IHP news 565 : Acceleration - International Health Policies

IHP news 565 : Acceleration
( 27 March 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.

Pour les lecteurs qui préfèrent une version française de la newsletter: à partir de cette
semaine, nous essayons également de fournir une traduction française (voir pdf).

Dear Colleagues,

As we all see the horrific images of overwhelmed health systems and immeasurable sadness of the
people left behind on our tv screens, day after day and in country after country, and with a “Third
Wave” now starting to hit LMICs, refugee camps and other very vulnerable populations, this is
perhaps not the right moment to ask too many questions, or contemplate already the post-Covid-19
world. And yet, we must, as it’s clear that some countries, societies and health systems are coping
better, while others feel in many ways the neoliberal (globalization) edifice coming down like never
before (although admittedly, some so called “leaders” are also giving a hand…). By the way, you
probably noticed with me that the likes of Steven “the world is slowly but steadily getting better”
Pinker - also quite popular in some global health circles, I recall - are remarkably silent these days.

Against the backdrop of the now rapidly accelerating pandemic, and with billions of people under a
lockdown regime, dr. Tedros used a football metaphor earlier this week to describe the situation:
“We shouldn’t just defend (cfr the lockdowns), but also attack”. Clearly, Tedros is no fan of José
Mourinho, he probably favours Jürgen Klopp’s strategies (but who doesn’t like Klopp, these days, in
global health ?) PS: I bet Tedros already misses high-level football as much as I do, it’s the one
neoliberal toy I can’t do without.

With FIFA, WHO also started a campaign earlier this week, the “Pass the message to kick out
coronavirus” campaign. While central banks, multilateral organisations & development banks,
massive stimulus packages, … under the leadership/coordination of the G20 (or not), will hopefully
be able to prevent the worst including in terms of global economic impact, now that suddenly and
almost magically all neoliberal monetary & fiscal frameworks are being abandoned (Let’s call it the
Covid-19 version of ‘Billions becoming Trillions’ (ahum)), I hope dr. Tedros will also be inspired by the
wisdom of Marcus Aurelius, who invented a ‘Pandemic tax’ for the rich in the year 166 already. Hope
he’ll use one of his media briefings to argue forcefully for a global “corona-tax” on the strongest
shoulders. I reckon he can start with some of these football super stars featured in the campaign
spots ! #Solidarity

Meanwhile, as you might recall, 2020 is also the ‘Year of the Nurse & Midwife’. And boy it is. But
it’s not just nurses and other care workers working their asses off (often in dangerous conditions,
given the lack of proper protection material), the same goes for the many ordinary people who keep
working and on whom we rely to maintain a semblance of normality in our societies - the often
underpaid people in supermarkets, cleaning ladies, postmen & women, … and who also worry about
the Covid-19 risk they run, by the way… It’s abundantly clear now who has a ‘bullshit job’ (see

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Graeber) in ordinary times and who doesn’t (PS: Slightly worried about mine too ). Let’s hope
we’ll remember that when, one day, we will build up again a hopefully fairer world on the ashes of
the Covid-19 tragedy.

Enjoy your reading.

Kristof Decoster

Featured Article

Political forces in the frontlines of service delivery: How do
they matter in India and beyond?
Sudha Ramani (Doctoral Scholar, Tata Institute of Social Sciences, Mumbai; Fellow, Health Policy
Analysis Program )

The 6th Global Symposium on Health Systems Research (Dubai 2020) intends to facilitate deeper
engagement with the political forces that surround health systems. While politics exist everywhere
and at all levels, there is a tendency to equate these forces with ‘Big Politics’, the power dynamics that
play out at global and national levels. In doing so, the micro-level political forces at the frontline of
service delivery, that is, the set of everyday conditions that create frontline behaviours and shape
ground-level action, often get discounted. But these micro-level political forces merit careful
consideration. These forces have the potential to explain why certain underlying challenges continue
to persist in health systems, leading to health inequities. Indeed, many of the work by Dr. Lucy Gilson
and team (for instance, see here) focus on the ‘everyday politics’ in health systems.

In this article, I talk about how and why we need to engage with the micro-level everyday politics in
health systems from my experiences. As a doctoral scholar, I have had the opportunity to spend some
time observing the frontline of public primary health care delivery in rural India and engaging in
discussions at this level. In these settings, medical doctors have often been blamed for having
disrespectful attitudes or exhibiting behaviour that amounts to negligence of patients. However, an
alternate way of looking at these attitudes and behaviour is by considering these as ways through
which doctors cope with the everyday situational complexities they face. Such a perspective resonates
with theorists such as Lipsky (1980), who hold that frontline health providers do not exhibit ‘random
acts’ of poor behaviour; instead, such acts are contextually-rooted.

When considered through the above lens, doctors appear to navigate an extremely complex world.
Professionally, they face a world that touts primary care models as accessible and affordable means
to health equity and yet, the actual provision of primary care is associated with little prestige. Doctors
share that they often feel like invisible workers, who merely complete mandated checklists imposed
on them by senior management. In these settings, helping patients beyond these select mandates is
often considered risky behaviour. For instance, a professionally laudable act like attempting to do a
complicated delivery of a woman who simply cannot reach referral care on time is thought of as risky
since any mishaps could give government health services a bad name and the media would leave no
stone unturned to blame the doctor. In the web of power relationships that doctors function within,

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they are expected to be the “master-spiders”, yet, they often report feeling like trapped insects. In
coping with several unrealistic demands from the system, limited support to staff and a culture of risk-
avoidance, most doctors appear resigned to being less-than-ideal professionals.

The above experiences show that micro-level, everyday politics in health systems matters. While ‘Big
Politics’ determines broadly what policy solutions get to the table, the effect of these solutions is often
shaped at the frontline.

If frontline politics matter and can shape the way policies work, what can we do about it? For instance,
in this case, how can we make doctors feel secure enough to take necessary professional risks? How
can we create a culture where doctors can voice their concerns rather than remain silent about
impractical or unrealistic expectations? There are no ready-made answers to such questions.

But one does see scattered positive indications that such answers are worth looking for. Once, I met
an exceptionally committed doctor, who had painstakingly created an innovative kitchen garden in his
health facility for the use of families with malnourished children. To me, such doctors signal that
despite organizational constraints and other conditions that limit them, doctors can do more than
what they do now, when they think of themselves as leaders and change agents. Thus, interventions
that provide space for frontline participation, reflection and leadership can bring about culture change
and make deep contributions to improving health systems.

But in the Indian setting, health systems strengthening has, conventionally, mostly been about
structural interventions (the procurement of drugs and equipment, recruiting human resources and
technical training). In fact, the Indian government has recently committed to a large-scale structural
program to strengthen primary-level services (see here). While there is no denying that such initiatives
are critical, our field experiences signal that even if they are properly resourced, they may not be
adequate to overcome all frontline hurdles. There is also a need to work with the ‘software’, that is,
the ideas, beliefs and values within health systems. Health system reform frameworks in India need
to acknowledge the myriad interactions between the structural inputs and the system ‘software’. For
instance, in this case, the uptake of structural interventions like technical training in the frontline may
not be optimal if the primary care doctors are not motivated to act; but at the same time, one cannot
realistically motivate all doctors to perform under stark conditions of insufficient resources. Hence,
structural inputs need to be combined with culture change interventions for the system to really
improve. One set of interventions is handicapped without the other in place.

Having said this, I must also point out that culture change interventions in the Indian setting are
definitely not easy to design. Prior experiences warn us that the ‘letter’ of such interventions can get
enacted even while their ‘spirit’ gets sacrificed. There is no denying that it is a challenge to design and
implement interventions that remain true to the spirit of culture change, particularly in top-down
hierarchies wherein frontline thinking and power have been historically supressed. But if we really
consider health systems as Complex Adaptive Systems, it is evident that we need to move into these
less familiar intervention arenas.

To conclude, globally, we have recognised that engaging with frontline political forces is essential for
bringing about lasting positive changes in health systems. As we move forward, however, there is
much more to think about. What combination of interventions is feasible? What sort of time frames
do culture change interventions need? How can we truly embed such interventions? These are some
questions to deliberate on in the upcoming symposium (fingers crossed that it materializes!) and
beyond.

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The author would like to acknowledge Dr. Kerry Scott, Dr. Stephanie Topp and Kristof Decoster for their
inputs.

Highlights of the week

Lancet Global Health (Comment) - COVID-19 gives the lie to
global health expertise

Sarah Dalglish https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30739-
X/fulltext

“As the coronavirus disease 2019 (COVID-19) outbreak began spreading in Europe and the USA, a
chart started circulating online showing ratings from the 2019 Global Health Security Index, an
assessment of 195 countries' capacity to face infectious disease outbreaks, compiled by the US-based
Nuclear Threat Initiative and the Johns Hopkins School of Public Health's Center for Health Security.
The USA was ranked first, and the UK second; South Korea was ranked ninth, and China 51st; most
African countries were at the bottom of the ranking. Things look different now….”

“Is preparedness in the eye of the beholder? COVID-19 is giving the lie to prevailing notions of
expertise and solidarity. The global health model is based in large part on technical assistance and
capacity building by the US, the UK, and other rich countries, whose response has been sclerotic and
delayed at best. A recent report by Global Health 50/50 showed … . Global health will never be the
same after COVID-19—it cannot be. The pandemic has given the lie to the notion that expertise is
concentrated in, or at least best channelled by, legacy powers and historically rich states. We must
move quickly, for our own security, beyond the rhetoric of equality to the reality of a more democratic,
more multipolar, more networked, and more distributed understanding and operation of global
health. …”

Why WHO needs a feminist economic agenda
Lancet Comment by A Herten-Crabb & Sara Davies;
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30110-0/fulltext

“In September, 2019, Alan Donnelly and Ilona Kickbusch called for a chief economist at WHO. Such
a position, they argued, would enable WHO to better advocate for greater recognition of, and thus
action on, the interdependency of health and the economy. We support this proposal: recognition of
the interdependence of health and the economy is vital for WHO to achieve its mandate: “the
enjoyment of the highest attainable standard of health…without distinction of race, religion, political
belief, economic or social condition”. Given this mandate, WHO should be more ambitious than the
appointment of one economist. A more strategic and enlightened approach, especially in the
aftermath of the coronavirus disease 2019 (COVID-19) pandemic, would be for WHO to embrace and
articulate a feminist economic agenda….”

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“A feminist economic agenda interrogates power dynamics and peoples’ relative access to and use
of wealth and resources. A feminist economic lens that incorporates intersectionality must address
the power dynamics between genders and acknowledge the power relationships between nation
states, ethnicities, ages, abilities, and other dimensions of diversity, and how they are interconnected
with gender inequality and the economy…”

One of the must-reads of the week.

Lancet World Report - WHO launches crowdfund for COVID-
19 response
In other WHO related news, check out this Lancet World Report - WHO launches crowdfund for
COVID-19 response

“For the first time, WHO is asking the general public and private donors for support. The project is a
test run for the WHO Foundation, to be launched later this year. Ann Danaiya Usher reports.”

“The mechanism is unprecedented for WHO, says Kate Dodson at the UN Foundation. While UN
agencies such as UNICEF have a long tradition of private fundraising, this has never been the case for
WHO. Because of the agency's standard-setting role, it has been seen as important to keep an arm's
length from private interests. This breakthrough was possible in the midst of the current health crisis
because the UN Foundation has a well established relationship with WHO, she says….”

“Suerie Moon, co-director of the Global Health Centre at the Graduate Institute of International and
Development Studies in Geneva, Switzerland, says the donors’ failure to step up left WHO with little
choice. “Their backs are against the wall. Ideally, governments would adequately fund WHO to do
the work they have asked the agency to do”, she says. “The launch of the Solidarity Response Fund is
a good sign that WHO is agile and responding quickly to a rapidly changing situation. But the real
question is why do they need to do so in the first place? It reflects donors’ total failure to fund the
response to this outbreak at the international level.” According to Gaudenz Silberschmidt, director
for health and multilateral partnerships at WHO, the origins of this new COVID-19 fund are linked to
another, much larger project: the WHO Foundation, an external independent entity that will
broaden WHO's funding base by raising money from the general public, private foundations, and
the private sector.;..”

Covid-19
Given that you probably all get your daily dose of Covid-19 updates, via newspapers like the
Guardian/NYT/… or more specific health news media (like STAT, Cidrap News, HPW, …) and daily
global health newsletters, as this is a weekly newsletter, we will try to focus on our knowledge
management role in our own niche – that is, with a focus on analysis (rather than the latest
updates), and links with global health policy/governance and health policy & systems.

Structure of this big Covid-19 section: (1) Some additional resources; (2) Funding updates (&
multilateral coordination); (3) some key news updates (of which you should be aware); (4) Science

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(with a focus on readable articles on scientific trends on vaccines, drugs, …); (5) Analysis (from
various angles).

Focus lies on the Analysis section.

Figures from this morning (via JH university global dashboard): “The global number of confirmed
cases of coronavirus has passed 532,000; The latest number of confirmed deaths worldwide was
24,072.”

 (1) Resources

WHO Technical guidance on Covid-19 (by topic)
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
Constantly updated.

FT – Coronavirus tracked
https://www.ft.com/coronavirus-latest

Now open access. With the daily visualisations of trajectories of different countries (also split up
subnationally).

Stat News also launched a new Covid-19 Tracker with helpful data on case numbers by country,
state, province and county.

Global MediXchange for Combating COVID-19 (GMCC)
https://covid-19.alibabacloud.com/#J_7231040460

“The Jack Ma Foundation and Alibaba Foundation jointly established the Global MediXchange for
Combating COVID-19 (GMCC) programme, with the support of Alibaba Cloud Intelligence and
Alibaba Health, to help combat the global outbreak of the novel coronavirus, COVID-19. This
programme was established to facilitate online communication and collaboration across borders, as
well as provide frontline medical teams around the world with the necessary communication
channels to share practical experience about fighting the pandemic. This center offers overseas
Chinese compatriots with COVID-19 prevention and treatment consultation from frontline doctors,
and supports medical scientific research institutions with AI, big data, and cloud computing
capabilities…”

PS: with the support of the GMCC, the Chinese experts have also published the Handbook of COVID-
19 Prevention and Treatment.

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George institute for Global Health - Frontline health workers in
COVID-19 prevention and control: rapid evidence synthesis
https://www.georgeinstitute.org.in/frontline-health-workers-in-covid-19-prevention-and-control-
rapid-evidence-synthesis

“… The Government of India is embarking on a mammoth task to prevent COVID-19 spread among
communities. The Rapid Evidence Synthesis team received a request to support the planning and
development of resources for ensuring preparedness of FLHWs (frontline health workers) for
COVID-19 . The rapid evidence synthesis was conducted in a period of three days. The findings
highlight what we can learn from recent pandemics such that we are prepared for potential scenarios
and challenges due to COVID-19….”

HSG (Wakelet) COVID-19: sharing learning and evidence for health
policy and systems
https://wakelet.com/wake/e30cc9ad-dba9-4928-8972-765da1519c04

“An ongoing collection of articles, blogs, social and multimedia content exploring evidence and
learning on and for health policy and systems responses to COVID-19 (Coronavirus). Curated by
members of Health Systems Global (HSG)…”

WHO Afro newsletter on Covid-19
http://whotogo-whoafroccmaster.newsweaver.com/JournalEnglishNewsletter/jme2vxx6b31

A weekly newsletter focusing on the African region. See the WHO Afro website on Covid-19.

You find the situation reports & newsletters on Covid-19 there, as well as the dashboard.
Meanwhile, “African countries move from COVID-19 readiness to response as many confirm cases.”
There’s also a weekly briefing (on Thursday – lunchtime).

Covid-19 visualizer
https://www.covidvisualizer.com/

Using the most-up to date data.

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EQUINET Information sheet on COVID-19 - Produced by Training and
Research Support Centre for the Regional Network for Equity in
Health in east and southern Africa (EQUINET)1 March 20, 2020
https://www.equinetafrica.org/sites/default/files/uploads/documents/EQUINET%20COVID%20brief
1%20%2020March.pdf

Recommended. Focus on East & Southern Africa.

COVID-19 and the Core Humanitarian Standard: How to meet our CHS
commitments in the coronavirus pandemic
https://www.chsalliance.org/get-support/article/covid-19-and-the-chs/

(from Civil society). “The Core Humanitarian Standard on Quality and Accountability (CHS) sets out
our sector’s core commitments to the people we assist.”

Some other resources:

 • Social Science in Humanitarian Action (brief) - Key considerations: online information, mis-
 and disinformation in the context of COVID-19

 • WHO - WHO Information note on COVID-19 and NCDs
 WHO information note on #COVID19 and #NCDs. “Older people and people with preexisting
 conditions (as heart diseases, diabetes, respiratory conditions) appear to be more susceptible
 to becoming severely ill with the #coronavirus. “

 • WHO Tips for Living in Quarantine (7 tips)

 (2) Funding & coordination
With an overview of funding announcements, multilateral initiatives taken, etc.

UN Launches humanitarian appeal
https://news.un.org/en/story/2020/03/1060222

“To confront the unprecedented worldwide challenge posed by the COVID-19 Coronavirus pandemic,
top UN officials on Wednesday, launched a massive humanitarian appeal to mitigate its impact,
particularly on fragile countries with weak health systems.”

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“At a joint virtual press briefing, Secretary-General António Guterres, UN Humanitarian Coordinator
Mark Lowcock, UN Children’s Fund (UNICEF) Executive Director Henrietta Fore and World Health
Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, launched a $2 billion
coordinated global humanitarian response plan, to fight COVID-19 in some of the world’s most
vulnerable countries in a bid to protect the millions most at risk….”

You find the full (Global Humanitarian Response on Covid-19) plan here.

PS: you wonder why it’s an ‘appeal’, though, now that central banks etc are ‘creating’ trillions for
economic stimulus packages …

Reuters - UN to create global coronavirus fund, Norway says
https://www.reuters.com/article/us-health-coronavirus-unitednations-norw/un-to-create-global-
coronavirus-fund-norway-says-idUSKBN21A0Q4

As you notice, Norway was one of the key initiators of this UN donor fund. “…The purpose of the
fund is to assist developing countries with weak health systems in addressing the crisis as well as to
tackle the long-term consequences. … Norway, which suggested the fund, has not committed how
much money it would put into the initiative, similar to a 2014 United Nations Ebola Response
Fund….”

“…On Thursday, the UN secretary general António Guterres warned “millions” of lives were at stake if
the international community did not show solidarity, especially with the world’s poorest countries,
amid the coronavirus outbreak….”

Devex - World Bank, IFC look to quickly deploy COVID-19 funds
https://www.devex.com/news/world-bank-ifc-look-to-quickly-deploy-covid-19-funds-96813

“Using new funds, existing vehicles, and fast-track authorities, the World Bank and International
Finance Corporation aim to get recently announced COVID-19 funding to the countries and
companies that need it fast, to tackle immediate health needs, and also to address longer-term
economic and social impacts….”

See also Reuters - World Bank moving forward on first $1.7 billion in pandemic aid projects

In less positive (WB related) news (FT), Waiting game continues for pandemic bonds payout

“Countries will not find out until April whether virus-fighting funds will be released.”

“Poor countries affected by the coronavirus outbreak will have to wait until the middle of next
month to find out if the World Bank’s specially designed “pandemic bonds” will release funds to
help fight the disease. Some investors are questioning whether they will pay out at all…. …
The bonds require 84 days to have passed since the outbreak date determined by the World Health
Organization, which is a milestone that will be reached on March 23. But the World Bank says it will
take a further two and a half weeks to determine if the final trigger conditions for the bonds have

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been met, meaning investors and governments will find out on April 9 at the earliest. … …
Investors are already bracing for steep losses as all but two of these conditions have been reached;
among them, a minimum of 2,500 deaths, and more than 20 of them outside of the country of
origin…..”

African finance ministers call for $100 billion stimulus, debt holiday
https://www.usnews.com/news/world/articles/2020-03-23/african-finance-ministers-call-for-100-
billion-stimulus-debt-holiday

(from last week already) “African finance ministers have called for a $100 billion stimulus package,
including a suspension of debt service payments, to help the continent combat coronavirus. …
Some $44 billion would come from not servicing debt and they would also tap existing facilities in the
World Bank, International Monetary Fund (IMF), African Development Bank (AfDB) and other
regional institutions. … “ … The ministers held a virtual conference on Thursday to discuss how to
deal with the social and economic impacts of the pandemic on African nations, a statement by the
United Nations Economic Commission for Africa said on Monday….”

Africa leads calls for debt relief in face of coronavirus crisis
https://www.theguardian.com/global-development/2020/mar/25/africa-leads-calls-for-debt-relief-
in-face-of-coronavirus-crisis

“IMF and World Bank lend their support in bid to help poorest countries strengthen their health
systems.”

“Government ministers across Africa have called for the suspension of debt interest payments as the
Covid-19 crisis deepens. … … On Monday the heads of the World Bank and the International
Monetary Fund expressed support for debt relief to help countries strengthen their health systems
in readiness. During a conference call for G20 ministers on Monday, the IMF’s leader, Kristalina
Georgieva, pointed to the replenishing of funds used in a debt relief and aid mechanism during the
2014 Ebola epidemic that struck three African countries. The ministers also requested that principal
payments – the actual debt payment, as opposed to interest charges – be waived for fragile states,
where people are deeply vulnerable to a pandemic….”

 • See also the Guardian - Urgent call to head off new debt crisis in developing world

“Covid-19 crisis is raising borrowing costs for poorer nations just as commodity exports, tourism and
remittances sent home fall.”

 • And see also the Guardian - Western governments told to suspend debt interest amid
 Covid-19

“IMF and World Bank asking countries to agree to requests for forbearance.”

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G7

G7 Finance ministers pledged “to do whatever is necessary” (to restore confidence & economic
growth…” .

G7 Foreign ministers apparently didn’t reach agreement on a joint consensus statement, as Pompeo
(the American Minister of State) insisted on calling the virus the ‘Wuhan virus’.

G20 virtual summit (hosted by Saudi Arabia) (26 March)
https://g20.org/en/media/Pages/default.aspx

Ahead of Thursday’s G20 virtual summit, a number of op-eds were published, advocating for a
thorough joint G20 response, both in terms of public health & economic coordination. Or with
some more specific demands.

A virtual meeting of Finance ministers also took place, early in the week (23 March)

The COVID-19 pandemic: A letter to G20 leaders

Erik Berglöf, Jeremy Farrar et al; https://voxeu.org/article/covid-19-pandemic-letter-g20-leaders

“The COVID-19 pandemic is a two-pronged health and economic crisis, and requires a two-pronged
response. Ahead of an extraordinary meeting of G20 Leaders, this letter signed by 20
economists and global health experts has one simple message: this crisis is global and requires
unprecedented cooperation across countries and disciplines.”

Check out what they asked, both in terms of public health response (see also below) (including
proper financing of WHO, obviously) & global economic coordination.

Project Syndicate - A Pandemic Strategy as Global as COVID-19

Erik Berglöf: https://www.project-syndicate.org/commentary/covid19-pandemic-g20-cooperation-
by-erik-berglof-2020-03

Excerpt: “The Global Preparedness Monitoring Board has requested at least $8 billion in immediate
new funding, including $1 billion to strengthen the WHO’s emergency and preparedness response,
$250 million for surveillance and control measures, $2 billion for vaccine development, $1 billion for
distributed manufacturing and delivery of vaccines, and $1.5 billion for therapeutic drugs to treat
COVID-19….” … “G20 finance ministers must provide the necessary resources … “

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Global Justice Now - G20 must fund ‘massive global health plan’ to tackle coronavirus crisis

https://www.globaljustice.org.uk/news/2020/mar/22/g20-must-fund-massive-global-health-plan-
tackle-coronavirus-crisis

Joint statement from Amnesty International, CIVICUS and Transparency International: The G20
must put human rights and the public interest at the heart of its response to the Covid-19
pandemic

Transparency international;

Jim O’Neill in Project Syndicate - The G20’s Pandemic Moment

https://www.project-syndicate.org/commentary/g20-must-create-covid-fund-by-jim-o-neill-2020-
03

Jim O’Neill also hoped that the G20 would seize the ‘Pandemic Moment’: “Just as a meager
investment to address antimicrobial resistance could yield a 2,000% return in the future, so, too,
would an immediate modest outlay to finance development of COVID-19 therapeutics. As world
leaders gather to formulate a response to the crisis, they must not lose sight of this simple cost-
benefit calculus.”

“Given the risks, the G20 will have no excuse if it fails to muster at least that amount [10 billion] for
the immediate provision of COVID-19 diagnostics and treatments, and another $10 billion to kick-
start the market for new antibiotics.”

G20 Finance ministers’ virtual meeting (23 March)

 • WB president (D Malpass) - Remarks by World Bank Group President David Malpass on G20
 Finance Ministers Conference Call on COVID-19

“… Today I want to make a call to action to the G20. I urge all official bilateral creditors of the
poorest countries to act with immediate effect to help IDA countries through debt relief, allowing
the countries to concentrate their resources on fighting the pandemic. In many cases this will require
comprehensive and fair debt restructuring that includes NPV reductions sufficient for restoring debt
sustainability. … … I’m calling on the G20 Leaders to allow the poorest countries to suspend all
repayments of official bilateral credit until the World Bank and the IMF have made a full
assessment of their reconstruction and financing needs…”

 • Guardian - G20 finance ministers' talks hampered by US-China standoff - Ministers fail to
 issue joint declaration on response to coronavirus as divisions persist

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“G20 finance ministers have held telephone talks but were not expected to issue a joint declaration,
as divisions persist primarily between the US and China over responsibility for the coronavirus
pandemic….”

For the press release of the virtual meeting, see G20.

G20 Leaders’ virtual summit (26 March)

Via the Guardian: “Leaders of the G20 industrialised nations, meeting in a virtual video conference
call, have committed to do “whatever it takes” to minimise the social and economic damage of the
world-wide pandemic. But a largely unspecific and uncontroversial joint communique set no
specific commitments such as deferring debt repayment to the world’s poorest countries, as sought
by the World Bank and the IMF. The two hour long meeting agreed to assess gaps in pandemic
preparedness and increase funding for research and development in funding for vaccines and
medicines, an area in which the G20 has shown an active interest in the past. However, an IMF call
for a doubling of its funding to $2 trillion was not addressed specifically in the communique. The joint
statement instead asserted G20 members had already undertaken a $5 trillion stimulus, through
targeted fiscal policy and insurance schemes…”

You find the full communiqué here. With four sections, the first one on ‘Fighting the pandemic’.

A few excerpts: “…The G20 is committed to do whatever it takes to overcome the pandemic, along
with the World Health Organization (WHO), International Monetary Fund (IMF), World Bank Group
(WBG), United Nations (UN), and other international organizations, working within their existing
mandates. We are determined to spare no effort, both individually and collectively, to: …”

“…We fully support and commit to further strengthen the WHO’s mandate in coordinating the
international fight against the pandemic, including the protection of front-line health workers,
delivery of medical supplies, especially diagnostic tools, treatments, medicines, and vaccines. We
acknowledge the necessity of urgent short-term actions to step up the global efforts to fight the
COVID-19 crisis. We will quickly work together and with stakeholders to close the financing gap in
the WHO Strategic Preparedness and Response Plan. We further commit to provide immediate
resources to the WHO’s COVID-19 Solidarity Response Fund, the Coalition for Epidemic
Preparedness and Innovation (CEPI) and Gavi, the Vaccine Alliance, on a voluntary basis. We call
upon all countries, international organizations, the private sector, philanthropies, and individuals to
contribute to these efforts….”

“We ask the WHO, in cooperation with relevant organizations, to assess gaps in pandemic
preparedness and report to a joint meeting of Finance and Health Ministers in the coming months,
with a view to establish a global initiative on pandemic preparedness and response. This initiative
will capitalize on existing programs to align priorities in global preparedness and act as a universal,
efficient, sustained funding and coordination platform to accelerate the development and delivery of
vaccines, diagnostics and treatments…”

 • PS: notice the difference between the ‘voluntary’ global health funding & “We are injecting
 over $5 trillion into the global economy, as part of targeted fiscal policy, economic

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measures, and guarantee schemes to counteract the social, economic and financial impacts
 of the pandemic.”

 • PS: Tedros’ statement at the G20 summit - WHO’s Director General calls on G20 to Fight,
 Unite, and Ignite against COVID-19 (with also a quick overview of the G20 pledges &
 commitments)

 • After the virtual meeting, Boris Johnson also announced a US$270 million boost in funding
 for CEPI.

“The extra funding makes the UK the largest single contributor to the international coalition
searching for a vaccine.”

Global Fund Supports Countries in Response to COVID-19
https://www.theglobalfund.org/en/updates/other-updates/2020-03-23-global-fund-supports-
countries-in-response-to-covid-19/

“Under WHO guidance, the Global Fund strongly encourages countries to take prompt action to
mitigate the potential negative consequences of COVID-19 on existing programs supported by
Global Fund grants. Particular attention should be given to health worker protection, communication
with affected communities, maintenance of essential services, supply chain coordination, early
replenishment of stocks, disinfection of assets, and waste management. Fifteen countries and a
regional grant have already accessed the funds to support their response. The 15 countries include
Afghanistan, Belarus, Bhutan, El Salvador, Eritrea, Georgia, India, Kyrgyzstan, Madagascar, Malawi,
Malaysia, Moldova, Myanmar, Rwanda and Ukraine. The regional grant in West Africa covers border
screening and passenger tracing in five countries along the Abidjan-Lagos corridor….”

Gavi Board calls for bold engagement to respond to COVID-19
https://www.gavi.org/news/media-room/gavi-board-calls-bold-engagement-respond-covid-19

(21 March) “With the COVID-19 pandemic already affecting 47 Gavi-supported countries, Gavi, the
Vaccine Alliance has already taken new steps to help strengthen the preparedness of health systems
in lower-income countries with the full support of its Board. Gavi will also be working closely with
WHO, CEPI, World Bank, UNICEF and other partners to create the optimal conditions for the
acceleration of priority candidate vaccines with a focus on access including assuring adequate scale
up of production and delivery to be sure the vaccine gets to where it is needed to stem the
pandemic….”

You might also want to read Seth Berkley’s Science Editorial - COVID-19 needs a Manhattan Project

“…If ever there was a case for a coordinated global vaccine development effort using a “big science”
approach, it is now….” Berkley explains what such a Manhattan project for a SARS-CoV-2 vaccine
would require.

 14

KFF - Preparing for COVID-19 in Low and Middle Income Countries:
Leveraging U.S. Global Health Assets
J Kates et al ; https://www.kff.org/global-health-policy/issue-brief/preparing-for-covid-19-in-low-
and-middle-income-countries-leveraging-u-s-global-health-assets/

“To assess where the U.S. government has existing global health assets that could be mobilized
when and if needed, we identified all countries that received U.S. government bilateral global health
assistance in FY 2018. We also identified LMICs that the U.S. has designated as high-priority for
receiving COVID-19 assistance….”

Some other Funding & (stakeholder) coordination news:

 • Tweet Tedros: “Today the #COVID19 Solidarity Response Fund reached over $100M in
 donations & pledges from individuals & orgs.”
 • Tweet: “The #EU will support the @WHO global preparedness and response plan with
 €114 million to help weaker health systems tackle #coronavirus. Another €15 million are for
 rapid diagnosis and epidemiological surveillance in Africa, including for the Institute Pasteur
 Dakar.”
 • OECD Action plan on Covid-19 : https://www.oecd.org/coronavirus/
 • Global Financing Facility - The GFF’s Response to the COVID-19 Pandemic

 (3) Some Key Updates of the past week

As we already mentioned, it’s impossible to give a full overview of all key updates related to the
(now very much global) pandemic, especially as the ‘Third Wave’ of the pandemic (after China + East
Asia, and then Europe/US) has unfortunately fully started now, also hitting very vulnerable
populations. We will also not try to give a geographical overview (KFF has good daily updates on
this, per continent/region). So in general, for this section, we refer to your daily updates,
newsletters, media, … Here just some of the things that struck our attention the past week. Many
of these will also come back, under some form, in the Analysis section.

We will also try to give some key WHO messages from this week. But check out certainly the daily
briefings from Tedros, Ryan, … here.

In no particular order:

COVID-19: UN chief calls for global ceasefire to focus on ‘the true fight
of our lives’
https://news.un.org/en/story/2020/03/1059972

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Just one example of the bizarre times we’re living in… “In an appeal issued on Monday, UN
Secretary-General António Guterres urged warring parties across the world to lay down their
weapons in support of the bigger battle against COVID-19: the common enemy that is now
threatening all of humankind.”

See also UN News - Ease sanctions against countries fighting COVID-19: UN human rights chief

“As the COVID-19 pandemic progresses, the UN High Commissioner for Human Rights on Tuesday
called for an easing of sanctions against countries such as Iran to allow their medical systems to
fight the disease and limit its global spread. Michelle Bachelet said humanitarian exemptions to
sanctions measures should be authorized for essential medical equipment and supplies to avoid the
collapse of any national healthcare system. …”

Should be a no-brainer, indeed, but unfortunately the US don’t see it like that (vs Iran, Venezuela, …)

Foreign Policy – The Next Wave
https://foreignpolicy.com/2020/03/23/coronavirus-hitting-developing-countries-war-zones-united-
nations-urgent-donation-appeal-syria-gaza-yemen-south-sudanthe-next-wave/

Background piece related to the UN Humanitarian Appeal (see above): “U.N. and relief agencies
warn the coronavirus pandemic could leave an even bigger path of destruction in the world’s most
vulnerable and conflict-riven countries.”

“…“While all countries need to respond to COVID-19, countries with existing humanitarian crisis are
particularly vulnerable and will require all humanitarian partners to look at their existing operations
to see how they can be reprioritized and adapted [to tackle the virus],” according to a confidential
draft Global Humanitarian Response Plan reviewed by Foreign Policy. … … As the arc of the
pathogen spreads from global capitals to war zones and refugee camps, U.N. relief officials and aid
organizations are bracing for what they fear could be a cataclysmic second phase of the pandemic:
spreading in the close-quarters encampments of the world’s more than 25 million refugees and
another 40 million internally displaced people….”

See also the Guardian - This virus is ravaging rich countries. What happens when it hits the poor
ones?

Guardian - Everyone will be contaminated': prisons face strict
coronavirus controls
https://www.theguardian.com/global-development/2020/mar/23/everyone-will-be-contaminated-
prisons-face-strict-coronavirus-controls

“New WHO guidelines are aimed at protecting one of the most vulnerable sectors of society from the
spread of Covid-19.”

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WHO - United States could become coronavirus epicenter: WHO
https://www.reuters.com/article/us-health-coronavirus-who-usa/u-s-has-potential-of-becoming-
coronavirus-epicentre-says-who-idUSKBN21B1FT

One of WHO’s key messages this week. And probably an understatement…

“The United States has the potential to become the new epicenter of the coronavirus pandemic due
to a “very large acceleration” in infections there, the World Health Organization said on Tuesday.
Over the past 24 hours, 85 percent of new cases worldwide were from Europe and the United States,
WHO spokeswoman Margaret Harris told reporters. Of those, 40 percent were from the United
States….”

Some other WHO messages from this week:

The pandemic is accelerating (cfr. the now rapidly rising numbers), the ‘young are not invincible’, …
“India’s swiftness in dealing with Covid-19 will decide the world’s future, says WHO” Or at least
countries like India – cfr Ryan: “The future of this pandemic will be determined by what happens to
densely-populated countries.”

Also: “Tedros Adhanom Ghebreyesus, said the time to act had been a month or two ago. “We
squandered the first window of opportunity … this is a second opportunity, which we should not
squander,” he said.”

Lockdowns not enough to defeat coronavirus - WHO's Ryan
https://www.reuters.com/article/health-coronavirus-who-ryan-idINKBN2190E2

Another key message, both by Tedros & Ryan.

“Countries can’t simply lock down their societies to defeat coronavirus, the World Health
Organization’s top emergency expert said on Sunday, adding that there need to be public health
measures to avoid a resurgence of the virus later on.” “What we really need to focus on is finding
those who are sick, those who have the virus, and isolate them, find their contacts and isolate them…
… “The danger right now with the lockdowns ... if we don’t put in place the strong public health
measures now, when those movement restrictions and lockdowns are lifted, the danger is the
disease will jump back up.”…”

HPW - Protective Equipment Manufacturing Must Increase By 80-100
Times During COVID-19 Pandemic; World Health Organization
Projects 26 Million Healthcare Workers In Need
https://www.healthpolicy-watch.org/world-health-organization-projects-protective-equipment-
manufacturing-must-increase-by-80-100-times-26-million-healthcare-workers-in-need/

Let these figures sink in. Key message from WHO (last week Friday): “Manufacturing of personal
protective equipment (PPE) for the COVID-19 pandemic response should be scaled up by 80 to 100

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times to meet the projected needs of the healthcare workforce, the World Health Organization said
on Friday. Amid a growing PPE shortage crisis in hotspots like Italy, the United States, and Iran, some
26 million healthcare workers around the world who may have to engage with COVID-19 patients
could be in need of personal protective equipment, WHO projected….”

See also Cidrap News - WHO grapples with PPE, test shortages

UN News - Human rights must be maintained in beating back the
COVID-19 pandemic, ‘without exception’ – UN experts
https://news.un.org/en/story/2020/03/1060372

“Dozens of independent UN human rights experts stressed on Thursday that in addition to public
health and emergency measures, battling the COVID-19 pandemic, must respect the fundamental
human rights of every individual.”

Life Sciences Companies Commit Expertise and Assets to the Fight
Against COVID-19 Pandemic Alongside Bill & Melinda Gates
Foundation
https://www.gatesfoundation.org/Media-Center/Press-Releases/2020/03/Life-Science-Companies-
Commit-to-the-Fight-Against-COVID-19-Pandemic-alongside-Gates-Foundation

“Collaboration to address product development and scale-up challenges posed by the current
pandemic.”

“… Following a conference call with Gates Foundation leadership earlier this month, companies are
working to identify concrete actions that will accelerate treatments, vaccines, and diagnostics to the
field. As a first step, 15 companies have agreed to share their proprietary libraries of molecular
compounds that already have some degree of safety and activity data with the COVID-19
Therapeutics Accelerator—launched by the Gates Foundation, Wellcome, and Mastercard two
weeks ago—to quickly screen them for potential use against COVID-19. Successful hits would move
rapidly into in vivo trials in as little as two months….”

Guardian - Trump signals change in coronavirus strategy that could
clash with health experts
https://www.theguardian.com/world/2020/mar/23/trump-social-distancing-coronavirus-rules-
guidelines-economy

Also a big story from this week. (PS: Bolsonaro even outdid him, still not taking it very seriously)

“Donald Trump has signalled a potential change in his handling of the coronavirus pandemic, amid
warnings of a record plunge in economic activity and unemployment…” The Donald wants to get

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‘back to business’ for the US by Easter (if it’s up to him). Public health experts clearly think this
would be a disaster.

But the ‘long game’ – and exit strategy will become an issue in many countries in the coming weeks
& months (see below for Analysis).

U.S. insisting that the U.N. call out Chinese origins of coronavirus
NBC;

“A Security Council resolution on the coronavirus stalls over attempts to single out China as the
country of origin.”

“The Trump administration is pushing the U.N. Security Council to call attention to the Chinese
origins of the coronavirus, four diplomats posted to the United Nations told NBC News, triggering a
stalemate as the global body seeks to cobble together a response to the pandemic. Talks among
U.N. Security Council nations over a joint declaration or resolution on the coronavirus have stalled
over U.S. insistence that it explicitly state that the virus originated in Wuhan, China, as well as
exactly when it started there. China's diplomats are enraged according to the diplomats, even as
they seek to put their own language into the statement praising China's efforts to contain the virus.
The dispute at the United Nations comes amid growing finger-pointing between Washington and
Beijing over the coronavirus….”

FT Health – Hidden infections challenge China’s claim coronavirus is
under control
https://www.ft.com/content/4aa35288-3979-44f7-b204-b881f473fca0

“Official figures suggest a breakthrough but local medics reveal unreported cases “.

“China’s official figures for new coronavirus cases suggest transmission has all but ended in many
regions, but local experts have warned that official numbers omit important categories of cases.
Hubei, the province where the outbreak originated, has reported no more than one new case a day
for more than a week, allowing the government to signal the end of the crisis period. Officials and
disease control teams have been able to leave the area, and travel restrictions and quarantines have
also been relaxed. But interviews with local medics and disease specialists reveal that the situation
in Hubei’s capital Wuhan could be worse than the official figures make out, suggesting any
declaration by Beijing of victory against the pandemic would be premature. Experts have highlighted
the existence of unreported cases, as well as the large number of asymptomatic cases that the
government refuses to publicise in its official tally….”

Reuters - Gilead's potential coronavirus treatment gets FDA's orphan
drug label
https://www.reuters.com/article/us-health-coronavirus-gilead-sciences-idUSKBN21A3PR

 19

This was a big story this week re Gilead’s experimental drug, remdesivir (causing big uproar, and
fortunately, Gilead already backed off).

Cfr tweet Els Torreele: “@GileadSciences does it again: morally and intentionally abusing
legislation and financial incentives designed to stimulate medical R&D for otherwise neglected
health needs, and turning it into a mega money making opportunity, likely precluding access for
the most vulnerable…”

For some analysis, see The Intercept - Coronavirus treatment developed by Gilead Sciences granted
“rare disease” status, potentially limiting affordability

See also Stat Gilead pauses access to experimental Covid-19 drug due to ‘overwhelming demand’

Fortunately, Stat already reported: “ Under intense criticism, Gilead forsakes monopoly status for
its experimental Covid-19 drug”

Well done, campaigners!

HPW - Médecins Sans Frontières Announces Campaign For $5 COVID-
19 Test On ‘GeneXpert’ TB Platform
https://www.healthpolicy-watch.org/medecins-sans-frontieres-announces-campaign-for-5-covid-19-
test-on-tuberculosis-testing-platform/

“Médecins Sans Frontiéres (MSF) on Tuesday launched a campaign to push for a US $5 price tag on
a new COVID-19 rapid diagnostic test that can be used on GeneXpert, a diagnostic instrument
widely deployed around the world for diagnosing tuberculosis. The test for SARS-CoV-2, the virus
that causes COVID-19, received US Food and Drug Administration emergency use approval just last
Friday, and represents a hope for scaling up COVID-19 testing in low- and middle-income countries.
The MSF announcement coincided with World Tuberculosis Day, and reflected one of the many
ways in which the battle against one of the world’s oldest respiratory diseases…”

HPW - Costa Rica Urges WHO To Lead Global Initiative For Pooled
Rights To COVID-19 Diagnostics, Drugs & Vaccines
https://www.healthpolicy-watch.org/costa-rica-urges-who-to-lead-global-initiative-for-pooled-
rights-to-covid-19-diagnostics-drugs-vaccines/

“Costa Rica’s president, Carlos Alvarado Quesada has appealed to Dr Tedros Adhanom
Ghebreyesus, Director General of the World Health Organization, to “pool rights to technologies
that are useful for the detection, prevention, control and treatment of the COVID-19 pandemic”.
The presidential letter dated Monday, 23 March, and co-signed by Minister of Health, Daniel Salas
Peraza, proposed that the global pool “should include existing and future rights in patented
inventions and designs, as well as rights in regulatory test data, know- how, cell lines, copyrights and
blueprints for manufacturing diagnostic tests, devices, drugs, or vaccines”. “It should provide for free
access or licensing on reasonable and affordable terms, in every member country.”….”

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See also Stat News - WHO is asked to create a voluntary intellectual property pool to develop
Covid-19 products

Other updates:

 • To increase access to reliable information, WHO has worked with @WhatsApp and
 @Facebook to launch a new WHO Health Alert messaging service.
 • Last week on Thursday, Big Pharma promised to deliver a vaccine everywhere in the world,
 within 12-18 months (with 18 months their deadline)
 • FT - UK in talks with Amazon and others to deliver coronavirus tests

“The UK government has approached Amazon and other companies about using their services to
increase urgently the delivery of coronavirus tests to frontline health and social care workers. In a
move that would have been unthinkable in Britain’s largely publicly funded health sector before the
Covid-19 crisis, the government is in talks with companies about boosting the availability of tests for
healthcare staff, according to two public health officials….”

 • Coronavirus: S'pore Government to make its contact-tracing app freely available to
 developers worldwide

Meanwhile, you see similar trends in Northern (democratic) countries… hopefully they’ll manage to
protect privacy better (than Singapore or South Korea).

 • Reuters - Exclusive: U.S. axed CDC expert job in China months before virus outbreak
 • HPW - WHO & FIFA Launch Campaign to “Kick Out Coronavirus”

 (4) Science

As we mentioned, given that this is not our niche, with a preference for ‘readable’ (i.e. not too
technical/biomedical) articles here, to sketch some of the broader trends on the science of Covid-
19, drugs, vaccines, tests, epidemiology, modelling …

Stat - What we’ve learned about the coronavirus — and what we still
need to know
https://www.statnews.com/2020/03/26/what-weve-learned-about-the-coronavirus-and-what-we-
still-need-to-know/

By Helen Branswell (26 March). Cutting through the crap. Recommended.

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Guardian - Men are much more likely to die from coronavirus - but
why?
https://www.theguardian.com/world/2020/mar/26/men-are-much-more-likely-to-die-from-
coronavirus-but-why

“Trend has been replicated in all nations, but scientists cannot yet fathom the cause.” With the
various hypotheses.

Science - WHO launches global megatrial of the four most promising
coronavirus treatments
https://www.sciencemag.org/news/2020/03/who-launches-global-megatrial-four-most-promising-
coronavirus-treatments

News from late last week. “On Friday, the World Health Organization (WHO) announced a large
global trial, called SOLIDARITY, to find out whether any can treat infections with the new
coronavirus for the dangerous respiratory disease….”

For an update, see Science - Race to find COVID-19 treatments accelerates (27 March)

“… The World Health Organization (WHO) last week announced a major study to compare treatment
strategies in a streamlined clinical trial design that doctors around the world can join. Other trials are
also underway; all told, at least 12 potential COVID-19 treatments are being tested, including drugs
already in use for HIV and malaria, experimental compounds that work against an array of viruses in
animal experiments, and antibody-rich plasma from people who have recovered from COVID-19….”

FT Analysis - The global hunt for a coronavirus drug
https://www.ft.com/content/91bd081e-6e7b-11ea-9bca-bf503995cd6f

“With a vaccine up to 18 months away, drug companies are testing existing virus treatments.”

“… Scientists are investigating three main types of drugs. The first are antivirals to stop the virus
from replicating. Treatment guidelines compiled by the Chinese government during the outbreak
include HIV drug combination Kaletra, which US biotech AbbVie recently waived its patents on so it
can be made available as a generic; antimalarials such as chloroquine, which generic drugmakers are
gearing up to manufacture at scale; and favipiravir, an anti-flu drug from Japan’s Fujifilm. The
second category is anti-inflammatories that treat the lungs after the immune system is
overwhelmed. Regeneron and Sanofi have partnered on Kevzara, while Roche has started a trial on
Actemra, approved for use on rheumatoid arthritis in 100 countries. The third group are antibody-
based treatments, derived either from recovered Covid-19 patients or developed in labs, to be
given to the seriously ill or as a temporary prophylactic for healthcare workers. Eli Lilly has paired
up with Canadian start-up AbCellera to work on antibodies developed from one of the first US Covid-
19 patients, while Japan’s Takeda is developing a new drug derived from the blood plasma of others
who have survived the virus….”

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