The risk of COVID-19 infection from breastfeeding is negligible and has never been documented, the World Health Organization (WHO) said on Tuesday, in a call for greater support for the practice.
“WHO has been very clear in its recommendations to say absolutely breastfeeding should continue,” said Dr. Laurence Grummer-Strawn, head of the World Health Organization’s Food and Nutrition Action in Health Systems unit. “We have never documented, anywhere around the world, any (COVID-19) transmission through breastmilk.”
Exclusive breastfeeding for six months has many benefits for the infant and mother which far outweigh any risk from the new coronavirus pandemic, according to WHO.
These advantages include the fact that breastmilk – including milk which is expressed – provides lifesaving antibodies that protect babies against many childhood illnesses.
This is only one of the reasons why new mothers should initiate “skin-to-skin contact” and “room-in” with their babies quickly, as “the risks of transmission of the COVID-19 virus from a COVID-positive mother to her baby seem to be extremely low”, added Dr. Grummer-Strawn.
Having tested the breastmilk of “many” mothers around the world in a variety of studies, the WHO official explained that although a few samples had contained the virus, “when they followed up to see whether the virus was actually viable and could be infective, they could not find any actual infective virus”.
Underscoring the WHO’s longstanding support for using mother’s milk over substitutes, Dr. Grummer-Strawn also warned that the pandemic had weakened essential breastfeeding support usually provided to families with newborns.
COVID ‘undermining essential support’
“The interruption of services has been tremendous around the world providing the kind of support mothers normally would get with breastfeeding,” Dr. Grummer-Strawn told journalists.
“Oftentimes, the health services that would provide maternal child health have been diverted to take care of the COVID response; sometimes families do not feel comfortable in going into the health services, because they’re afraid that they might get COVID and so they don’t come for the routine kinds of support.”
According to the WHO, “about 820,000 children’s lives are lost every year because of a lack of breastfeeding”, Dr. Grummer-Strawn continued, in reference to deaths among under-fives. “Economically, there are losses of about $300 billion a year in economic productivity, lost because of a lack of breastfeeding,” he added.
Numerous good things come from breastfeeding – for the child and their mother in developing and industrialized countries – WHO has long maintained.
It has insisted that “it is not safer to give infant formula milk”, together with UN Children’s Fund (UNICEF) and the International Baby Food Action Network (IBFAN).
Benefits for baby and mother
The three organizations have united in their call to Governments to protect and promote women’s access to skilled breastfeeding counselling, for World Breastfeeding Week 2020 (1-7 August).
“Breastfeeding provides benefits during the time of breastfeeding, and those that are most recognised are protection against diarrhoea, which is one of the top causes of mortality in low-income countries, protection against respiratory infections, against obesity – childhood obesity later on – as children get older, protection against leukaemia,” said Dr. Grummer-Strawn.
Breastfeeding also protects the mother against breast cancer, ovarian cancer, Type 2 diabetes later on, the WHO official said, “so there are benefits for both the mother and the baby, and when we added these up it comes out to about 820,000 lives around the world, even in high-income countries”.
In addition to the pandemic, breastfeeding is under pressure from what WHO and UNICEF have described as harmful promotion of breast-milk substitutes.
Countries could do more to protect parents from misleading information, the UN agencies believe. “We continue to be very concerned about the practices of the formula industries, both the big multinational corporations as well as in many countries there are local manufacturers of breastmilk substitutes that are trying to get mothers to get on to their products,” said Dr. Grummer-Strawn. “They use a number of tricks, sometimes it’s not as blatant advertising as it once was, because they know that they can get caught.”
According to WHO, of 194 countries analysed, 136 have legal measures related to the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions adopted by the World Health Assembly (known as the Code).
Tricks of the trade
However, only 79 countries prohibit the promotion of breast-milk substitutes in health facilities, and only 51 have provisions that prohibit the distribution of free or low-cost supplies within the health care system, WHO said in a report published in May.
Only 19 countries have prohibited the sponsorship of scientific and health professional association meetings by manufacturers of breast-milk substitutes, which include infant formula, follow-up formula, and growing up milks marketed for use by infants and children up to 36-months old, the UN health agency study found.
WHO and UNICEF recommend that babies be fed nothing but breast milk for their first six months, after which they should continue breastfeeding – as well as eating other nutritious and safe foods – until at least two years old.
“The aggressive marketing of breast-milk substitutes, especially through health professionals that parents trust for nutrition and health advice, is a major barrier to improving newborn and child health worldwide,” said Dr. Francesco Branca, Director of WHO’s Department of Nutrition and Food Safety. “Health care systems must act to boost parent’s confidence in breastfeeding without industry influence so that children don’t miss out on its lifesaving benefits.”
Pandemic will not end for anyone, ‘until it ends for everyone’
The COVID-19 pandemic “will not end for anyone, until it ends for everyone”, an independent UN human rights expert said on Friday, advocating for an equitable and globally-coordinated vaccine distribution programme.
“The virus can still travel from the vastly unvaccinated massive population of the Global South to the Global North, including in its increasingly mutating forms”, Obiora Okafor, UN Special Rapporteur on human rights and international solidarity, said in a statement.
He explained that with mutations constantly evolving, only inoculating rich countries would likely “complicate or delay” the eradication of the virus.
Skewed vaccine delivery
The last few weeks of 2020 witnessed the approval of several COVID-19 vaccines by regulators in various countries, “offering much hope to billions of people worldwide”, according to the UN expert.
And while several States, mostly in the north, have already secured large quantities of vaccine and have begun inoculation campaigns, this has not been the case for most of the Global South, where close to 90 per cent of the world’s population lives.
“The world, therefore, faces a sharp and highly problematic vaccine-divide in which the much richer Global North States, which host a very small percentage of the global population, have so far cornered the vast majority of available COVID-19 vaccines, leaving the bulk of the world’s population with almost no access to these medicines”, Mr. Okafor said.
“A globally coordinated vaccine distribution programme is highly preferable to the individualized approaches adopted by all-too-many of the richer States”, Mr. Okafor said.
International vaccine solidarity
He said it was vital that States and non-State actors cooperate – such as through the COVID-19 Vaccine Global Access Facility (COVAX), which, led by the World Health Organization (WHO), is part of the Access to COVID-19 Tools (ACT) Accelerator – or risk a stalled recovery.
While noting that COVAX aims to fairly distribute two billion vaccine doses by the end of 2021, Mr. Okafor emphasized that “international vaccine solidarity” be favored over “international vaccine competition”.
“Given the great urgency of ensuring for everyone, everywhere, as rapid and effective access to COVID-19 vaccines as possible, I, therefore, urge urgent and strong action by States and other actors toward a course correction”, he said.
Click here for the names of the UN experts who endorsed the statement.
Fair access for migrants
Separately, UN independent experts González Morales and Tlaleng Mofokeng have urged States to ensure that migrants are also included in national COVID vaccination programmes, saying that global immunization access for everyone who needs them “is the only solution” to ending the pandemic.
This includes priority groups of vulnerable people “regardless of who they are” or their migration status, said the rights experts.
They also called on world leaders to refrain from discriminatory discourse that could lead to the exclusion of migrants in irregular situations from the global public health response.
Special Rapporteurs and independent experts are appointed by the Geneva-based UN Human Rights Council and are neither UN staff nor paid for their work.
WHO chief warns against ‘catastrophic moral failure’ in COVID-19 vaccine access
A “me-first approach” to COVID-19 vaccines on the part of some countries and manufacturers is putting equitable access to these lifesaving treatments at risk, the head of the World Health Organization (WHO) warned on Monday.
Addressing the agency’s Executive Board, WHO chief Tedros Adhanom Ghebreyesus expressed fear that “even as vaccines bring hope to some, they become another brick in the wall of inequality between the world’s haves and have-nots.”
Describing the rapid development of vaccines as a literal and figurative “shot in the arm” during the pandemic, Tedros reported that while 39 million doses have been administered in nearly 50 richer countries, only 25 have been given in one lowest income nation.
A self-defeating approach
“I need to be blunt: the world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries”, he said, speaking from WHO headquarters in Geneva.
Ensuring all countries will have access to any COVID-19 vaccines is the promise of a global mechanism established last April, known as the COVAX Facility. It has secured two billion doses so far, with a billion more in the pipeline, and deliveries should begin next month.
“Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue. This is wrong”, Tedros stated.
Additionally, most manufacturers also have prioritized regulatory approval in rich countries, where profits are higher, rather than submitting their dossiers to WHO for prequalification.
“This could delay COVAX deliveries and create exactly the scenario COVAX was designed to avoid, with hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption”, he said.
“Not only does this me-first approach leave the world’s poorest and most vulnerable people at risk, it’s also self-defeating.”
Change the rules of the game
Underlining that vaccine equity also has economic benefits, Tedros urged countries to “work together in solidarity” to ensure inoculation of all health workers and older people at most risk worldwide is underway, within the first 100 days of the year.
He pressed for action in three areas to “change the rules of the game”, starting with an appeal for transparency in any bilateral contracts between countries and COVAX, including on volumes, pricing and delivery dates.
“We call on these countries to give much greater priority to COVAX’s place in the queue, and to share their own doses with COVAX, especially once they have vaccinated their own health workers and older populations, so that other countries can do the same”, he said.
Tedros also called for vaccine producers to provide WHO with full data for regulatory review in real time, to accelerate approvals, and he urged countries to only use vaccines that have met international safety standards, and to accelerate readiness for their deployment.
“My challenge to all Member States is to ensure that by the time World Health Day arrives on the 7th of April, COVID-19 vaccines are being administered in every country, as a symbol of hope for overcoming both the pandemic and the inequalities that lie at the root of so many global health challenges”, he said, adding, “I hope this will be realized.”
‘Vaccinationalism’ threatens recovery: UN chief
UN Secretary-General António Guterres has again stressed that COVID-19 vaccines must be a global public good, available to everyone, everywhere.
Speaking in New York at a ceremony for the world’s developing nations, he underlined the need for funding for medicines and diagnostics to defeat the virus.
“We need manufacturers to step up their commitment to work with the COVAX facility and countries around the world, in particular the world’s leading economies, to ensure enough supply and fair distribution,” said Mr. Guterres.
“‘Vaccinationalism’ is self-defeating and would delay a global recovery.”
The Secretary-General said recovery also represents a chance to “change course”, away from the old “normal” of inequalities and injustices, and he continues to advocate for greater support from developed countries and international financial institutions.
“With smart policies and the right investments, we can chart a path that brings health to all, revives economies and builds resilience,” he said. “But developing countries must have the necessary resources to do so.”
UN agencies supporting mammoth India COVID-19 vaccine rollout
India has begun what is the world’s biggest COVID vaccination campaign so far, deploying hundreds of thousands of health workers, with the training and support of the UN World Health Organization (WHO).
On 16 January, the first day of the campaign, 207,229 vaccine shots were given across the country, one of the worst-hit by COVID-19, with over 10 million COVID-19 infections and 150,000 deaths.
“[We] provided technical assistance to the Government of India for the development of operational guidelines and other training materials for state and district programme managers and vaccinators, and establishing tracking and accountability frameworks”, Roderico H. Ofrin, WHO Representative in India said.
“WHO field officers have facilitated the highest-level oversight through regular task force meetings at state and district levels, which are chaired by the Principal Secretaries (Health) at the state level, and District Magistrates at the district level”, he added.
According to media reports, an estimated 10 million health workers are targeted to be vaccinated in the first round, followed by other front-line workers such as police, security forces and municipal staff, with plans to inoculate 300 million people by August.
Prior to the start of the campaign, UN agencies help with detailed preparations.
For its part, WHO participated in dry-run simulations and provided feedback on management of vaccines, registration of beneficiaries, as well as reporting on vaccination coverage and adverse events following immunization.
It also worked with the Government and the UN Development Programme (UNDP) on real-time reporting and problem-solving when issues arose at the vaccination sites, according to Dr. Ofrin.
At the provincial level, WHO also supported implementation and monitoring of health policy, such as developing standard operating procedures, preparing technical briefs, and providing best practices from other parts of the India as well as other countries.
Similarly, the UN Children’s Fund (UNICEF) supported communication and advocacy efforts to ensure the dissemination of factual information to stakeholders and communities. The agency also helped train healthcare staff in infection control and prevention, and psychosocial support to children and caregivers.
Aside from directly supporting vaccine rollout, UN agencies continued their programmes to assist the most vulnerable communities impacted by COVID-19 and its socio-economic fallouts.
For instance, the UN World Food Programme (WFP) supported NGOs in order to identify and register some 19,000 vulnerable households and distributed food packets; while the UN Population Fund (UNFPA) conducted awareness raising programmes on sexual and reproductive health, and prevention of gender-based violence, on behalf of some 30 million vulnerable individuals.
The three W’s
Though vaccination programmes are underway, continued vigilance against COVID-19 and preventing its spread remain as important as ever.
WHO’s Dr. Ofrin urged continued vigilance over tracking cases, cluster investigation, isolation and clinical care, and quarantining to break the chain of transmission.
Alongside, he also highlighted the “three W’s – wear a mask, wash your hands and watch your distance.”
“These efforts must continue to stop the spread of COVID-19. We as individuals and communities must work with the Government to save lives and the economy by protecting health and livelihoods,” he added.
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