IHP news 659 : A perfect storm - International Health Policies
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IHP news 659 : A perfect storm
( 4 March 2022)
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,
Unlike “Grand Convergence in Global Health” dreamers, I used to think the world was heading for a
‘Perfect Storm’ by 2030 or so. Turns out that was still overly optimistic. As if climate breakdown,
massive global inequality and the pandemic weren’t bad enough, we now also entered a new
geopolitical era - with a horrific bang. What’s going on in the Ukraine feels like a bizarre mix of the
19th, 20th and 21st century, with some of the ‘worst practices’ from earlier centuries (back) on our tv
screens coupled with some not exactly enticing ‘innovations’ from this one (though I do like some of
the global financial system wizardry). Anyway, it’s incredibly tragic and sad to watch. Perhaps even
more tragic is that Nesrine Malik’s take in the Guardian - “Let the horror in Ukraine open our eyes to
the suffering of war around the world” is – in the year 2022 – still so needed.
Earlier this week, in an address to the Human Rights Council in Geneva, UN SG Guterres, while again
referring to the “5-alarm global fire” threatening the international community, urged countries to
mobilize to address the COVID-19 pandemic, global finance, climate action, lawlessness in cyber
space, and peace and security. “The solutions to these crises are all rooted in human rights,” he told
the Council. He’s absolutely right. Unfortunately, mankind currently faces a rather uphill battle to
put out all these global fires in time, not unlike the (ill-fated) League of Nations in the 30s. As for
human rights, I doubt they ever were much of a concern in the global corridors of power…
Zooming in on just one of these ‘global alarms’, the climate emergency, the latest (ultra-bleak) IPCC
report pointed out that the dangers of climate change are now mounting so rapidly that they could
soon overwhelm our ability to adapt, with predicted impacts worst for ecosystems and humanity's
most vulnerable. Or as Johan Rockström said, earlier this week, at a Club of Rome “anniversary
webinar”, “Limits to Growth +50: Global equity for a healthy planet”: “for the first time IPCC talks
about billions of people, not millions… “. One of the IPCC’s new messages is also that climate risks
are ‘compounding’, i.e. climate change poses cascading risks to economies, social systems and
business models. Along the same lines, the global chief of the Red Cross warned “ Governments
must start treating the climate crisis as a national security concern on a par with war as climate
breakdown threatens countries’ stability and safety”.
Against this dark backdrop, the theme of this year’s World Health Day, “Our Planet, our Health '
might seem a bit naïve but is more urgent than ever. “In the midst of a pandemic, a polluted planet,
increasing diseases …. on World Health Day 2022, WHO will focus global attention on urgent actions
needed to keep humans and the planet healthy and foster a movement to create societies focused on
well-being.” Add to that Owen Jones’ call for a global anti-war movement, in a nuclear era more
needed than ever, and perhaps we can still leave this planet as a better place for our children and
future generations. Indeed, now that all the intersections between crises are becoming increasingly
clear for everybody (such as “fossil fuels funding war”, in the words of a fierce young climate activist
1(Luisa Neubauer) at the abovementioned webinar from Wednesday), we better also heed her “take
home message”: “… don’t be afraid in this era of shocks, this is in fact exactly the time to go out in
the streets and ask for systems change to tackle all these massive but intersected crises.”
Meanwhile, if you want it in the words of my generation ( and thinking of an old Sting song ), let’s
hope Putin loves his daughters too. Though reading on his army’s shelling of a nuclear reactor this
morning, you gotta wonder.
Enjoy your reading.
Kristof Decoster
Featured Article
‘One Health’ should be the New Nexus of Global Health in the
Middle East and North Africa Region
Hoda K. Hassan (public health professional with an MPH from the School of Health and Related
Research (ScHARR), The University of Sheffield, UK; pharmacist. On Twitter: @Hoda3011)
COVID-19 was a watershed moment for all countries in the Middle East and North Africa (MENA)
region, especially after decades of geopolitical and economic shocks. But even before the pandemic
struck, sustainable development was already jeopardized by an unstable economic environment and
scarce resources, among other challenges. See for example this 2014 Lancet report: “The dynamics
of population change, ecological degradation, and resource scarcity, and development policies and
practices, all occurring in complex and highly unstable geopolitical and economic environments, are
fostering …. poor prospects [for health].” The MENA region is a global climate (crisis) hotspot and
there’s also a constant threat of food and water insecurity. Over the past years, the region
witnessed increased demographic pressure, rapid urbanization and increased cross boarder
movement due to armed conflict and displacement.
The MENA region is also a hotspot for zoonotic diseases, among others due to its geographic
location under migratory birds' flight paths, mass gatherings (such as the Islamic pilgrimage, Hajj),
political conflicts, and refugee crises. The region has a wide variety of wildlife interacting with the
environment and allowing for zoonotic disease emergence and (re)-emergence. All this results in
(potentially) devasting consequences: high morbidity and mortality, disruption of regional trade,
extra stress on scarce public health resources. Unfortunately, in the region there is still a disconnect
between population, environmental policies and health starkly putting its citizens at risk. Against this
backdrop, rethinking health security in the region has become a matter of survival. In this piece we
argue that a One Health approach should be a vital element of a global health approach “fit for the
21st century” in the region.
As mentioned, the MENA region is characterized by a unique vulnerability to zoonotic threats. In
recent years, infectious outbreaks were detected in a number of countries in the region, among
others yellow fever, cholera, the spread of avian influenza A (H5N1) and the emergence of MERS-
2CoV (2012). Antimicrobial resistance is also a serious threat in the region. An expert from the
region put it in a Lancet World Report from 2019 like this: “….Middle Eastern conflict zones, such
as Syria, Yemen, Iraq, and Gaza, face a “perfect storm” of circumstances to foster AMR, including
destroyed or collapsed health-care systems amid ongoing conflict, unchecked and unregulated
use of antibiotics, and lack of laboratories and other diagnostic tools.” In countries ravaged by
conflict, the risk of developing a drug resistant infection due to treatment interruption is thus
common and exposure to sewage and wastewater may lead to drug-resistant outbreaks, for
example in refugee camps. Humanitarian crises can exacerbate infectious diseases. For example,
Yemen was recently hit by one of the worst cholera epidemics in history. Amid the lack of basic
amenities, chronic malnutrition, and unfavourable weather conditions, aerial transfer infection
occurred by cholera-infected chironomid insects. Moreover, cultural habits, such as the
consumption of unpasteurized dairy products, can trigger diseases that can spread between
humans and animals. All these factors threaten regional health security. It’s quite a list, sadly.
Against this backdrop, it is clearly time for the region to dedicate more attention to the animal
kingdom and the environment, and how they directly affect health. The One Health approach
connects disciplines across the human–animal–environment interface to address health through a
coordinated, effective, efficient, and sustainable approach. Just a few months before the pandemic,
a commentary titled “A chance to implement ‘One Health’ in the Middle East and North Africa” was
published in The Lancet Planetary Health. It sparked a thought in my mind that ‘One Health’ could
break the health security conundrum in the MENA region and strengthen health systems. It wouldn’t
solve everything, but it’s a vital part of ‘Health for All’ in the region, I believe.
While arguably, the introduction of a ‘One Health’ approach is not new in the region, practitioners
have started to be more proactive lately in terms of adopting the approach. Egypt and Jordan are
two countries that are paving the path towards (more) ‘One Health’ in the region. As the old saying
goes, you must ‘make the most of what you have’, and so Egypt is now strengthening its existing
‘One Health’ capacities by capitalizing on a multisectoral coordination mechanism, the 4-Way Linking
(4WL) Task Force which supports regular information sharing across four functional streams:
epidemiology, laboratories, animal and human health. Recently, a ‘One Health Technical Advisory
Group’ (OHTAG) has been established which presents a real opportunity to strengthen health
systems resilience. This group calls on relevant sectors and disciplines to collaborate, communicate
and coordinate key actions, and comes up with recommendations to address Priority Zoonotic
Diseases (PZDs), including COVID-19 and antimicrobial resistance.
In Jordan, Priority Zoonotic Diseases were identified using a ‘One Health’ approach and a
systematized Center of Diseases Control (CDC) tool – One Health Zoonotic Disease Prioritization
(OHZDP). Input from representatives of human, animal (livestock and wildlife), and environmental
health sectors was collected during an OHZDP workshop. This was a great stride toward
strengthening surveillance of emerging infectious diseases in the region. It is a steppingstone in the
arena of strengthening health informatics and paves the way for countries in the region to leverage
“Big data” to enhance the effectiveness of “One Health”.
This is a wakeup call to integrate animal and environmental health into our response to future
pandemics. As a chain is as strong as its weakest link, it is no longer plausible to work in silos.
Consequently, ‘One Health’ should be the new nexus of global health in the region. MENA countries
need to transition from traditional health strengthening approaches to approaches which also
consider human societies and natural ecosystems.
3On the bright side, the region supports the global calls for establishing a pandemic treaty. Indeed,
it is crystal clear ‘One Health’ is not only a multidisciplinary collaboration but also a global health
governance issue. As today’s crisis, the COVID-19 pandemic, should not go to waste, the
International Centre for Comparative Environmental Law (CIDCE) recently developed a draft
convention on pandemics. ‘One Health’ is still not integrated in international treaties, and so,
determined to avoid the next pandemic, the draft convention calls for operationalizing ‘One Health’
through a pandemic treaty. In fact, the international NGO in special consultative status with the
United Nations calls for the rapid conclusion of the pandemic treaty in the outcome documents of
both UNEP@50 and Stockholm+50, in 2022 already, as this would help to promote progress in
health law and environmental law globally, in harmony with nature, through a specific convention to
combat pandemics.
That might be a bit ambitious. But in a world with so many threats, it’s perhaps good to be
ambitious.
Highlights of the week
UHC & PHC
Cause we refuse to start with ‘Vlad’.
WHO - Launch of the Primary health care monitoring framework and indicators
https://www.who.int/news-room/events/detail/2022/02/28/default-calendar/launch-of-the-
framework-and-indicators-for-monitoring-primary-health-care
On Monday, “WHO and UNICEF jointly [released] a landmark Primary health care monitoring
framework and indicators, the first-ever globally normative and endorsed primary health care
measurement and monitoring framework, and the official measurement framework in support of
the Declaration of Astana and Operational Framework for PHC. As countries strive to reorient their
health systems around the principles of primary health care, this Framework responds to Member
States’ request to monitor primary health care performance to accelerate progress towards universal
health coverage and the other health-related Sustainable Development Goals.”
For the new framework, see WHO: Primary health care measurement framework and indicators:
monitoring health systems through a primary health care lens
The new measurement framework supports all three components of PHC: 1) integrated health
services w/emphasis on primary care & essential public health functions 2) multisectoral policy and
action 3) empowered people and communities.
WB “Investing in Health” blog - Don’t let the budget fool you
https://blogs.worldbank.org/health/dont-let-budget-fool-you
4“Despite being widely recognized as critical, evidence on how well the health budgets are being
implemented in developing countries is not systematically collected. Further, the literature is scarce
on how budget execution practices relate to health financing functions and service delivery. A
new World Bank and WHO publication addresses this issue head on. The report identifies multiple
ways in which budget execution practices can affect UHC goals…..”
See the new WB/WHO report: Budget Execution in Health : Concepts, Trends and Policy Issues
“…. there is no systematic evidence on how well the health budget is implemented and literature
remains thin on how budget execution practices relate to health financing functions and service
delivery. This report is the first in a series of publications on the topic following an active World
Health Organization and World Bank collaboration. It aims to define concepts, characteristics and
trends in health sector budget execution. The report first calls for clarity in use of terminology. It
helps to differentiate between ‘budget execution rates’ and ‘budget execution practices’. The former
refers to the share of the budget being executed. The latter to processes on how well the budget is
executed. Both aspects are equally important. Not implementing the budget in full is a lost
opportunity, efficiency and accountability concern and undermines the health sector’s ability to
deliver services. It also undermines prospects for increased fiscal space going forward. To identify
trends and patterns in over and underspending, the report draws on previously unexplored PEFA
annex and World Bank BOOST data. This reveals the following: Health budget execution rates are
inversely related to levels of income and maturity of PFM systems. Health budget under-execution
is particularly pervasive in LMICs where the budget is executed at around 85-90 percent. Some
countries have chronic budget execution problems where the budget is executed at a rate below 85
percent across consecutive years. In LMICs, the health budget is systematically implemented at a
lower rate than the general government budget. This means, that governments are effectively
deprioritizing health during budget implementation. For Sub-Saharan Africa countries in the sample,
the average health budget was 6.7 percent of the general government budget. Health spending as
a share of general government spending was half a percentage point less at 6.2 percent. In some
countries this is much more pronounced, where health is deprioritized by 2-3 percentage points of
general government spending during implementation. ….”
International Women’s Day (8 March)
Lancet World Report - International Women's Day: dismay at alcohol and arms
ties
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00415-9/fulltext
“Health advocates are concerned at the corporate capture of International Women's Day, with the
alcohol industry and arms manufacturers backing a popular website. Sophie Cousins reports.”
“Held on March 8, International Women's Day (IWD) is an annual event, recognised by the UN, that
celebrates women while raising awareness of continued gender inequality, with events held around
the world. The UN's theme for 2022 is “Gender equality today for a sustainable tomorrow”.
However, women's health activists have expressed concern at how the day is being captured by
corporate influences. The website internationalwomensday.com promises to celebrate women,
provide guidance and resources to support IWD events, and provides a means to donate to female-
focused charities. The website's hashtag, #BreakTheBias, has gained immense popularity on social
5media channels and has been adopted by various organisations, companies, institutions, and
celebrities. It is unclear who runs the website, and it does not appear to have any direct links to the
UN. But the website lists several partners, including DHL, Nottingham Trent University, and several
medical technology and pharmaceutical companies. The website is also supported by Northrop
Grumman, one of the world's largest weapons manufacturers and military technology providers,
and Lockheed Martin, a US aerospace, arms, defence, information security, and technology
corporation with worldwide interests. It is also being supported by Diageo, one of the world's
largest producers of alcohol, and Beam Suntory, another major alcohol producer….”
Planetary health
Guardian - IPCC issues ‘bleakest warning yet’ on impacts of climate breakdown
https://www.theguardian.com/environment/2022/feb/28/ipcc-issues-bleakest-warning-yet-
impacts-climate-breakdown
“Report says human actions are causing dangerous disruption, and window to secure a liveable
future is closing.”
For the report, see IPCC: Climate Change 2022: Impacts, Adaptation and Vulnerability. “The
Working Group II contribution to the IPCC Sixth Assessment Report assesses the impacts of climate
change, looking at ecosystems, biodiversity, and human communities at global and regional levels.
It also reviews vulnerabilities and the capacities and limits of the natural world and human
societies to adapt to climate change.”
Among others, “….The report says: Everywhere is affected, with no inhabited region escaping dire
impacts from rising temperatures and increasingly extreme weather. About half the global
population – between 3.3 billion and 3.6 billion people – live in areas “highly vulnerable” to
climate change. Millions of people face food and water shortages owing to climate change, even at
current levels of heating. Mass die-offs of species, from trees to corals, are already under way. 1.5C
above pre-industrial levels constitutes a “critical level” beyond which the impacts of the climate
crisis accelerate strongly and some become irreversible. Coastal areas around the globe, and small,
low-lying islands, face inundation at temperature rises of more than 1.5C. Key ecosystems are losing
their ability to absorb carbon dioxide, turning them from carbon sinks to carbon sources. Some
countries have agreed to conserve 30% of the Earth’s land, but conserving half may be necessary to
restore the ability of natural ecosystems to cope with the damage wreaked on them…..”
PS: “…. … Monday’s IPCC publication is the second of four parts of the “sixth assessment report”,
the latest in a series of comprehensive summaries of the world’s knowledge of the climate, stretching
back to 1988. ….”
• Related link: Science - U.N. panel warns of global warming's toll on humans and nature
“Impacts will be worst for ecosystems and humanity's most vulnerable.”
“….With temperatures already 1.2℃ warmer than in preindustrial times, some ecosystems are
nearing a hard limit on their ability to adapt, including warm water coral reefs, coastal wetlands and
rainforests, and the frigid mountain and polar realms, the report warns. And although humanity can
6adapt to warming more easily than the natural world, it needs to move faster, says Michael
Oppenheimer, a climate scientist at Princeton University and one of 270 report co-authors. “We’re
not keeping up. The rate of climate change is faster than our ability to figure out how to deal with
climate change.””
“….Most projects to adapt to this future are small, fragmented, and focused on near-term risks,
the report finds. “There’s an adaptation gap,” Oppenheimer says. “Governments are paying much
more lip service than actually doing a lot.” So far the adaptations mostly focus on water: levees and
flood warning systems; coastal wetland restoration; soil moisture conservation for farming; and
armoring of coastlines. Bolstering access to health care or establishing heat emergency plans
would also make societies more resilient. And the report calls for adaptations to preserve the
natural world: restoring the diversity of forests, aiding the migration of species, and protecting more
lands and waters to give species space to adapt….”
• And via Politico’s Global Pulse – New climate report suggests health systems are at risk
“…. The newest report from the U.N.’s Intergovernmental Panel on Climate Change warns that
health care is still at serious risk of being affected by climate change. The threats of increased
disease, malnutrition, heat exposure, displacement and even mental health risks were mentioned in
the new report, with negative impacts forecast across continents. The impact: The models of climate
change impacts are often adding health care challenges to countries around the world — mosquitos
will carry diseases like malaria farther in warmer conditions, for example. In turn, organizations that
address these challenges are amending their plans; Malaria No More, among others, is working to
develop improved capacity to meet the new needs. Aaron Bernstein, interim director of the Center
for Climate, Health, and the Global Environment at Harvard’s school of public health, said two areas
caught his eye in the new report: climate-resilient health systems and a more integrated approach
to health care…..”
“A rethinking: He told Global Pulse that climate financing should more often include the health
sector, especially in low- and middle-income countries, to keep it up and running through climate
shocks. That might require rethinking the mandate of climate-oriented organizations, he said.
Bernstein also said that the health of humans, animals and ecosystems need to be seen as
interconnected to tackle these problems in more effective ways….”
Guardian - Climate emergency a ‘national security’ concern, says Red Cross
https://www.theguardian.com/environment/2022/feb/27/climate-emergency-a-national-security-
concern-says-red-cross
“Governments must start treating the climate crisis as a national security concern on a par with
war as climate breakdown threatens countries’ stability and safety, the global chief of the Red
Cross has warned. Jagan Chapagain, secretary general of the International Federation of Red Cross
and Red Crescent Societies, said: “People should be seeing the climate as a national security issue,
as it is having an impact on national security. We need to see that the climate crisis is not only
having an environmental impact, but a very significant security impact.”…”
7Guardian - African countries spending billions to cope with climate crisis
https://www.theguardian.com/environment/2022/feb/26/african-countries-spending-billions-to-
cope-with-climate-crisis
“Report says average 4% of GDP will be spent on adapting to climate breakdown, risking deeper
poverty.”
“African countries are being forced to spend billions of dollars a year coping with the effects of the
climate crisis, which is diverting potential investment from schools and hospitals and threatens to
drive countries into ever deeper poverty. Dealing with extreme weather is costing close to 6% of
GDP in Ethiopia alone, equating to a spend of more than $1 repairing climate damage for every $20
of national income, according to research by the thinktank Power Shift Africa….”
Guardian - World leaders agree to draw up ‘historic’ treaty on plastic waste
https://www.theguardian.com/environment/2022/mar/02/world-leaders-agree-draw-up-historic-
treaty-plastic-waste
“UN environment assembly resolution is being hailed as biggest climate deal since 2015 Paris
accord.”
“World leaders, environment ministers and other representatives from 173 countries have agreed to
develop a legally binding treaty on plastics, in what many described a truly historic moment. The
resolution, agreed at the UN environment assembly in Nairobi, Kenya, calls for a treaty covering
the “full lifecycle” of plastics from production to disposal, to be negotiated over the next two
years. It has been described by the head of the UN Environment Programme (UNEP) as the most
important multilateral environmental deal since the Paris climate accord in 2015….”
50 million Euros to seed new Nature for Health Trust Fund for Pandemic
Prevention
https://www.unep.org/news-and-stories/press-release/50-million-euros-seed-new-nature-health-
trust-fund-pandemic
“The German Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and
Consumer Protection (BMUV), the UN Environment Programme (UNEP), and the Secretariat of the
Convention on Biological Diversity (SCBD) today jointly announced the establishment of a Multi-
Partner Trust Fund (MPTF) on Nature for Health. Announced on World Wildlife Day, the Fund –
through an initial contribution of 50 million Euros from Germany’s International Climate Initiative
(IKI), brings together leading UN agencies, intergovernmental organizations and civil society groups
in the field of environment and health… …. The new Fund will help countries achieve more holistic
policymaking by creating further evidence of the links between biodiversity, climate and health,
and will support decision makers and relevant actors to take measures to prevent future
pandemics. Through application of enhanced One Health approaches, the Fund aims to achieve
improved policies and cross-sector collaboration. “Above all, the Multi-Partner Trust Fund will focus
on implementation…..”
8FP2P blog - What has global military spending and emissions got to do with
development? Rather a lot.
D Burton; https://oxfamapps.org/fp2p/what-has-global-military-spending-and-emissions-got-to-do-
with-development-rather-a-lot/
“Global military spending is currently $2 trillion per year, twice as much as at the height of the Cold
War. Although the emissions data available is far from comprehensive, it’s obvious that military
spending literally fuels military GHG emissions…..”
Nature (Comment) - G20’s US$14-trillion economic stimulus reneges on emissions
pledges
J Nahm et al; https://www.nature.com/articles/d41586-022-00540-6
“Analysis of pandemic economic recovery packages from the 20 largest economies reveals that
governments are not spending on emissions cuts despite promises to ‘build back better’.”
Covax & ACT-A
Reuters - Factbox: Vaccines delivered under COVAX sharing scheme for poorer
countries
Factbox: Vaccines delivered under COVAX sharing scheme for poorer countries | Reuters
As of earlier this week, the COVAX facility had delivered 1.33 billion Covid-19 vaccine doses to 144
countries, so far.
COVAX — A broken promise for vaccine equity
Jessica Malter & and Kate Elder (MSF Access Campaign) https://msf-access.medium.com/covax-a-
broken-promise-for-vaccine-equity-fb8b398b56f0
Blog on why COVAX has not been the great equaliser we were promised, and what needs to happen
to improve vaccine equity around the world.
9th ACT-Accelerator Facilitation Council meeting (29 Feb)
https://www.who.int/news-room/events/detail/2022/02/28/default-calendar/9th-act-accelerator-
facilitation-council-meeting
Check out the presentations, with among others: Update on ACT-A advocacy campaign Chair: (John-
Arne Røttingen, Ambassador for Global Health, Norway); Where are we in relation to global targets
(Scott Pendergast, Health Systems & Response Connector); and two country spotlights (Rwanda &
Kenya).
9UN News - COVID-19: Germany first to contribute ‘fair share’ for vaccine equity
push
https://news.un.org/en/story/2022/03/1113072
“Germany has become the first country to answer a call for wealthy nations to contribute their
“fair share” towards ending the COVID-19 pandemic, the World Health Organization (WHO)
reported on Tuesday. The country has committed to provide $1.22 billion to support the ACT-
Accelerator, the global partnership for equitable access to tests, treatments, vaccines, and personal
protective equipment (PPE). The mechanism requires $16.8 billion to meet urgent needs. …
…. German Finance Minister Christian Lindner, announced the pledge at the G7 Finance Ministers’
Meeting, which was held virtually. ….”
TRIPS waiver discussions / tech transfer…
Some news & analysis from this week:
TWN - Russia-Ukraine conflict casts a pall at WTO, raising doubts over MC12
R Kanth; https://wp.twnnews.net/sendpress/email/?sid=NjQ4ODA&eid=NDUyOQ
“The sudden flare-up of Russia’s military conflict with Ukraine seems to have cast a pall over the
World Trade Organization on 24 February, raising doubts as to whether the WTO’s 12th ministerial
conference (MC12) could be held if current developments continue to worsen in the coming days,
said people who asked not to be quoted. Even though there are more than three months to go before
MC12 reconvenes in the week of 13 June, the continued precipitation of the tensions, including the
magnitude of economic and other sanctions being imposed on Russia, could throw “a spanner in
the works” in the run-up to the ministerial conference, said several members, who asked not to be
quoted…..”
HPW - WHO Director General Calls On WTO To Take ‘Practical’ Action On IP
Waiver For COVID Vaccines & Medicines
https://healthpolicy-watch.news/who-welcomes-un-security-council-resolution/
From late last week. “WHO Director General Dr Tedros Adhanom Gheyebresus on Friday issued his
strongest call to date for a waiver on intellectual property related to COVID vaccines, medicines
and other health products – which is due to be considered next week by the World Trade
Organization’s General Council….”
“While welcoming a new UN Security Council resolution also approved on Friday, which calls for
broader access to COVID vaccines in conflict zones and poor countries, Dr Tedros stressed that the
UN resolution needed to be accompanied by concrete global actions of the kind that the WTO was
positioned to take – by relaxing rules that restrict the generic manufacture and trade in patented
COVID vaccines and health products. …. ….. …. The UN Security Council resolution, which was
10passed unanimously, calls for “the strengthening of national and multilateral approaches and
international cooperation.. to facilitate equitable and affordable access to Covid-19 vaccines in
armed conflict situations, post-conflict situations and complex humanitarian emergencies.” It also
calls on developed economies to donate vaccines to low- and middle-income countries and other
countries in need…..”
Politico - WTO Director-General Ngozi Okonjo-Iweala calls for more 'political will'
on Covid, future pandemics
https://www.politico.com/news/2022/02/25/wheres-the-political-will-wto-director-calls-for-more-
collaboration-for-covid-future-pandemics-00011860
From last weekend. “Ngozi Okonjo-Iweala, the director-general of the World Trade Organization,
told POLITICO that member states are still in “difficult” conversations about a potential agreement
on an intellectual property waiver that would allow countries to more easily manufacture the
Covid-19 vaccine.” Some excerpts:
“For more than a year, WTO members have discussed a possible agreement on a Trade-Related
Aspects of Intellectual Property Rights waiver. In recent weeks, Okonjo-Iweala and a small group of
representatives, including those from the U.S., European Union, South Africa and India, have held
targeted talks about a potential agreement. Okonjo-Iweala met with the organization’s general
council this week in Geneva to discuss what she described in an interview as a “landing zone.”
Striking a deal on the waiver will not be easy, said Okonjo-Iweala, who added that smaller, closed-
door conversations would continue ahead of the WTO ministerial meeting the week of June 13….”
“…Over five years, the world should spend $75 billion, $15 billion a year of which $10 billion goes
into a financial intermediary fund that could be managed by the World Bank to prepare for the
next pandemic. And the point is that there’s reluctance to come up with this money. We’ve spent
$26 trillion in fighting the pandemic. But we are not ready to spend $75 billion for starting prevention
now. That is wrong. That is plain, absolutely wrong….
“…Is an agreement for an IP waiver on diagnostic materials and therapeutics achievable? A: It
would be jumping too fast. People need to wait and see what we come up with respect to vaccines
before we move on to therapeutics…..”
Geneva Health Files - Efforts to Narrow the TRIPS Waiver Continue: "Eligibility
Requirements" Still on The Table
Geneva Health Files
Must-read analysis from last week on Friday. “…a comprehensive analyses on the state of play in the
TRIPS Waiver discussions and the factors outside of it, that are shaping these negotiations. Surely
and slowly they are now entering a crucial phase. ….”
“….The TRIPS waiver discussions at the WTO continue to teeter on the brink of a possible outcome
that risks becoming too complicated to use. More importantly, the discussions continue to be
mired in narrow eligibility requirements that could potentially set conditions on the circumstances
under which a waiver will be applicable. This essentially aims to achieve the lowest possible
11“impact” of a potential waiver, sources suggest. As we reported earlier, it is understood that these
proposals continue to be pushed by the US and the EU…..”
“….Eligibility requirements are understood as conditions under which a potential waiver will be
applicable. It is learned that language could be crafted in a way that will effectively exclude countries
such as India and China, without explicitly stating so. …. ….Africa continues to be a priority for the
EU, and some suggest that the efforts to limit implementation of a waiver to the continent may be
a part of this broader diplomatic goal. …. ….Apart from restricting the implementation of a
potential waiver to specific geographies, the EU and the US have suggested other limitations.
….….While the EU is unwilling to relent on IP scope, the US continues its stance on restricting the
waiver to vaccines, effectively reducing the product scope of the waiver…..”
“…As mentioned earlier, Africa has become a key strategic priority for the EU during the pandemic.
The emphasis on EU’s support to the South Africa mRNA hub is a case in point. ….while investing in
mRNA hubs in Africa might be a useful diplomatic goal for the EU, it is also an effective policy to
deflect potential commitments in the TRIPS Waiver discussions that seek to decentralize and boost
manufacturing capacities everywhere and not just in Africa….”
“Assuming that a narrow waiver proposal does get approved at the WTO, what will be the
implications? Supporters of the waiver believe that it could still be helpful to developing countries.
They also suggest that when COVID-19 does become endemic, there will continue to be a need for a
waiver in order to access medical products easily…..”
Developers of a key mRNA delivery tech, seeking a piece of Moderna's Covid
riches, sue for patent infringement
https://endpts.com/developers-of-a-key-mrna-delivery-tech-seeking-a-piece-of-modernas-covid-
riches-sue-for-patent-infringement/
“The lawsuit that Moderna has been dreading finally got to it. Arbutus and Genevant have sued the
big biotech for infringing on their patent on a lipid nanoparticle platform that they say was crucial
to the delivery of Moderna’s widely-used Covid-19 vaccine…..”
See also the Washington Post - Moderna faces new lawsuit over lucrative coronavirus vaccine
“The suit is the second patent fight over the development of the messenger RNA shot.” “Moderna
faces yet another patent challenge over its coronavirus vaccine after Arbutus Biopharma and
Genevant Sciences, both small biotechnology companies, filed a lawsuit on Monday alleging
Moderna hijacked its technology to develop the multibillion-dollar vaccine. Arbutus and Genevant
said in their lawsuit that Moderna infringed on their patent for so-called lipid nanoparticle
technology, which they say was key in the development of Moderna’s mRNA vaccine and took
scientists from Arbutus and Genevant “years of painstaking work to develop and refine.”
The Conversation - A South African company addresses vaccine supply inequity,
despite Canada’s lack of support
M Herder et al ; https://theconversation.com/a-south-african-company-addresses-vaccine-supply-
inequity-despite-canadas-lack-of-support-177416
12“…. Afrigen Biologics, a South African based company, produced its own version of Moderna’s mRNA
COVID-19 vaccine. This was achieved with no support from Moderna or Pfizer-BioNTech, the
manufacturer of the other mRNA vaccine. What many don’t realize is that two Canadian companies
control a key component of the mRNA vaccines. Busy fighting over their lucrative patent rights,
there is no sign they shared their technology with Afrigen either. The two companies in question
— Acuitas Therapeutics and Arbutus Biopharma — are based in Vancouver, B.C., and have strong
ties to the University of British Columbia. They have been lauded for their positive “global impact” in
combating the pandemic. But that impact seems to stop short of sharing their technology with
Afrigen and other would-be suppliers of COVID-19 vaccines in the Global South…..”
And a link: South Centre - Direct Monetary Costs of Intellectual Property for Developing Countries:
a changing balance for TRIPS ?
C-TAP
WP - U.S. to share some coronavirus technologies with World Health Organization
U.S. to share some coronavirus technologies with World Health Organization - The Washington Post
“Plan would allow other countries to replicate American scientific breakthroughs, intended to boost
supplies to fight pandemic.”
“The Biden administration will share U.S. government-devised coronavirus technologies with the
World Health Organization, a policy shift intended to allow other countries to replicate some
American scientific breakthroughs and better fight the pandemic abroad, according to three people
with knowledge of the announcement who were not authorized to discuss it. Under the plan, some
technologies now being developed by the National Institutes of Health will be licensed to WHO’s
COVID-19 Technology Access Pool, the people said. The technologies will also be sub-licensed to
the United Nations-backed Medicines Patent Pool…..”
“….The policy is not intended to apply to the vaccines and therapeutics that have been developed by
private companies and are currently in the U.S. market, the people said. The United States is not
expected to share NIH-developed technology that was used by Moderna….”
“….Sharing the technologies behind NIH-devised coronavirus diagnostics, treatments and vaccines is
intended to allow other nations and developers to replicate the manufacturing process. As a result,
officials expect the decision to more quickly build a global stockpile of supplies to combat the
pandemic….. U.S. participation in the WHO pool could jump-start global donations of such
technologies, officials and advocates said…..”
Link: WHO - WHO and MPP welcome NIH’s offer of COVID-19 health technologies
13Other news/analysis/reports on Global Health Governance,
financing & security
Geneva Health Files - Game on at WHO: International Health Regulations Vs The
Pandemic Treaty
GHF
“…. the first edition of Treaty Talks, a new series that will track negotiations around a potential
pandemic treaty in the coming months (and years). This edition is a comprehensive analysis of the
first meeting of the Intergovernmental Negotiating Body that took place last week (Feb 24)…..”
In-depth analysis. Starting with: “….The bombing of Ukraine by Russia has likely changed the
delicate discussions on a pandemic treaty. After all, Russia was one of the key voices countering the
proponents of the treaty, raking up the centrality of International Health Regulations and arguing
against the rush for a treaty…..”
PS: Priti Patnaik concludes: “….In the coming months, a slew of simultaneous proposals will
progress on parallel tracks to collectively transform the ways to govern health emergencies. At the
world health assembly in May, the following proposals will be considered: a formal decision on the
US proposal to amend the IHRs may be considered; the Austrian proposal for a Standing Committee
on Health Emergency; a UK sponsored resolution on clinical trials; an action plan formulated by the
WGPR; recommendations by the Sustainable Financing Working Group. In addition, the DG will also
present a set of proposals for strengthening the global health architecture for emergency
preparedness, response and resilience…..”
HPW - 13 African Nations Have Expressed Interest in Hosting the New African
Medicines Agency
https://healthpolicy-watch.news/13-african-nations-bids-new-ama/
“Some thirteen African nations have expressed interest in hosting the new African Medicines
Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022,
senior African Union officials say. A decision on a headquarters would also pave the way for the
recruitment of a director general for the new AMA agency. And if the DG selection is completed by
the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.”….”
Development Today - Unsolved dispute over counting COVID vaccine donations as
aid leaves loopholes
Development Today;
“After seven months of wrangling about how to report COVID-19 vaccines donated to developing
countries as aid, the OECD issued last-minute guidance for donors. One expert says it could lead to
a “free for all” and civil society actors warn of a “massive diversion” of aid. …. OECD Development
Assistance Committee recommends donors report $6.72 per donated dose. If they use this rate for all
vaccine donations, it could inflate global aid by >USD 6 billion in 2021…..”
14Report - Global Public Investment for Pandemic Preparedness and Response
https://secureservercdn.net/160.153.137.14/qjz.3c1.myftpupload.com/wp-
content/uploads/2022/02/GPI-for-Pandemic-Preparedness-and-Response.pdf?time=1645692427
“The report offers details on how a functioning system of Global Public Investment (GPI) could
actually operate for a particular sector of global cooperation - all contribute, all decide, all benefit.
With snowballing agreement on the principles underpinning GPI, the challenge is now putting it into
practice. … The paper demonstrates how GPI would meet substantial PPR financing needs in five
basic ways: 1. fair share financing for ongoing investments; 2. inclusive governance and decision-
making; 3. public investments for equity; 4. reduced volatility through statutory financing; 5.
countering nationalism with incentives for a common framework.”
The report is also available on the GPI website: https://globalpublicinvestment.org/resources/
FT - Billions required to prevent next pandemic, warns epidemic expert
https://www.ft.com/content/dc0d8407-446d-4fb5-86a5-a628bed4d786
“Governments must invest billions of dollars to prevent the next pandemic and begin constructing
a library of vaccines for every single family of viruses, says the organisation charged with preparing
the world for emerging infectious diseases. Richard Hatchett, chief executive of the Coalition for
Epidemic Preparedness Innovations, said it could take as little as five years to create the vaccine
bank that could be adapted when a threat was detected, to ensure the world could start vaccinating
within 100 days. Vaccine makers were able to deliver Covid-19 vaccines in record time partly because
they were already developing jabs for Mers, another coronavirus. But Hatchett said that unless shots
were prepared for other virus families, the world might not be as lucky next time…..”
“….Cepi has so far raised $300mn from Japan and about $213mn from the UK, as well as funds
from Germany and Norway. The Wellcome Trust and Gates Foundation kicked off its campaign
with $300mn. But it is still far short of its goal to raise $3.5bn. The donations also tend to come
from budgets earmarked for health or international aid rather than those aimed at security
threats….”
NEJM (Perspective) - Delivering Pandemic Vaccines in 100 Days — What Will It
Take?
M Saville, R Hatchett et al ;
https://www.nejm.org/doi/full/10.1056/NEJMp2202669?query=featured_home
« ….. We interviewed 46 representatives from vaccine-development firms, international
organizations, regulatory agencies, academia, and the media to identify innovations that could
shorten the development process and challenges that would need to be overcome to meet the 100-
day goal, focusing on the first SARS-CoV-2 vaccines to be approved by a stringent regulatory
authority (the Pfizer–BioNTech, Moderna, and AstraZeneca products). We reviewed reported
development timelines and lessons learned to come to a consensus about the most condensed
timeline under which vaccines could be developed if these lessons were applied…..”
15Conclusion: « …. Stopping the next pandemic, let alone in 100 days, isn’t something that a single
country or organization can do alone. Success will require advances in the organization,
governance, and financing of global-preparedness systems and the development of multiple
interconnected, scientifically guided collaborative efforts. We believe the “moonshot” goal of
making a vaccine against a new pandemic pathogen available in 100 days is ambitious but is within
reach. »
Science - Spurred by pandemic, U.S. government will revisit federal policies on
risky virus research
https://www.science.org/content/article/spurred-pandemic-u-s-government-will-revisit-federal-
policies-risky-virus-research
“Advisory panel asked to examine whether definition of certain gain-of-function studies should be
expanded.”
“In the wake of the coronavirus pandemic, the U.S. government is revisiting its oversight of
experiments that involve modifying pathogens in ways that might make them more harmful to
people. Yesterday, White House officials and the National Institutes of Health (NIH) asked an
expert advisory board to undertake a swift, broad review of the agency’s policies that aim to make
sure federally funded studies of viruses and other microbes that could cause a pandemic are
undertaken safely, and to bar funding for experiments deemed too risky. The review—to be
conducted over 10 months by the National Science Advisory Board for Biosecurity (NSABB)—could
include consideration of whether controversial coronavirus experiments funded by the United
States in China should have received stricter scrutiny. The panel might also explore whether the
United States should fund any such pathogen research conducted abroad, where NIH may have less
ability to enforce its rules…..”
South Centre - Can Negotiations at the World Health Organization Lead to a Just
Framework for the Prevention, Preparedness and Response to Pandemics as
Global Public Goods?
V M Tellez; https://www.southcentre.int/research-paper-147-28-february-2022/
“This paper advances that WHO Member States, having agreed to the objectives of advancing equity
and solidarity for future pandemic prevention, preparedness and response, now must operationalize
these. The paper offers suggestions for the ongoing WHO processes of: 1) review of
recommendations under examination by the Working Group on Strengthening WHO Preparedness
and Response to Health Emergencies, 2) consideration of potential amendments to the International
Health Regulations (IHR) 2005, and 3) elaboration of a draft text for an international instrument on
pandemic preparedness and response.”
TWN - WHO: Africa Region calls for amendment of IHR to address equity
https://www.twn.my/title2/health.info/2022/hi220301.htm
“Member States from the WHO Africa Region called for the inclusion of equity provisions within
the potential amendments to the International Health Regulations (IHR) 2005 during the 7th
meeting of the Member States Working Group on Strengthening WHO Preparedness and Response to
16Health Emergencies (WGPR). The 7th Meeting of the WGPR took place on 21-23 February at the
WHO Geneva Headquarters in a hybrid mode….”
“…. The Africa Group recommended “that Equity should be addressed both within the potential IHR
(2005) amendments as well as the new international instrument….
“…. the Africa Region submitted an indicative list of proposals on improving equity under IHR as
follows:….”
CGD Notes - The IMF and Health Taxes: Progress Falters during COVID-19
Emergency
C Lane; https://www.cgdev.org/publication/imf-and-health-taxes-progress-falters-during-covid-19-
emergency
“Corrective taxes on harmful products—health taxes—are a cost-effective way to save lives and
generate additional tax revenue. Our previous work shows that corrective tax revenue from alcohol,
tobacco, and sugar-sweetened beverages remains well below the health-related costs from
consumption (externalities and internalities). We survey measures taken in IMF lending to 93
countries during 2017–2021. We show that health tax measures during COVID-19 have diminished
in number and strength because the international community has mobilized additional, largely
unconditional financing to fill budgetary gaps and because countries sought to cushion consumers’
reduced spending power by delaying new or increased taxes. But, as policymakers look to medium-
term budget consolidation, international financial organizations (IFIs), especially the IMF, have an
important role to play in ensuring health taxes move forward more rapidly. We reiterate an action
agenda on health taxes for the IMF in coordination with other international agencies….”
Guardian - Melinda French Gates says she is ‘friendly’ but not friends with Bill
Gates
https://www.theguardian.com/us-news/2022/mar/03/melinda-french-gates-friendly-bill-gates
“Melinda French Gates has addressed her divorce from Bill Gates publicly, saying that although
she and the Microsoft co-founder are “friendly at this point”, she is not ready to label her
relationship with Gates as “friends”. In a recent interview with CBS’s Gayle King, French Gates said
multiple factors resulted in the couple’s high-profile divorce last May after 27 years of marriage….”
Ukraine
HPW - WHO Appeals for Humanitarian Corridor in Ukraine to Enable Delivery of
Medical Supplies
https://healthpolicy-watch.news/who-ukraine/
17“The World Health Organization (WHO) has appealed for a “humanitarian corridor” to enable it to
deliver emergency medical supplies to sick and injured Ukrainians – particularly oxygen, insulin and
supplies to treat battle wounds…..”
And a link: CNBC - ‘We are not politicians’: WHO avoids naming Russia as it condemns attacks on
civilians and hospitals in Ukraine
Reuters – WHO sees little impact on COVID-19 vaccine supplies to Africa over war
in Ukraine
https://www.reuters.com/world/africa/who-sees-little-impact-covid-19-vaccine-supplies-africa-
over-war-ukraine-2022-03-03/
“The World Health Organization said on Thursday it does not expect immediate impact on vaccine
supply to Africa due to the fighting in Ukraine, and that Russia's Sputnik COVID-19 vaccines were a
minimal component of imports to the continent.”
Links:
• Lancet Offline – Offline: Ukraine and the lessons of Alexander Herzen (R Horton)
“….What connects this European war to a global pandemic? One word: security. This concept is not
fashionable in global health. We prefer to talk about sustainability. Securitisation is seen as
anathema to the values of global health—the progressive expansion of rights, equity, and social
justice. Serious efforts have been made to redefine the notion of security to accommodate these
concerns. The most definitive statement came from the 2003 Commission on Human Security, Human
Security Now. … ….. As western nations debate how to address the ongoing conflict in Ukraine,
human security must be put on the security agenda—by the UN Security Council and WHO. So far,
these multilateral actors have been weak in both words and deeds. ….”
• Devex - China-based AIIB and NDB halt work in Russia as sanctions hit
COVID-19 Global Research and Innovation Forum
HPW - Expanding Global Research Capabilities to Prepare for Future Pandemics
https://healthpolicy-watch.news/global-research-future-pandemics/
Coverage of the Covid-19 Global Research and Innovation forum from last week.
“From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’
and public trust, participants in the COVID-19 Global Research and Innovation Forum considered
ways to globally prepare for future pandemics and end the current one. The third such forum, hosted
by the World Health Organization, brought together over 100 research scientists, experts, policy
18makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-
25 February. ….”
Covid key news
PS: The (official) death toll from COVID-19 is expected to reach 6 million this week. The real toll is
probably around 20 million by now. Not to mention all the long Covid sufferers.
AP - COVID cases, deaths continue to fall globally, WHO reports
https://apnews.com/article/coronavirus-pandemic-business-health-pandemics-united-nations-
269660a4236ad73527d057fd6b74d816
“The number of new coronavirus cases reported globally dropped by 16% last week, marking a
month-long decline in COVID-19 infections, according to figures from the World Health
Organization. In its weekly report on the pandemic issued late Tuesday, the U.N. health agency also
said that deaths fell by 10%, continuing a drop in fatalities first seen last week. WHO said there were
more than 10 million new cases and about 60,000 deaths globally. The Western Pacific was the only
region where COVID-19 increased, with about a third more infections than the previous week. Deaths
rose by 22% in the Western Pacific and about 4% in the Middle East, while declining everywhere else.
WHO said the omicron variant remains overwhelmingly dominant worldwide; among virus
sequences shared with the world’s largest publicly accessible database, more than 99.5% were
omicron while only 0.3% were delta. In the last month, none of the other worrying variants —
including beta, gamma, lambda or mu — have been reported, although WHO said there were
surveillance challenges in many countries…..”
See also Cidrap News - Global COVID cases, deaths drop, except in key hot spots
Reuters - Analysis: Is WHO's aim to vaccinate 70% of world by June still realistic?
Reuters;
“Vaccinating 70% of the population in every country in the world against COVID-19 by mid-2022
has been the World Health Organization's (WHO) rallying cry to end the pandemic. But recently,
public health experts say that while boosting immunity globally remains essential, the figure is
neither achievable nor meaningful.” Some excerpts:
“…. WHO head of immunization Kate O'Brien said 70% remained more than just a "rallying cry",
even though some well-equipped countries with plenty of vaccines have also struggled to reach it.
"We are calling for countries to be serious about their actions towards achieving that target, while
acknowledging that - on a country-by-country basis - there may be a rationale why that target is not
specifically suited to that country," she told Reuters….
“…. Gavi, the Vaccine Alliance - WHO's partner in the COVAX initiative aimed at getting shots to the
world's poorest – has pulled back from the "one-size-fits-all" 70% focus. At a virtual briefing last
week with WHO Africa, Aurelia Nguyen, managing director of COVAX within Gavi, said it was
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