊). So if you want to know how people like Pompeo (State Department) think about issues, probably a good read.

UHC

Impact for Health - Resource House: Engaging the Private Sector in the COVID-19 Response

https://impactforhealth.com/resource-house-private-sector-engagement/

Cfr a tweet: “#WHO has commissioned a resource house of news and materials about how governments and Ministries of Health are approaching the private health sector as part of their work on the #Covid_19 pandemic. Search by areas of engagement, Country and WHO Region. “

BMC Public Health - Forty years after Alma-Ata: how people trust primary health care?

H S Bazargani et al; https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-

09082-w

“Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran.”

Among the conclusions: “…PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.”

Planetary health

Guardian - Global oil demand could hit record growth rate next year, IEA warns

https://www.theguardian.com/business/2020/jun/16/global-oil-demand-could-hit-record-rate-next-

year-iea-warns

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“The world’s oil demand could climb at its fastest rate in the history of the market next year, and may reach pre-crisis levels within years, unless new green policies are adopted, according to the International Energy Agency (IEA). The global energy watchdog has forecast that the world’s daily oil demand may climb by 5.7m barrels next year, the fastest annual climb on record, to an average of 97m barrels of oil a day in 2021….”

Infectious diseases & NTDs

VOA - WHO Expects to Quickly Tackle DR Congo’s New Ebola Outbreak

VOA

“The World Health Organization says lessons learned from previous outbreaks of Ebola in the Democratic Republic of Congo and effective therapeutics will allow it to more quickly contain a new outbreak of the deadly disease in Equateur Province. U.N. health officials report there is no link between the Ebola outbreak declared June 1 in Mbandaka, Equateur Province, and the epidemic, which broke out nearly two years ago in DR Congo’s North Kivu and Ituri provinces. They say the experience gained, however, and lessons learned from tackling this deadly disease in eastern DRC will help them to more quickly stop the spread of the virus in Equateur Province in the western part of the country….”

Reuters – How a vaccine made of mosquito spit could help stop the next epidemic

Reuters;

“… Building on the work of colleagues and other scientists, Manning, a clinical researcher for the U.S. National Institute of Allergy and Infectious Diseases, believed she could use pieces of mosquito saliva protein to build a universal vaccine. The vaccine, if it pans out, would protect against all of the pathogens the insects inject into humans - malaria, dengue, chikungunya, Zika, yellow fever, West Nile, Mayaro viruses and anything else that may emerge…. On Thursday, The Lancet published the initial results of this work with her colleagues: the first-ever clinical trial of a mosquito spit vaccine in humans. The trial showed that an Anopheles mosquito-based vaccine was safe and that it triggered antibody and cellular responses….”

Telegraph - Worst dengue outbreak for seven years in Singapore linked to coronavirus lockdown

https://www.telegraph.co.uk/global-health/science-and-disease/worst-dengue-outbreak-seven-

years-singapore-linked-coronavirus/

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“Some scientists say the fact that people have been at home all day in wet and warm weather may have made the outbreak worse; others disagree.”

AMR

Clinical Microbiology Reviews - Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

https://cmr.asm.org/content/33/3/e00048-19

“…Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.”

NCDs

Lancet (World Report) - Plain packaging ruling hailed as a victory for tobacco control

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31406-9/fulltext

“The decision of the World Trade Organization's appeals body is expected to spur more countries to implement similar stringent packaging laws. John Zarocostas reports from Geneva.”

Foodnavigator Asia.Com – Tax attack? Philippines considers higher sugar levy and new junk food tax to offset Covid-19 impacts

https://www.foodnavigator-asia.com/Article/2020/06/15/Tax-attack-Philippines-considers-higher-

sugar-levy-and-new-junk-food-tax-to-offset-COVID-19-impacts#.XukL9AR-ER0.twitter

“The Philippines is considering implementing higher sugar taxes as well as new taxes on ‘junk food’ high in sodium and transfat to offset the costs incurred by the COVID-19 pandemic outbreak this year.”

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SS&M - Using Syndemic Theory to Understand Food Insecurity and Diet-Related Chronic Diseases

D Himmelgreen et al; https://www.sciencedirect.com/science/article/abs/pii/S0277953620303439

“Syndemic Theory (ST) provides a framework to examine mutually enhancing diseases/health issues under conditions of social inequality and inequity. ST has been used in multiple disciplines to address interacting infectious diseases, noncommunicable diseases, and mental health conditions. The theory has been critiqued for its inability to measure disease interactions and their individual and combined health outcomes. This article reviews literature that strongly suggests a syndemic between food insecurity (FI) and diet-related chronic diseases (DRCDs)…”

Sexual & Reproductive / maternal, neonatal & child health

HP&P –What will it cost to prevent violence against women and girls in low- and middle-income countries? Evidence from Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia

https://academic.oup.com/heapol/advance-

article/doi/10.1093/heapol/czaa024/5859174?searchresult=1

“Violence against women and girls (VAWG) is a global problem with profound consequences. Although there is a growing body of evidence on the effectiveness of VAWG prevention interventions, economic data are scarce. We carried out a cross-country study to examine the costs of VAWG prevention interventions in low- and middle-income countries. We collected primary cost data on six different pilot VAWG prevention interventions in six countries: Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia. …. … The cost per beneficiary reached in the pilots ranged from ∼US $4 in a community-based intervention in Ghana to US $1324 for one-to-one counselling in Zambia. When scaled up to the national level, total costs ranged from US $32 million in Ghana to US $168 million in Pakistan. …”

Lancet Child & Adolescent Health (Viewpoint) – The effects of social deprivation on adolescent development and mental health

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30186-3/fulltext

Cfr the press release:

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“The Lancet Child & Adolescent Health: Experts call for more awareness of the potential impact of physical distancing on adolescent peer relationships and social development. In an opinion piece, authors say that adolescents could be more susceptible to negative effects of physical distancing during COIVD-19 as they are in a period of vulnerability where peer interaction is a vital aspect of their social development. They call for policymakers to give urgent consideration to young people when considering easing of physical distancing measures, and that reopening schools and other social environments for young people should be a priority when it is considered safe to do so….”

And a link:

Guardian - Climate crisis poses serious risks for pregnancy, investigation finds

Or the NYT - Climate Change Tied to Pregnancy Risks, Affecting Black Mothers Most

Cfr a tweet A Giridharadas: “A forceful reminder that the five great crises of this moment — health, economic, democratic, racial, and climate — are connected.”

Access to medicines

CGD (blog) - Understanding the Impact Of COVID-19 On Essential Medicine Supply Chains

A McDonnell et al ; https://www.cgdev.org/blog/understanding-impact-covid-19-essential-medicine-

supply-chains

“This blog outlines some of the challenges in the global supply of medicines and introduces a methodology that will enable countries to spot early challenges in supply.”

Independent - Coronavirus vaccine: US Chamber of Commerce calls for more transparency from big pharma over licensing deals

https://www.independent.co.uk/news/health/coronavirus-vaccine-us-chamber-commerce-covid-19-

trials-astrazeneca-johnson-sanofi-a9558926.html

Hear, hear, who would have thought 😊

“The US Chamber of Commerce, the largest lobbying group in America and the leading voice for corporate power in Washington, has suggested that more transparency is needed surrounding the Covid-19 vaccine deals that are being struck between pharmaceutical firms and governments. More than 150 vaccine candidates are currently being developed across the world, with numerous industry collaborations between the private and public sectors serving to bolster these efforts….”

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Human resources for health

Devex - The rise of the robo-health worker

https://www.devex.com/news/the-rise-of-the-robo-health-worker-97414

It’s only waiting for the horror sci-fi movie now, in which the robo-health workforce goes horribly

wrong. Starring Will Smith 😊.

“ In Rwanda’s Kanyinya COVID-19 treatment facility, white humanoid robots glide from patient to patient, taking temperatures, monitoring their vitals, and feeding information back to health professionals. Donated by the United Nations Development Programme, the robots are cutting the amount of time that doctors and nurses spend in direct contact with patients — reducing the risk of contracting COVID-19 and freeing them up for other tasks. While the use of robotics in health care is not new, the need to limit the spread of the coronavirus and plug gaps in the health workforce — there is a global shortage of 5.9 million nurses worldwide — has brought such technology to the fore. Allowing robots to perform time-consuming tasks — such as registering data — means health workers can focus their efforts where they are needed most, said Elizabeth Mutamba, head of exploration at the Accelerator Lab for UNDP Rwanda. Already, the potential of this technology is visible in some places — but there are limits, and there is work to be done before “robo-health workers” can take off in many lower-income settings…..”

Devex - Opinion: Weak health systems kill — here's how we can stop that from happening

https://www.devex.com/news/opinion-weak-health-systems-kill-here-s-how-we-can-stop-that-

from-happening-97410

“Community health workers need to be integrated into public health systems at all levels. Here are 10 practical ways this can be done.”

And a quick link, via Bloomberg Philantropies - Training Nearly 6,000 Health Care Workers Fighting COVID-19 in Africa

Miscellaneous

A variety of other reads, including some more related to Covid-19.

Medium - Good Bureaucracy: Max Weber on the 100th anniversary of his death

W Drechsler; https://medium.com/iipp-blog/good-bureaucracy-max-weber-on-the-100th-

anniversary-of-his-death-c3dc6846d6be

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Cfr a tweet: “Countries built on administrative competence and state resources, New Zealand, Taiwan, South Korea, Vietnam, Germany have succeeded against Covid. Countries where administrative capacity has been dismantled, most notably U.S. and U.K., are failing.”

The things my movie Contagion got wrong: the slow vaccine, the damaging

president

https://www.irishtimes.com/culture/film/the-things-my-movie-contagion-got-wrong-the-slow-

vaccine-the-damaging-president-1.4276784

Interview with the director of “Contagion”, Scott Z Burns, on the current Covid-19 pandemic &

response.

Harvard Business Review - We Need Better Masks

R Dillon, A Karan et al; https://hbr.org/2020/06/we-need-better-masks

“To get control of the epidemic & give people the confidence they need to revive the economy, we need better masks that are more protective, scalable, reusable, comfortable & have style.”