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ngq, you sexy beast! Here is a sanity check for that clean meta. ;)

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                    [post_date] => 2020-07-21 11:19:55
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  • During its Monday media briefing, the WHO Director General outlined four types of COVID-19 outbreaks occurring globally, including countries that [1] responded rapidly and avoided large outbreaks, [2] brought large outbreaks under control, [3] overcame their first peak and are struggling with new peaks, and [4] are currently in the intense transmission phase. The last category presents the biggest immediate risk and includes ten countries that account for almost 80% of new infections, with half of these in the U.S. and Brazil alone. The rate of new infections in the  U.S. does not appear to be slowing despite an increase in testing, with total cases expected to surpass 4 million this week. With over 2 million confirmed cases, the outbreak in Brazil continues to be a major concern, particularly in light of irregularities in official government figures. This led to a stand-off last month between Brazilian President Bolsonaro– who has been criticized for downplaying the pandemic despite testing positive for the virus last week – and the Supreme Court, which prompted one Justice to demand the government immediately “re-establish the daily dissemination of epidemiological data on the COVID-19 pandemic.”
  • The Red Cross Red Crescent has warned that South Asia is quickly becoming the next epicentre of the pandemic, with rapidly rising cases across India, Pakistan, Bangladesh and Afghanistan. With the second highest number of daily new cases and over 1.1 million confirmed infections, the outbreak in India is rapidly escalating. This includes the Delhi metropolitan area that is home to 25 million people and accounts for almost half of all cases in the country. The latest projection from MIT, still under peer review, warns that India could have the largest number of cases in the next six months, with modelling scenarios estimating up to 287,000 cases per day in the absence of stronger public health measures.
  • Across Africa, the number of COVID-19 infections surpassed 750,000 this week, as the over 15,000 mortalities over the past five months have now exceeded the total number of lives lost to the West African Ebola outbreak between 2014 and 2016. At least 22 African countries have seen the number of Coronavirus cases double in the last month, with at least 35 countries experiencing community transmission. With the largest number of cases on the continent, South Africa recently re-imposed a ban on the sale of alcohol to reduce avoidable injuries and the burden on hospitals, while tightening curfews and mask requirements. Fragile health systems in many countries on the continent are increasingly overwhelmed, according to the WHO Director for Africa, who called on governments and the international community to scale up public health measures such as testing, contact tracing and case isolation. There is particular fear of outbreaks among vulnerable populations such as humanitarian response locations, marginalized communities as well as elderly populations, who are on average ten times more at risk of death, although they only account for 20% of COVID-19 infections in Africa.
  • Countries that previously succeeded in containing the virus are meanwhile reporting resurgence in cases, such as Hong Kong where a third wave of outbreaks prompted renewed lockdowns and physical distancing measures. A paper in the BMJ shows how COVID-19 related mortalities in Mexico have also tripled since the country began to relax lockdowns in early June despite warnings by experts and local health officials questioning official figures by the government. The cost of a subsequent lockdown in OECD countries alone has been estimated at US$1.1 trillion in additional output losses this year, which would increase five-fold if an outbreak were to occur in early 2021.
[post_title] => World is Entering a ‘New and Dangerous Phase’ of the Pandemic, WHO [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => world-is-entering-a-new-and-dangerous-phase-of-the-pandemic-who [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/world-is-entering-a-new-and-dangerous-phase-of-the-pandemic-who/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 2007 [post_author] => 1 [post_date] => 2020-06-10 22:21:09 [post_date_gmt] => 2020-06-22 02:21:09 [post_content] =>
  • As countries eagerly hope to end the lockdowns that have decimated national economies, one idea that has gained traction is the issuance of immunity passports to those that have either tested negative or recovered from COVID-19. In Nature, however, an article this week outlines four practical challenges and six ethical objections to immunity passports:
    1. Unclear whether recovered patients develop immunity to future exposure to virus.
    2. Serological testing for antibodies remains unreliable (low specificity and specificity).
    3. No country has sufficient serological testing capacity (minimum of two per person).
    4. Only a small fraction of the population would be certified (e.g. less than 0.5% of the U.S. population based on current number of confirmed cases).
    5. Systems to monitor immunity will erode privacy and increase the risk of forgery.
    6. Marginalized communities will be disproportionately impacted, including profiling and potential harms to racial, sexual, religious or other minority groups.
    7. Unfair access due to testing shortages and systemic inequities.
    8. Create further inequity between immuno-privileged and vulnerable communities.
    9. Could open the possibility for discrimination on the basis of other health information (e.g. mental health status, genetic tests) by employers, insurers, or law enforcement.
    10. Can lead to perverse incentives, e.g. if social and economic liberties are only granted to people who recover from COVID-19.
[post_title] => Immunity Passports: 10 practical challenges and ethical objections [post_excerpt] => As countries eagerly hope to end the lockdowns that have decimated national economies, one idea that has gained [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => immunity-passports-10-practical-challenges-and-ethical-objections [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/immunity-passports-10-practical-challenges-and-ethical-objections/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 2006 [post_author] => 1 [post_date] => 2020-06-10 22:20:09 [post_date_gmt] => 2020-06-22 02:20:09 [post_content] =>

The WHO and UNHCR signed an agreement to strengthen partnerships and operational capacities that focus on improving access to health services for some 70 million forcibly displaced people around the world from COVID-19. The poorest countries in Africa, Asia, and Latin America are facing pandemic-induced economic and public-health emergencies that demand immediate action. G20 leaders therefore must agree now on measures to prevent the current recession from deepening, and to mitigate its impact on the world’s most vulnerable people. We are at a critical moment, because the poorest countries in Africa, Asia, and Latin America are facing economic and public-health emergencies that demand immediate action.

[post_title] => A call to protect vulnerable populations from COVID-19 [post_excerpt] => The WHO and UNHCR signed an agreement to strengthen partnerships and operational capacities that focus on improving access [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => a-call-to-protect-vulnerable-populations-from-covid-19 [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/a-call-to-protect-vulnerable-populations-from-covid-19/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 2005 [post_author] => 1 [post_date] => 2020-06-10 22:18:09 [post_date_gmt] => 2020-06-22 02:19:09 [post_content] =>

The WHO published an updated COVID‐19 Strategic Preparedness and Response Plan containing the latest epidemiological findings in order to support countries preparing for a phased transition from widespread transmission to a steady state of low‐level or no transmission. The Strategy Update emphasizes a whole-of-UN approach, and provides practical guidance for whole‐of‐society strategic action that can be adapted to local conditions and capacities. Countries have been asked to identify the lead coordinator of multiagency COVID-19 plans, map existing preparedness and response capacities and gaps, engage key technical and operational partners to identify appropriate coordination mechanisms and mobilize resources and capacities, and to establish monitoring mechanisms and operational reviews to track progress and adjust strategies.

[post_title] => WHO Updates COVID-19 Strategic Preparedness and Response Plan [post_excerpt] => The WHO published an updated COVID‐19 Strategic Preparedness and Response Plan containing the latest epidemiological findings in order to support [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => who-updates-covid-19-strategic-preparedness-and-response-plan [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/who-updates-covid-19-strategic-preparedness-and-response-plan/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 2004 [post_author] => 1 [post_date] => 2020-06-10 22:17:09 [post_date_gmt] => 2020-06-22 02:18:09 [post_content] =>

The decision by President Trump to “terminate” relations with the WHO over accusations of undue influence by China on the agency was widely condemned, within the U.S. and globally. It remains uncertain if and how this would happen, but experts worry it may exacerbate global health challenges. The President’s suggestion to redirect intended resources (about US$450 million last year, accounting for 15% of the WHO budget) through bilateral development channels could lead to greater incoherence and inefficiency, according to Rebecca Katz (Georgetown University). A Nature article outlines a range of other possible repercussions, from the resurgence of polio and malaria to barriers in the flow of information on COVID-19. As Dr Kelly Lee (Simon Frasier University) warns, the damage to scientific partnerships would also extend to waning U.S. influence in global health initiatives, including ongoing drug and vaccine development and distribution.

[post_title] => What the U.S. 'WHOexit' could mean for Global Health [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => what-the-u-s-whoexit-could-mean-for-global-health [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/what-the-u-s-whoexit-could-mean-for-global-health/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 2003 [post_author] => 1 [post_date] => 2020-06-10 22:16:09 [post_date_gmt] => 2020-06-22 02:17:09 [post_content] =>

An article by the WHO Director General and President of Costa Rica remind us that COVID-19 will remain a global threat everywhere as long as it is present anywhere, demanding a collective and collaborative global response. At the World Health Assembly last month, Costa Rica took leadership in proposing a new COVID-19 Technology Access Pool (C-TAP) that would allow all participating countries, research partnerships and companies to share data, knowledge and intellectual property relating to diagnostics, treatments and vaccines for COVID-19. The mechanism was launched in the first week of June and has attracted at least 30 countries after resolutions by the WHA and UN General Assembly were adopted in support of “universal, timely, and equitable access to health technologies.”

At the Global Vaccine Summit on June 4, countries, philanthropic foundations and private companies pledged US$8.8 billion towards the WHO Access to COVID-19 Tools Accelerator, which places special emphasis on access.

While the IMF reports that countries have committed over $10 trillion USD in global fiscal response to the pandemic (of which 90% is in OECD countries), the monthly funding update by UNOCHA shows that only about $2 billion has been pledged thus far for the COVID-19 Global Humanitarian Response Plan ( that requests 6.7 B USD). This represents less than 18% of requested emergency funding for UN and aid agencies needed for supplies and logistical support to reach those in urgent need of assistance.

[post_title] => Globalizing the COVID-19 Response [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => globalizing-the-covid-19-response [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/globalizing-the-covid-19-response/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [6] => WP_Post Object ( [ID] => 2001 [post_author] => 1 [post_date] => 2020-06-10 22:15:09 [post_date_gmt] => 2020-06-22 02:15:09 [post_content] =>

According to the latest report by UNDP, global human development is projected to decline for the first time since the UN defined and began measuring the concept in 1990. Unlike other crises over the past three decades, the “triple hit to health, education and income” as a result of COVID-19 has been reported globally. The UNDP warns that developing countries that are less able to cope with the pandemic’s social and economic fallout remain acutely vulnerable.

The report urges countries to focus on equity in order to limit these impacts. Closing the digital divide by providing more equitable internet access, for example, is estimated to cost less than 1% of the fiscal support packages but could result in a two-thirds reduction of the impact of school closures that currently leave 60% of children globally without access to education.

[post_title] => The pandemic is a magnifying glass for inequalities [post_excerpt] => According to the latest report by UNDP, global human development is projected to decline for the first time [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-pandemic-is-a-magnifying-glass-for-inequalities [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/the-pandemic-is-a-magnifying-glass-for-inequalities/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [7] => WP_Post Object ( [ID] => 2002 [post_author] => 1 [post_date] => 2020-06-10 22:15:09 [post_date_gmt] => 2020-06-22 02:16:09 [post_content] =>

The latest media briefing by the WHO warned that the global outlook has been “worsening” over the past week, with over 100,000 daily case reports in nine of the past ten days, as total confirmed cases surpass 7 million and total reported deaths approach half a million. One challenge has been complacency, as the WHO Technical Lead explains “people grow tired” which makes it difficult for governments to maintain or reintroduce public health and social distancing measures. As some regions like parts of Europe are beginning to see stabilizing or declining rates of new COVID-19 infection, Latin America has quickly become the ‘epicentre of the pandemic’. Of the 136,000 reported cases on Monday June 1, 2020, almost 75% came from just 10 countries, more than half of which were from Central and South American countries. The WHO Director General said he was “especially worried” given the large number of countries reporting rapidly increasing case and mortality rates straining health systems “from Mexico through to Chile.”

With almost 600,000 confirmed cases, Brazil has the second highest case count in the world following the U.S. With 2,600 deaths reported in just two days, the WHO Regional Office for the Americas, PAHO, warns that Brazil could see 88,000 deaths from COVID-19 by August unless the country takes drastic containment measures. Elsewhere in the world, Iran has reported more than 3,000 confirmed cases for a fourth consecutive day, raising concerns that the country may be experiencing a second wave of infections.

[post_title] => South America emerges as ‘new epicentre of the pandemic’ [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => south-america-emerges-as-new-epicentre-of-the-pandemic [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/south-america-emerges-as-new-epicentre-of-the-pandemic/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [8] => WP_Post Object ( [ID] => 2000 [post_author] => 1 [post_date] => 2020-06-10 22:14:09 [post_date_gmt] => 2020-06-22 02:14:09 [post_content] =>

The ongoing global protests against police brutality in the United States and the structural racism that enables it, remind us that racism is detrimental, and deadly. As such, racism and structural manifestations are a major public health concern and compound with other issues like COVID-19 to magnify negative impacts on dignity, and on morbidity and mortality.

A recent study by the U.K. Government shows how the risk of death from COVID-19 for ethnic minorities is 10-50% higher risk. The WHO expressed support of the global movement and clarified that attending a mass gathering did not necessarily require more restrictive measures. Instead, WHO officials urged protesters to follow local guidelines in maintaining safe practices, including physical distancing, masks and hand washing.

[post_title] => There is no stopping COVID-19 without addressing structural violence and racism [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => there-is-no-stopping-covid-19-without-addressing-structural-violence-and-racism [to_ping] => [pinged] => [post_modified] => 2020-11-03 09:33:18 [post_modified_gmt] => 2020-11-03 14:33:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/there-is-no-stopping-covid-19-without-addressing-structural-violence-and-racism/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [9] => WP_Post Object ( [ID] => 1999 [post_author] => 1 [post_date] => 2020-06-10 22:13:09 [post_date_gmt] => 2020-06-22 02:13:09 [post_content] =>

Chronology of events

On May 1, the NEJM published a study that suggested that two types of blood pressure medications (angiotensin-converting–enzyme inhibitors and angiotensin-receptor blockers) were not associated with worse outcomes in patients with COVID-19, while noting ACE inhibitors in particular had significantly protective effects on mortality.

On May 22, the Lancet published an article by the same authors that found that chloroquine and hydroxychloroquine, explored as potential therapies for COVID-19, did not correspond with improved outcomes and may be associated with higher mortality by up to 30%.

Over the following week, a number of high-profile clinical trials were halted or suspended as a result of the Lancet paper. That included the multi-country Solidarity Trial that was being coordinated by the WHO.

On May 28, more than 180 scientists submitted an open letter to the Lancet editor and study authors outlining questions about the statistical analysis and a lack of transparency in the underlying data, including contributing countries or hospitals.

On June 2, the editors of the NEJM and Lancet issued respective “Expressions of Concern” over methodological and data integrity questions related to the two publications, while the WHO resumed the relevant arm of the Solidarity Trial. Two days later, the co-authors retracted both papers from the NEJM and Lancet, as the journal editors indicated that they would undertake an internal audit of their procedures.

What are the issues?

Data Integrity

Much of the controversy has been around the quality and nature of the large proprietary collection of electronic health records analysed and provided by Surgisphere, a private medical data provider based in the U.S. The primary author of both papers claimed that an independent audit of the data was requested by Medical Technology and Practice Patterns Institute, but were told by the medical data research institute that Surgisphere would not share the underlying data due to “agreements with its clients and the fact that the documents contain confidential information,” It should be noted that Surgisphere Chief Executive was a co-author on the papers. According to a statement on the Surgisphere company website, its data registry was based on electronic health records from customers of its machine learning program and data analytics platform producing data that allows researchers to study “real-world, real-time patient encounters.”

Methodological integrity

The high-profile retractions and pulled pre-print raise broader questions about working with large datasets that researchers are not able to validate, and particularly about how such work could pass peer review at prestigious medical journals.While it is not uncommon for studies to use large datasets without external scrutiny of the raw data, but it is far more uncommon for high-impact journals like the Lancet. While its editor and the NEJM claim the review process was confidential, both journals claim the papers had “external peer review, statistical review, as well as scientific and manuscript editing.” How such a comprehensive dataset could have been gathered from hospitals around the world in the middle of a pandemic is a question that researchers, journals and peer reviewers should have raised.

Adverse Impacts

Although the retrospective analysis was not a randomized control trial, it received a lot of attention given its publication in a high-impact journal and purported scale of almost 100,000 patient records from 671 hospitals around the world between December 2019 and April 2020. Even if the results were correct, however, experts suggest such observational data, with its inherent weaknesses, should not be used to stop trials that could provide definitive and actionable answers. Among the major adverse impacts of the published Lancet study has been suspension of several well-designed clinical trials. One of the major concerns is that the publicity around the Lancet findings have made it harder to conduct trials or recruit patients, as the retraction won’t receive as much attention as the original study. In retrospect, researchers and decision makers may have placed too much reliance on the study, particularly as there had been prior queries about the methods of analysis and some of the results did not fit with what is known about other risk factors. The Annals of Internal Medicine, for example, maintained an ongoing and regularly updated review that summarised data from randomised trials and from observational studies. The journal did not include the Lancet study in their review or conclusion that “at this time, there is insufficient and often conflicting evidence on the benefits and harms of using chloroquine  or hydroxychloroquine to treat COVID-19” that currently make it “impossible to determine the balance of benefits to harms.”

Ensuring research integrity during a pandemic

Scientific publication must above all be rigorous and honest. The retractions raise larger issues of reproducibility and scientific integrity, particularly when using big databases to draw conclusions, an approach that has been gaining rigor in the era of big data. While big databases have opened new lines of inquiry, there are also major issues as experts warn conducting studies properly is far more difficult and require a thorough understanding of underlying data to ensure the methods are rigorous and outcomes reasonable. There have been calls from scientists for independent auditing of data by journals and possibly regulatory bodies like the FDA which has extensive experience of auditing clinical data.

Part of the challenge has been pace. Unlike prior pandemics like SARS and Ebola, the COVID-19 pandemic has led to substantially more scientific publications, most notably pre-prints that are often not peer-reviewed. The rapidly increasing number of publications and urgency to quickly understand the virus present significant challenges in ensuring that research is conducted according to methods and standards of research integrity. This includes, for example, underlying models used to plan pandemic response and predict future outbreak trajectories that are often “poorly reported, at high risk of bias, and reported performance that are optimistic.” Serological tests that have received accelerated approval raise similar concerns, as claims by manufacturers around specificity and sensitivity often lack published data, presenting challenges as countries use testing to determine how to ease lockdowns.

Related papers

  • Top journals raise concerns about data in two studies related to COVID-19 (STAT)
  • High-profile coronavirus retractions raise concerns about data oversight (Nature)
  • Jeffrey Aronson: When I Use a Word . . . Retraction (BMJ Opinion)
  • After retractions of two Covid-19 papers, scientists ask what went wrong (STAT)
  • Will the pandemic permanently alter scientific publishing? (Nature)
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Updates on COVID-19 clinical trials

The pace of research and development for treatments and vaccines for the novel Coronavirus has intensified, with dozens of clinical trials underway around the world. Several papers were published over the weekend with preliminary findings on the two largest studies that were both stopped for different reasons.

  • In the New England Journal of Medicine, researchers reported on a randomized double-blind study for remdesivir by the U.S. CDC that was stopped prematurely due to positive preliminary results. For patients hospitalised with COVID-19, the antiretroviral appears to reduce the recovery time (by four days) and mortality (from 12% to 7%), while presenting no additional adverse events. While this is promising, the results appear to be worse for visible minorities (a group that has been disproportionately impacted by the pandemic). Researchers have also been surprised that patients treated sooner after symptom onset may not have markedly better outcomes than those treated later in the course of disease.
  • A paper in the Lancet, meanwhile, presents on the WHO Global COVID-19 Solidarity Trail on chloroquine and hydroxychloroquine. Based on the advice of the WHO Executive Group – comprised of experts from ten countries involved in the trial – the observational study was stopped as preliminary findings suggest the possibility of higher mortality rates. The WHO Chief Scientist committed to a comprehensive analysis of all emerging clinical trial data globally to consider benefit and harm, acknowledging that unlike randomized controlled trials, observational studies have been known to yield misleading results. Expertshave also critiqued the failure of the study to adequately adjust for the fact that many of the patients in the trial are more likely to be severely ill and already at increased risk of death. 

Ethics of controlled Coronavirus infection

An article in Science this week also expresses concern in the growing trend of researchers pursuing, and thousands of people expressing interest in participating in, controlled human infection (CHI) studies, i.e. deliberately exposing healthy people to COVID-19 to study infection and treatment efficacy. The authors present an ethical framework for CHIs that emphasizes “social value” as fundamental in justifying these studies. The proposed Ethical Framework for SARS-CoV-2 CHI considers six additional criteria, including: Reasonable Risk-Benefit Profile, Context-Specific Stakeholder Engagement, Suitable Site Selection, Fair Participant Selection, Robust Informed Consent, and Proportionate Payment.

Everyone in the (patent) pool

More than 100 former heads of government and leading scientists have urged all COVID-19 related research and intellectual property to be shared freely, and for the equitable distribution of vaccines. An editorial this week in Nature laments that the growing concern of “techno-protectionism” necessitates such a letter, while highlighting the remarkable speed of advancements as a result of global consortia of researchers (“Work that would normally have taken months, possibly years, is completed in weeks”). The Nature article focuses particularly on the patent pool model that is was popularized by the UNITAID Medicines Patent Pool that was successful in bringing antiretrovirals to market.

The World Health Assembly Resolution last week made explicit reference to IP rights flexibilities with respect to R&D, manufacturing and distribution of COVID-19 vaccines. Support was not unanimous, however, as some countries (notably the U.S. and the U.K) and research consortia (including the Coalition for Epidemic Preparedness Innovations) expressed their preference for conventional models where vaccine developers retain the IP rights that they may sub-license and their determined price. An article in the Harvard Business Review drew attention to the dangers of this form of ‘vaccine nationalism’, particularly as the underlying research thus far has been pooled and governments around the world have shouldered much of the risk in funding the vaccine effort.

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Global Map of COVID-19 Innovations

StartupBlink in collaboration with Health Innovation Exchange (a UNAIDS initiative) and the Moscow Agency of Innovations launched a Coronavirus Innovation Map this week. The platform aims to connect innovators with venture capital and government officials in order to support the response to COVID-19 and address its impacts across five categories: prevention, diagnosis, treatment, information and life and business adaptation. Over 500 innovations are currently on the visual database, and the Health Innovation Exchange has committed to producing a report on shortlisted innovations to share with country partners.

Local Challenges, Local Solutions: African Innovators and COVID-19

Among the WHO reforms in 2018 were three key priorities: increasing capacity around digital health, recruiting diverse and younger leaders, and seeking local solutions to local challenges. This past week, the WHO AFRO Regional Office hosted an inaugural virtual event at the intersection of all three: showcasing solutions by young African innovators that have been implemented to address local challenges in responding to the pandemic. From the 350 innovators in attendance, the virtual event highlighted eight projects, including interactive public transport contact tracing apps, mobile testing booths and low-cost critical care beds. The event builds on a ‘Hackathon’ the WHO AFRO Region hosted in April to develop scalable solutions that align with one of the priority areas, providing seed funding to three projects.

Ten actions to boost local manufacturing in developing countries

Record demand globally for medical supplies like PPEs, diagnostics and treatments for COVID-19 has disproportionately affected affordability and access in developing countries. While local and regional production has gained more prominence, producers and investors in developing countries often face unique challenges. The UNCTAD highlights at least five: lack of capital, technical and resource capacity; low quality and regulatory standards; weak enabling policy frameworks; small markets and unstable demand; and poor physical infrastructure. In order to increase coordination and cooperation with existing initiatives (e.g. WHO voluntary technology pool and ACT Accelerator Global Response Framework) and partner agencies (e.g. The Global Fund, UNICEF, UNIDO, and UNAIDS), the UCTAD proposes the following ten actions to boost medicine production capacity in developing countries:

  1. Investment in skills development to ensure GMP-compliant production
  2. Sharing COVID-19-related technologies to enable affordable mass production
  3. Target impact investors to access necessary capital
  4. Build partnerships to initiate “lighthouse” projects on low-hanging fruit
  5. Improve investment incentives to increase local firms’ sustainability
  6. Use streamlined regulation to facilitate investment
  7. Invest in infrastructure
  8. Emphasize the regional approach to reduce costs
  9. Seek funding from official development assistance
  10. Ensure sustainability of efforts despite an unpredictable market
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  • During its Monday media briefing, the WHO Director General outlined four types of COVID-19 outbreaks occurring globally, including countries that [1] responded rapidly and avoided large outbreaks, [2] brought large outbreaks under control, [3] overcame their first peak and are struggling with new peaks, and [4] are currently in the intense transmission phase. The last category presents the biggest immediate risk and includes ten countries that account for almost 80% of new infections, with half of these in the U.S. and Brazil alone. The rate of new infections in the  U.S. does not appear to be slowing despite an increase in testing, with total cases expected to surpass 4 million this week. With over 2 million confirmed cases, the outbreak in Brazil continues to be a major concern, particularly in light of irregularities in official government figures. This led to a stand-off last month between Brazilian President Bolsonaro– who has been criticized for downplaying the pandemic despite testing positive for the virus last week – and the Supreme Court, which prompted one Justice to demand the government immediately “re-establish the daily dissemination of epidemiological data on the COVID-19 pandemic.”
  • The Red Cross Red Crescent has warned that South Asia is quickly becoming the next epicentre of the pandemic, with rapidly rising cases across India, Pakistan, Bangladesh and Afghanistan. With the second highest number of daily new cases and over 1.1 million confirmed infections, the outbreak in India is rapidly escalating. This includes the Delhi metropolitan area that is home to 25 million people and accounts for almost half of all cases in the country. The latest projection from MIT, still under peer review, warns that India could have the largest number of cases in the next six months, with modelling scenarios estimating up to 287,000 cases per day in the absence of stronger public health measures.
  • Across Africa, the number of COVID-19 infections surpassed 750,000 this week, as the over 15,000 mortalities over the past five months have now exceeded the total number of lives lost to the West African Ebola outbreak between 2014 and 2016. At least 22 African countries have seen the number of Coronavirus cases double in the last month, with at least 35 countries experiencing community transmission. With the largest number of cases on the continent, South Africa recently re-imposed a ban on the sale of alcohol to reduce avoidable injuries and the burden on hospitals, while tightening curfews and mask requirements. Fragile health systems in many countries on the continent are increasingly overwhelmed, according to the WHO Director for Africa, who called on governments and the international community to scale up public health measures such as testing, contact tracing and case isolation. There is particular fear of outbreaks among vulnerable populations such as humanitarian response locations, marginalized communities as well as elderly populations, who are on average ten times more at risk of death, although they only account for 20% of COVID-19 infections in Africa.
  • Countries that previously succeeded in containing the virus are meanwhile reporting resurgence in cases, such as Hong Kong where a third wave of outbreaks prompted renewed lockdowns and physical distancing measures. A paper in the BMJ shows how COVID-19 related mortalities in Mexico have also tripled since the country began to relax lockdowns in early June despite warnings by experts and local health officials questioning official figures by the government. The cost of a subsequent lockdown in OECD countries alone has been estimated at US$1.1 trillion in additional output losses this year, which would increase five-fold if an outbreak were to occur in early 2021.
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