at Dadhaleh Institute

Compounding crises undermine ethical, equitable COVID-19 response

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh The strongest cyclone ever recorded in [ ... ]

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.

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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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 ) [3] => 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.

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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 ) [5] => WP_Post Object ( [ID] => 1995 [post_author] => 1 [post_date] => 2020-05-28 08:01:20 [post_date_gmt] => 2020-05-27 12:01:20 [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.

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.

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Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh

The strongest cyclone ever recorded in the Bay of Bangal (with maximum sustained winds up to 265km/h) is expected to hit India and Bangladesh on Wednesday. Millions of people are being forced to evacuate north-east India, while only 12,000 shelters have been prepared in Bangladesh to house the nearly five million people in the expected path of Cyclone Amphan. The impact is likely to be hardest on those living in low-lying flood prone coastal areas, as the Needs Assessment Working Group of Bangladesh estimates that up to 14.2 million people in coastal districts are likely to be affected, displacing 1.4 million people and damaging up to 600,000 houses.

Vulnerable communities affected by COVID-19 outbreaks and lockdown will also likely be impacted, including the approximately 1.2 million Rohingya refugees that live in over-crowded camps in Cox’s Bazar in Bangladesh. In collaboration with humanitarian partners, including UNICEF and UNHCR, the IOM is constructing a COVID-19 treatment centre in Cox’s Bazar along with cyclone preparedness effort (alerting the community, reinforcing critical infrastructure and prepositioning emergency items before the cyclone makes landfall).

COVID needs in Humanitarian Emergency Settings

The UN High Commissioner for Refugees made an appeal for US$745 million for preparedness and response to outbreaks of COVID-19 among the more than 71 million refugees and forcibly displaced people that remain acutely vulnerable. While no major outbreaks have been reported in large refugee and IDP settlements, UNHCR is rapidly scaling up efforts in 134 refugee-hosting countries that are reporting local transmission. There is also widespread evidence of deep economic impacts on refugees, as 70% of refugees surveyed admitted to skipping meals, and this is most acute among refugee women.

Médecins Sans Frontières has outlined five key priorities for the international community in order to protect migrants and vulnerable populations in humanitarian response locations. These include:

Ensuring COVID-19 is not used as an excuse to enforce restrictive migration control policies and evade international obligations towards refugees, asylum seekers and migrants;
Governments must not use COVID-19 emergency measures to target refugees, asylum seekers and migrants, and measures should be proportionate and limited in duration, respect human dignity, and based on scientific evidence and not applied arbitrarily;
Lockdowns and mass quarantining cannot be cut-and-pasted or discriminatorily applied;
Direct humanitarian evacuation corridors for displaced people at risk (including people above 60 years and those with respiratory conditions, diabetes, or other health complications); and
Safeguarding access to healthcare for all (ensuring border closures do not prevent the mobility of people, essential supplies and aid workers, particularly in humanitarian response locations).

EU is Creating Humanitarian Air Bridges to enable the COVID-19 Response

The European Commission has allocated 10 million Euro to support a humanitarian air bridge amid travel shutdowns. In the absence of commercial air travel, the air bridge will allow humanitarian staff and supplies to be delivered across 30 routes deemed important for the COVID-19 response, with the first flight launched last week from France to the Central African Republic with 60 humanitarian workers and 13 metric tons of humanitarian cargo.

Build Back Better After COVID-19

The International Recovery Platform developed a toolkit of existing guidelines and tools to support countries and communities when they are ready to recover from the COVID-19 pandemic crisis. It supports recovering communities to “build back better” towards more resilient health systems, economies, and more just societies. The Compendium of Tools and Guidelines are organized according to four categories: Health Sector Recovery; Private Sector and Livelihood Recovery; Inclusive Recovery; and Disaster Recovery Governance. The IRP is a joint initiative of UN, international finance institutions, national and local governments, and NGOs engaged in disaster recovery and sustainable development.

A paper commissioned by the Swedish International Development Cooperation Agency provides analysis and guidance on to inform the design, implementation and adaptation of conflict sensitive humanitarian and development responses to COVID-19.

Lancet Papers Decry the lack of Ethical global leadership on health inequities around COVID-19

A paper in the Lancet calls for greater ethical global leadership on health inequities during the COVID-19 pandemic. The authors reference widespread reports of the disproportionate impact of the pandemic on vulnerable communities around the world, while pointing to “unconscionable stockpiling by wealthy countries” and even attempts to extract profits from the crisis through economic speculation.

Another paper in the same issue highlights how social inequalities in health profoundly, and unevenly, impacting COVID-19 morbidity and mortality. Among the social determinants of health, the authors identify emerging findings on the correlation of the pandemic with poverty (including homelessness), physical environment, and race or ethnicity. The paper also notes how physical distancing measures are significantly more difficult for vulnerable and marginalized populations, while school closures have increased food insecurity for children living in poverty, exacerbating physical and mental health. The authors urge policymakers to emphasize the mitigation of social determinants, including improving housing and reducing overcrowding as well as improving access to health services and income support. The paper also calls on social determinants of health to be an essential part of pandemic research priorities, public health goals, and policy implementation.

Preventing a COVID-19 Related Global Food Crisis

The Food and Agriculture Organization made an appeal for US$350 million to scale up efforts to address hunger and livelihood-boosting efforts in contexts vulnerable to food crisis. As part of the broader UN Global Humanitarian COVID-19 Plan, the appeal will include supporting farmers’ access to fields, seeds and other inputs to plant or buy feed for their animals in order to avoid the cascading impacts of missing planting seasons such as drops in output. The FAO also advocates proactive efforts for stronger emergency livelihoods interventions to avoid famines.
The WEF also reports how the pandemic has amplified the risk of worldwide food-price spikes, urging greater coordination across governments to avert disruptions to food supply chains, including through food protectionism. While lockdowns have led to a collapse in demand for discretionary goods and services, the opposite is true of food as panic buying and food hoarding has proliferated. On the supply side, global grain stockpiles could be quickly depleted as the virus disrupts production and distribution, compounded by the worst locust outbreak in 70 years that have left countries in East Africa acutely vulnerable. In Kenya, for example, the price of staple foods has risen by 60% since last year.
ICRISAT published a new report that outlines four key strategies to protect the lives and livelihoods of farming communities in Eastern and Southern Africa. These include:
1. Diversification of farming systems for improved resilience and profitability (including technologies suitable for sustainable intensification);
2. Enhancing access to seed at scale of grain legumes and dryland cereals (through community seed banks that also supports grain aggregation);
3. Building capacity of partners to promote technologies in a participatory manner (including governments, community organizations, local leaders and women); and
4. Gender integration and empowerment to engage actively in agribusinesses (including livelihood-strengthening activities like climate-smart agriculture)

CommunityFirst COVID-19 Roadmap

This week, SeeChange Initiative and Ilisaqsivik Society, in partnership with the Association of Médicos Sin Fronteras in Latin America, and the Dahdaleh Institute, launched the CommunityFirst COVID-19 Roadmap, a planning tool to empower communities in developing local strategies to organize, prepare and respond to COVID-19. The Roadmap is available in English, Spanish and Inuktitut, and also includes an Emergency Readiness Checklist. Last month, the Executive Director of SeeChange and a Steering Committee member of the CommunityFirst Roadmap published an article in the Lancet on local efforts among Inuit communities to address COVID-19 and TB. The role of community-based responses to the pandemic was also highlighted in STAT.

Webinar Resources

COVID-19 in Humanitarian Setting: Magnifying Gender Inequalities? (JHU)
- Wednesday, May 20, 2020 (8-9am EST)
Digital Solutions to Covid-19 and Urban Challenges in Sub-Saharan Africa (CSIS)
- Thursday, May 21, 2020 (9-10am EST)
Humanitarian Operations During Covid-19: A Conversation with UNHCR (CSIS)
- Monday, June 8, 2020 (9:30-10:15am EST)

[post_title] => Compounding crises undermine ethical, equitable COVID-19 response [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => compounding-crises-undermine-ethical-equitable-covid-19-response [to_ping] => [pinged] => [post_modified] => 2020-08-13 22:31:50 [post_modified_gmt] => 2020-08-14 02:31:50 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/compounding-crises-of-covid-19-and-super-cyclone-in-india-and-bangladesh/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [7] => WP_Post Object ( [ID] => 2372 [post_author] => 1 [post_date] => 2020-04-19 11:30:30 [post_date_gmt] => 2020-04-19 15:26:30 [post_content] =>

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

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

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

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

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

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Reflections by Dr. Andrew Nevin, Price Waterhouse Cooper Nigeria, 5 April 2020

The Dahdaleh Institute invited Dr. Andrew Nevin, a Partner and Chief Economist at PWC Nigeria, to offer his views on core structural imperatives in dealing with COVID-19 in Africa beyond healthcare responses.

In the absence of a climate effect, Dr. Nevin warns African countries are headed for a humanitarian crisis in part due to weak healthcare systems, vulnerable populations, limited risk messaging, overcrowded housing and other difficulties with socially distancing. He anticipates the impacts in Africa could include:

Significant reduction in daily wages;
Breakdown of food supply chains;
Inability of the public sector to function virtually;
Strong private sector response in managing their businesses;
Confusion about who is in charge, and
Lack of information.

Based on these anticipated impacts, Dr. Nevin identified the following non-health system related priorities for African countries for COVID-19:

Direct transfers to the bottom of the pyramid to replace purchasing power;
Ensuring that food supply chains keep working;
Getting organized private sector to support the public sector (e.g. national emergency committees as decision-making bodies with government and industry partners);
Rapid and coordinated economic support and debt relief by international finance institutions; and
Reflect on possible structural change (e.g. economic decentralization) following response

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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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