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Prepared by. Dr. James Orbinski Director, Dahdaleh Institute for Global Health Research,  Aria Ilyad Ahmad, Dahdaleh Institute for Global Health Research
Period. 15 - 21 September 2020

State of the Pandemic

The WHO Weekly Epidemiological Update reported that the pandemic has surpassed 30 million confirmed cases, and that the number of confirmed COVID-19-related deaths approach one million globally. Many regions are reporting a [... ]one minute.
The WHO Weekly Epidemiological Update reported that the pandemic has surpassed 30 million confirmed cases, and that the number of confirmed COVID-19-related deaths approach one million globally. Many regions are reporting a resurgence in cases, as countries experiment with different strategies for reopening schools and businesses, as the International Monetary Fund last month estimated the pandemic is costing the global economy US$375 billion a month. With more than 15 million confirmed cases, the region of the Americas represents over half the global burden of the pandemic. The U.S. and Brazil remain among the top three countries, while Venezuela is approaching a humanitarian catastrophe as outbreaks in the capital have exacerbated existing food shortages and economic crisis. Public health experts are also warning that the virus is spreading from major cities to less populated areas of Latin America where health systems are weaker. A quarter of the countries in the region have suspended routine vaccination, at least 25 countries have suspended primary care programs for diabetes and hypertension – notable risk factors for COVID-19 – while pregnancy-related health services have dropped by nearly 40% in the region. The WHO Director for the Americas region urged countries to sustain essential health services, as well as scaling up alternative approaches such as telemedicine, home visits, and community outreach.
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UN Resolutions Encourage International Cooperation on COVID-19 Response

Countries will meet for the 75th UN General Assembly this coming week where they will adopt two resolutions on the Global Response to COVID-19. Acknowledging the key leadership role of the WHO [... ]a minute and a bit.
Countries will meet for the 75th UN General Assembly this coming week where they will adopt two resolutions on the Global Response to COVID-19. Acknowledging the key leadership role of the WHO and the UN system more broadly, the all-encompassing resolutions call for intensified international cooperation and solidarity to contain, mitigate and overcome the pandemic and its consequences through responses that are people-centred and gender-responsive, with full respect for human rights. It also encourages countries to partner with relevant stakeholders in order to increase R&D funding for diagnostics, treatment and vaccines, leverage digital technologies, and strengthen scientific cooperation. The resolution moreover urges climate- and environment-sensitive approaches to drive the recovery, reflecting growing support and recognition within the UN of the importance of combatting the threat of climate change. Two countries voted against the UN resolution in a break from multilateralism: the U.S. launching renewed attacks against China in rejecting the expressions of support for the WHO, while Israel objected to an amendment that discouraged countries from enacting unilateral sanctions on states that were not in accordance with international law. The last-minute amendment was introduced by Cuba and supported by 84 countries, claiming the original text failed to reflect concerns on national efforts to deal with the COVID-19 crisis. In a second resolution that was adopted unanimously, the UN General Assembly called for intensified international cooperation and multilateral efforts in addressing current and future disease outbreaks. That includes sharing timely, accurate and transparent information, exchanging epidemiological and clinical data, sharing materials necessary for R&D, and implementing relevant guidance, including the International Health Regulations. The resolution also stressed the importance of expanding global efforts to fight health crises in order to maintain economic stability by supporting economies, protect workers and businesses as well as shielding the vulnerable through adequate social protection.
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Strengthening Pandemic Preparedness and Response

Last week, the Global Pandemic Monitoring Board published its second annual report calling for multilateral systems to strengthen global pandemic preparedness and response capacity. The independent body, convened by the WHO and [... ]one minute.
Last week, the Global Pandemic Monitoring Board published its second annual report calling for multilateral systems to strengthen global pandemic preparedness and response capacity. The independent body, convened by the WHO and the World Bank, noted that the COVID-19 pandemic has been exacerbated by a “failure of governance in global collective action, including coordination and engagement with multilateral systems” as well as financing gaps in global health security, including “chronic underinvestment in preparedness as well as states withdrawing financial support.” The report calls for a re-centering of governance across multilateral systems, including in the following areas: (a) global and regional mechanisms to track pathogens, (b) strengthen early warning and information sharing, (c) intermediate grading of health emergencies, (d) evidence-based policy formulation on travel and trade restrictions, (e) collaborative mechanisms for research and regulatory harmonization, as well as (f) strengthening IHR compliance assessment and enforcement mechanisms. Global health security presents distinct challenges in low- and middle-income countries, according to the Centre for Global Development, requiring policy restructuring to ensure development gains. In the article, the President of CGD outlines three key problem areas that require coordinated global action: (1) reversing decades of underinvestment in global health security, (2) ensuring the continuity of developmental programs, and (3) expanding funding for these programs to reflect the disproportionate impact of the looming economic crisis on vulnerable populations.
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Africa Surpasses One Million Cases as Pandemic Expands to Rural Areas

With 17% of the world’s population, countries in Africa account for only 4% of reported cases and 3% of COVID-related deaths globally. Researchers have not been able to explain what the WHO [... ]less than two minutes.
With 17% of the world's population, countries in Africa account for only 4% of reported cases and 3% of COVID-related deaths globally. Researchers have not been able to explain what the WHO Regional Director for Africa described as a "slow burn" in early August despite the continent surpassing one million cases. Various hypotheses are being explored, including the continent’s youthful population, the possibility of a certain degree of 'herd immunity' from past exposure to other coronaviruses, or a lack of adequate disease surveillance. Two studies published this month, however, suggest that Africa’s infection rate may be significantly higher than the official figures. The South African Medical Research Council, reviewing mortality trends, recorded over 41,000 “excess deaths” between May 6 and August 25, 2020 compared to last year, indicating a steeper pandemic trajectory. The researchers also reported that 40% of pregnant women as well as people with HIV/AIDS that visited public health facilities in Cape Town had SARS-CoV-2 antibodies. In another study, blood samples of Kenyan blood donors tested between in the first two weeks of May found that 5.6% had antibodies for COVID-19, while almost 10% of donors in Mombasa were positive, significantly higher than Kenya’s official infection rate at the time (2093 cases, 71 deaths). With almost half of all cases, South Africa remains a particular concern, as the WHO earlier this month dispatched a surge team to support pandemic response efforts in the country. Additional resources have been deployed in other countries as the burden of infections spreads beyond major cities to rural areas, increasing the need for decentralized testing, tracing, isolation, and treatment beyond urban hubs. The continent’s pandemic response funding gap is expected to exceed US$100 billion annually over the next three years. So far, the World Bank, the IMF and the African Development Bank have disbursed about US$60 billion to countries in Africa. That sum is slightly lower than the estimated $65 billion monthly cost of lockdowns, as the IMF projects economic activity in Sub-Saharan Africa to contract by 3.2% this year alone. Many of these developing economies will need significant capital bases to frontload pandemic preparedness and response capacity, as multilateral development banks and the international community have been urged to take bold, innovative, and expeditious action. Among the proposals is another replenishment round for the World Bank’s International Development Association, as well as new allocations of the IMF's Special Drawing Rights that currently exceed US$129 billion.

The Coronavirus Comorbidity Crisis & Progress Against Infectious Diseases

A paper in Lancet highlights growing concerns over COVID-19 and underlying comorbidities. Major disruptions in essential non-communicable disease care have been reported by 75% of countries, as public health campaigns and NCD [... ]one minute.
A paper in Lancet highlights growing concerns over COVID-19 and underlying comorbidities. Major disruptions in essential non-communicable disease care have been reported by 75% of countries, as public health campaigns and NCD surveillance efforts are also impacted. This has raised alarms, particularly as chronic conditions like diabetes and cardiovascular diseases are both drivers of and exacerbated by COVID-19. One recent study in JAMA Cardiology, for example, shows how individuals recovering from the virus develop myocarditis, while 78% of participants had evidence of prior heart inflammation. The NCD Alliance suggests that the concern between COVID-19 and NCDs could be country-specific. Pointing to investments in chronic disease prevention and treatment measures by countries like Jamaica, Jordan and South Africa, the control of NCDs should in this way also be part of pandemic preparedness. The WHO Director for the Americas last month also warned that COVID-19 is undermining efforts to eliminate and control other infectious diseases such as HIV/AIDS, TB and Hepatitis. Upwards of 80% of countries in Latin America and the Caribbean reported challenges, as manageable cases risk becoming active infections. Decline in the number of people being tested is also obscuring the true picture of what is happening with the diseases, as health systems are urged to leverage telemedicine and provide care outside of hospital settings, such as in community outreach programs or home visits. Spikes in cases in Peru have meanwhile led to escalating unrest over demands for economic aid.

Record-Low Influenza Season in the Southern Hemisphere

The WHO has reported a significant drop in flu activity in the Southern Hemisphere which would typically be in the middle of its influenza season. There were initial concerns that the decline [... ]just over two minutes.
The WHO has reported a significant drop in flu activity in the Southern Hemisphere which would typically be in the middle of its influenza season. There were initial concerns that the decline in reported flu cases reflected reduced testing capacity or strained health care systems attempting to respond to COVID-19. The WHO, however, maintains a network of national research centres, including Australia, Argentina, South Africa, Paraguay, New Zealand and Chile. While the total number of influenza tests fell by 20% in these six countries, the share of positive tests dropped to record lows that are “unprecedented,” according to the South African National Institute for Communicable Diseases. An article in the Lancet credits the enhanced hygiene and physical distancing measures that many countries are undertaking as part of their COVID-19 response efforts for the reduction in reported flu cases. The author, meanwhile, also warns of the potential impact of altered infection testing priorities, health-care personnel capacity, and health seeking behaviours during the pandemic should not be ignored. At the same time, the record-low flu season flu in the Southern Hemisphere has also created a potential blind spot, as less circulating influenza virus means fewer clues about the genetic variants most prevalent and likely to contribute to the coming flu season in the Global North. One strategy to reduce the likelihood of a double epidemic would be to expand influenza vaccination programs, both in reducing the flu burden and to counteract their facilitatory impact on COVID-19. The Director of the CDC has urged local health authorities to scale up flu vaccine programs, particularly among high-risk populations such as children and the elderly, in order to reduce the overall burden on health systems. In the U.S., flu vaccine production is expected to increase by 13% to 200 million doses, with two new quadrivalent flu vaccines specifically developed for seniors this year. The CDC has also developed a new diagnostic test that allows public health labs to test for both influenza and COVID-19, that would be used for surveillance purposes to track how both diseases are spreading and whether they can co-circulate. As advanced economies have been able to place large order for the influenza vaccine, however, there are concerns that the further increase in global demand could lead to a vaccine shortage. Public health experts have also warned that entering the winter without a Coronavirus vaccine could present challenges for countries where pressures to reopen schools and businesses could result in COVID-19, influenza and seasonal cold co-circulating in indoor spaces. That caution is echoed by a pre-publication on MedRXiv that models the impact of the coming flu season on the spread of COVID-19. The study, currently under peer-review, uses a population model to project an estimated 2 to 2.5-fold increase in novel Coronavirus transmission associated with influenza during the period of co-circulation.

Reducing Asymptomatic Transmission with Universal Masking

A new paper in the New England Journal of Medicine provides further support for the use of face masks by suggesting that universal masking may be a way to sharply reduce asymptomatic [... ]less than a minute.
A new paper in the New England Journal of Medicine provides further support for the use of face masks by suggesting that universal masking may be a way to sharply reduce asymptomatic cases of COVID-19. The theory is inspired by variolation, an inoculation concept first developed to vaccinate against smallpox, where an individual is exposed to material worn by an infected person with the aim of prompting a mild infection. The hypothesis with respect to COVID-19 is that masks provide protection against the majority of infectious material, but if some viral matter were to pass through, it would likely be low enough for the body to develop an immune response. At this point, the theory remains only theoretical, as one respiratory scientist suggests variolation could be feasible as the body reacts to low levels of airborne COVID-19 which should incite an immune response.

Vaccine Capped at US$3 per dose in LMICs

The GAVI Vaccine Alliance announced a landmark collaboration last month that aims to expand existing vaccine capacity so that production can begin as soon as a COVID-19 vaccine is approved, which could [... ]less than a minute.
The GAVI Vaccine Alliance announced a landmark collaboration last month that aims to expand existing vaccine capacity so that production can begin as soon as a COVID-19 vaccine is approved, which could be as early as 2021. The partnership includes the Gates Foundation, the Coalition for Epidemic Preparedness Innovations as well as the Serum Institute of India (SII), the world leading vaccine manufacturer. The former would provide US$150 million in initial funding to support vaccine production for low- and middle-income countries who are often relegated to the back of the line for new therapeutics or vaccines. As part of the agreement, SII would develop candidate vaccines that are licensed to the WHO prequalification, at a capped price of US$3 per dose. The development would be part of the COVAX Facility, a collaboration between the WHO, Gavi, and CEPI to share the risks of vaccine development, invest in manufacturing, and pool purchasing power to deliver vaccines equally among all countries. The advance marketing commitment part of the COVAX Facility provides vaccine purchase funding for 92 low- and middle-income countries.

Resumption of Vaccine Trials Following Safety Concerns

Astra Zeneca and Oxford University resumed clinical trials for AZD1222, considered among the most promising COVID-19 vaccine candidate. The Phase 3 human trials for the experimental vaccine were briefly put on hold [... ]a few seconds.
Astra Zeneca and Oxford University resumed clinical trials for AZD1222, considered among the most promising COVID-19 vaccine candidate. The Phase 3 human trials for the experimental vaccine were briefly put on hold after one participant was hospitalized with neurological symptoms. Health experts noted that it was standard procedure to halt trials in the case of an adverse event and commended the quick stoppage of the trials. Following established safety protocols, the research team was able to confirm that the symptoms were consistent with transverse myelitis that was not related to the vaccine. The participant recovered in a few days, and no other trial participants reported any notable symptoms.

Improving Access and Affordability to Remdesivir through Compulsory Licensing

The U.S. FDA last month approved an Emergency Use Authorization for Remdesivir, an experimental broad-spectrum antiviral. Initially developed by Gilead Sciences for the treatment of Ebola virus and despite mixed clinical findings, [... ]less than a minute.
The U.S. FDA last month approved an Emergency Use Authorization for Remdesivir, an experimental broad-spectrum antiviral. Initially developed by Gilead Sciences for the treatment of Ebola virus and despite mixed clinical findings, Remdesivir has since been approved to treat severe cases of COVID-19 in hospitalized patients. An article in BMJ, however, reports on major shortages, in part due to limited supply and its steep price. While Gilead claims it has temporarily licensed the production of the antiviral on a non-cost basis to nine generic manufacturers, as Gilead’s CEO blames the shortages on global supply chain disruptions. Critics, however, argue that countries not covered by Gilead’s licence would still have to procure Remdesivir directly from Gilead at themselves at US$2,340-3,120 for one course of treatment. Supply issues are also exacerbated by advanced economies placing advance purchase commitments that limit access in lower income countries, as the authors of the BMJ paper urge greater compulsory licensing. The former head of the CDC also urged local, regional and national authorities to accelerate preparation to ensure efficient vaccine distribution.

Handwashing and Hygiene Initiatives increasing in Africa

During World Water Week in early September, the Lancet published a series of articles highlighting the impact of global gaps in water, sanitation and hygiene (WASH) measures on both the COVID-19 pandemic [... ]nearly a minute.
During World Water Week in early September, the Lancet published a series of articles highlighting the impact of global gaps in water, sanitation and hygiene (WASH) measures on both the COVID-19 pandemic as well as progress towards UN Sustainable Development Goal 6. While 1.8 billion people gained access to basic water and sanitation services since 2000, according to the WHO, as of 2017 about 2.2 billion still lack access to safe water, 3 billion lack basic handwashing facilities and 4.2 billion people lack safe sanitation services. In another article, authors showcase the range of WASH measures countries have adopted during the COVID-19 pandemic. That include efforts by African governments, including increased access to handwashing stations in high-density locations (e.g. community centres, schools, bus terminals and shopping markets) and expanding access to clean water (e.g. drilling boreholes mobilizing water tankers). Significant challenges remain in humanitarian response locations as well as dense low-income urban settlements. The acceleration of clean cooking initiatives also remains critical, as 80% of the population in high-risk areas of Sub Saharan Africa rely on solid fuels (i.e. wood, coal, crop residues) gathered from high-density location, that moreover present respiratory health concerns.