Developments at Dadhaleh Institute

‘Incomes Virtually Stopped Overnight’, Threaten Global Food Insecurity

An alarming new report by the ILO estimates that nearly half of the global workforce, more than [ ... ]

“Impartial, independent, and comprehensive evaluation”

For the first time in the WHO’s history, its annual World Health Assembly (WHA) was entirely virtual. With a focus almost entirely on the Coronavirus pandemic, the condensed two-day meeting was preceded by three weeks of intense negotiations.

The most significant outcome this year was the adoption of a COVID-19 resolution that was proposed by the European Union and supported by 120 countries that contained three major elements (A73/CONF/1), including an “impartial, independent, and comprehensive evaluation (of the) international health response to COVID-19.” In the closing remarks, the WHO Director General affirmed that the review would take place “as soon as possible.”

Rising geopolitical tensions shape emergent Global Health institutions and practices

The WHA opened with a failed motion to grant Taiwan Observer status, underscoring growing tensions in part arising from accusations by the U.S. (and shared by other Western and Pacific Asian countries) that China was not transparent in the early days of the pandemic.

In a letter, the U.S. President threatened to permanently eliminate the funding that was temporarily withdrawn from the WHO, suggesting the U.S. would pursue bilateral aid channels including US$500 million to 40 ‘at risk’ countries. The President of China addressed the Assembly directly pledging US$2 billion over the next two years to support COVID-19 response efforts in developing countries, and an ambition to establish China as a “global humanitarian response capital and hub.” Focusing on African countries in particular, President Xi referenced debt suspension initiatives, building “green corridors” to accelerate delivery of essential goods as well as partnering with 30 major hospitals in Africa to build a China Centres for Disease Control headquarters on the continent.

‘No monopolies on access’ to COVID treatments and vaccines in a pandemic

The negotiations on access to treatments and future vaccines were far more divisive. Led by Costa Rica, developing countries and civil society organizations expressed particular concern about ensuring equitable access, including to COVID-related knowledge, lessons learned, experience, and best practices. The WHO Secretariat will have until May 29 to develop a framework for a voluntary COIVD-19 Intellectual Property Pool for patents and clinical trial data, while the EU-led resolution also references WTO TRIPS flexibilities allowing countries to override patents to ensure access.

COVID is a ‘wake-up call to our global fragility’

In his address to the World Health Assembly, the UN Secretary General called for greater unity and solidarity along three dimensions: a coordinated and comprehensive health response guided by the WHO and focusing on developing countries; policies to address the social and economic dimensions of the COVID crisis; and a response and recovery plan based on equity, inclusion and sustainability centred on human rights. Given the unprecedented nature of the pandemic, some civil society organizations such as South Centre expressed disappointment in the lack of ambition of the COVID-19 resolution. Knowledge Ecology International (KEI) likewise referred to the “typical watered down, lawyered ambiguity” of the final draft that fails to limit legal monopolies that could affect access (they noted that other proposals like Canada’s would have called for “universal and non-exclusive and open-licensing” that referenced data sharing and more expansive mandate beyond existing mechanisms).

A new WHO study projects that up to 190,000 people in Africa could die and an additional 29-44 million could get infected by the Coronavirus in the first year if containment measures fail.
Harvard Professor Joseph Nye – one of the world’s leading scholars on global governance- examines the “abysmal failure of leadership” from the U.S. and China, urging that more global solidarity and recognition of mutual interest is essential to address the pandemic
In collaboration with DIGHR, the Ilisaqsivik Society, and Médecins Sans Frontières (Latin), SeeChange Initiative is launching a Community Roadmap planning tool today to support communities organize, prepare and respond to COVID-19. See:
- CommunityFirst COVID-19 Emergency Readiness Checklist
- What the Covid-19 pandemic is teaching us about community (STAT)
In a commentary, Nobel Peace Prize laureate, Kailash Satyarthi, highlights the compassionate work of community and civil-society groups working with vulnerable populations, urging G20 to increase international aid and coordination through UN agencies like WHO, UNICEF and UNOCHA.
A study in Lancet Global Health projects an additional 0.25-1.2 million children under 5 could die indirectly in the next six months as a result of the pandemic though disruption of health systems and decreased access to food. This would be the first increase in global child mortality since World War II. The researchers from Johns Hopkins also estimate that indirect maternal deaths could rise from 8% to 38%.
An analysis by the New York Times reveals spikes in fatalities across Latin America (including Brazil, Ecuador and Peru) that exceed the worst pandemic trajectories in Europe and the U.S. The Brazilian president, when asked about the death toll, replied “So what? What do you want me to do?”.
Amazon indigenous leaders warn of the potentially devastating effects of COVID-19 (New Humanitarian), where “no specific attention has been given to indigenous communities”.In Brazil, the potential effects highlight the lack of government support with food and health services. The former health minister of Ecuador, meanwhile, warns that “everyone is at risk” if marginalized communities are not able to afford basic health services, while officials in Mexico suggest that thousands of deaths are not being reported, obscuring the true toll of the COVID-19 epidemic.
China, South Korea and Japan are experiencing a resurgence in COVID cases, as the WHO and public health experts warn against lifting containment measures too early (CNBC)
- Authorities in Wuhan plan to test all 11 million residents over the next ten days after discovering new infections for the first time since its lockdown was lifted, prioritizing vulnerable groups and high-density areas (BBC)
Exceptionally heavy seasonal rains across East Africa since late April have resulted in widespread floods that caused a heavy loss of life and property, compounding the risks to human health and food security from the COVID-19 pandemic and the most serious desert locust invasion in decades. (WMO)
COVID19 epitomises why a “One Health” approach – which recognises the fundamental interconnectedness of humans, animals, and their shared environment- is key to ensuring the healthy and sustainable future of the planet. coChairs of the Lancet One Health Commission are calling for a COVID-19 One Health Research Coalition (Lancet)

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An article in The Lancet (Has COVID-19 subverted global health?) emphasize the importance of context and equity as key principles of global health. In light of limited financial aid from wealthier countries, the authors urge developing countries to adopt policies that reflect their local context that focus on what is possible, acceptable, just, and sustainable.

What accounts was South Korea’s COVID Secret? Fast Testing, High-Tech Tracing, Zero-Tolerance Isolation (Atlantic)

Lockdown Is a Blunt Tool, We Have a Sharper One: Contact Tracing (NYT)

WHO issues a Technical Guidance on Contact Tracing for COVID-19 in Africa (WHO)

The U.S. can expect a series of ‘mini-epidemics’, as the flattening curve is misleading, as the CIDRP outlines three potential futures: recurring small outbreaks, monster wave, persistent crisis (NYT)

Where the latest models think we are headed and why they disagree (FiveThirtyEight)

Reopening some states can heighten risk of or recurring second waves in others (STAT)

Simulation: Ending restrictions earlier is associated with higher projected cases and deaths, but also quicker economic recovery according to a RAND Corporation online tool

In the New England Journal of Medicine, the authors provide two lessons in the Italian response to the pandemic, highlighting the important of testing of health care workers, and how “urgent and decisive” lockdown of the region earlier could have contain the epidemic (Adaptations and Lessons in the Province of Bergamio)

National Geographic reviews the lessons learned from national responses to the COVID-19 pandemic, including the spread of social mitigation, the effectiveness of travel restrictions, testing and the impact of speed of response on outbreak trajectory (How to measure your nation’s response to coronavirus).

It took the U.S. only seven days to exceed projected COVID-19 deaths for August (Newsweek)

A new paper in the Journal of Risk Research (Resilience in the face of uncertainty) describe how political interference undermined the ability of the U.K. National Health Service with COVID-19 preparedness and response. Similar to the Bank of England, the authors argue that national emergency preparedness requires greater independence.

While the full impact of the pandemic on food security remains unknown, Dr. Rhonda Ferguson (DIGHR Research Fellow) argues that the displacement of localized food systems require transformation in trade to protect the estimated 265 million people threatened by famine (Coronavirus: Another chance to transform the global food trade)

COVID-19 and Globalization (One Health)

Could COVID-19 mark a ‘turning point’ in the climate crisis? (WEF)

Effective transmission across the globe: the role of climate in COVID-19 mitigation strategies (Lancet Planetary Health)

Iran’s locust threats grow amid coronavirus pandemic, sanctions (New Humanitarian)

As the number of cases in Iran top 100,000, the spokesperson for the Health Ministry expressed concern in the “rising trend” over the least three days (Daily Star Lebanon)

Public Health Emergency of International Concern (PHEIC) Declaration for COVID-19 extended (WHO)

Why we can’t compare country responses to COVID-19: death rates, data and geography (WEF)

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The doubling rate of confirmed COVID-19 cases dropped to once every 21 days from a high of once every 7 days on April 1. As some countries experience stabilizing or declining national death tolls, it has prompted attempts to loosen lockdown measures. This includes France, Italy and Spain, three of the world’s hardest hit countries (accounting for 20% of cases and a third of all COVID-related deaths worldwide). Germany is begun to relax lockdown measures, as face masks have become mandatory in public. The National Health Service of the United Kingdom set out a six-week plan to ‘return to normal’ following projections that the U.K. has ‘likely survived the first wave’ of the pandemic and will get close to testing targets. Despite a record daily increase in confirmed cases,South Africa restarted some mining operations, as India has also begun to ease lockdown measures following a drop in reported

As some Asian-Pacific countries such as Singapore experience major outbreaks in the second wave of transmission, hospitals across Europe have raised concerns. The WHO noted that many states also do not have adequate testing capacity needed to support a safe reopening strategy that can detect, trace and isolate new COVID transmission. China has meanwhile provided a guide on how countries can prevent a second wave, including compulsory masks in public, fines for failure to exercise public hygiene practices, as well as public markings for social distancing lanes.

The LSHTM is gathering data on hundreds of intervention measures from around the world to determine factors contributing to disease outbreak as well as relative effectiveness of control strategies. For example, to date, Hong Kong’s swift surveillance, quarantine and social-distancing measures – such as the use of face masks and school closures – helped to cut Coronavirus transmission with only 4 deaths in a (urban) population of 7.5 million. The LSHTM platform is being developed to support the WHO’s technical support to member states, and includes more than 1,100 volunteers, multiple universities, public health organizations and non-profits, including ACAPS which analyses humanitarian crises.

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A paper in Nature this week reports that Chinese scientists discovered RNA of the virus in tiny droplets in Wuhan hospitals, raising the possibility of airborne transmission. The range of clinical manifestations in patients that test positive for COVID-19 remains a public health challenge, with some remaining asymptomatic while others die quickly. Despite the more than 1,000 papers that are published every week, a Science articles concludes that a “clear picture is elusive, as the virus acts like no pathogen humanity has ever seen.”

The CDC this week added six new symptoms that may be linked with COVID-19. These include chills, repeated shaking with chills, muscle pain, headache, sore throat and a loss of taste or smell – in addition to previously listed symptoms (fever, cough and shortness of breath or difficulty breathing).

The number of cases in Russia has surged past 100,000 following a record daily increase that included its Prime Minister testing positive. The Prime Minister of Japan has also suggested the country is likely to extend the state of emergency past May 4. Yesterday, Chile announced that it will back away from plans to distribute immunity cards following warnings by the WHO of the lack of evidence of ‘sufficient immunity’ to COVID-19 that would prevent reinfection. In its daily briefing, the WHO also has urged countries to be vigilant and to avoid prematurely lifting control measures as early evidence of sero-epidemiological data suggests a significant proportion of infected people may have been missed by surveillance measures.

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An alarming new report by the ILO estimates that nearly half of the global workforce, more than 1.6 billion people, could lose their livelihoods due to COVID-19 related reductions in global trade and increased lockdown control measures. The report projects that lost income could total US$3.4 trillion this year, as the equivalent of 200 million full-time jobs have or will disappear since the start of the pandemic. The staggering figures include many informal workers that may lack worker benefits or social protection, and push upwards of 500 million people into poverty. The UN High Commissioner for Human Rights issued a Guidance for countries to adopt strategies that protection homeless people, as the Special Rapporteur on Extreme Poverty and Human Rights raised the likelihood that extreme poverty will increase for the first time in 20 years that is threatening 40 to 60 million people globally.

With incomes virtually stopping overnight in some countries, the UN Global Network Against Food Crisis warns that as many as 265 million people around the world may suffer from food insecurity and possible starvation. This includes the half a billion smallholder farmers that produce almost 80% of food consumed in Asia and Sub-Saharan Africa. Some countries have turned to cash payments to support the poor, including Pakistan where the government announced US$900 million in emergency funds for over 80 million people. Many countries such as Bangladesh are confronted by increasing public protests due to lockdowns. In Malawi, the High Court set aside plans for a COVID-19 lockdown pending a review within seven days, as protestors against the lockdown carried placards declaring that it would be better to contract the virus than die of hunger because they are unable to work. The WHO has also expressed concern of community spread in West Africa, as multiple countries have issued targeted lockdowns and curfews in major cities in addition to restrictions on inter-urban travel, stopping short of nationwide lockdowns.

With a looming recession and ballooning debt obligations in many developing countries, the IMF urged donor countries to support economic stimulus packages to address the immediate and long-term hunger impact. UN OCHA also states that about 700 million people (10% of the world’s population) are most vulnerable and concentrated in about 30 to 40 countries which already receive humanitarian assistance and will see a big drop in incomes as the virus spreads and governments impose restrictive measures and lock downs. They estimate that US$90 billion would be needed to provide income support, protect against starvation, and support a systematic health response for the world’s most vulnerable people. This represents 1% of the approximately US$8 trillion stimulus packages that the IMF states G20 countries have put in place to safeguard their own economies. The World Bank’s Pandemic Emergency Financing Facility will meanwhile provide a modest $200 million in pandemic bonds to 64 low- and middle-income countries to finance COVID-19 related medical and personal protective equipment, medicines and support for frontline health workers.

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Ten countries have now confirmed more than 1,000 COVID-related deaths, with 14 countries reporting more than 10,000 cases. With less than 17% of all confirmed cases globally, Italy and Spain continue to account for more than 35% of all reported deaths (21,645 and 19,130, respectively). Both countries are experiencing a slow-down in the rates of transmission, however, and while Spain is beginning to relax control measures, Italy has extended lockdown measures until May.

Sweden (12,540) is the latest country to exceed 10,000 cases, as the number of deaths doubled in less than a week, which has been blamed on its controversial voluntary public health measures. France (147,863) and Turkey (69,392) continue to experience significant daily increases in confirmed cases and deaths, while the U.K. is expected to see a drop in new cases and hospitalization, despite surpassing 10,000 deaths and approaching 100,000 cases. The U.K. Prime Minister Boris Johnson was moved out of Intensive Care over the weekend, noting “I owe (NHS staff) my life.”

Transmission rates in Russia have also raised concerns, as daily reported cases continue to surge 20% for a second consecutive day, approaching 28,000 cases and 232 deaths. As the number of COVID-related deaths in Belgium surpass China, Germany is reporting an increase of COVID-related outbreaks in nursing homes and hospitals, where the elderly account for only 17% of cases but 86% of all deaths.

Many European countries are also reporting high CFR near or above 10%, including Italy, Spain, France, the U.K., Netherlands, Belgium, and Sweden. This has been partly attributed to selective testing strategies, as a paper this week in BMJ suggests early and widespread testing may be contributing to Germany’s relatively low CFR (2%). The European CDC has recommended that countries scale up testing and surveillance systems to guide and monitor the escalation and de-escalation of mitigation strategies.

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Earlier today, China increased the number of COVID-related deaths in Wuhan by 50%, raising the country’s toll by 1,300 to 4,632. While the government claims this reflects updated hospital counts as well as those who died at home, the revision in the reported figures partially validates accusations of under-reporting, including by intelligence agencies. The broader challenge is that most models of the pandemic are based on prior figures from China and may need to be revised to reflect these significant adjustments.

In China, a cluster of cases linked to the Nigerian community in Guangzhou has also sparked alleged discrimination towards Africans by locals and virus prevention officials.

Asian-Pacific countries are beginning to experience second waves of infections, including Singapore which is reporting the highest case rate in the region (500 cases per million people). Despite these spikes, the “suppress and lift” strategy of aggressive testing, isolation, and contact tracing by countries such as Singapore and Hong Kong remains a model response and has helped prevent exponential spread.

In Iran, the number of reported cases and deaths approach 80,000 and 5,000, respectively. Fearing a protracted economic crisis, some “low-risk” businesses were allowed to open, prompting concerns of a second wave of infections. The government has asked for economic support and sanction relief from the IMF, which the U.S. has thus far blocked despite international pressure to sideline geopolitical tensions to allow countries to respond to the pandemic.

With 13,835 confirmed cases, India has become the third Asian country to surpass the 10,000 mark. Like in Pakistan (7,025) and Bangladesh (1,838), the true outbreak size is expected to be significantly higher in India due to varying testing and counting strategies. In India, the government has extended the nation-wide lockdown until May 3, while food shortages and a mass exodus from major urban areas has raised concern about local transmission in rural parts of the country. There are positive reports that some states like Kerala have managed to bend the curve by adopting “aggressive testing, contact tracing, and cooked meals.”

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Northern Africa remains the most affected region on the continent, as Egypt surpassed South Africa with the highest number of confirmed cases (2,673), and Algeria (2,528) and Morocco (2,266) remaining close behind. Despite reporting over 2,600 cases, South Africa has been praised for its proactive response and for taking a regional leadership role in drafting a comprehensive action plan to assist African countries with COVID-19 response.

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This week, the UN Economic Commission for Africa issued a projection that an estimated 300,000 and 3.3 million African people could lose their lives as a direct result of COVID-19, depending on the intervention that governments introduce. As all 55 African countries are now reporting cases, the Director of the Africa CDC called COVID-19 an existential threat to the continent. Increased local transmission also contributing to exponential growth in some regions, particularly in the 24 countries that have confirmed at least 100 cases. As of this morning, there are almost 1,000 deaths and over 18,500 confirmed cases across Africa, representing a 30% increase over the past week.

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Despite reporting the highest number of cases on the continent, South Africa (2,506) has been praised for its proactive response. After a drastic drop in the rate of new daily reported cases from 42% (150-200 new cases per day) three weeks ago to an estimated 4% (20-80 new cases per day) following the government’s early and strong control and testing, the last four days have seen a slight uptick in case reports (90-140 new cases per day). The South African government, meanwhile, has proposed a comprehensive action plan to assist African countries with COVID-19 response.

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Several countries have made adjustments to their official figures over the last couple days, including China adding over 1,300 uncounted deaths from Wuhan. The broader challenge is that most models of the pandemic are based on prior figures from China and may need to be revised to reflect these significant adjustments.

The U.S. CDC revising its case and death counts to reflect both confirmed and probable cases and deaths. With more than 675,000 total cases, the U.S. has more cases than the next four highest reporting countries combined, while accounting for almost 20% of all reported COVID-related deaths globally.

Revelations of significantly higher rates of transmission and deaths in elderly care facilities contributed to Canada becoming the 15^th country to report at least 1,000 deaths, as total cases spiked by 30% this week to over 30,000. While the Canadian government announced that control and border measures will remain for months to come, the U.S. President yesterday outlined a Federal Plan to open up the country to widespread criticism by public health experts and government officials across the country.

Total confirmed cases worldwide increased to 2.2 million, as the number of COVID-19 related deaths approach 150,000 as of Friday morning.

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“Impartial, independent, and comprehensive evaluation”

Rising geopolitical tensions shape emergent Global Health institutions and practices

‘No monopolies on access’ to COVID treatments and vaccines in a pandemic

COVID is a ‘wake-up call to our global fragility’

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