COVID-19 has been a test of International Cooperation we have “essentially failed”: UN Secretary General
Period. 29 September - 5 October 2020
75th UN General Assembly Dominated by COVID-19, Calls for Global Solidarity
- In a week where the U.S. President became the latest head of state to test positive for COVID-19, world leaders met for the 75th UN General Assembly that was dominated by the pandemic as the global death toll has officially surpassed one million lives. The first ever virtual meeting of Member States was underscored by growing inequalities and heightened geopolitical tensions, however, with the UN Secretary General claiming that COVID-19 has been a “clear test of international cooperation — a test we have essentially failed.” As countries have struggled to pay their regular budget contributions, the UNDP admits that existing development finance systems have fallen short, furthermore asking if the institutions and means by which they are resourced “as a backbone, as a global safety net, as a humanitarian response capacity” remain sufficient. The Director of NYU’s Center on International Cooperation likewise remains uncertain about the long-term implications of the pandemic. A bad outcome, she claims, would be a system that becomes overwhelmed and under-resourced, constantly shifting attention from crisis to crisis. Conversely, a good outcome would arise from using this systemic shock to isolate a small number of persistent global issues, including the interconnectedness of health and social systems, rising inequality and associated political instability and conflict.
- In their address to the General Assembly, world leaders took up the question of the role and continued relevance of the UN, with the Kenyan President asking what the UN brings to the world at 75. Referring to the increasing difficulties to achieving consensus, French President Macron warned the UN “ran the risk of impotence (for having) such a hard time agreeing on so little,” while his Swiss counterpart urged that it was countries themselves that were often to blame for undermining the work of the UN bodies. The latter sentiment was echoed by the UN Secretary General who spoke of a “disconnect between leadership and power,” arising from a failure to recognize that in our increasingly interconnected world, “solidarity is self-interest.” The UN head concluded his remarks by offering Member States with two scenarios: either wealthier countries significantly scale up financial and technical support to the Global South – including debt relief and ensuring access to future vaccines – or one where poorer countries are left on their own, resulting in long-term economic disruption and dramatic human costs.
‘It’s Never Too Late to Turn Things Around’: WHO Director General
- The WHO Director General issued a statement last week in commemorate the tremendous loss of life from the COVID-19 pandemic that so far has claimed over one million lives in just nine months. Coinciding with the week-long UN General Assembly, the commentary urged that “no matter what stage a country is in an outbreak, it is never too late to turn things around.” The WHO head proceeded to offer four key lessons to individuals, communities and countries in order to take control of the pandemic. These include: (1) Preventing “amplifying events” from occurring (including any cluster of people), (2) Reducing deaths by protecting vulnerable groups (including the elderly, health workers and those with underlying risk factors), (3) Adhering to known preventative measures (including physical distancing, frequent hand washing, masking and respiratory etiquette), and (4) Governments to enact tailed actions to support detection, isolation, testing, contact tracing and caring for cases.
WHO Announces 120 Million Rapid Tests for LMICs While COVID-19 Accelerator Remains Underfunded
- The Access to COVID-19 Tools (ACT) Accelerator is the world’s largest effort to scale up the research, development and equitable distribution of diagnostics, therapeutics, and vaccines. The WHO-led program announced last week that it would supply low- and middle-income countries with 120 million rapid tests for SARS-CoV-2 over the next six months to assist governments to expand testing capacities. The rapid test package includes volume guarantees, funding to help countries deploy the tests, as well as an initial US$50 million commitment by the Global Fund to assist governments with procuring the US$5 tests. The WHO Director General claimed these rapid tests were particularly useful for developing countries, as they provide reliable results in less than 30 minutes at a lower price with less sophisticated equipment or specialized staff. The tests will begin to roll out in October in 20 African countries with the support of Africa CDC and UNITAID.
- While much of the world’s focus has been on a COVID-19 vaccine, the growing demand has not translated to a global framework that would ensure equitable access, as wealthier countries have been accused of vaccine nationalism by preemptively purchasing entire vaccine supplies. The COVAX Facility, which is a pillar of the ACT Accelerator, also incorporates a section on Advanced Market Commitments that target the delivery of two billion safe and effective doses of COVID-19 vaccines. Last Wednesday, world leaders pledged US$1 billion towards the ACT Accelerator. Despite the latest round of pledges, the ACT Accelerator remains grossly underfunded, with a staggering $35 of $38 billion still needed to meet its goals, including $15 billion in immediate funding. To support low- and middle-income countries with vaccine procurement and distribution, the World Bank President announced his intention last week to seek approval for a US$12 billion COVID-19 vaccine dispersal fund. The World Bank board is expected to vote on the vaccine fast-track financing fund in early October, which would be part of over US$160 billion that the international financing institution has pledged in COVID-19 aid financing to developing countries.
World’s Largest Contact Tracing Study Points to ‘Superspreading’, Children as Key Transmission Vectors
- A new paper in Science provides early results from the world’s largest contact tracing study examining COVID-19 transmission dynamics in dense, low resource areas. The research team from Princeton sampled 575,071 residents from two Indian provinces (Tamil Nadu and Andhra Pradesh) that were exposed to 84,965 confirmed cases of COVID-19. Among the most notable study findings was the role of ‘superspreading’ events by a small proportion of those infected. For example, 71% of individuals with confirmed cases of COVID-19 did not infect close contacts, while only 8% of infected individuals accounted for 60% of new infections. The authors also present the first large-scale evidence that India’s country-wide shutdown contributed to a substantial reduction in transmission by reducing the opportunity for ‘superspreader’ events. Based on a sampling of over half a million residents, the study estimates the chance that an individual (regardless of age) would pass the virus to a stranger or family member was remarkably low at 2.6% and 9%, respectively. The research team furthermore demonstrate how children and young adults constituted a third of all cases, with the former an especially effective vector of transmission in resource limited settings.
Diverging Hypotheses on Africa's Slow Pandemic Trajectory
- As data emerges from across African countries, experts have been puzzled at the slow pandemic trajectory on the African continent relative to the rest of the world. The continent’s case fatality count stands at 2.4%, with roughly 35,000 deaths among the more than 1.4 million people infected, while in North America and Europe the case fatality has been 2.9% and 4.5%, respectively. WHO data also suggests that 91% of COVID-19 infections in sub-Saharan Africa are in individuals who are younger than 60 years old, while up to 80% of cases in the region are asymptomatic. A number of different hypotheses are currently being explored as possible factors for Africa’s distinct pandemic trajectory, including the potential that COVID-19 infections and deaths are being missed due to limited testing rates, the continent’s youthful population and the “gift of time” that enabled African governments to scale up public health interventions and control measures based in part on lessons from previous disease outbreaks on the continent.
School Reopenings Associated with Elevated Transmission Risk
- As colleges across North America reopened through August and September, a new study by the U.S. CDC suggests weekly COVID-19 cases among young adults aged 18-22 more than doubled across the country, and as much as 144% in the Northeastern U.S., with increases not solely attributable to greater testing. Health experts have long expressed reservations about prematurely reopening schools, particularly given the challenges with enacting public health interventions such as mask wearing, social distancing, hygiene etiquette and testing capacities on campuses. Countries around the world have also been divided on the reopening of primary and secondary schools, as school boards have made differing decisions on whether to resume classes with COVID-19 precautions or to continue with electronic and/or distance-based learning platforms. A study last week in Health Affairs outlining the risk percentage of COVID-19 exposure to both students and faculty members, projecting that 34-44 million adults in the U.S. are at an increased risk of severe COVID-19 from direct or indirect school exposure alone. The researchers based their analysis on pre-pandemic census data to evaluate how often at-risk individuals were connected to schools. The findings suggest that between 42-51.4% of all school employees had elevated risk of severe COVID-19, while 63.2% of employees and 58.7% of students lived with at least one “at-risk” adult. The racial divide was also captured, as Black (67.3%) and Hispanic (64.6%) children were most likely to live with an ‘at-risk’ adult.
New Insights on COVID-19 Reinfection, 'Spike' Binding Proteins
- A study in Infectious Disease Society tracked the possibility of COVID-19 reinfection using data from over 1,200 patients that were discharged from hospitals in the U.S. from mid-January to mid-March. Over a 28-day period, almost 15% (n=189) of discharged patients retested positive, most notably including younger patients and with symptoms that were observed to be more moderate relative to the first positive tests. While these results are encouraging in terms of COVID-19 reinfection, the CDC notes that the study did not include viral genotyping to determine whether the COVID-19 reinfection was due to a relapse or new infection.
- A number of research papers last week also point to our expanded understanding of how the Coronavirus attacks cells. One notable study in Nature revealed unique morphological characteristics of the ‘spike’ binding proteins of SARS-CoV-2, including binding to ACE2 receptors which are commonly located on cells and tissues on organs such as the heart, lungs, kidneys, and the liver. The results from Benton et al suggest that during this binding process, the spike protein changes is able to reshape “at least 10 times,” occurring after the initial binding process and becomes more open to allow its binding sites to be easily accessible.
Rising Rates of Forced Migration Exacerbated by COVID-19, Food Insecurity
- The Internal Displacement Monitoring Centre (IDMC) released its mid-year update last week, highlighting the catalyzing role of COVID-19 alongside conflict and violence that led to 4.8 million people being displaced in Africa and the Middle East, an increase of more than one million people when compared to the previous year. While countries like Syria and the Democratic Republic of Congo constitute the largest net drivers of forced displacement (with 1.5 and 1.4 million people, respectively), the situation in Burkina Faso is quickly devolving into the worst displacement crisis in West Africa, with over 420,000 at-risk population being forcibly displaced due to armed conflict. The IDMC Director noted that the pandemic has limited access to health care while increasing economic hardship and protection risks for displaced communities. In Syria, Save the Children reports that an additional 700,000 children face chronic hunger, with one in eight face developmental risks such as stunting, due to a collapsing economy (including the crash of its local currency) and COVID-19 restrictions. During its annual consultation with NGOs, the Chairman of the UNHCR stressed that the biggest challenge would be to shield refugees from the economic impacts of the pandemic, which has hit the most marginalized the hardest. The international community was also urged to ensure refugees are included in social safety nets and support services.
UNDP and UN Women Launch COVID-19 Global Gender Response Tracker
- The UNDP in collaboration with UN Women launched the COVID-19 Global Gender Response Tracker that examines policy measures by governments that integrate a gender lens. The aim of the dashboard is to monitor progress and share best practices that support the social and economic protection of women and girls, including tackling gender-based violence, strengthening women’s economic security and supporting unpaid care work. While Devex reports that only 25 countries have thus far responded, the Tracker has identified that 71% of all government actions (representing 704 measures across 135 countries) focus on these issues. The emphasis on government policy measures reflects the fact that only sustained and long-term planning policies can effectively address the long-term consequences of the pandemic on women and girls, which is why the Tracker aims to provide guidance for policymakers and evidence for advocates to ensure a gender-sensitive COVID-19 policy response.
Encouraging Results from Moderna Stage 3 Clinical Trials
- The researchers behind Moderna’s COVID-19 vaccine candidate (MRNA1273) published a new paper in the New England Journal of Medicine with preliminary results from its Stage 3 Human Trials. Based on 40 participants over the age of 56 that were recruited for the study, the authors conclude that the at-risk cohort has reacted very well to the vaccine candidate when given two doses of the vaccine four weeks apart. After the second immunization, the researchers noted that neutralizing antibody responses were recorded in all participants using several different methods, while binding and antibody responses were similar to those reported in those aged between 18 and 55 years old. Side effects were also reported to be “mild or moderate” in severity with common symptoms including fatigue, chills, headache, myalgia and injection site pain.
GAVI, Gates and Serum Institute to Produce 200 million COVID-19 Vaccines for LMICs
- Last week also saw the Gates Foundation and Gavi, the Vaccine Alliance doubling their funding to the Indian Serum Institute in order to provide up to 200 million doses of a future COVID-19 vaccine to low- and middle-income countries. The partnership includes 16 of the leading pharmaceutical companies that are developing Coronavirus vaccines, as the increased likely that more than one vaccine may be available as early as next year would allow for a rapid scaling up of production and distribution capacities. The additional funds will allow the Serum Institute to boost manufacturing of the vaccine candidates that are being developed by AstraZeneca and Novavax for delivery under the COVAX Facility as early as the first half of 2021. An analysis by DW outlines the enormous manufacturing capacity of the Serum Institute that have made it the largest vaccine manufacturer by volume in the world at over 1.5 billion doses a year. While 33 COVID-19 vaccine candidates are currently in clinical trials, the Serum Institute has already produced two million doses of the Oxford-AstraZeneca ‘Covishield’ vaccine candidate for use in testing, including State 3 Clinical Trials in India, the U.S., Brazil and South Africa. Should the clinical trials indicate that the vaccine candidate is both safe and effective, the Serum Institute has indicated it could scale up production to 10 million doses a month, as economies of scale would bring the cost down to under US$13 a dose.