Developments at Dadhaleh Institute

International Pandemic Response ‘Grossly inadequate and dangerously short-sighted’

The UN released an updated COVID-19 Global Humanitarian Response Plan, doubling its appeal to $10.3 billion, more [ ... ]

In an increasingly interconnected and interdependent world, human security means that global health is necessarily the responsibility of all countries, requiring long term, predictable, flexible and sustained financing based on global solidarity.[45]) We believe this should be rooted in principles of Human Security, that include: (a) the right of all people to live in freedom and dignity, free from poverty and despair; (b) the pursuit of people-centred, context-specific and prevention-oriented responses that strengthen protection and empowerment of all people and communities; (c) acknowledging the interlinkages between peace, development and human rights; and (d) strengthening national solutions which are compatible with local realities.[46]

The protection of health underpins all aspects of a functioning, prosperous society. COVID-19 has made clear that pandemic preparedness and response are not choices between protecting people and protecting the economy: one reputable estimate projects the cumulative global fiscal deficit as a result of the pandemic at US$25-30 trillion, equivalent to 30% of global GDP.[47] Existing emergency funding mechanisms are inadequate for a pandemic response, which include established models of development assistance that depend on a small number of countries, foundations, and development banks.[48] Although the WHO Contingency Fund for Emergencies and the Pandemic Emergency Financing Facility can be deployed quickly, only a relatively small amount of funds is available through these mechanisms and they can be depleted quickly. This has meant that international financial institutions needed to play a critical role at the beginning of the pandemic. The World Bank was able to rapidly mobilize US$14 billion for emergency COVID-19 response in the first three months, as the IMF disbursed US$87.8 billion to date through its US$250 billion Catastrophe Containment and Relief Trust.[49]^,[50] There are nonetheless no dedicated mechanisms to allow the rapid deployment of a large amount of funds at the beginning of a pandemic. A lack of sustainable financing threatens WHO’s capacity to play a central role in global health emergencies but also to deliver on its broader mandate.

Among the most difficult challenges beyond the current COVID-19 pandemic is how quickly and effectively nations will be able to develop strategies and mobilize resources should this situation arise in the near or distant future. It is also important to recognize that global preparedness is not simply the sum of national preparedness: a pandemic is a global event demanding global action.[51] That includes stronger mechanisms for collective action that enable countries, businesses, and societies to coordinate and collaborate towards a common goal. While multilateral systems like the UN and G20 have reiterated strong commitments to preparedness, they have struggled to implement a collective response, which has been further hampered by global political tensions undermining multilateral institutions and exacerbating WHO’s financial fragility.

A strong multilateral system is foundational of global pandemic preparedness, across public, private and non-profit sectors working together bilaterally, regionally and internationally. Collective action is needed to ensure a common strategy, coordinated and effective clinical and public health action, and equitable access to countermeasures. Interconnected supply chains and international travel mean that all countries depend on the economic, social, and physical health of all others. The Global Preparedness Monitoring Board (GPMB) is an independent monitoring and accountability body, convened by the WHO and the World Bank to ensure preparedness for global health crises. In its first annual report in September 2019 three months before COVID-19 was discovered, the GPMB outlined the urgent need for strong multilateral systems to undertake the following set of core functions for pandemic preparedness and response:[52]

Developing global and regional mechanisms for tracking potential pathogens;
Strengthening early notification and comprehensive information sharing;
Intermediate grading of health emergencies;
Development evidence-based recommendations on the role of domestic and international travel and trade recommendations;
Collaborative mechanisms for R&D, regulatory capacity building and harmonization and allocation of countermeasures; and
Mechanisms for assessing International Health Regulation compliance and core capacity implementation, including a universal, periodic, objective and external review mechanism.

The COVID-19 pandemic has also demonstrated that efforts are also needed to ensure stockpiles, including global supply chains for essential goods are strengthened, developed, sustained, and financed.[53] Here, simulations and exercises that test and demonstrate the capacity and agility of health emergency preparedness systems, and their functioning within societies can be developed using predictive mechanisms for assessing multisectoral preparedness.

Lastly, COVID-19 has highlighted a fundamental issue with how we define and measure preparedness. Our understanding of preparedness is based on a narrow set of public health capacities that do not fully capture the range of national and international capacities necessary to ensure preparedness, including R&D, measures to mitigate the socio-economic impacts of epidemics and ensure continuity of essential services, international cooperation, and preparedness of international organizations.[54] In addition, current measures focus more on the presence of an institutional policy rather than a demonstrated capacity to operationalize those capacities, and the critical importance of science-informed political leadership.

The COVID-19 pandemic has mobilized the largest global research effort in history.[30] Within weeks of first discovering the SARS-Cov-2 virus, its genome was sequenced while diagnostic tests have been developed at unprecedented speeds. By May, over 1,000 scientific papers were being published every day, as journal publications enabled open and rapid dissemination of critical epidemiological trends and clinical public health guidelines.[31] Despite the scale and speed of the global scientific response, there is still no treatment or vaccine for COVID-19. In addition to persistent uncertainties regarding transmission pathways, the type and duration of immunity is not yet known, while the emergence of viral mutation is a certainty, and can emerge anywhere.^[32] The truth remains that countries that adopted public health interventions quickly and aggressively were able to control transmission: one study estimates that shutdowns in Europe averted 3.1 million COVID-19 related deaths, while another analysis of the six countries with the highest reported cases in June 2020 suggests the public health and containment measures likely prevented or delayed an estimated 62 million cases.[33]^,[34]

In the first six months of 2020, billions in public funding have poured into research, contributing to at least 38 COVID-19 vaccine candidates in clinical trials and another 93 preclinical vaccines in actively studies in animal hosts, as of September 10, 2020.[35] While wealthier countries continue to sign agreements to secure advanced access to vaccine – a kind of ‘Vaccine Nationalism’ that is now being condemned – there is an urgent need for new arrangements at the global level to facilitate the development, finance, production, and equitable distribution of COVID-19 vaccines.[36] The international community must ensure that COVID-19 related diagnostics, therapeutics and vaccines are treated as global public goods, and access must be equitable to ensure appropriate containment, control and mitigation of the COVID pandemic.

WHO activated the COVID R&D Blueprint and established the Solidarity international clinical trials aimed at rapidly assessing the relative effectiveness of COVID- 19 treatments. As awareness grew of the need for strengthened international coordination of the COVID-19 R&D efforts – and in response to a call from G20 leaders – WHO, together with CEPI, FIND, GAVI, the Global Fund, UNITAID the Wellcome Trust and the World Bank, established the Access to COVID-19 Tools (ACT) Accelerator with support from governments, manufacturers and funders.[37]Through its extensive network of global collaborators, the ACT Accelerator aims to improve the speed and scale of development, production, and equitable access to COVID-19 tests, treatments, and vaccines. It the largest and most diverse COVID-19 vaccine portfolio in the world with ten candidate vaccines under evaluation, with 9 of them in clinical trials, and over 170 countries engaged in the new COVID-19 Vaccine Facility (COVAX).

COVAX allows countries to pool resources, share vaccine development risks, allow procurement of sufficient volumes of vaccines to support equitable access materials and medical equipment globally, and where there is oversupply, to donate surplus doses to a central pool.[38] Among the 170 countries that have signed on to COVAX, 55 would finance the vaccines using domestic budgets, while partnering with up to 90 lower income countries that would be supported through the COVAX Advance Market Commitment coordinated by GAVI. While these initiatives hold much promise, it remains to be seen whether they will achieve their goals, and they remain limited to COVID-19.[39] To date, less than 10% of required funding for the ACT Accelerator has been contributed, with US$35 billion urgently needed to ensure its viability. On September 10, 2020 UN Secretary General António Guterres appealed for a “quantum leap in funding,” warning that “without an infusion of US$15 billion over the next 3 months, beginning immediately, we will lose the window of opportunity.”[40]

Lessons from previous pandemics show that without mechanisms and procedures to facilitate the equitable sharing of limited medical countermeasures, low- and middle-income countries may be unable to secure access to vaccines and treatments until after wealthier countries have secured enough doses for their populations.[41] Challenges with the financing and coordination of R&D for COVID-19, fragile supply chains and trade restrictions on essential medical goods, and concerns regarding equitable and effective allocation of vaccines have highlight the need for adequate governance frameworks around R&D, trade and access to medical countermeasures.

While the WHO focuses on the immediate health response, the UN Research Roadmap will address longer-term downstream socio-economic consequences of COVID-19. Launched in April 2020, the UN Research Roadmap for the COVID-19 Recovery seeks to identify research priorities that will support an equitable global socio-economic recovery from this pandemic and continued progress towards the UN Sustainable Development Goals.[42] The Roadmap aims to transform COVID-19 recovery into a rapid learning initiative, where national and international responses can be informed by rigorous social scientific evidence generated in the anticipated recovery period. It is also intended to ensure national and international strategies are informed by rigorous social scientific evidence generated in anticipation of, and during, the COVID-19 recovery period.[43] It will seek alignment in support of priority areas identified in the UN Framework for the Immediate Socio-Economic Response to COVID-19.[44]Environmental sustainability and gender equality are part of a research Roadmap aimed at building a greener, more inclusive, gender-equal and sustainable world, with specific attention to at-risk populations experiencing greater socio-economic marginalization.

[post_title] => 2. Global R&D Roadmap and Equity [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => 2-global-rd-roadmap-and-equity [to_ping] => [pinged] => [post_modified] => 2022-09-26 10:40:42 [post_modified_gmt] => 2022-09-26 14:40:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/2-global-rd-roadmap-and-equity [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 2843 [post_author] => 1 [post_date] => 2020-09-13 22:04:31 [post_date_gmt] => 2020-09-14 02:04:31 [post_content] =>

As the world engages in unprecedented containment, control and mitigation measures, COVID-19 has exposed inequities and vulnerabilities. In low- and middle-income countries, fragile health systems and inadequate financial safety nets compound the triple challenge of pandemic response, social protection, and economic collapse. Global and national economic fragility and massive public debt are new realities, as are unprecedented job losses. Among the approximately two billion informally employed workers globally, containment measures are projected to lead to a decline of 82% in earnings, as the International Labour Organization estimates the pandemic could push 500 million people into poverty.^[13]^,[14] The World Bank has moreover projected the sharpest historic decline in global remittances that could push 40-60 million further people into extreme poverty.^[15]^,[16]

Six months of lockdown have also reversed advances on the rights of women and girls, including an estimated 31 million cases of gender-based violence as well as 7 million additional unintended pregnancies.^[17] Lockdowns and border restrictions have also disrupted agricultural production, with the Food and Agriculture Organization and World Food Programme warning that even best-case scenarios will result in global famines that see acute hunger increase by more than 130 million people by the end of 2020.^[18] The pandemic is upending food supply chains, crippling economies and eroding consumer purchasing power. The populations most at risk of famine are predominantly in ten countries that are concurrently affected by conflict, economic crisis and climate change.^[19]

In complex humanitarian settings, COVID-19 can further amplify existing stressors among vulnerable populations, including among the 70 million forcibly displaced people that often live in displacement camps that are overcrowded, and lack access to health care, sanitation and clean water.[20] Another billion people around the world live in informal peri-urban slums and barrios without safe potable water or adequate health or sanitation services face additional vulnerabilities, while the recent Tropical Cyclone Harold in Fiji illustrates the compounding challenges of natural disasters hitting communities experiencing COVID-19.^[21]

Many advanced economies have responded to the pandemic by passing major stimulus packages, as the International Monitory Fund estimates G20 countries have spent upwards of US$11 trillion in new fiscal measures, representing one tenth of global GDP.[22] The gap between donor commitments and the funding needed to respond to the pandemic in low- and middle-income countries, meanwhile, continues to grow reinforcing global inequities in the distribution of resources and fiscal support capacities.[23] The UN Office for the Coordination of Humanitarian Affairs (OCHA) has tripled its unprecedented and “Extraordinary Appeal” for an immediate Global Humanitarian Response to COVID-19 in fragile countries to US$10.3 billion, that as yet remains only 24% funded.[24] Protecting the most vulnerable 10% of the world (or 700 million people) across 32 countries from the worst impacts of COVID-19 in complex humanitarian settings would require US$90 billion, or less than 1% of the stimulus packages that G20 countries have underwritten.[25] The UN Emergency Response Coordinator warns that the pandemic and the associated global recession are about to wreak havoc in fragile states, while describe the response by wealthier countries as “grossly inadequate and dangerously short-sighted.”[26]

Health emergency preparedness requires effective, agile systems for prevention, detection, response, and recovery with the flexibility and scalability required to cope with a variety of emergencies, commensurate with the required response.[27] Planning for emergencies requires prioritizing systems building across the whole of society, in a variety of contexts, testing different models, and creating environments and mechanisms for sharing best practices, among countries at all economic levels. This lack of multisectoral preparedness left many societies scrambling to figure out how to maintain essential services and mitigate economic disruptions.[28]

The potential impact of pandemics on non-health sectors and the private sector has been a known risk for years; yet, health emergency preparedness remains siloed and with little reach beyond public health.[29] As COVID-19 has shown, pandemics require a comprehensive response, encompassing health, mental health and psycho-social support education, and other aspects of the social and economic sectors. Many sectors lacked plans to mitigate not only the public health risks but also the potential socioeconomic impact of the pandemic, including strategies for managing breaks in supply chains, school and childcare closures, food shortages, and unemployment, in a way that was least disruptive to personal finances, commerce, and daily lives.

[post_title] => 1. Humanitarian Issues and Implications [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => 1-humanitarian-issues-and-implications [to_ping] => [pinged] => [post_modified] => 2022-09-26 10:40:42 [post_modified_gmt] => 2022-09-26 14:40:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/1-humanitarian-issues-and-implications [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 2842 [post_author] => 1 [post_date] => 2020-09-13 22:03:31 [post_date_gmt] => 2020-09-14 02:03:31 [post_content] =>

Briefing document in preparation for The Recovery Summit (Sep 14-17)

• Agenda: www.recoveryproject.org/

• Livestream: https://youtu.be/LIHJRku6-Oc

The COVID-19 Pandemic is the worst global public health emergency in over a century, and described by the United Nations Secretary-General as the “most challenging crisis since World War II.”^[1] In less than three months since it was first internationally reported on New Year’s Eve 2019, the virus has rapidly spread to almost every country with varying patterns and waves of infection, contributing to almost a million deaths and 30 million confirmed cases as of September 12, 2020.^[2] Its unique epidemiological characteristics and diverse range of clinical manifestations contribute to one reputable study estimating that 1.7 billion people – or 22% of the global population – could be at an increased risk of severe COVID-19 if infected.^[3]

As the first waves of infection rapidly swept across Asia, Europe, the Americas and Africa, we are reminded that the second and third waves of the 1918 influenza pandemic killed significantly more people.^[4] Limited disease detection and testing capacity, not only in lower income countries but also advanced economies, obscure the true toll of the COVID-19 pandemic, including community spread and deaths. Public health experts and governments have turned to rapid surveillance of excess mortality as a key indicator of overall epidemic impact and trajectory.^[5]In Africa, up to 190,000 people could die of COVID-19 by the end of 2020, and an additional 44 million people could be infected.^[6]

Beyond the direct effects on morbidity and mortality, COVID-19 also contributes to secondary health impacts. Disruptions in essential care as well as food shortages with self-evident health impacts are projected to contribute to 1.2 million additional under-five deaths, representing the first increase in global childhood mortality since World War II.^[7] Immunization campaigns have also been suspended globally, as Médecins Sans Frontières describes the “devil’s choice” that countries and aid organizations face in balancing pandemic response while maintaining vaccination programs.^[8] Indirect maternal deaths are likewise expected to rise from 8% to 38%, undermining major gains in Maternal and Child Health over the past decade.^[9] Global shortages in personal protective equipment, uncertainties around transmission dynamics as well as weak infection prevention and control measures have also contributed to elevated risks among front-line health workers that make up more than 11% of all cases worldwide.^[10]

COVID-19 also threatens plans to eliminate and control infectious diseases, with widespread interruptions to HIV, TB, and malaria care. Many countries are also reporting challenges in maintaining chronic disease care, including 80% of countries in Central and South America, as manageable cases risk becoming active infections.^[11] Recent projections indicate public health containment, control and mitigation measures such as hand washing, wearing masks, widespread COVID-19 testing, contact tracing and social distancing, may need to be maintained into 2022, further straining health systems and exacerbating social and economic impacts.^[12] The impacts of the pandemic cascade beyond health across all sectors, compounding existing vulnerabilities and emerge as network hyper-risks that ramify across systems and geographies. Like all natural and health hazards, COVID-19 has also shown how marginalized and vulnerable communities are disproportionately impacted, while exacerbating existing inequities and vulnerabilities such as malnutrition, insecurity, gender-based violence and the impacts of natural hazards, among others.

[post_title] => Global Public Health [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => global-public-health [to_ping] => [pinged] => [post_modified] => 2022-09-26 10:40:42 [post_modified_gmt] => 2022-09-26 14:40:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/global-public-health [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 2387 [post_author] => 1 [post_date] => 2020-07-21 11:27:55 [post_date_gmt] => 2020-07-21 15:27:55 [post_content] =>

Over 150 efforts are currently underway around the world to develop COVID-19 vaccines and therapeutics, according to the WHO, with 23 vaccine candidates currently in human trials. Most of these studies are in Phase 1 trials that typically include a small number of healthy people where the goal is to determine safety and whether an immune response is observed. A small number of Phase 2 trials are also underway that include a larger and more diverse population, while none of the vaccine candidates have entered Phase 3 trials that focus on balancing efficacy (i.e. vaccine dosage to elicit immune response against SARS-Cov-2) and safety (i.e. minimizing adverse side effects). A number of papers over the past week reported on promising developments in three leading vaccine trials currently underway in the U.S., the U.K. and China.
A paper in the New England Journal of Medicine last week shows encouraging interim results for Moderna’s mRNA-1273 that targets the “spike” protein used by SARS-Cov-2 to enter cells. The Phase 1 clinical trials conducted by the U.S. National Institutes of Health confirmed that 45 health adults who received two doses of the vaccine 28 days apart had higher levels of antibodies than those who had recovered from being infected by COVID-19 (with the peak in antibody production coming only after the second dose). Moderna will begin Phase 2 trials on July 27, while mRNA-1273 is also expected to be the first vaccine candidate to enter Phase 3 efficacy trials later this year, with efforts underway to recruit over 30,000 people.
The Lancet this week also published encouraging results for another leading vaccine candidate from the U.K., AZD1222, developed by Oxford University and AstraZeneca. The interim findings show the vaccine continues to induce antibody and T-Cell immune responses up to day 56 of the ongoing Phase 1/2 trials that involve 1,077 health adults. A sub-group study of 10 patients receiving a second dose showed an even greater immune response to SARS-Cov-2. While no major adverse events were observed, 60% of patients did report mild side effects (fever, headaches, muscle aches, and injection site reactions) compared to the control group, a meningitis vaccine. AZD1222 is expected to advance to Phase 2 trials this month of a diverse patient population.
A research team from China also published results in the Lancet this week on Phase 2 trials for a vaccine candidate developed by CanSino. The latest findings validate previous Phase 1 data that show the vaccine induces an immune response to SARS-Cov-2, but that the neutralizing antibody response is not as strong in some key demographics, including people over the age of 55.
While these early results are promising, Merck’s CEO in the Harvard Business Review claimed it would be a “great disservice” to raise hopes that a vaccine would be available to the public by the end of the year. Novel vaccines often take years or decades to develop, due to established research protocols to ensure safety and efficacy. Vaccines also present unique manufacturing and distribution challenges that often limit production capacity while requiring complex logistical efforts. This is further strained by the global demand for a COVID-19 vaccine, as civil society groups have urged the international community to establish vaccine distribution agreements to prevent hoarding by wealthier countries.
The WHOhas confirmed that 165 countries representing 60% of the world’s population have engaged in COVAX, the COVID-19 vaccine global access facility that is designed to promote rapid, fair and equitable access. As part of the mechanism, 75 countries would finance the vaccines using domestic budgets, while partnering with up to 90 lower income countries that would be supported through voluntary donations to the COVAX Advance Market Commitment coordinated by GAVI. Other regions like PAHO announced parallel pooled procurement plans to ensure countries receive vaccines at subsidized, affordable prices.

[post_title] => Early Vaccine Trials Show Encouraging Results [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => early-vaccine-trials-show-encouraging-results [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:17 [post_modified_gmt] => 2020-11-03 14:33:17 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/early-vaccine-trials-show-encouraging-results/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 2386 [post_author] => 1 [post_date] => 2020-07-21 11:26:55 [post_date_gmt] => 2020-07-21 15:26:55 [post_content] =>

Rapid and non-invasive antibody diagnostics remain a holy grail in scaling up testing for COVID-19. Preliminary results are currently under peer review for the rapid finger prick antibody test, AbC-19 Lateral Flow, that claims to be 98.6% accurate. While these claims seem promising, the results have not been made public, with questions remaining on the sets of samples the study used or what the researchers mean by ‘accuracy’. Diagnostic tests are typically assessed by sensitivity (false negative) and specificity (false positive). The other outstanding issue with these types of tests, however, relate to uncertainties in the period of time after infection that IgG antibodies disappear from the blood. Since acuity of COVID-19 infection appears to be correlated with the intensity of the antibody response, it is plausible that the test could come back negative for those with low antibody levels in as little as three months (for reference, antibody levels for SARS were detectable for up to two years). A rapid antibody test would nonetheless be a valuable diagnostic tool for detecting positive cases, even if negative test results would require further investigation. It is also important to note that other human coronaviruses don’t confer lifelong immunity, while ongoing research is also examining the role of T-cell immunity.

[post_title] => High Accuracy Shows Promise of Rapid Fingerprick Antibody Testing [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => high-accuracy-shows-promise-of-rapid-fingerprick-antibody-testing [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:17 [post_modified_gmt] => 2020-11-03 14:33:17 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/high-accuracy-shows-promise-of-rapid-fingerprick-antibody-testing/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [6] => WP_Post Object ( [ID] => 2385 [post_author] => 1 [post_date] => 2020-07-21 11:25:55 [post_date_gmt] => 2020-07-21 15:25:55 [post_content] =>

During Monday’s media briefing, the WHO Technical Lead for COVID-19 suggested that while those who are infected with the novel Coronavirus did mount some level of immunity, there are persistent uncertainties how strong that protection is and for long it lasts. This came a day after a study by King’s College London found that immunity appeared to peak three weeks after the first symptoms, waning rapidly thereafter. The study, which is currently under peer review, shows that 60% of people had a “potent” antibody response at the height of their infection, but that only 17% retained the same potency three months later, while others had undetectable antibody levels. This is corroborated by other studies that suggest loss of immunity within a couple months after infection, which if true could challenge the notion of herd immunity to COVID-19.
A paper in Nature Medicine this week meanwhile provides a detailed survey of the immune response in a cohort of COVID-19 patients to the Spike antigen by memory B cells and T cells. In addition to coordinating and controlling antibody responses, T cells can also detect fragments of a virus (peptides) which makes it harder to dodge immune defences. Although the study only included a small number of adults with mild infections, both could be detected in the blood one month after COVID-19 infection, suggesting key protective immune responses could be generated in natural infection and may be potentially boosted.
These results could have important implications for vaccine development, as certified antibody diagnostic tests are currently designed to detect one single antibody response, and not to quantify it. Consistent and sustained levels of antibody response, however, may require annual booster immunization, similar to the seasonal flu vaccine. According to the Nature Medicine paper, the most effective vaccine against COVID-19 is likely to elicit both neutralizing antibodies, as well as a high total antibody titre and strong T cell response. While immunological questions persist, the WHO warned that it remains possible that people may be re-infected, urging safe public health measures.

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The World Food Programme has identified 25 ‘hotspots’ where acute hunger is reached devastating levels. Most of the countries stretch between West and East Africa, while vulnerable populations in Latin American and Middle Eastern countries, where the pandemic has exacerbated income losses, disrupted supply chains that contributed to surging food prices. The WFP and FAO previously estimated that food security could increase by 81% this year to almost 270 million people. Every 1% rise in acute hunger also contributes to a 2% increase in refugee outflows, which further threaten vulnerable populations as well as regional stability. The UN released an updated COVID-19 Global Humanitarian Response Plan last week, with the $4.9 billion WFP response accounting for nearly half of the sum, and an additional $500 million special provision for the 25 hotspots most at risk of famine.
A new study in PLoS Medicine shows that combining severe and moderate acute malnutrition treatments into a simplified protocol could be as effective as traditional treatment while saving $123 per child. The ‘Combined Protocol for Acute Malnutrition Study’ was conducted by LSHTM, the International Rescue Committee and Action Against Hunger, and found that the combined protocol was 76.3% effective at promoting nutritional recovery, which is slightly better than the 73.5% for standard treatment. With 50 million children currently not receiving malnutrition treatment, the efficacy and cost savings could translate into program expansions, with three million child deaths a year are linked to malnutrition.

[post_title] => COVID-19 is Pushing Countries ‘Closer to the Abyss’ of Famine, WFP [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => covid-19-is-pushing-countries-closer-to-the-abyss-of-famine-wfp [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:17 [post_modified_gmt] => 2020-11-03 14:33:17 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/covid-19-is-pushing-countries-closer-to-the-abyss-of-famine-wfp/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [8] => WP_Post Object ( [ID] => 2383 [post_author] => 1 [post_date] => 2020-07-21 11:23:55 [post_date_gmt] => 2020-07-21 15:23:55 [post_content] =>

The UN released an updated COVID-19 Global Humanitarian Response Plan, doubling its appeal to $10.3 billion, more than 80% of which would support responses in 63 low-income countries. Another $1.8 billion would be directed for ‘global requirements’, transport of aid workers and supplies accounting for $1 billion, with a further $300 million allocated directly for NGOs and $500 million for 25 ‘hotspots’ most at risk of famine. The UN Emergency Response Coordinatorwent on to warn that the pandemic and the associated global recession are about to wreak havoc in fragile states, while describe the response by wealthier countries as “grossly inadequate and dangerously short-sighted.”
The timely and directed appeal comes as G20 Finance Ministers and heads of central banks are set to meet virtually this coming Saturday. An estimated $11 trillion in stimulus packages have been appropriated by G20 countries as part of an unprecedented economic response, representing 10% of global GDP. To protect the most vulnerable 10% of the world across 32 low-income countries would meanwhile cost less than $90 billion, which is less than 1% of domestic stimulus packages by wealthier countries. The UN Emergency Response Coordinator contrasted the solidarity and international coordination in the aftermath of the 2008 Global Financial Crisis, particularly highlighting the need to reinforce and reassert the role of the IMF and World Bank in supporting lower income countries.

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During the Sustainable Development Goals progress review meeting over the weekend, the UN Secretary General issued one of his strongest rebukes of the international community for systemic inequities that the COVID-19 pandemic has exposed. In a significant departure from his traditional diplomatic tone, the Mandela Day speech by the UN head noted the many “myths, delusions, and falsehoods” around international progress on equality. Among the examples he listed was the “lie that free markets can deliver healthcare for all. The fiction that unpaid care work is not work, the delusion that we live in a post-racist world, the myth that we are all in the same boat.” He went on to call for a “New Social Contract” with commitment of renewed and inclusive multilateralism, while urging for fundamental reforms to the UN Security Council, the IMF, and the World Bank.
Humanitarian response locations remain a particular cause for concern, including in sub-Saharan Africa which is home to over 26% of the world’s refugees. Ongoing conflicts and persistent attacks have led to the closure of hundreds of health facilities, including in Mali and Burkina Faso where 1.5 million people are left without adequate health care. During its Monday media briefing, the WHO cited a recent study by Oxford University highlights the risk of conflict on outbreaks, identifying 63 fragile countries currently facing unrest and conflict in the background of the COVID-19 pandemic, while additional 13 countries are projected to experience new conflicts over the next two years. The study further estimates that the average cost to host and neighbouring countries for a civil war is about $60 billion, while 100 million could be pushed into extreme poverty and 130 million face starvation.

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A new study in Science demonstrates the need for a coordinated approach for countries in Europe to lift lockdown measures in order to prevent subsequent outbreaks of cases. The research team from WorldPop highlight the significant impact of actions by countries that are populous, well-connected and with strong interventionsin place – which include France, Germany, Italy, Poland and the UK. The study produced over 1,200 exit strategy scenarios, using publicly available epidemiological data as well as anonymized mobile phone data to map population movement in 35 European countries. A notable finding of the study is that premature and uncoordinated easing of control measures by some countries could accelerate the resurgence of COVID-19 outbreaks across the entire continent by up to five weeks. The simulations furthermore show that synchronizing intermittent lockdowns across countries would lead to half as many necessary lockdown periods in order to achieve an end to community transmission in six months.

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The Centre for Global Development published a study this week providing a comprehensive taxonomy of direct and indirect costs associated with failure to act proactively in containing the spread of the Coronavirus and mitigating its cascading effects. These can include direct and spill-overs health care costs, such as disruptions and resource diversion (with one study estimating two million additional deaths due to HIV, TB and Malaria alone). The human and economic costs associated with increased poverty have also been unprecedented, with the latest biennial World Bank Global Economic Prospects estimating the biggest collapse in per capita GDP in over 150 years. The two billion informal workers are expected to be impacted most severely, with 80% already affected by pandemic containment measures. Protracted school shutdowns will also generate learning losses estimated at $10 trillion globally, while a study by Oxford highlights the risk of outbreaks across 63 fragile countries, with 13 additional states projected to experience new conflicts over the next two years. Based on present and anticipated human and economic costs, the CGD study argues frontloading responses to COVID-19 and its secondary effects would not only cost exponentially less but would also be more dignified for people globally.
The unorthodox approach Sweden initially adopted of virtually ignoring COVID-19 has since become the cautionary tale. Unlike the rest of Europe, the country resisted lockdowns and physical distancing measures for economic reasons, gambling instead on herd immunity. The result three months later has been significantly higher cases as well as 12 times higher mortality rates than neighbouring Norway, while a much slower projected economic recovery. An analysis by Peterson Institute for International Economics affirms Sweden “literally gained nothing” from what they describe as a “self-inflicted wound.”

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Developing global and regional mechanisms for tracking potential pathogens;
Strengthening early notification and comprehensive information sharing;
Intermediate grading of health emergencies;
Development evidence-based recommendations on the role of domestic and international travel and trade recommendations;
Collaborative mechanisms for R&D, regulatory capacity building and harmonization and allocation of countermeasures; and
Mechanisms for assessing International Health Regulation compliance and core capacity implementation, including a universal, periodic, objective and external review mechanism.

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