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Escaping the ‘Era of Pandemics’: Experts warn worse crises to come options offered to reduce risk

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Future pandemics will emerge more often, spread more rapidly, do more damage to the world economy and kill more people than COVID-19 unless there is a transformative change in the global approach to dealing with infectious diseases, warns a major new report on biodiversity and pandemics by 22 leading experts from around the world. 

Convened by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) for an urgent virtual workshop about the links between degradation of nature and increasing pandemic risks, the experts agree that escaping the era of pandemics is possible, but that this will require a seismic shift in approach from reaction to prevention.

COVID-19 is at least the sixth global health pandemic since the Great Influenza Pandemic of 1918, and although it has its origins in microbes carried by animals, like all pandemics its emergence has been entirely driven by human activities, says the report released on Thursday. It is estimated that another 1.7 million currently ‘undiscovered’ viruses exist in mammals and birds – of which up to 850,000 could have the ability to infect people.

“There is no great mystery about the cause of the COVID-19 pandemic – or of any modern pandemic”, said Dr. Peter Daszak, President of EcoHealth Alliance and Chair of the IPBES workshop. “The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment. Changes in the way we use land; the expansion and intensification of agriculture; and unsustainable trade, production and consumption disrupt nature and increase contact between wildlife, livestock, pathogens and people. This is the path to pandemics.” 

Pandemic risk can be significantly lowered by reducing the human activities that drive the loss of biodiversity, by greater conservation of protected areas, and through measures that reduce unsustainable exploitation of high biodiversity regions. This will reduce wildlife-livestock-human contact and help prevent the spillover of new diseases, says the report. 

“The overwhelming scientific evidence points to a very positive conclusion,” said Dr. Daszak. “We have the increasing ability to prevent pandemics – but the way we are tackling them right now largely ignores that ability. Our approach has effectively stagnated – we still rely on attempts to contain and control diseases after they emerge, through vaccines and therapeutics. We can escape the era of pandemics, but this requires a much greater focus on prevention in addition to reaction.” 

“The fact that human activity has been able to so fundamentally change our natural environment need not always be a negative outcome. It also provides convincing proof of our power to drive the change needed to reduce the risk of future pandemics – while simultaneously benefiting conservation and reducing climate change.” 

 The report says that relying on responses to diseases after their emergence, such as public health measures and technological solutions, in particular the rapid design and distribution of new vaccines and therapeutics, is a “slow and uncertain path”, underscoring both the widespread human suffering and the tens of billions of dollars in annual economic damage to the global economy of reacting to pandemics. 

Pointing to the likely cost of COVID-19 of $8-16 trillion globally by July 2020, it is further estimated that costs in the United States alone may reach as high as $16 trillion by the 4th quarter of 2021. The experts estimate the cost of reducing risks to prevent pandemics to be 100 times less than the cost of responding to such pandemics, “providing strong economic incentives for transformative change.”

The report also offers a number of policy options that would help to reduce and address pandemic risk. Among these are: 

  • Launching a high-level intergovernmental council on pandemic prevention to provide decision-makers with the best science and evidence on emerging diseases; predict high-risk areas; evaluate the economic impact of potential pandemics and to highlight research gaps. Such a council could also coordinate the design of a global monitoring framework.
  • Countries setting mutually-agreed goals or targets within the framework of an international accord or agreement – with clear benefits for people, animals and the environment.
  • Institutionalizing the ‘One Health’ approach in national governments to build pandemic preparedness, enhance pandemic prevention programs, and to investigate and control outbreaks across sectors.
  • Developing and incorporating pandemic and emerging disease risk health impact assessments in major development and land-use projects, while reforming financial aid for land-use so that benefits and risks to biodiversity and health are recognized and explicitly targeted.
  • Ensuring that the economic cost of pandemics is factored into consumption, production, and government policies and budgets.
  • Enabling changes to reduce the types of consumption, globalized agricultural expansion and trade that have led to pandemics – this could include taxes or levies on meat consumption, livestock production and other forms of high pandemic-risk activities.
  • Reducing zoonotic disease risks in the international wildlife trade through a new intergovernmental ‘health and trade’ partnership; reducing or removing high disease-risk species in the wildlife trade; enhancing law enforcement in all aspects of the illegal wildlife trade and improving community education in disease hotspots about the health risks of wildlife trade.
  • Valuing Indigenous Peoples and local communities’ engagement and knowledge in pandemic prevention programs, achieving greater food security, and reducing consumption of wildlife.
  • Closing critical knowledge gaps such as those about key risk behaviors, the relative importance of illegal, unregulated, and the legal and regulated wildlife trade in disease risk, and improving understanding of the relationship between ecosystem degradation and restoration, landscape structure and the risk of disease emergence.

Speaking about the workshop report, Dr. Anne Larigauderie, Executive Secretary of IPBES said: “The COVID-19 pandemic has highlighted the importance of science and expertise to inform policy and decision-making. Although it is not one of the typical IPBES intergovernmental assessments reports, this is an extraordinary peer reviewed expert publication, representing the perspectives of some of the world’s leading scientists, with the most up-to-date evidence and produced under significant time constraints.”

“We congratulate Dr. Daszak and the other authors of this workshop report and thank them for this vital contribution to our understanding of the emergence of pandemics and options for controlling and preventing future outbreaks. This will inform a number of IPBES assessments already underway, in addition to offering decision-makers new insights into pandemic risk reduction and options for prevention” she added.

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Health & Wellness

Pharmaceutical Strategy for Europe: Affordable, accessible and safe medicines for all

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The Commission has today adopted a Pharmaceutical Strategy for Europe to ensure patients have access to innovative and affordable medicines and to support the competitiveness, innovative capacity and sustainability of the EU’s pharmaceutical industry. The Strategy will allow Europe to cover its pharmaceutical needs, including in times of crisis, through robust supply chains. A key component of building a stronger European Health Union, as called for by President von der Leyen in her State of the Union Speech, the Strategy will help to establish a future-proof and crisis-resilient EU pharmaceutical system.

Europe’s Pharmaceutical Strategy has four main objectives:

  • Ensuring access to affordable medicines for patients, and addressing unmet medical needs (e.g. in the areas of antimicrobial resistance, cancer, rare diseases);
  • Supporting competitiveness, innovation and sustainability of the EU’s pharmaceutical industry and the development of high quality, safe, effective and greener medicines
  • Enhancing crisis preparedness and response mechanisms, and addressing security of supply;
  • Ensuring a strong EU voice in the world, by promoting a high level of quality, efficacy and safety standards.

Although the Strategy is much more than a crisis-response instrument, it draws lessons from the initial response to the COVID-19 pandemic, and makes Europe’s pharmaceutical sector better prepared and more resilient.

The Strategy presents concrete actions to ensure accessibility, availability and affordability of medicines. It supports diversified and secure supply chains, ensuring the EU’s open strategic autonomy in the world, and it promotes environmentally sustainable pharmaceuticals.

The Strategy will also ensure that the EU’s pharmaceutical policy continues to serve public health in an ever-changing environment of scientific and commercial transformations. It will support patient centred innovations and accommodate digital and technological change.

Members of the College said

President of the European Commission, Ursula von der Leyen, stated: “The coronavirus pandemic has highlighted the vital need to strengthen our health systems. This includes access to safe, effective and high-quality medicines at an affordable price.  In the challenging economic and social times the EU is currently facing, the strategy adopted today will ensure that Europe and Europeans will continue to benefit from such medicines. I call on Member States and the Parliament to endorse this approach which will be rolled out in the next three years, and beyond.”

Vice-President for Promoting the European Way of Life, Margaritis Schinas, said: “Effective and safe medicines, vaccines and treatments have helped to tackle some of the leading causes of disease and life-threatening illnesses in the past. These products will be crucial to uphold the health and well-being of the European citizens in these challenging times. Today’s strategy supports the EU’s pharmaceutical industry to remain competitive and innovative, whilst addressing the needs of the patients and those of our health systems.”

Stella Kyriakides, Commissioner for Health and Food Safety, stressed: “Today we launch the work to ensure that safe and effective medicines are accessible and affordable at all times and to all patients across the EU. With our Pharmaceutical Strategy for Europe, we are delivering on our commitment to create a future-proof and patient-centred pharmaceutical environment in which the EU industry can innovate, flourish and continue to be a global leader. It is our long-term vision for open strategic autonomy, and our response to the challenges of today and the vulnerabilities exposed by COVID-19. Today we put in place another pillar of the European Health Union.”

Background

The Pharmaceutical Strategy for Europe marks the beginning of a process: its implementation includes an ambitious agenda of legislative and non-legislative actions which will be launched over the coming years.  

Actions will cover the whole ecosystem of pharmaceuticals, but also some aspects of medical devices. It creates synergies with the Green Deal and our actions under the EU Strategic approach of pharmaceuticals in the environment to reduce their environmental risk, address pollution from pharmaceutical residues and promote greener manufacturing, use and disposal (a progress report is available). It is also linked to the action plan on Intellectual Property presented today.  

The flagship actions of the Strategy include:

  • A revision of the basic pharmaceutical legislation* (target date for a proposal: 2022) with a view to making this framework future-proof and innovation friendly;
  • A proposal for a EU Health Emergency Response Authority (proposal: 2nd semester 2021);
  • A revision of the regulations on medicines for children and rare diseases
  • Initiating a structured dialogue with and between all actors in the pharmaceutical manufacturing and public authorities to identify vulnerabilities in the global supply chain of critical medicines and shape policy options to strengthen the continuity and security of supply in the EU;
  • Cooperation between national authorities on pricing, payment and procurement policies, to improve the affordability, cost-effectiveness of medicines and health system’s sustainability;
  • The creation of a robust digital infrastructure, including a proposal for a European Health Data Space (target date for a proposal: 2021);
  • Support to research and innovation, notably via Horizon 2020 and EU4Health;
  • Actions to promote innovative approaches to EU R&D and public procurement for antimicrobials and their alternatives and measures to restrict and optimise their use.

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‘Real hope’ surrounding COVID vaccines ‘cannot be overstated’: WHO

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Along with other tried and tested public health measures, the head of the World Health Organization (WHO) told journalists on Monday that “there is now real hope” that vaccines will play an essential part in helping end the COVID pandemic. 

“With the latest positive news from vaccine trials, the light at the end of this long, dark tunnel is growing brighter”, said Director-General Tedros Adhanom Ghebreyesus. “The significance of this scientific achievement cannot be overstated”. 

Setting new standards 

Noting that no vaccine in history has been developed as rapidly, the WHO chief remarked that the scientific community had set “a new standard for vaccine development” and now the international community must set “a new standard for access”. 

“The urgency with which vaccines have been developed must be matched by the same urgency to distribute them fairly”, he spelled out, warning of a real risk that the poorest, and most vulnerable will be “trampled in the stampede” to get innoculated. 

ACT Accelerator 

Tedros explained that it was against this backdrop that WHO and its partners had established the Access to COVID-19 Tools (ACT) Accelerator back in April. 

“The ACT Accelerator has supported the fastest, most coordinated and successful global effort in history to develop vaccines, diagnostics and therapeutics”, he attested. 

He said that currently 50 diagnostics are under evaluation; rapid antigen diagnostics are now available for low and middle income countries; while life-saving treatments are being rolled out and new medicines tested. 

Moreover, 187 countries are taking part in the COVAX facility, to collaborate on the procurement and rollout of vaccines, “ensuring the best possible prices, volumes and timing for all countries”, he said. 

Funding needs 

Despite the excellent progress, Tedros said that “only a fundamental change in funding and approach will realize the full promise of the ACT Accelerator”. 

He revealed that $4.3 billion is still needed to support mass procurement and delivery, tests and treatments this year and another $23.8 billion would will be required in 2021. 

“This isn’t charity, it’s the fastest and smartest way to end the pandemic and drive the global economic recovery”, he stressed. 

According to the International Monetary Fund (IMF), if medical solutions can be made available faster and more widely, they could lead to a cumulative increase in global income of almost $9 trillion by the end of 2025. 

“The real question is not whether the world can afford to share vaccines and other tools; it’s whether it can afford not to”, stated the WHO chief.

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Remdesivir no COVID-19 silver bullet

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An advisory body of the UN health agency is not recommending the use of the high-profile antiviral drug Remdesivir for hospitalized COVID-19 patients, saying on Thursday there is insufficient evidence that it improves survival outcomes or cuts down on the need for patients to be put onto ventilators. 

A World Health Organization (WHO) Guideline Development Group (GDG) panel of international experts made the recommendation in the BMJ – the weekly peer-reviewed medical journal, published by the British Medical Association – as part of so-called “living guidelines” to manage the coronavirus and help doctors make better decisions in consultation with patients. 

“Living guidelines are useful in fast moving research areas like COVID-19 because they allow researchers to update previously vetted and peer reviewed evidence summaries as new information becomes available”, said WHO, in a press release on the findings. 

Evidence-based decisions  

Remdesivir has received global attention in treating severe coronavirus cases and is increasingly being used for hospitalized patients. But its role in clinical practice has remained uncertain. 

WHO’s recommendation is based on new evidence comparing the effects of several drugs on treating the virus and includes data from four international randomized trials involving more than 7,000 COVID-19 inpatients. 

After reviewing the evidence, the WHO GDG expert panel, which includes four patients who have had the coronavirus, concluded that the intravenously administered Remdesivir “has no meaningful effect on mortality or on other important outcomes for patients, such as the need for mechanical ventilation or time to clinical improvement”. 

Arguing its use 

The panel acknowledged that the certainty of the evidence is low and did not prove that Remdesivir has no benefit; but rather, “there is no evidence based on currently available data that it does improve important patient outcomes”, according to the WHO release. 

However, the GDG supported the continued enrolment of patients into Remdesivir evaluation trials to determine whether more substantial evidence can be obtained, especially with regards to specific groups of patients.  

The WHO press release also cites a feature article linked in the panel’s BMJ report, which says that the full story of Remdesivir will not be understood until its manufacturer, Gilead, releases full clinical study reports. 

In the meantime, reports the journalist who wrote the feature, Jeremy Hsu, alternative treatments such as widely available corticosteroid, dexamethasone, that has been proved to reduce mortality among some severely-ill COVID-19 sufferers, are “now impacting discussions about Remdesivir’s cost-effectiveness”, in the words of the WHO press release.

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