COVID-19: A Magnifying Glass for Inequalities
Period. 21 - 28 May 2020
COVID-19: A Magnifying Glass for Inequalities
WHO COVID-19 Strategic Preparedness and Response Plan
The WHO published a Strategy Update to the COVID‐19 Strategic Preparedness and Response Plan of the emerging epidemiological situation 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. An accompanying COVID‐19 Monitoring & Evaluation Framework was developed to support countries, listing key public health and health systems indicators for countries to monitor their preparedness and response to the pandemic. The M&E Framework is organized across three dimensions: Geographical Scope (global, all countries, priority countries); Planning and Monitoring Needs (informing strategic planning, operational tracking, evidence‐based decision‐making, as well as advocacy and transparency between donors, UN agencies, and partners); and across 9 Pillars (Country‐level coordination/planning/monitoring, Risk communication/community engagement, Surveillance/rapid response teams, Points of entry/travel/transport, National laboratories, Infection prevention & control, Case management, Operational support & logistics, Maintaining essential health services & systems).World Economic Forum’s COVID-19 Risks Outlook
The World Economic Forum, which publishes the annual Global Risks Report, released two new reports that map the global risks, challenges and opportunities that COVID-19 presents. Adopting a complex systems approach, the reports highlight the interdependencies within and across borders but also health, economic, environmental, social, geopolitical systems. At the same time, the emphasis in both documents tilts towards the Great Transformation that will be needed. These include the need to reframe essential public services, notably health but also education, care and social safety nets. The factors that promote and inhibit solidarity and compassion are also raised, alongside needed behavioural shifts towards more sustainable consumption and mobility habits.Global fiscal support during the COVID pandemic
The monthly IMF Fiscal Monitor adjusted the estimated fiscal support by countries around the world to US$9 trillion as a result of COVID-19. This was roughly divided between public sector loans (and other equity injections) as well as direct budgetary support. The IMF reports that a second wave of government measures to address the economic impact of the pandemic this past month accounted for the $1 trillion increase in the overall figure. The G20 account for most of this sum ($8 trillion), reinforcing global inequities in the distribution of resources and fiscal support capacities. Developing countries, meanwhile, are also anticipating a “hidden debt risk” due to the unprecedented synchronization of fiscal stresses. Including currency depreciation, capital outflows and foreign-currency borrowing.Dynamic intervention to relax lockdowns and school closures
A study in the European Journal of Epidemiology modelled dynamic interventions (i.e. cycles of lockdown to reduce R0 to below 1, and intervals of relaxed social distancing) across 16 distinct countries globally. The authors conclude that a ‘rolling schedule’ of 50 days of lockdown followed by 30 days of relaxation could reduce transmission levels and keep ICU demands below national capacities. The model furthermore suggests that adopting such dynamic suppression measures over 18 months could lead to significant reductions of new infections and deaths, particularly in developing countries. Since each model was only run one time per country, one study limitation is testing underlying factors at one fixed value rather than a range of possible outcomes from multiple runs, introducing uncertainty. The SAGE group in the U.K. also released a report last week that modelled the impact of eight scenarios of school re-opening on community transmission of COVID-19. Between the two extremes of staying closed and fully opening, the most promising scenario was breaking classes into two cohorts and alternating between ‘two weeks on / two weeks off’ over academic year. The authors acknowledge the uncertainties associated with the model, but nevertheless suggest that the impact of school re-opening is likely to be relatively small compared to maintenance of other social distancing measures in the broader community.A call to arms to protect vulnerable populations from COVID-19
Hidden risks of COVID-19: violence against women and girls
UN Women published a report based on a rapid assessment to understand the impact of COVID-19 on violence against women and girls and service provision. The synthesis is based on data collection from government and civil society partners in 49 countries, highlighting the increasing prevalence of gender-based violence that often go unreported. UN Women also released an accompanying pocket tool that provides practical guidelines for gender-responsive evaluation management and data collection, structured around the four main evaluation phases: planning, preparation, conduct, and reporting and follow-up. In a separate article, researchers draw attention to the escalating global crisis in access to reproductive health.Webinars
Future Strategy Forum: COVID-19 and Grand Strategy (CSIS) | Wednesday, June 3 (1-2pm EST) Global crises, local action: a humanitarian reset in response to COVID-19 (ODI) | Wednesday, June 3 (6:30pm EST) Humanitarian Operations During COVID-19: A Conversation with UNHCR (CSIS) | Monday, June 8 (9:30 am EST)Face masks: latest guidance, demand and supply challenges
Recruiting Digital First Responders to counter pandemic misinformation
The latest on COVID-19 transmission dynamics: good and bad news
Immunity Passports: 10 practical challenges and ethical objections
- Unclear whether recovered patients develop immunity to future exposure to virus.
- Serological testing for antibodies remains unreliable (low specificity and specificity).
- No country has sufficient serological testing capacity (minimum of two per person).
- 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).
- Systems to monitor immunity will erode privacy and increase the risk of forgery.
- Marginalized communities will be disproportionately impacted, including profiling and potential harms to racial, sexual, religious or other minority groups.
- Unfair access due to testing shortages and systemic inequities.
- Create further inequity between immuno-privileged and vulnerable communities.
- 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.
- Can lead to perverse incentives, e.g. if social and economic liberties are only granted to people who recover from COVID-19.
Innovative responses look for solutions
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:- Investment in skills development to ensure GMP-compliant production
- Sharing COVID-19-related technologies to enable affordable mass production
- Target impact investors to access necessary capital
- Build partnerships to initiate “lighthouse” projects on low-hanging fruit
- Improve investment incentives to increase local firms’ sustainability
- Use streamlined regulation to facilitate investment
- Invest in infrastructure
- Emphasize the regional approach to reduce costs
- Seek funding from official development assistance
- Ensure sustainability of efforts despite an unpredictable market
Updates on COVID-19 clinical trials
- 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.