Low-income countries have received just 0.2 per cent of all COVID-19 shots given

Although more than 700 million vaccine doses have been administered globally, richer countries have received more than 87 per cent, and low-income countries just 0.2 per cent. 

“There remains a shocking imbalance in the global distribution of vaccines”, said WHO chief Tedros Adhanonom Ghebreyesus, speaking during the agency’s regular briefing from Geneva.   

“On average in high-income countries, almost one in four people has received a vaccine. In low-income countries, it’s one in more than 500.  Let me repeat that: one in four versus one in 500.” 

Bilateral deals hurt COVAX 

The global solidarity initiative, COVAX, has also experienced a shortage of vaccines.  While the mechanism has distributed some 38 million doses so far, it was expected to deliver nearly 100 million by the end of March. 

“The problem is not getting vaccines out of COVAX; the problem is getting them in”, he said. 

“We understand that some countries and companies plan to do their own bilateral vaccine donations, bypassing COVAX for their own political or commercial reasons. These bilateral arrangements run the risk of fanning the flames of vaccine inequity.” 

Scaling up solidarity 

COVAX partners, who include Gavi, the vaccine alliance, are working on several options to scale up production to meet the goal of delivering two billion doses by the end of the year. 

Dr Seth Berkley, the Chief Executive Officer at Gavi, highlighted the need for continued solidarity. 

“What we are now beginning to see are supply constraints, not just of vaccines, but also of the goods that go into making vaccines”, he said. 

COVAX is in discussions with several high-income countries to get them to share surplus vaccine doses, he said. It is also developing cost-sharing mechanisms so that low income countries can buy additional doses through COVAX, funded by multilateral development banks. 

Dr Berkley added that financing is also needed as demand for vaccines has risen with the emergence of new COVID-19 variants. 

Concern over the ‘raging inferno’ in Brazil 

WHO remains deeply concerned about what one of its experts labelled the “raging inferno of an outbreak” in Brazil, in response to a journalist’s question about scaling up vaccines to address the emergency there. 

South America’s largest country has recorded more than 340,000 deaths since the pandemic began, making it second only to the United States. 

Tedros said he has spoken with the newly appointed health minister, and officials at the federal level, which he hoped will “help with moving forward in our partnership.” 

Continue prevention measures

Dr. Bruce Aylward, a WHO Senior Adviser, described the situation in Brazil as “very, very concerning”.  Delivering more vaccines would have minimal impact, he said, emphasizing the need to continue measures that have proved to slow virus spread. 

“Even by the time you get vaccines into a country, by the time you get them into people – and you’re getting them to a relatively small proportion of the population – that will have a small effect in limiting the risk to some people”, he said. 

“But what you’re dealing with here is a raging inferno of an outbreak, and that requires population-level action in the rapid identification, isolation, quarantining, because you have to approach this at that scale to slow this thing down.” 

Dr. Maria Van Kerkhove, WHO Technical Lead on COVID-19, added that while vaccines are a powerful tool, they alone will not end the pandemic.   

“The trajectory of this pandemic around the world is going in the wrong direction”, she said, referring to six consecutive weeks of increased cases and rising deaths.  

“We have tools right now that can prevent infections and can save lives, so we need to find reasons why measures aren’t in place…and find solutions to actually get these in place.” 

Migrants left stranded and without assistance by COVID-19 lockdowns 

According to the International Organization for Migration (IOM), the first year of the pandemic saw more than 111,000 travel restrictions and border closures around the world at their peak in December.  

These measures “have thwarted many people’s ability to pursue migration as a tool to escape conflict, economic collapse, environmental disaster and other crises”, IOM maintained. 

In mid-July, nearly three million people were stranded, sometimes without access to consular assistance, nor the means to meet their basic needs.  

In Panama, the UN agency said that thousands were cut off in the jungle while attempting to travel north to the United States; in Lebanon, migrant workers were affected significantly by the August 2020 explosion in Beirut and the subsequent surge of COVID-19 cases. 

Business as usual 

Border closures also prevented displaced people from seeking refuge, IOM maintained, but not business travellers, who “have continued to move fairly freely”, including through agreed ‘green lanes’, such as the one between Singapore and Malaysia.  

By contrast, those who moved out of necessity – such as migrant workers and refugees – have had to absorb expensive quarantine and self-isolation costs, IOM said, noting that in the first half of 2020, asylum applications fell by one-third, compared to the same period a year earlier.  

Unequal restrictions 

As the COVID crisis continues, this distinction between those who can move and those who cannot, will likely become even more pronounced, IOM said, “between those with the resources and opportunities to move freely, and those whose movement is severely restricted by COVID-19-related or pre-existing travel and visa restrictions and limited resources”. 

This inequality is even more likely if travel is allowed for anyone who has been vaccinated or tested negative for COVID-19, or for those with access to digital health records – an impossibility for many migrants. 

Health risks 

Frontier lockdowns also reduced options for those living in overcrowded camps with high coronavirus infection rates in Bangladesh and Greece, IOM’s report indicated.  

In South America, meanwhile, many displaced Venezuelans in Colombia, Peru, Chile, Ecuador and Brazil, lost their livelihoods and some have sought to return home – including by enlisting the services of smugglers. 

COVID-19: WHO chief outlines five ‘vital changes’ to address inequities

“While we have all undoubtedly been impacted by the pandemic, the poorest and most marginalized have been hit hardest – both in terms of lives and livelihoods lost,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, speaking in Geneva on Tuesday. 

A major barrier 

At the beginning of the year, Tedros called for countries to start vaccinating all health workers within the first 100 days of 2021.  Some 190 nations have meet the deadline, while the global vaccine equity initiative, COVAX, as delivered 36 million doses worldwide. 

Tedros said scaling up production and equitable distribution remains the major barrier to ending the acute stage of the pandemic. “It is a travesty that in some countries health workers and those at-risk groups remain completely unvaccinated”, he stated. 

WHO will continue to call on governments to share vaccine doses and to support the ACT Accelerator for the equitable distribution of vaccines, rapid tests and therapeutics. 

Invest in primary health care 

With the pandemic exposing the fragility of health systems, Tedros stressed investment in primary health care must also be stepped up.  At least half of the world’s population still do not have access to essential health services, while 100 million are pushed into poverty each year due to medical expenses. 

“As countries move forward post-COVID-19, it will be vital to avoid cuts in public spending on health and other social sectors. Such cuts are likely to increase hardship among already disadvantaged groups,” he said. 

Instead, governments should target spending an additional one per cent of GDP on primary health care, while also working to address the shortfall of 18 million health workers needed globally to achieve universal health coverage by 2030. 

Social protection, safe neighbourhoods 

Tedros also encouraged national authorities to prioritize health and social protection, and to build safe, healthy and inclusive neighbourhoods.  

“Access to healthy housing, in safe neighbourhoods, is key to achieving health for all”, he said.  “But too often, the lack of basic social services for some communities traps them in a spiral of sickness and insecurity. That must change.” 

Countries must also intensify efforts to reach rural communities with health and other basic services.  Tedros noted that “80 per cent of the world’s populations living in extreme poverty are in rural areas where 7 out of 10 people lack access to basic sanitation and water services.” 

For his final point, the WHO chief emphasized the need to enhance data and health information systems, which are critical to finding and addressing inequalities. 

“Health inequality monitoring has to be an integral part of all national health information systems – at present just half the world’s countries have any capacity to do this”, he said. 

Change the rules

The huge inequalities in health care also figured heavily in the statement from the Executive Director of UNAIDS, Winnie Byanyima, for World Health Day, which further revealed that 10,000 people die every day because they cannot access services.  

She warned that the gaps will continue to widen as health systems increasingly become profit-led, but added that the pandemic could lead to greater commitment towards ensuring all people have access to quality healthcare.

“Now, in the midst of the COVID-19 crisis, leaders across the world have an opportunity to build the health systems that were always needed, and which cannot be delayed any longer,” Ms Byanyima said. 

“We cannot tinker around the edges—we need radical, transformative shifts. The COVID-19 response gives us an opportunity to change the rules and guarantee equality.”

COVID-19 lays bare social inequality says UN chief, as COVAX doses top 36 million

Highlighting the inequalities and injustices that have been apparent throughout the pandemic, Secretary-General António Guterres said in his message for the day to be marked on Wednesday, that the vast majority of vaccine doses administered so far, have been confined to “a few wealthy countries” or those producing the shots cleared for distribution.

“Within countries, illness and death from COVID-19 has been higher among people and communities that contend with poverty, unfavourable living and working conditions, discrimination and social exclusion”, said Mr. Guterres.

Countries forced to ‘watch and wait’

Thanks to the COVAX initiative, the UN backed international effort to provide equitable vaccines across the world, more countries are receiving doses, “but most people in low and middle income countries still must watch and wait”, the UN chief added.

“Such inequities are immoral, and they are dangerous for our health, our economies and our societies.”

86 countries reached

To date, COVAX has shipped more than 36 million doses to 86 countries, the UN Spokesperson Stéphane Dujarric told correspondents at UN Headquarters on Monday.

Algeria received more than 36,000 doses over the weekend from COVAX, he said, helping to accelerate the vaccination campaign already underway there.  

“The UN Resident Coordinator, Eric Overvest, said the new doses will help ensure that no one is left behind”, Mr. Dujarric added. “Our teams on the ground have helped to train healthcare workers, sensitize people on vaccines, and supported the cold chain. 

And in Laos, the country has vaccinated more than 4,000, including frontline healthcare workers, with doses received from COVAX, Mr. Dujarric told reporters.

The UN team, led by the Resident Coordinator Sara Sekkenes Tollefsen, is supporting the country’s vaccination campaign, which began on Friday.  

More than 130 million cases

As of 5 April, the World Health Organization (WHO) is reporting that there have been nearly 131,021,000 confirmed cases of COVID-19, including more than 2,850,520 deaths.

Up to the end of 31 March, there had been 547,727,346 vaccine doses administered worldwide.

Vaccines for all

“As we recover from the COVID-19 pandemic, we must implement policies and allocate resources so all can enjoy the same health outcomes”, said Mr. Guterres.

That will involve reaching the Sustainable Development Goals by 2030, he added, “and it means delivering universal health coverage so everyone, everywhere, can thrive.”

Secretary-General welcomes US decision to lift sanctions against ICC officials

President Joseph Biden on Friday revoked a Trump-era executive order issued after the ICC announced it was investigating alleged war crimes committed by all sides in the conflict in Afghanistan, including the US.

Executive Order 13928 of 11 June 2020 imposed economic sanctions against ICC Prosecutor Fatou Bensouda and the Head of the Jurisdiction, Complementarity and Cooperation Division, Phakiso Mochochoko.  A separate 2019 policy regarding visa restrictions on certain court staff was also terminated. 

“These decisions reflect our assessment that the measures adopted were inappropriate and ineffective”, US Secretary of State Anthony J. Blinken said in a statement.

In welcoming the decision, the Secretary-General noted that the ICC “plays an important role in advancing accountability for international crimes”, his Spokesperson, Stéphane Dujarric, said in a statement on Saturday.

Ready to re-engage

The Court, which is based in The Hague, in the Netherlands, prosecutes the most serious crimes of concern to the international community, such as genocide, war crimes, and crimes against humanity.

It was established in July 1998 under a treaty known as the Rome Statute, which more than 120 countries have signed. The US is not a party to the treaty.

The ICC also issued a statement on Saturday welcoming the developments from Washington.

“The Court is mindful that the United States has traditionally made important contributions to the cause of international criminal justice,” the statement said.

“The Court stands ready to reengage with the US in the continuation of that tradition based on mutual respect and constructive engagement.”

First Person: A diabetes fighter in Eswatini pours all her efforts into beating COVID-19

“Our association trained over 300 caregivers, who can empower other community leaders, and ensure that their support groups are effective. In addition, we led an initiative to train a total of 48 rural health motivators in five chiefdoms in the region of Shiselweni, and another group of 20 rural health motivators was trained in the Lubombo region.

A lack of medication

Even though the lockdown negatively affected our operations, we managed to visit health centers across the country, and we soon discovered that most rural clinics did not have relevant and adequate medication, so we pressed for more of them to made available, working closely with the Ministry of Health.  

We have also been in close contact with the United Nations: the UN country team in Eswatini has intensified its effort to help the government procure sufficient stocks of medical supplies at health care facilities in response to the coronavirus pandemic, and the World Health Organization (WHO) has supported Diabetes Association Eswatini in developing information and educational materials, helping us to communicate a wide variety of critical issues such as nutrition, coping mechanisms, and prevention.

Creating opportunities out of the COVID crisis

When I was diagnosed with diabetes in 2005, I didn’t know how to deal with my condition, and there was no help readily available. I was in a coma for three days and, when I woke up, I told myself that I was going to learn everything there was to learn about this disease. Since then, nothing has stopped me from going the extra mile to fulfil my purpose: spreading my knowledge and helping other diabetic patients. Not even COVID-19.

In this time of economic crisis, we are also helping people with diabetes to improve their livelihoods. For example, I mobilized a group of women in my community to start a textile and handicraft business. I was lucky enough to successfully convince local textile companies to donate waste material to us, that we recycle to produce a lot of useful products that we then sell to the community, including facemasks, soaps and sanitizers.

And we have other plans to help unemployed young people to make a living: a branch of the association in Shiselweni, located in the south of the country, has embarked on a project to establish a vocational centre that will provide them with this skills they need. 

We must create a stronger health system to meet the needs of people living with diabetes. There’s a lot of work to do if we are to have a healthier future in Eswatini: we need to invest more in prevention, early diagnosis, screening, treatment, and rehabilitation.”
 

Use COVID-19 recovery to make inclusion ‘a reality’, UN chief says on World Day

“The crisis has created new obstacles and challenges. But efforts to reignite the global economy offer an opportunity to reimagine the workplace to make diversity, inclusion and equity a reality”, Secretary-General António Guterres said. 

“Recovery is also a chance to rethink our systems of education and training to ensure that persons with autism are afforded opportunities for realizing their potential”, he added. 

Breaking ‘old habits’ crucial 

Mr. Guterres also emphasized that breaking old habits will be crucial. For persons with autism, he added, access to decent work on an equal basis requires creating an enabling environment, along with reasonable accommodations. 

“To truly leave no one behind in pursuit of the 2030 Agenda on Sustainable Development, we must realize the rights of all persons with disabilities, including persons with autism, ensuring their full participation in social, cultural and economic life”, he said. 

“Let us work together with all persons with disabilities and their representative organizations to find innovative solutions to recover better and build a better world for all.” 

Inequalities worsened by COVID-19

According to the UN World Health Organization (WHO), one in 160 children has an autism spectrum disorder (ASD). ASD begins in childhood and tends to persist into adolescence and adulthood. 

Intervention during early childhood is important to promote the optimal development and well-being of persons with an ASD, WHO added, emphasizing the importance of monitoring of child development as part of routine maternal and child health care. 

While some individuals with ASD are able to live independently, others have severe disabilities and require life-long care and support. Persons with an ASD are also often subject to stigma and discrimination, including unjust deprivation of health care, education, protection under law, and opportunities to engage and participate in their communities.

The World Day

The World Autism Awareness Day, to be commemorated annually on 2 April, was established in December 2007 by the UN General Assembly, which affirmed that “ensuring and promoting the full realization of all human rights and fundamental freedoms for all persons with disabilities is critical to achieving internationally agreed development goals”. 

The General Assembly also highlighted the importance of early diagnosis and appropriate research and interventions for the growth and development of the individual, and called for efforts to raise awareness throughout society, including at the family level, regarding children with autism. 

COVID-19 origins report inconclusive: We must ‘leave no stone unturned’ – WHO chief

“This report is a very important beginning, but it is not the end”, said WHO Director-General, Tedros Adhanom Ghebreyesus. “We have not yet found the source of the virus, and we must continue to follow the science and leave no stone unturned as we do.”

He welcomed the findings of the 34-member team, which in January, visited the Chinese city of Wuhan where the first cases of the then new coronavirus came to light at the end of 2019.

But the WHO chief was clear that overall, it raises “further questions that will need to be addressed by further studies, as the team itself notes in the report.”

He noted that although much data had been provided, to fully understand the earliest cases, they would need access from Chinese authorities “to data including biological samples from at least September” 2019.

“In my discussions with the team, they expressed the difficulties they encountered in accessing raw data. I expect future collaborative studies to include more timely and comprehensive data sharing.”

Animal markets’ role, ‘still unclear’

Tedros welcomed the recommendations for further studies to understand the earliest human cases and clusters, and to trace animals sold at markets in and around Wuhan, but “the role of animal markets is still unclear.”

The team confirmed there had been widespread contamination in the large market of Huanan but could not determine the source of this contamination.

“Again, I welcome the recommendations for further research, including a full analysis of the trade in animals and products in markets across Wuhan, particularly those linked to early human cases”, he said.

He agreed that farmers, suppliers and their contacts should be interviewed, and that more study was needed to identify what role “farmed wild animals may have played in introducing the virus to markets in Wuhan and beyond.”

Lab leak theory not ruled out

The team also visited several laboratories in Wuhan and considered the possibility that the virus had entered the human population as a result of a laboratory incident, noted Tedros.

“However, I do not believe that this assessment was extensive enough. Further data and studies will be needed to reach more robust conclusions”, he said.

“Although the team has concluded that a laboratory leak is the least likely hypothesis, this requires further investigation, potentially with additional missions involving specialist experts, which I am ready to deploy.”

As far as WHO is concerned “all hypotheses remain on the table”, he told the Member State briefing on the report in Geneva.

“Finding the origin of a virus takes time and we owe it to the world to find the source so we can collectively take steps to reduce the risk of this happening again. No single research trip can provide all the answers.”

World leaders call for new international treaty to improve pandemic response

In a joint article published on Tuesday across leading news platforms, the signatories said that the coronavirus pandemic had been a “stark and painful reminder that nobody is safe until everyone is safe” and that “there will be other pandemics and other major health emergencies”. 

‘Not if, but when’

“The question is not if, but when. Together, we must be better prepared to predict, prevent, detect, assess and effectively respond to pandemics in a highly coordinated fashion”, they said.

The question is not if, but when. Together, we must be better prepared to predict, prevent, detect, assess and effectively respond to pandemics in a highly coordinated fashion

The main goal of the treaty, which would be rooted in the WHO Constitution, would be to foster a comprehensive approach to strengthen national, regional and global capacities and resilience to future pandemics, the leaders added.

Standing with WHO Director-General Tedros Adhanom Ghebreyesus, the leaders signing on so far, represent Albania, Chile, Costa Rica, the European Council, Fiji, France, Germany, Greece, Indonesia, Italy, Kenya, the Netherlands, Norway, Portugal, the Republic of Korea, Romania, Rwanda, Senegal, Serbia, South Africa, Spain, Thailand, Trinidad and Tobago, Tunisia, the United Kingdom, and Ukraine.

“At a time when COVID-19 has exploited our weaknesses and divisions, we must seize this opportunity and come together as a global community for peaceful cooperation that extends beyond this crisis”, the leaders said.

‘We must act boldly’: Dr. Tedros 

Speaking at a press conference later in the day, WHO Director-General Dr. Tedros highlighted that the idea behind the proposal for the treaty is to “systematically tackle the gaps exposed by COVID-19”. 

The pandemic has brought out the best and worst in humanity, he added, recalling “acts of incredible courage” from health workers and communities around the world, on a daily basis, but also inequalities in societies, geopolitical fault lines and frayed trust in public institutions. 

“The impacts on our societies, economies and health, especially for the poor and the most vulnerable, are too significant”, Dr. Tedros said, stressing that “we cannot do things the way we have done them before and expect a different result…we must act boldly”. 

We cannot do things the way we have done them before and expect a different result … we must act boldly 
– Dr. Tedros 

He went on to note that the treaty would strengthen the implementation of the International Health Regulations (IHR) as well as provide a framework for international cooperation and solidarity.   

It would help build resilience to pandemics and other global health emergencies, with robust national and global preparedness systems; ensure timely and equitable access to pandemic countermeasures, including vaccines; support sustainable funding and capacity for prevention, detection, and responses to outbreaks; and promote mutual trust. 

Member States’ decision 

Dr. Tedros also said that ultimately, the Member States would decide. 

“How such a treaty is developed and what it looks like, and whether it is ratified, is a matter for our Member States – the nations of the world”, he added. 

“We must leave a legacy for our children: a safer world for all.”

$29 billion a year by 2025 needed to get back on track to tackle AIDS, say UNAIDS

UNAIDS adopted the new Global AIDS Strategy 2021–2026 during a special session, chaired by the Minister of Health of Namibia, held on 24 and 25 March 2021.

2020 targets unmet

The strategy updates the 2016 targets for 2020, which were not met, and was developed utilising extensive analysis of HIV data and input from more than 10,000 stakeholders from 160 countries.  

It found the total resource needs for lower income, and lower-middle income countries, is around $13.7 billion. Donor resources are mainly needed for these countries. 

For upper-middle income countries, which account for 53% of the investments needed, domestic resources are the predominant source of funding.

The strategy’s three priorities are to: 

• Maximise equitable and equal access to comprehensive people-centred HIV services. 
• Break down legal and societal barriers to achieving HIV outcomes. 
• Fully resource and sustain HIV responses and integrate them into systems for health, social protection and humanitarian settings.

A key focus of the strategy is the call on countries to utilise the full potential of HIV prevention tools, especially for adolescent girls and young women in sub-Saharan Africa, sex workers, people who inject drugs, gay men and other men who have sex with men, transgender people and people in prison settings.

If the targets of the strategy are achieved:

• The number of people who newly acquire HIV will decrease from 1.7 million in 2019 to less than 370,000 by 2025. 
• The number of people dying from AIDS-related illnesses will decrease from 690,000 in 2019 to less than 250,000 by 2025. 
• The number of new HIV infections among children will drop from 150,000 in 2019, to less than 22,000 in 2025.. .

The strategy comes after the 2016 United Nations Political Declaration on Ending AIDS agreed to invest $26 billion in the HIV response by 2020. 

Resources in low and middle income countries peaked in 2017 but they started decreasing in 2018. 

The failure to achieve the targets has come at a tragic human cost: an additional 3.5 million people were infected with HIV and an additional 820 000 people died of AIDS-related illnesses between 2015 and 2020.

“We must not repeat the mistakes of the past”, said Jose Izazola, UNAIDS Special Advisor on Strategic Information and Evaluation. “The time to invest is now.”

Motherhood on the brink in Yemen

“It was the morning of a normal working day before fighting escalated close to the hospital. I heard a mother screaming at the gate”, midwife Shrook Khalid Saeed told UNFPA, at the Al Shaab Hospital in the district of Crater, in Yemen.

By the time she arrived at the entrance to the hospital, hostilities in the area had flared and a gunfight had broken out. “Bullets were coming from all the corners of the street”, she recounted. “When I arrived at the gate, I found the pregnant woman lying down and crying for help. I pulled her and rushed her inside a car. That is where all of it happened. In a few minutes, she had delivered a healthy baby boy.”

Childbirth can be harrowing in even the best of times but the cascade of humanitarian crises in Yemen have made the journey to motherhood more dangerous than ever. The country’s long-running conflict has depleted the health system. Currently only half of all health facilities are functioning.

The pandemic has only aggravated the situation, with roughly 15 per cent of the health system shifted to deal with COVID-19 cases. Only 20 per cent of functioning health facilities are providing maternal and child health services. 

Today, a woman in Yemen dies during childbirth every two hours, almost always from preventable causes. And now, the threat of famine looms.

“The situation is catastrophic,” said UNFPA Executive Director Dr. Natalia Kanem, during her recent three-day visit to the country.

In place of joy, fear looms

Pregnant and breastfeeding women are especially vulnerable during times of food insecurity. Currently 1.2 million pregnant and breastfeeding women are acutely malnourished, and these numbers could double if humanitarian funding does not materialize.

“When I came to receive antenatal care at Al Shaab Hospital, I was very weak and pale. I could not stand straight”, 33-year-old Hafsa told UNFPA during Dr. Kanem’s visit. “My nutritional status was very poor. I was given medicines to supplement my diet, and I was advised to eat meat, vegetables and fruits.”

But good nutrition was beyond reach due to her family’s low income. When she delivered her daughter months later, the girl weighed only 1.8 kg. “The baby stayed in the hospital for a couple of days as I did not have enough breast milk to feed her”, Hafsa said.

Malnutrition puts both women in childbirth and newborn babies at serious risk.

“I’ve been in many maternity wards, and they are usually a place of joy. But in Yemen, I witnessed the devastation of malnutrition and hunger, with newborn babies on feeding tubes and mothers weakened by fear and exhaustion,” Dr. Kanem noted. “It is heartbreaking to see fellow members of the human family in such dire conditions.”

Violence at home

Women’s and girls’ vulnerability to violence has greatly escalated under the country’s crisis.

During Dr. Kanem’s visit, she spoke to women at a UNFPA-supported shelter.

One young girl, Alea*, told Dr. Kanem about being married off at age 13. Child marriage is increasingly being used as a coping mechanism by impoverished families. 

“When I told my father, I do not want to get married, my father and grandmother beat me with a water pipe. They said by getting married I will have a better life”, Alea said. “My life only got worse. My husband started to sell all my jewellery and when I inquired about them, he would beat me. I then ran to my father’s house, but he also beat me and chased me back to my husband. I was left with nowhere to go.”

Escape to shelter

A neighbour helped Alea escape. She has been living at the shelter for over five months, attending training workshops and dreaming of returning to school.

“I spoke to young girls and pregnant women who had to flee for their lives and seek protection at UNFPA sites, which are among the very few safe spaces for women and girls”, Dr. Kanem said.

UNFPA is supporting eight such shelters and 51 women’s and girls’ safe spaces. Last year, UNFPA provided more than half of all health facilities in Yemen with essential life-saving medicines and reached more than 1.2 million women and girls with reproductive health services.

But much more support is needed. “The women and girls of Yemen deserve peace. For too long, they have been caught up in a conflict that is not of their making,” Dr. Kanem urged. “The world must act now.”

* Name changed for protection and privacy

Drug use among older persons a ‘hidden epidemic’, narcotics experts warn

The independent expert body also highlighted the negative impact the COVID-19 pandemic is having on the global supply of medicines, and on the well-being of people with mental health and substance abuse disorders. 

An ‘alarming trend’ 

“The pandemic has caused great harm to the health and the well-being of older people. However, there is also a hidden epidemic of drug use affecting this population group.  Drug use and drug-related deaths among older people have been on the rise, as has the number of older people in treatment for drug use problems,” said Cornelis de Joncheere, the INCB President. 

As the world grows older, drug use among people over 65 has also grown. The report found increased use of pain relievers, tranquilizers and sedatives among this demographic.  Older people with substance use problems also face unique age-related issues, including isolation or physical challenges. 

To reverse this “alarming trend”, the INCB has recommended that governments step up research on drug use among older persons, who are largely overlooked in drug use surveys, and improve access to health and treatment services for them. 

Accessing treatment 

Meanwhile, demand for some controlled medicines has increased during the COVID-19 pandemic, which has also caused disruptions in global supply chains.  Health services and access to medication, including for persons with mental health and substance use disorders, have been affected. The INCB underscored that governments must ensure these populations have continued access to prevention and treatment services during the global crisis. 

With rising demand for COVID-19 therapeutics further reducing the availability of some medicines that contain controlled substances, countries are urged to review their forecasted demand for these treatments, and to streamline administrative and logistical requirements. 

New online drug trade 

The INCB reported on other by-products of the pandemic, such as the growth in online drug dealing through encrypted communications by organized crime groups.  

Drug users are also using the dark web, social media and online forums to obtain illicit substances.  Travel restrictions and physical distancing measures have also led to shortages of some drugs, and higher prices on the illicit market.  At the same time, overdose rates have risen due to the decreased purity of illicit drug supplies and use of fentanyl, a synthetic opioid. 

The deteriorating drug control situation in Afghanistan continues to be a concern.  The country accounted for nearly 85 per cent of global opium production over the past five years, and illicit production remained high during 2019. 

The INCB urged the international community to provide technical and financial assistance to support drug control efforts there. 

“If illicit drug cultivation and production, drug trafficking, drug use and drug use disorders in Afghanistan are not comprehensively addressed, broader efforts on sustainable development, prosperity and peace in Afghanistan are unlikely to be effective,” Mr. de Joncheere warned.

Global COVID-19 infections rise for fourth consecutive week, deaths level off

The number of new deaths from the coronavirus levelled off after a six-week decrease, with just over 60,000 new deaths reported.

Europe and the Americas continued to account for nearly eight in 10 of all cases and deaths, while the only region to report a decline in fatalities was the Western Pacific, down nearly a third, compared to the previous week.

No region untouched

Infections rose notably in South East Asia, the Western Pacific, Europe and the Eastern Mediterranean, according to the World Health Organization’s Weekly Epidemiological Update.

In the African region and the Americas, infection numbers have remained stable in recent weeks, although WHO pointed to “concerning trends” in some countries within these regions.

These include Brazil, where the highest numbers of new cases were reported (508,010 new cases in a week, representing a three per cent increase)

The United States saw 374,369 new cases – a 19 per cent decrease – while India saw 240,082 new cases, a 62 per cent increase, France saw 204,840 new cases (up 27 per cent) and Italy saw little change, with a recorded 154,493 new cases.

Variants of concern

WHO said that latest data on coronavirus variants of concern, indicate that the so-called “UK” strain is present in 125 countries, across all six global regions.

This variant – VOC202012/01 – may be associated with an increased risk of hospitalization, severity and mortality, WHO noted, pointing to a study involving 55,000 COVID-19 patients between last October and January, where deaths from the UK variant were 4.1 per 1,000, compared with 2.5 per 1,000 among those infected with the previously circulating coronavirus.

Vaccine efficacy

On a more positive note, data from vaccine tests conducted in England from December 2020 to February 2021 – when VOC202012/01 was very prevalent – “showed the early real-world effectiveness of the Pfizer/BioNTech – BNT162b2 vaccine and AstraZeneca – ChAdOx1 vaccine against confirmed COVID-19, hospitalizations and deaths”, WHO explained.

Variant 501Y.V2 predominant

The so-called “South African” variant – 501Y.V2 – is now present in 75 countries across all regions, WHO continued, in “over 90 per cent of sequenced specimens in some settings”.

Highlighting the results of a study comparing hospital admissions in South Africa during the peak of the first wave of the coronavirus in mid-July 2020 with the second wave that peaked in January 2021 – when variant 501Y.V2 was the predominant variant – WHO pointed out that “the risk of in-hospital mortality increased by 20 per cent”.

Third variant of concern

The third variant of concern, P.1, was reported in three additional countries in the last week, bringing the total to 41 nations across all regions.

WHO cited a recent analysis of hospitalizations and frequency of P.1 in Manaus city, Amazonas State, Brazil, where it was first detected, noting that it has spread widely.

“Based on the preliminary findings, P.1 is found to be 2.5 times more transmissible … compared to the previously circulating variant, while the reinfection probability was found to be low (at) 6.4 per cent.”

Globally, on 23 March, there have been 123,419,065 confirmed cases of COVID-19, including 2,719,163 deaths, reported to WHO.

As of 22 March 2021, a total of 403,269,879 vaccine doses have been administered

1.4 million with tuberculosis, lost out on treatment during first year of COVID-19

Latest data from the World Health Organization (WHO) from more than 80 countries, showed a reduction in treatment of 21 per cent in the first year of the pandemic, compared with 2019.

The biggest differences were in Indonesia (down 42 per cent), South Africa (41 per cent), the Philippines (37 per cent)  and India (25 per cent).

“The disruption to essential services for people with TB is just one tragic example of the ways the pandemic is disproportionately affecting some of the world’s poorest people, who were already at higher risk for TB,” said Tedros Adhanom Ghebreyesus, WHO Director-General.

Universal care a priority

“These sobering data point to the need for countries to make universal health coverage a key priority as they respond to and recover from the pandemic, to ensure access to essential services for TB and all diseases.”

TB remains one of the world’s deadliest infectious killers.

Each day, nearly 4,000 people die from TB and close to 28,000 people fall ill with this preventable and curable disease. Global efforts to combat it have saved an estimated 63 million lives since the year 2000.

Ahead of World TB Day on Wednesday 24 March, WHO pointed out that some countries have already taken steps to sidestep the impact of new coronavirus on the delivery of TB services.

Successful policies have included expanding the use of digital technologies such as computer-aided diagnosis in chest X-rays – particularly beneficial in countries lacking sufficient numbers of trained radiographers – along with the provision of remote advice and support and providing home-based TB prevention and care.

10 million a year infected

Despite these innovations, many people who have the preventable disease are still unable to access the care they need. Globally, some 10 million people fall ill with TB every year.

“WHO fears that over half a million more people may have died from TB in 2020, simply because they were unable to obtain a diagnosis,” WHO said, adding that this is by no means a new problem; before COVID-19 struck, the gap between the estimated number of people developing TB each year and the annual number of people officially diagnosed with the virus was about three million.

“The pandemic has greatly exacerbated the situation,” the UN health agency said.

Recommended steps

In new recommendations to help health authorities tackle the problem, the WHO urged systematic TB screening for the following groups: household and close contacts of people with TB, people living with HIV, people in prisons and detention centres, people exposed to silica (mainly miners).

Community screening is beneficial in vulnerable populations with limited access to health care, WHO insisted, such as urban poor communities, homeless communities, migrants, refugees, remote isolated communities, and other vulnerable or marginalized groups.

Further drug innovations have meant that health professionals should also encourage patients with multidrug-resistant tuberculosis to adopt the new shorter and fully oral medicine regime, which no longer has an injectable element.

This shorter regimen is nine to 11 months long “and research has shown that patients find it easier to complete the regimen, when compared to the longer regimens which last up to 20 months”, WHO said.

First Person: Prepare for the next pandemic, says WHO scientist

During the early ‘90s, Dr. Soumya Swaminathan successfully raised funds to get antiretroviral drugs to those affected by the HIV epidemic. Many of the children of those patients are still alive today thanks to her work. As part of the podcast series, Awake At Night, she shares her insights with the UN’s head of communications, Melissa Fleming.

Getting vaccines to those who need them

“We’ve seen time and time again that products developed in high income countries take decades to find their way to low income countries. This has happened with influenza pandemics, with HIV, and with hepatitis B vaccines.

It took 30 years for hepatitis B vaccines to get to developing countries and that’s exactly the reason why COVAX [the UN-led scheme to distribute two billion COVID-19 vaccines to mostly poorer countries] was set up, to make sure that as vaccines get developed, that there’s also equity in access.

I think that it was a good move and that it’s going to be successful. I’m very hopeful that, for the first time ever, COVAX is going to bring vaccines to people in every country in the world, having taken lessons from HIV and all of the other diseases for which the richer world found treatments and vaccines. The funding was slow but finally, there is rollout and there is hope.

The promise of science

To me, what has happened with science and the scientific collaboration that happened during the past year is very positive, the fact that people have been so willing and open to share knowledge. It’s helped us in the WHO, to be ahead of the curve, and I think it’s the reason that we’ve had so many dozens of vaccine candidates being developed.

Of course, there’s still a technology gap between the high, middle and lower income countries, and we want to focus on bridging that gap by enabling a technology transfer, particularly for some of these new technology platforms like the mRNA vaccines, which offer the possibility of being able to very quickly adapt to COVID-19 variations, as well as to create vaccines against new pathogens.

So, it’s a perfect platform for pandemic response. This is the time that the world needs to think about getting to the end of this pandemic but also, at the same time, preparing for the next one by making sure that this technology is not limited to a few sites in the world, but is more broadly available, and could be used to control some of our other big public health problems, like TB.

The deadly toll of tuberculosis

Most of my career has essentially involved research on tuberculosis (TB), on HIV, and on other infectious diseases. TB patients usually come from the poorest sections of society, so I’ve been to all the slums in Chennai, and I know the conditions in which those patients live.

It gave me a better appreciation for why a purely biomedical approach is unlikely to work in a disease like tuberculosis, where there are so many social, economic and environmental risk factors driving that disease.

One and a half million people die of tuberculosis every year. It’s takes such a huge toll on people and yet we get used to deadly diseases that are often invisible because they hit the poor.

So, in a country like India, a person who dies of dengue fever in a city would make headlines, whereas you’d have had 1000 deaths due to TB on the same day and they would not feature in any news story at all.

Perhaps, the lesson that we’ve learned from the COVID-19 pandemic is that, because we live in a globalized world, it doesn’t take much for a disease that starts in one part of the world to travel and infect people in other countries.

I hope that there’ll be a new public health paradigm now, not focusing only on your own country, but really thinking about global health security. And it’s not only humans, but animals that we need to think about, and the environment, because we know that the pandemics arise from interactions between animals, humans and the environment”.