IHP news 567 : "Celebrating" Easter in Covid- 19 times - International Health Policies

IHP news 567 : “Celebrating” Easter in Covid-
19 times
( 10 April 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,

With a long Easter weekend coming up for many of you, I won’t take much of your time in the intro.
The week was once again full of Covid-19 related news & publications, and far too many victims,
sadly. And so even World Health Day, this year with the tagline “Support nurses and midwives”
couldn’t be seen distinct from the ongoing Covid-19 battle, clearly. It feels a bit wry, of course, all
this rhetoric on “health worker heroes”/”backbone of the health system”/”saints next door” ( the
last one HT the pope), against the backdrop of a global lack of PPE for many of them, and –
especially in authoritarian countries – a crackdown on whistleblowers if they dare raise the issue.
And let’s not forget the armies of trolls usually assisting authoritarian & populist leaders. The
situation is only slightly better in our ‘democracies’, I’m afraid, where we also see a sudden boost in
appreciation for ‘key workers’, now that neoliberal/austerity shit of past decades hits the fan. Or see
this week’s Offline by Horton on health worker “freedom of speech” currently in the UK…

Anyway, as it’s almost Easter, I don’t want to sound too grim, and so I would just like to point you to
a great analysis by Sarah Mendelson (on Global Dashboard). She tries to explore what the Covid-
19 pandemic could mean for the SDG agenda and discerns three possible future scenarios. It’s my
(admittedly, cheesy) hope for Easter that we all do whatever we can to help turn the third one into
reality: “that the pandemic, once we are past the emergency response, drives a surge of collective
action and elevates the issues that are at the core of the SDGs enabling the type of transformation
envisioned by the Global Goal.” In line with what UN SG just called "The fight of a generation". As a
start, I’m more than happy to see virologists and epidemiologists now top celebrities' lists around
the globe. Let’s hope many of them also get a prominent role on WHO/Global Citizen’s “One World,
Together at Home” party, on 18 April. As somebody pointed out on Twitter, it appears WHO is also a
bit ‘Gaga-centric’ these days .

Meanwhile, the ‘wearing a mask in public (or not)’ discussion continued this week, with new
(interim) guidelines by WHO. I have no clear opinion on this – my wife has one, though – but
one thing I know for sure: I really would like the Donald to wear one (I let you guess for what
reason )!

Enjoy your reading (and the chocolate!).

Kristof Decoster

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Featured Article

What else should we know by now?

Kaaren Mathias

Ten days ago, a friend rang to ask me whether it would be reasonable to start a cottage-industry
sewing cotton facemasks. Thomas lives in Daliganj, Lucknow, a densely populated urban community
where families live in single brick rooms. He thought facemasks could both protect people from
coronavirus and generate income for families struggling in India’s giant lockdown. I said I’d check the
evidence and get back to him. I searched online and found we are all in a black hole for evidence on
virus’ and facemask. Cotton facemasks, like papier-mache motorcycle helmets, look right but may
not actually protect. To wear or not to wear a facemask is the question of the week.

The Covid-19 epidemic is like a plough, churning up new questions that we really should have known
the answers to years ago. It seems so obvious now, that any modelling and planning for a global
pandemic should have recognised the huge need for surgical masks, and thus developed evidence
around home-made cotton face masks. This month there are new and critical questions for public
health globally: do home-sewn two-layer cotton facemasks protect wearers from a viral respiratory
infection? Do they reduce transmission of infected respiratory droplets? Is there a difference in
efficacy between two layers of cotton, or three? What about increasing the effectiveness of a cotton
mask with a non-woven layer of polypropylene? Do they reduce face touching? Can they be
disinfected by sunlight? Answering these questions would be relatively easy with time and good
research design, but I, and thousands of other public health physicians the world over did not think
of asking them. Today this is as desperate a question for a daily wage labourer in a Uttar Pradesh
slum as for the president of USA.

There is just one peer-reviewed randomised controlled clinical trial which evaluates the
effectiveness of different types of facemasks in protecting workers from an influenza like respiratory
viral infection. It was conducted among 1607 hospital workers in Vietnam five years ago. It shows
that cloth masks let through double the volume of virus particles as surgical masks and risk of
infection was nearly four times higher for the cloth mask group vs surgical mask group. The authors
of the study above have added a post-script, which I fully endorse, in light of huge shortages of
personal protective equipment for health workers currently:

“If health workers choose to work using cloth masks, we suggest that they have at least two and
cycle them, so that each one can be washed and dried after daily use. [ ]. These are pragmatic, rather
than evidence-based suggestions, given the situation. Finally, for COVID-19, wearing a mask is not
enough to protect healthcare workers – use of gloves and goggles are also required as a minimum.1

Behind this current mask quandary, I wonder aloud, what else should we know by now? What are
the upcoming urgent questions that we need to ask now, to generate life-saving evidence in possible
crises in months or years ahead? How do we ensure we ask the right questions in global public
health and in science?

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Learning fast and doing things differently is a huge opportunity offered through the Covid pandemic.
Responding to unravelling complex systems requires thinking that is both careful and carefree.
Typically, global health research is guided by relationships and conversations. Conversations with
researchers at conferences (and Zoom meetings) generates one set of questions. Conversations with
friends living in informal urban communities can generate another set of questions. Both are
important to the world, but while global health research policy and questions continue to be set
exclusively in boardrooms in Nairobi or New York, we may miss out on crucial questions that people
who live in small rooms in a Lucknow slum might ask.

I emailed Thomas saying “The evidence for home-made cotton facemasks as protective is not great,
but the point is moot. We know most people can’t access a surgical mask and cotton-masks possibly
reduce transmission.” Pragmatically, Thomas and a band of enterprising people with sewing
machines are sewing volumes of cotton masks. We then discussed whether there could be an
upcoming shortage of motorcycle helmets too. They could provide excellent protective visors against
respiratory droplets. His next question, how about a cottage industry making papier-mache
motorcycle helmets with hard plastic visors to protect against airborne virus particles?

To respond to the current Covid crisis we must recognise there are known unknowns and unknown
unknowns lurking out there. To develop questions, find answers, implement them and evaluate their
success we need ways to quickly integrate the questions of practitioners, policy makers and
especially people whose lived reality it is, as well as academics. The questions continue and we need
to keep asking, what else should we know by now?

Kaaren Mathias is a public health physician who leads Burans, a community mental health project in
poor urban and rural settings in Uttarakhand, North India with the Emmanuel Hospital Association, a
large network of not-for-profit hospitals located in North India. She is also the South East Asia
regional Board director for Health Systems Global.

Highlights of the week

World Health Day (7 April ) – “Support nurses and midwives”
& World Health Worker week (5-11 April)

https://www.who.int/news-room/campaigns/world-health-day/world-health-day-2020

“7 April 2020 is the day to celebrate the work of nurses and midwives and remind world leaders of
the critical role they play in keeping the world healthy. Nurses and other health workers are at the
forefront of COVID-19 response - providing high quality, respectful treatment and care, leading
community dialogue to address fears and questions and, in some instances, collecting data for
clinical studies. Quite simply, without nurses, there would be no response. In this International Year
of the Nurse and the Midwife, World Health Day will highlight the current status of nursing and

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around the world. WHO and its partners will make a series of recommendations to strengthen of
the nursing and midwifery workforce….”

WHO - State of the World’s Nursing Report - 2020
WHO;

First ever ‘State of the World’s Nursing report’. “The State of the world’s nursing 2020 report
provides the latest, most up-to-date evidence on and policy options for the global nursing workforce.
It also presents a compelling case for considerable – yet feasible – investment in nursing education,
jobs, and leadership. The primary chapters of the report outline the role and contributions of nurses
with respect to the WHO “triple billion” targets; the health labour market and workforce policy levers
to address the challenges to nurses working to their full potential; the findings from analysis of
National Health Workforce Account (NHWA) data from 191 Member States and progress in relation
to the projected shortfall of nurses by 2030; and forward-looking policy options for an agenda to
strengthen the nursing workforce to deliver the SDGss, improve health for all, and strengthen the
primary health care workforce on our journey towards universal health coverage. The report
concludes with a call to Member States and other stakeholders to commit to this agenda. …”

A similar report on the midwifery workforce will be launched in 2021.

For some great coverage (and key messages), see for example:

HPW - Six Million More Nurses Needed Ensure Health for All by 2030, Says New
WHO Report
https://www.healthpolicy-watch.org/six-million-more-nurses-needed-ensure-health-for-all-by-2030-
says-new-who-report/

“The world needs 6 million more nurses in the next 15 years in order to reach the Sustainable
Development Goals, according to the first-ever State of the World’s Nursing report released by the
World Health Organization, Nursing Now, and the International Council of Nurses. The report,
released Tuesday on World Health Day, explores challenges and successes faced by the world’s
largest cadre of health workers, whose essential roles have been highlighted even more dramatically
during the COVID-19 pandemic. … … There are just under 28 million certified nurses working
around the world today. However, the distribution of nurses is highly unequal – approximately 80%
of nurses serve only 50% of the world’s population. The greatest shortages of nurses are in Africa,
South East Asia and the WHO Eastern Mediterranean region as well as some parts of Latin
America. …”

And Devex - WHO estimates global shortfall of 5.9M nurses as world battles COVID-19 (with quotes
from Giorgio Cornetto, among others )

UN News – COVID-19 highlights nurses’ vulnerability as backbone to health
services worldwide
UN News;

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“ Nurses are on the frontline fighting COVID-19 but “an alarming failure” in the global supply of
protective clothing and new coronavirus tests – together with “unprecedented” overwork linked to
global staff shortages - have highlighted how vulnerable they are, the World Health Organization
(WHO) said on Tuesday. The development coincides with an impassioned personal message from
UN Secretary-General António Guterres to the world’s medical professionals for World Health Day,
marked on Tuesday 7 April.”

Lancet Editorial – The status of nursing and midwifery in the world
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30821-
7/fulltext?utm_campaign=eds20&utm_source=twitter&utm_medium=social

“Two reports mark the International Year of the Nurse and the Midwife, and World Health Day,
April 7, in honour of their vital work providing health services. State of the World's Nursing 2020,
released today, is a comprehensive analysis of nursing around the world, produced by WHO with the
International Council of Nurses and Nursing Now. The third global State of the World's Midwifery,
building on 2011 and 2014 editions, is due in 2021, and will be foreshadowed by a May, 2020, forum
for action organised by WHO, the International Confederation of Midwives, and the International
Council of Nurses. These evidence-based reports are essential tools to inform international, regional,
and national policy dialogues about where and how to invest in the nursing and midwifery
workforces to improve primary health care, strengthen emergency response and resilience, and
achieve health for all….”

COVID-19 Emergency – PSI priorities and perspectives
https://publicservices.international/resources/news/covid-19-emergency--psi-priorities-and-
perspectives?id=10694&lang=en

“PSI (Public Services International – the global union federation of workers in public services)
realises the moment we are living in requires the whole trade union movement to focus on two
fronts: a set of immediate targeted emergency actions and an economic response (composed of 8
points each).”

Hard-hitting recommendations – no empty waffling about ‘honoring our health care heroes’ here
 .

PSI - Breaking the “cycle of panic and neglect” with solidarity and action
https://publicservices.international/resources/news/breaking-the-cycle-of-panic-and-neglect-with-
solidarity-and-action?id=10700&lang=en

“This year’s World Health Day falls during the gravest public health emergency in the history of the
World Health Organization (WHO). Supporting nurses, midwives and all health workers at this
moment requires a genuine return to the spirit of the Alma Ata Conference for health as a
fundamental human right, based on a radical new economy which guarantees quality public services
for all. Healthcare workers on the front line of the COVID-19 response face a perilous situation.
They are overstretched because our hospitals are grossly understaffed. And there is not enough

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personal protective equipment (PPE) to protect them properly. This sobering situation is worrying for
health workers and their families. It also impedes the global pandemic response. Years of
privatisation and cuts in the funding of public healthcare preceded this morbid scenario of
unpreparedness of health systems. Based on a neoliberal consensus, pushed with the policies and
programmes of the international financial institutions, governments have slashed wages and put
ceilings on health and social sector employment, despite the pressing need for employing more
health workers….”

“As Dr Tedros Ghebreyesus pointed out, the world has to break the cycle of panic and neglect. This
can be achieved by applying the positive actions taken by some WHO member states thus far and
implementing subsisting international covenants which could ensure universal public health. To
achieve this, PSI calls on all governments to:… (with then a number of recommendations, starting
by: “Urgently make PPE available to all health workers, including community health workers, as
well as workers in all sectors with high risk of contagion. And COVID-19 should officially be
considered an actionable occupational disease in the health sector….”

And some links:

 • Frontline Health Workers Coalition Policy Recommendations on COVID-19

Among others, with some great Policy Recommendations to Protect and Support Frontline Health
Workers in Low- and Middle Income Countries.

 • OECD - Women at the core of the fight (30 p. report)

 • K Decoster (blog) - World Health Day - Dear global health leaders, it’s more than time for a
 “double message” on health care workers Quote: “Health workers without proper PPE
 have the right to strike, to quit, and/or ‘stay healthy at home’.”

Forbes - Can We Reimagine Global Health In The Post-
Pandemic World?

Madhukar Pai; https://www.forbes.com/sites/madhukarpai/2020/04/06/can-we-reimagine-global-
health-in-the-post-pandemic-world/#50ae7ae64c22

Must-read. Plain & simple.

« When the pandemic is eventually brought under control (hopefully soon!), I believe, along with a
dozen experts I interviewed, it will profoundly change the field of global health. In some ways, the
pandemic will make global health easier. In other ways, the pandemic will make global health much
harder. Much harder…. »

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And now, over to the dreaded Covid-19 section (and disease). Now with over
1.6 million cases and more than 95000 deaths… (via JH ).

As already mentioned last week, we will again try to structure the Covid info-
tsunami. (1) Resources; (2) key updates/news & WHO messages; (3) funding &
initiatives; (4) science; (5) analysis (+ some final snippets).

Covid-19 Resources

The Covid-19 related resources keep on growing, near exponentially – not unlike the virus itself
(sigh).

Evidence to inform the COVID-19 response: Collection of Health Policy & Planning
papers
http://blogs.lshtm.ac.uk/hppdebated/2020/04/08/evidence-to-inform-the-covid-19-response-
collection-of-hpp-papers/

“What measures were effective in previous pandemics? Can we anticipate the impacts of COVID-19
on nutrition, mental health and other health issues in order to address them proactively? What is
health systems resilience and does it explain why some countries are combatting COVID-19 more
effectively? These and other critical questions during the COVID-19 health emergency have been
addressed by robust health policy and systems research published in Health Policy and Planning. We
have made a special collection of papers freely accessible….”

IMF Tracking Policy Responses to COVID-19
http://sdg.iisd.org/news/imf-tracking-policy-responses-to-covid-19/

“The [IMF] COVID-19 Policy Tracker summarizes the economic responses that governments are
taking to address the COVID-19 pandemic. The Tracker includes information regarding number of
COVID-19 cases, deaths and containment measures for each of 193 economies; it also summarizes
each economy's fiscal, monetary and macro-financial, and exchange rate and balance of payments
policy responses.”

WHO (Alliance for HPSR ) - Bringing together evidence to tackle COVID-19
https://www.who.int/alliance-hpsr/news/2020/bringing-evidence-together-for-covid-19/en/

The Alliance is currently supporting #rapidreview platforms that are working on #COVID19
responses. But many others are gathering evidence to tackle the disease. Find resources for
#rapidreviews and #evidencesynthesis on #covid19 …

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UNAIDS - New innovations map to strengthen the response to COVID-19
https://www.unaids.org/en/resources/presscentre/featurestories/2020/april/20200408_covid-19-
innovations

“A Coronavirus Innovation Map has been launched by StartupBlink together with the Health
Innovation Exchange—a UNAIDS initiative to leverage the potential of innovations to improve the
health of all—and the Moscow Agency of Innovations….”

COVID-19 and Fragility
http://www3.compareyourcountry.org/states-of-fragility/covid/0/

“In light of the ongoing novel coronavirus (COVID-19) situation, the States of Fragility platform,
hosted by the Crises & Fragility team in the Global Partnerships & Policies Division of the
Development Cooperation Directorate (DCD), will provide key resources and analysis on COVID-19
and fragile contexts. This page features data and visualizations on COVID-19 rates in the 58 fragile
contexts on the 2018 OECD fragility framework, updated daily. It also links to publications from the
Crises & Fragility team related to COVID-19 and forced displacement, conflict, and fragility….”

IHP – preparedness checklist for Covid-19, especially focusing on limited
resource/rural settings in India. (but also relevant for other LMIC settings)
https://iphindia.org/iph-contributing-to-fight-covid-19/

Via one of the initiators, NS Prashanth: “Amidst the talk of ventilators and all the specialist advice
the strength of Indian/many other country settings is indeed our community-oriented PHC based
health systems and hence PHC preparedness will be an important element in responsiveness to
COVID-19. “ “I believe this resource may be helpful in many other contexts as well. …”

See also the link from The George Institute of GH - India website: COVID-19 Preparedness Checklist
For Rural Primary Health Care & Community Settings

New WHO interim guidance - Advice on the use of masks in the context of COVID-
19
https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-
home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-
outbreak

For more on this new document ( released 6 April) (and how it’s been received), see the section on
Key News - “This document provides advice on the use of masks in communities, during home care,
and in health care settings in areas that have reported cases of COVID-19. It is intended for
individuals in the community, public health and infection prevention and control (IPC) professionals,
health care managers, health care workers (HCWs), and community health workers. This updated
version includes a section on Advice to decision makers on the use of masks for healthy people in
community settings.”

 8

WHO - “Solidarity” clinical trial for COVID-19 treatments
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-
coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments

With all updates on the ongoing “Solidarity” clinical trial for COVID-19 treatments.

New WHO guidance on disability
(26 March) Disability considerations during the COVID-19 outbreak

Nature summarizes must-read papers & preprints on Covid-19 from across all
publications
Nature;

Continuously updated.

K2P Covid-19 Rapid response series
Fadi el Jardali et al ;
https://www.aub.edu.lb/k2p/Documents/K2P%20COVID_19%20Rapid%20Response%20Series%20S
uppressing%20COVID_19%20Epidemic%20through%20Community%20Centered%20Care%20Approa
ch.pdf

“K2P COVID-19 Rapid Response Series is a collection of evidence-informed policy documents that aim
to inform and provide insights for action to help shape the collective response needed to address
COVID-19. …”

See for example :

 • K2P Rapid Response Series: Strengthening the Role of Local and International Non-
 Governmental Organizations in Pandemic Responses

 • K2P Guide on Informing readiness and response to COVID19 in Hospitals and Primary
 Healthcare Centers

IDS – K4D COVID-19 Health Evidence Summaries

IDS;

“K4D is publishing daily Health Evidence Summaries to signpost DFID and other UK government
departments to the latest relevant evidence and discourse on COVID-19 to inform and support their
response.”

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UN Women - COVID-19 and ending violence against women and girls

https://www.unwomen.org/en/digital-library/publications/2020/04/issue-brief-covid-19-and-
ending-violence-against-women-and-girls#view

“This brief highlights emerging evidence of the impact of the recent global pandemic of COVID-19 on
violence against women and girls. It makes recommendations to be considered by all sectors of
society, from governments to international organizations and to civil society organizations, in order
to prevent and respond to violence against women and girls, at the onset, during, and after the
public health crisis, with examples of actions already taken. It also considers the economic impact of
the pandemic and its implications for violence against women and girls in the long term….”

Covid-19 key news updates & WHO messages
Some key news from the past week, as well as WHO messages (and commotion, unfortunately)…

You will have noticed that this section is not always clearly differentiated from the next ( Covid-19
funding & initiatives), but let’s just say that the emphasis is more on the big bucks, in that latter
section .

Some key news & updates, with some of the more recent ones first.

For some of the latest (global) updates (10 April), see The Guardian - Global coronavirus cases pass
1.5 million amid fears of second wave of outbreaks or Cidrap News - Nations eye COVID-19
lockdown extensions as global cases rise

Science news - ‘We will have many body bags.’ WHO chief responds to Trump’s
criticisms
https://www.sciencemag.org/news/2020/04/we-will-have-many-body-bags-who-chief-responds-
trumps-criticisms

On a no-nonsense media briefing by dr. Tedros on Wednesday. “The head of the World Health
Organization today gave an impassioned but indirect rejoinder to recent comments from U.S.
President Donald Trump criticizing WHO’s handling of the coronavirus pandemic and suggesting he
would try to cut its U.S. funding. “Please quarantine politicizing COVID,” Tedros Adhanom
Ghebreyesus said in response to a question from ScienceInsider about Trump’s comments. “We will
have many body bags in front of us if we don’t behave.” Tedros also indirectly addressed Trump’s
criticisms of China’s early handling of the pandemic and claims that WHO is too accommodating to
the Chinese government. “The United States and China should come together and fight this
dangerous enemy,” he said, urging politicians not to exploit global political differences. “It’s like
playing with fire,” he said. “When there are cracks at national level and global level that’s when the
virus succeeds. For God’s sake, we have lost more than 60,000 citizens of the world.”

Cfr a tweet: “@drtedros says he wants three things: 1. unity at national level 2. honest solidarity at
global level incl. honest leadership from US and China 3. "quarantine politicising" of #covid19”.

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See also Cidrap News (8 April) - Pandemic cases hit 1.5 million; WHO head dismisses Trump criticism

“Regarding the claim that the WHO is too close to China, he said the WHO is close to every nation.
"We're color blind. We're wealth blind. Weak and strong, the same," Tedros said. "We respect every
nation. We work with every nation. We try to understand the problems of every nation."”

See also UN News –“ 100 days of unwavering commitment “ (on WHO’s remarkable track record so
far, listed by Tedros in his media briefing of 8 April (which we recommend you read in full)

“With Thursday marking 100 days since WHO was first notified about the new coronavirus, Tedros
gave an overview of the agency’s output during this period. “It’s incredible to reflect on how
dramatically the world has changed, in such a short period of time”, he remarked. The UN health
chief said WHO has been “working day and night” in five key areas which include helping countries
in both preparation and response, countering the “infodemic” surrounding the disease, and ensuring
supplies of medical equipment for front line healthcare workers. … … WHO and private sector
partners, including the International Chamber of Commerce and the World Economic Forum, are
ramping up production and distribution of essential medical supplies…. UN agencies are also
contributing to a UN COVID-19 Supply Chain Task Force, launched on Wednesday, which will match
supply with needs, among other goals….”

For a great overview of these “five pillars”, see UN News - 5 reasons the world needs WHO, to fight
the COVID-19 pandemic Tedros outlined five ways the agency is leading the global response.

WHO Timeline (published on April 8) - WHO Timeline - COVID-19

Starting on December 31.

CNBC - WHO chief addresses death threats, racist insults: ‘I don’t give a damn’
https://www.cnbc.com/2020/04/08/who-chief-addresses-death-threats-racist-insults-i-dont-give-a-
damn.html?__source=twitter%7Cmain

Still on the same conference call: “The leader of the World Health Organization, Tedros Adhanom
Ghebreyesus, said he’s received death threats and racist insults while running the global efforts to
fight the coronavirus pandemic. “I can tell you personal attacks that have been going on for more
than two, three months. Abuses, or racist comments, giving me names, Black or Negro. I’m proud of
being Black, proud of being Negro,” he told reporters on a conference call from the organization’s
Geneva headquarters on Wednesday. “I don’t care to be honest ... even death threats. I don’t give a
damn.”

Stat - Trump pledges to put a hold on U.S. funding for the World Health
Organization
https://www.statnews.com/2020/04/07/trump-hold-who-funding/

And this was obviously big news worldwide this week, mostly for the wrong reasons.

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“President Trump said Tuesday that the United States would halt funding to the World Health
Organization, the global health agency that has been a leading voice in coordinating the world’s
response to the coronavirus pandemic. The shocking announcement appears to be in response to
Trump’s anger over the WHO’s criticisms of U.S. policy. “They’ve been wrong about a lot of things,”
Trump said. “We’re going to put a hold on money [sent] to the WHO. We’re going to put a very
powerful hold on it.” Later in the briefing, Trump said his announcement was not a decision to end
all U.S. funding for the agency, but rather a chance to give his administration the chance to “look
at it.” …”

Reuters - WHO denies being 'China-centric' after Trump comment
Reuters;

“World Health Organization officials on Wednesday denied that the body was “China-centric” and
said that the acute phase of a pandemic was not the time to cut funding, after U.S. President
Donald Trump said he would put contributions on hold. “We are still in the acute phase of a
pandemic so now is not the time to cut back on funding,” Dr Hans Kluge, WHO Regional Director for
Europe, told a virtual briefing in response to a question about Trump’s remarks. Dr Bruce Aylward,
senior advisor to the WHO Director-General, also defended the U.N. agency’s relationship with China,
saying its work with Beijing authorities was important to understand the outbreak which began in
Wuhan. “It was absolutely critical in the early part of this outbreak to have full access to everything
possible, to get on the ground and work with the Chinese to understand this,” he told reporters. “This
is what we did with every other hard hit country like Spain and had nothing to do with China
specifically.”

See also the Guardian - Now is not the time to cut WHO funds, says official after Trump threat “US
president and supporters have accused organisation of being biased towards China.”

Guardian - Trump scapegoating of WHO obscures its key role in tackling
pandemic
https://www.theguardian.com/world/2020/apr/08/world-health-organization-coronavirus-donald-
trump

Balanced (and recommended analysis) of the (pretty good) WHO track record so far in this
pandemic, with the view of many global health scholars (like A Jha, G Yamey, L Gostin).

The one issue where Trump has perhaps a point: “The US president’s accusations that the WHO is
“China-centric” have more resonance with public health scholars….”

Guardian - Global coronavirus cases near 1.5m as fresh WHO row erupts
https://www.theguardian.com/world/2020/apr/09/global-coronavirus-cases-near-15m-as-fresh-
who-row-erupts

“… accusations of racism in fight between Taiwan and WHO…” Let’s hope this gets sorted soon
between Tedros & Taiwan – nobody wins from this…

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Excerpt:

“WHO director-general Tedros Adhanom Ghebreyesus said on Wednesday that he had been
subjected to months of attacks, including racist ones against him and black communities, and
accused Taiwan of condoning the “campaign”. “This attack came from Taiwan,” said Tedros.
“Taiwan, the foreign minister, they know the campaign and they don’t disassociate themselves.
“They even started criticising me in the middle of all those insults and slurs.” On Thursday, Taiwan’s
foreign ministry demanded a clarification and apology for what it said was a “groundless”
accusation and an “extremely irresponsible act of slander”. It said the government in no way
condoned or encouraged personal attacks on Tedros. “Taiwan’s 23 million population also
experiences serious discrimination from the global health system,” the ministry said. “We can relate
[to Tedros] and we condemn any form of discrimination and injustice.”…”

ABC News - Intelligence report warned of coronavirus crisis as early as
November: Sources
https://abcnews.go.com/Politics/intelligence-report-warned-coronavirus-crisis-early-november-
sources/story?id=70031273

“As far back as late November, U.S. intelligence officials were warning that a contagion was
sweeping through China’s Wuhan region, changing the patterns of life and business and posing a
threat to the population, according to four sources briefed on the secret reporting. Concerns about
what is now known to be the novel coronavirus pandemic were detailed in a November intelligence
report by the military's National Center for Medical Intelligence (NCMI), according to two officials
familiar with the document’s contents. The report was the result of analysis of wire and computer
intercepts, coupled with satellite images. It raised alarms because an out-of-control disease would
pose a serious threat to U.S. forces in Asia -- forces that depend on the NCMI’s work. And it paints a
picture of an American government that could have ramped up mitigation and containment efforts
far earlier to prepare for a crisis poised to come home. "Analysts concluded it could be a cataclysmic
event," one of the sources said of the NCMI’s report. "It was then briefed multiple times to" the
Defense Intelligence Agency, the Pentagon’s Joint Staff and the White House…”

Trump’s reaction (via the Guardian): “During Wednesday’s White House briefing, Trump also
responded to reports that US intelligence officials had warned his office as far back as November
that a coronavirus was spreading through China’s Hubei region. According to US media outlet ABC
News, a report from the military’s National Center for Medical Intelligence (NCMI) said it could be “a
cataclysmic event” and would threaten US forces in Asia. Trump said: “When I learned about the
gravity of [the outbreak] was some time just prior to closing the country to China. So I don’t know
exactly, but I’d like to see the information.””

That is probably, for once, true – see CNN. “US spy agencies were tracking the rise of the novel
coronavirus as early as November, weeks before that information was included in President
Donald Trump's daily intelligence briefing, a former US military official told CNN….” “Intelligence is
often only elevated to the highest levels of the government once analysts and officials reach a certain
threshold of confidence in their assessment. That day came on January 3, the first day the
President's daily briefing included information the US intelligence community had gathered about
the contagion in China and the potential it had to spread, including to the US, according to a
person briefed on the matter.”

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Vox - US allies express dismay over US handling of global medical supply chain
https://www.vox.com/2020/4/4/21208250/coronavirus-trump-canada-germany-spain-brazil

“Other countries complain the US is outbidding them, as a German official accuses its ally of “modern
piracy.””

See also the Guardian on the ‘mask wars’ (& other protective medical equipment) - US accused of
'modern piracy' after diversion of masks meant for Europe

See also FT - E.U. warns of global bidding war for medical equipment

"A 'global scramble' for anti-coronavirus medical equipment has broken out, a top Brussels official
has warned, after days of angry claims by countries that cargoes have been suddenly diverted to the
U.S. Janez Lenarcic, the E.U.'s crisis management commissioner, said it was now 'difficult to arrange
an orderly procurement' to ensure crucial pandemic gear such as masks and ventilators went to
those who needed them most…”

NYT - In Scramble for Coronavirus Supplies, Rich Countries Push Poor Aside
NYT;

“Developing nations in Latin America and Africa cannot find enough materials and equipment to test
for coronavirus, partly because the United States and Europe are outspending them.”

“Scientists in Africa and Latin America have been told by manufacturers that orders for vital testing
kits cannot be filled for months, because the supply chain is in upheaval and almost everything they
produce is going to America or Europe. All countries report steep price increases, from testing kits to
masks. The huge global demand for masks, alongside new distortions in the private market, has
forced some developing countries to turn to UNICEF for help. Etleva Kadilli, who oversees supplies at
the agency, said it was trying to buy 240 million masks to help 100 countries but so far had managed
to source only around 28 million….”

“For poorer countries… the competition for resources is potentially a “global catastrophe,” as a once-
coherent supply chain has rapidly devolved into an arm-twisting exercise. Leaders of “every country”
are personally calling manufacturing chief executives to demand first-in-line access to vital supplies.
Some governments have even offered to send private jets….”

Guardian - Market for Chinese-made masks is a madhouse, says broker
https://www.theguardian.com/world/2020/apr/05/market-for-chinese-made-masks-is-a-madhouse-
says-broker

“Manufacturers making huge profits supplying to whoever can pay the most and pay fastest.”

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WHO and Global Citizen announce: 'One World: Together at home' Global Special
to support healthcare workers in the fight against the COVID-19 pandemic
https://www.who.int/news-room/detail/06-04-2020-who-and-global-citizen-announce-one-world-
together-at-home-global-special-to-support-healthcare-workers-in-the-fight-against-the-covid-19-
pandemic

On the plans for a mass virtual concert, “One World – Together At Home” on Saturday April 18th,
involving dozens of celebrity stars such as Sir Elton John and Paul McCartney.The event, in
collaboration with Hugh Evans of Global Citizen, aims to raise money for the WHO’s COVID-19
Solidarity Response Fund, particularly for test kits and protective gear to shield health workers in
low- and middle-income countries from infection.

Curated by Lady Gaga. (we’re fans, already since ‘poker face’ ).

PS: “Last month in response to the global pandemic, Global Citizen launched an urgent campaign
in support of the COVID-19 Solidarity Response Fund for WHO, powered by the UN Foundation.
Calling on individuals to take action, and asking world leaders and corporations to support the
response with sufficient resources, Global Citizens from over 130 countries around the world have
taken tens of thousands of actions in support of the response fund. Commitments from supporters
and corporate partners will go to the COVID-19 Solidarity Response Fund for WHO to support and
equip frontline healthcare workers around the world, with masks, gowns and other vital
equipment, and to local charities that provide food, shelter, and healthcare to those that need it
most.”

WHO - #HealthyatHome campaign
https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-
coronavirus/healthyathome

One of a number of current WHO campaigns to combat the coronavirus .

“To unite the world in the fight against coronavirus, WHO is bringing together a wide array of
partners on a series of engaging initiatives to motivate and mobilize people to Be Ready to beat
COVID-19, and to support the COVID-19 Solidarity Response Fund. Musicians, footballers, athletes
and artists will help you stay connected and healthy through shows of solidarity, lifesaving health
messages and entertainment during lockdown….”

HPW - … Countries Must Protect Health & Livelihoods During COVID-19 Pandemic
Say WHO and IMF
https://www.healthpolicy-watch.org/covid-19-infections-hit-one-million-mark-seven-fold-increase-
in-new-cases-for-south-east-asia-europe-usa-remain-epicentres/

Coverage of the joined WHO/IMF media briefing from end of last week.

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“As the global count of COVID-19 cases hit the sobering 1 million mark Thursday midnight, countries
should not have to face the choice of protecting lives or protecting livelihoods, World Health
Organization Director-General Dr Tedros Adhanom Ghebreyesus and International Monetary Fund
Managing Director Kristalina Georgieva said at a Friday press briefing. … … “We know that this is
much more than a health crisis. We are all aware of the profound social and economic
consequences of the pandemic,” said Dr Tedros. “The restrictions many countries have put in place
to protect health are taking a heavy toll on the income of individuals and families, the economies of
communities and nations”….”

Check out WHO’s & IMF’s respective messages.

 • “World Health Organization Director-General Tedros Ghebreyesus outlined these three "main
 areas" countries can emphasize to stem the spread of #Covid19: Fully-funded public health;
 Strengthened health systems; Removed financial barriers to health care.”

 • See also Cidrap News - WHO, IMF highlight pandemic's economic toll

“At the briefing today, IMF Managing Director Kristalina Georgieva, PhD, urged all countries to put
health expenditures at the top of their priority lists, while the IMF and its partners rush support to
desperate countries. So far, 85 countries have approached the IMF for emergency financing. She
said the group is deploying its $1 trillion capacity, which includes doubling fast disbursements from
$50 billion to $100 billion….”

 • At the same briefing, Tedros also called on countries to include services for addressing
 domestic violence as an essential service that must continue during the COVID-19
 response. See WHO.

For more coverage of this joint IMF/WHO message, see also the Telegraph - Some say there is a
trade-off: save lives or save jobs – this is a false dilemma

“At face value there is a trade-off to make: either save lives or save livelihoods. This is a false
dilemma – getting the virus under control is, if anything, a prerequisite to saving livelihoods. This is
what brings the World Health Organization (WHO) and the International Monetary Fund (IMF) so
closely together – the WHO is there to protect the health of people and well-placed to advise on
health priorities; the IMF exists to protect the health of the world economy – it advises on economic
priorities, and also helps provide financing. Our joint appeal to policymakers, especially in emerging
market and developing economies, is to recognise that protecting public health and putting people
back to work go hand-in-hand….”

UN News - UN chief calls for domestic violence ‘ceasefire’ amid ‘horrifying global
surge’
https://news.un.org/en/story/2020/04/1061052

Not just Tedros, UN SG Guterres also focused on the horrible rise in domestic violence.

 16

“UN chief António Guterres is calling for measures to address a “horrifying global surge in
domestic violence” directed towards women and girls, linked to lockdowns imposed by
governments responding to the COVID-19 pandemic. In a reference to his repeated appeals for a
ceasefire in conflicts around the world, to focus on the shared struggle to overcome the virus, the
Secretary-General pointed out that violence is not confined to the battlefield, and that “for many
women and girls, the threat looms largest where they should be safest: in their own homes”….”

Guardian - China reports zero daily deaths from coronavirus for the first time
since January
https://www.theguardian.com/world/2020/apr/07/china-reports-zero-daily-deaths-from-
coronavirus-for-the-first-time-since-january

Some of the merrier news is coming from China these days.

HPW - WHO Refrains From Public Mask Recommendation – Health Workers Need
Them First; Intensity of Virus Exposure May Drive More Serious COVID-19
Disease

https://www.healthpolicy-watch.org/who-refrains-from-public-mask-recommendation-health-
workers-need-them-first-intensity-of-virus-exposure-may-drive-serious-disease/

The “mask saga” continued this week. “WHO deferred any broad recommendation to the public on
the use of face masks, even as more countries were recommending some kind of a face cover or
protective mask to reduce COVID-19 transmission. World Health Organization Director General Dr
Tedros Adhanom Ghebreyesus stressed that health workers need to remain the key priority for the
use of medical masks….”

“… In other key comments, WHO’s head of Emergencies Mike Ryan said there is growing evidence
of a strong correlation between the “dose” of viral infection to which an individual is exposed and
the severity of disease that they develop, but those questions need to be explored further by
researchers.”

See also the Guardian - No need for healthy to wear face masks, says WHO after review

“Organisation says no evidence that wearing a mask outdoors prevents Covid-19 infection.”

But do read the new (interim) WHO guidelines for yourself. See WHO - Advice on the use of masks
in the context of COVID-19

BMJ Analysis – Face masks for the public during the covid-19 crisis
https://www.bmj.com/content/bmj/369/bmj.m1435.full.pdf

But the debate on the masks continues. See this stance. “Trisha Greenhalgh and colleagues argue
that it is time to apply the precautionary principle.”

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Key messages: “The precautionary principle states we should sometimes act without definitive
evidence, just in case. Whether masks will reduce transmission of covid-19 in the general public is
contested. Even limited protection could prevent some transmission of covid-19 and save lives.
Because covid-19 is such a serious threat, wearing masks in public should be advised.”

And a new BMJ Editorial - Covid-19: should the public wear face masks?

“Yes—population benefits are plausible and harms unlikely“

Stat - WHO director-general endorses a voluntary intellectual property pool to
develop Covid-19 products
https://www.statnews.com/pharmalot/2020/04/06/covid19-coronavirus-patents-voluntary-pool-
world-health/

(April 6) “Amid the race to find a salve for Covid-19, the World Health Organization director-
general has endorsed the idea of creating a voluntary pool to collect patent rights, regulatory test
data, and other information that could be shared for developing drugs, vaccines, and diagnostics.
The concept was proposed two weeks ago by Costa Rican government officials amid mounting
concerns that some Covid-19 medical products may not be accessible for poorer populations. By
establishing a voluntary mechanism under the auspices of the WHO, the goal is to establish a
pathway that will attract numerous governments, as well as industry, universities and nonprofit
organizations. “I support this proposal, and we are working with Costa Rica to finalize the details,”
said WHO Director-General Tedros Adhanom Ghebreyesus in a statement on Monday.”

In related news (HPW) - The Netherlands Joins COVID-19 IP Pool Initiative

“Dutch Deputy Prime Minister Hugo de Jonge on Wednesday offered to support the World Health
Organization to develop a pool of intellectual property rights for COVID-19 technologies, just days
after WHO Director-General Dr Tedros Adhanom Ghebreyesus announced WHO’s public support for
the initiative….”

The Medicines Patent Pool and Unitaid respond to access efforts for COVID-19
treatments and technologies
https://medicinespatentpool.org/mpp-media-post/the-medicines-patent-pool-and-unitaid-respond-
to-access-efforts-for-covid-19-treatments-and-technologies/

(3 April, last week on Friday) “The Board of the Medicines Patent Pool (MPP) has decided to
temporarily expand its mandate to include any health technology that could contribute to the
global response to COVID-19 and where licensing could facilitate innovation and access. With the
support of Unitaid, this will allow MPP to offer its IP and licensing expertise to the World Health
Organization (WHO) to assist the global effort in any way it can. Both MPP and Unitaid underline
their commitment to jointly ensure equitable and timely access to medicines and diagnostics by the
most vulnerable populations, as stressed in the G20 Leaders’ 26 March 2020 Statement….”

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Reuters - U.N. agency says coronavirus emergency could trump some patent
rights

https://uk.reuters.com/article/us-health-coronavirus-patents/u-n-agency-says-coronavirus-
emergency-could-trump-some-patent-rights-idUKKBN21P1PZ

“Discussions are under way on enabling wider access to some patented drugs and medical supplies
during the coronavirus pandemic, the head of the U.N.’s intellectual property agency said on
Tuesday. “Francis Gurry, director-general of the World Intellectual Property Organization (WIPO),
said that during an emergency, health and safety “trumps everything”.

“…WIPO’s Gurry, asked about demands for access to drugs and compulsory licensing, told a
separate news conference: “This is a hot issue, and it’s a very sensitive issue as well.” But
extraordinary situations call for “extraordinary measures”, he said, adding: “The international legal
framework does foresee a certain number of flexibilities for countries to be able to deal with health in
particular and health emergencies. “If they are targeted, such as the compulsory license situation, a
very specific compulsory license on a very specific product to ensure the supply of product in the
market, that’s arguably the sort of action that we need,” he said….”

FT - Covid-19 drugs could be made for $1 per day, say academics

https://www.ft.com/content/e72d0ed3-11c7-43f6-a5e4-53e446f1e5a2

(gated) “Study argues prices for potential treatments are far higher than the actual cost of
production.”

FT – African health officials warn of chronic medical shortages
https://www.ft.com/content/72ed316a-32fb-4ae2-aa91-8885e8bbc1d0

“African health officials have warned of a chronic shortage of the critical care equipment needed
to fight coronavirus as the outbreak gathers pace on the continent. Sierra Leone has just one
ventilator for its 7.5m people. In the Central African Republic there are three machines for 5m
citizens, while Burkina Faso has 11 for a population of 19m.“There is an enormous gap in the
numbers of ventilators needed,” said Matshidiso Moeti, head of the World Health Organization
Africa. “And this happens in the context of a global shortage and lockdowns that will make
transportation of these ventilators a challenge.” … … Both the WHO and Africa CDC are working
on an inventory of African countries’ capacity and needs. Some 17 governments — including
Angola, Côte d’Ivoire, Mozambique and South Sudan — have told the WHO they have no intensive
care unit capacity to treat severe cases of the virus….”

See also Devex - These countries have only a handful of ventilators with info on “a new report by
the International Rescue Committee looking at preparedness among fragile and conflict-affected
countries in responding to the COVID-19 pandemic….”

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Nature - African nations missing from coronavirus trials
https://www.nature.com/articles/d41586-020-01010-7

From late last week. “And a new, influential research consortium launches a bid to accelerate trials in
low-income countries.”

“The World Health Organization says it wants many more African nations to participate in its
SOLIDARITY trial, a global study of four potential COVID-19 treatments. The call comes as a new
international consortium of researchers urges faster action on clinical research in countries with
weak health systems — and offers to help coordinate the process so that researchers from Africa can
more easily join. … … At the same time, countries are moving ahead with their own trials….”

Guardian - Former world officials call on US to ease Iran sanctions to fight Covid-
19
https://www.theguardian.com/world/2020/apr/06/former-world-officials-call-on-us-to-ease-iran-
sanctions-to-fight-covid-19

“Group of former diplomats and ministers says shifting rules on medical trade could save hundreds of
thousands of lives.”

Politico – The United Nations goes missing
https://www.politico.com/news/2020/04/08/united-nations-coronavirus-176187

Pessimistic update on the UN security council & Covid-19. “It took more than three months, a death
toll above 87,000 and cases in more than 180 countries, repeated pleas from smaller nations, and a
growing sense of shame among senior diplomats — but the United Nations Security Council is finally
going to meet to discuss the coronavirus. That is, in a private session unlikely to yield any serious
action….”

Interesting read though.

Meanwhile, the meeting took place, see Reuters - U.N. Security Council meets over coronavirus as it
struggles to act “The United Nations Security Council met for the first time on Thursday to discuss
the coronavirus pandemic as the 15-member body - charged with maintaining international peace
and security - struggles to agree on whether it should take any action….”

“In recent weeks, council members have been negotiating two draft resolutions. The five veto-
wielding powers - the United States, China, France, Russia and Britain - have been discussing a French
text. The remaining 10 members - elected for two-year terms - have been discussing a Tunisian draft.
… … The council met on Thursday at the request of nine of the elected members. After the meeting
the council issued a short statement, agreed by consensus, which expressed support for Guterres’
efforts concerning “the potential impact of COVID-19 pandemic to conflict-affected countries.”…”

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