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COVID-19: Consequences of ‘chronic under-investment in public health’ laid bare

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A nurse who recovered from COVID-19 is back at work helping patients at a hospital in Malawi. © UNICEF

A global chronic under-investment in public health has been exposed by the coronavirus pandemic, which must now lead to a major re-think in how all societies value health, said the head of the World Health Organization (WHO) on Friday.

Tedros Adhanom Ghebreyesus was making closing remarks at the closing of WHO’s governing body, the World Health Assembly, which finalized its annual session this week after its regular May meeting was cut short by COVID-19 safety requirements.

Historic vaccine advances

The WHO chief highlighted the Pfizer/BioNTech vaccine breakthrough announced this week, which results indicate could be around 90 per cent effective, saying he had “no doubt” that vaccines were a vital tool for controlling the on-going pandemic.

“Never in history has vaccine research progressed so quickly. We must apply the same urgency and innovation to ensuring that all countries benefit from this scientific achievement.

“But we have a long way to go. The world cannot put all its eggs in one basket and neglect the many other tools at our disposal, that countries like Thailand have shown are effective, for bringing this virus under control.”

What works against the virus before inoculation, are isolation, testing and treatment programmes, where the contacts of those infected are traced and then quarantine.

Chronic weakness

The COVID-19 pandemic has “demonstrated the consequences of chronic under-investment in public health”, said Tedros, and the health crisis, “has ignited a socio-economic crisis that has impacted billions of lives and livelihoods and undermined global stability and solidarity. Returning to the status quo is not an option.”

The WHO chief said it wasn’t just more investment that was needed in public health infrastructure, “we must also rethink how we value health.”

New brains trust on health economics

Tedros told the Assembly that that time has now come to think of healthcare as an investment, not a cost, “that is the foundation of productive, resilient and stable economies.”

“To start building that narrative, today I am proud to announce that we are establishing a new Council on the Economics of Health for All, to focus on the links between health and sustainable, inclusive and innovation-led economic growth.”

He said the first virtual session of the Council, which will bring together leading economists and health experts, will likely hold its first virtual session in the coming weeks, to set out its work plan and best way of working.

“The pandemic has also shown that there is an urgent need for a globally agreed system for sharing pathogen materials and clinical samples”, he added, “to facilitate the rapid development of medical countermeasures as global public goods.”

Productive session

Among the Assembly’s achievements through the week were a new roadmap to defeat meningitis by 2030; a new roadmap for neglected tropical diseases; a resolution on scaled-up action on epilepsy and other neurological disorders; the adoption of the Immunization Agenda 2030; the Global Strategy to Accelerate the Elimination of Cervical Cancer as a public health problem; and the Global Strategy for TB Research and Innovation.

“Each of these represents an urgent health priority that affects the lives of millions of people, and which increases the demands on, and expectations of, WHO”, said Tedros.

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Health & Wellness

Moderna vs. Pfizer: Two Recent Studies Show Moderna to Be The More Effective One

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The first study was published by medRxiv “The Preprint Server for Health Sciences” on August 9th, and compared (on 25,589 vaccinated v. 25,589 unvaccinated Minnesotans) “the effectiveness of two full-length Spike protein-encoding mRNA vaccines from Moderna (mRNA-1273) and Pfizer/BioNTech (BNT162b2) in the Mayo Clinic Health System in Minnesota over time from January to July 2021.” Moderna was 86% effective against the infection; Pfizer was 76% effective. In July (when the “Delta” variant first became dominant) Moderna was 91.6% effective against hospitalization; Pfizer was 85%. But during that month, effectiveness against the infection was 76% for Moderna v. 42% for Pfizer. Nationwide (including Mayo in MN, WI, AZ, FL, & IA), Moderna was about twice as effective “against breakthrough infection” v. Pfizer.

The second study was far smaller, published on September 10th by the CDC, and studied only 1,175 hospitalized U.S. veterans (93% male) at V.A. centers nationwide. Moderna was estimated at 91.6% effective, Pfizer at 83.4%. Since no non-hospitalized comparison-sample were studied, “Vaccine effectiveness … to prevent Covid-19-associated hospitalization was estimated by using multivariate logistic regression to compare the odds of full vaccination between case-patients and controls,” and so the reliability of this study was far less than in the Mayo Clinic study.

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India Completes First Drone Delivery of Vaccines

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Health workers pose with a vial of COVID-19 vaccine after receiving their shots at a hospital in India. UNICEF/Vinay Panjwani

Today marks the beginning of the first trials for the delivery of MMR, influenza and COVID-19 vaccines in the southern state of Telangana.

The trials, which have been organized by the World Economic Forum in partnership with the state government of Telangana, Apollo Hospital’s HealthNet Global and NITI Aayog, will be conducted over 28 days in designated air corridors in the district of Vikarabad, Telangana.

Starting off with the first ever drone delivery of a vaccine in India, the trials are focused on laying the groundwork for a more elaborate drone delivery network that will improve access to vital healthcare supplies for remote and vulnerable communities. This is also the first drone programme since India recently liberalized its drone policy.

“The Forum is pleased to support Indian government and industry in demonstrating how emerging technologies can be used to improve access to healthcare for its most vulnerable populations,” says Timothy Reuter, Head of Aerospace and Drones, World Economic Forum. “The project has set into motion the adoption of drones to deliver lifesaving services across the country. We believe that India’s work with drones can serve as a model for other countries in the region and beyond.”

“Ever since Telangana issued the expression of interest in expanded drone use in March 2020, the industry has witnessed an acceleration around policy decisions,” said Vignesh Santhanam, Lead, Aerospace and Drones, World Economic Forum. “With the latest liberalization of India’s drone economy the Medicine from the Sky initiative has made efforts to invigorate the drone sector in India by demonstrating the essence of cooperative federalism and creating a template for the region.”

“Being at the forefront of leveraging emerging technologies, Telangana has always acted as a testbed for innovative solutions to support scaling across the nation,” said K.T. Rama Rao, Minister of Information Technology, Industries, Municipal Administration and Urban Development of Telangana, India. “The COVID-19 pandemic has highlighted that healthcare supply chains can be further strengthened and drones offer a robust value proposition especially when it comes to remote areas and emergencies. The Medicine from the Sky is the first of its kind initiative in the country to generate insights that shall benefit the entire ecosystem. The enthusiasm and support by all the partners is deeply appreciated.”

With the support of the Vikarabad municipality, India’s Ministry of Civil Aviation, the Directorate-General of Civil Aviation and the Airports Authority of India, this will be the first drone-delivered COVID-19 vaccine in Asia. After extended trials with MMR and influenza vaccines, COVID-19 vaccines will also be transported beyond the visual line of sight.

“This pilot has been enabled through a series of collaborations between India’s regulatory agencies state government, the World Economic Forum, international organizations, healthcare experts and drone companies,” said Anna Roy, Senior Adviser, Frontier Technologies, NITI Aayog, Government of India. “The Medicine from the Sky community has acted as an important platform providing advice and insight that has translated the extensive academic groundwork into action on ground. Through a highly collaborative effort, the pilot programme also demonstrates the importance of localized inputs and micro planning for healthcare in remote parts of the world.”

This initiative aims to improve equity in healthcare while enabling healthcare access for isolated populations and hazard-prone areas. The project has eight participating partners, including drone operators and experts in healthcare and airspace management among others. Together, these partners will demonstrate short and long-range drone-based deliveries to assess the efficacy of low-altitude aerial logistics in healthcare.

“Drone use provides the opportunity to support our traditional approaches to healthcare delivery especially in underserved or remote regions of the country,” said Dr. Sangita Reddy, Joint Managing Director, Apollo Hospitals Group. “Our healthcare sector could potentially witness large-scale deliveries of long-tail medicines, vaccines, blood and vital organs throughout the country across terrains with drones in action. As clinical partners in the Medicine from the Sky initiative, Apollo Hospital’s HealthNet Global will be responsible for enabling vaccine and medicine availability and properly monitoring the adherence of clinical protocols throughout the project.”

An industry core group was commissioned in June 2021 to help scale the effort to bolster last-mile mobility in healthcare. The outcomes from the trials will be analysed and used to scale up the effort to additional states with the support of the Medicine from the Sky community and key stakeholders. The project is expected to be expanded to six states in the coming months.

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Pandemic increasing risk factors for suicide

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Suicide prevention must be prioritized after 18 months of the COVID-19 pandemic, the Americas office of the World Health Organization (WHO) warned ahead of World Suicide Prevention Day, commemorated annually on 10 September. 

Studies show that the global crisis has exacerbated risk factors associated with suicidal behaviours, such as job loss, trauma or abuse, mental health disorders and barriers to accessing health care.

‘Urgent public health problem’ 

“Suicide is an urgent public health problem and its prevention must be a national priority,” said Renato Oliveira e Souza, head of the Mental Health Unit at the Pan American Health Organization (PAHO).  

“We need concrete action from all elements of society to put an end to these deaths, and for governments to create and invest in a comprehensive national strategy to improve suicide prevention and care,” he added. 

Globally, one in 100 deaths is by suicide, making it among the leading causes of death worldwide and the fourth leading cause of death among 15- to 29-year-olds, after road traffic accidents, tuberculosis and interpersonal violence. 

More people die each year from suicide than from HIV, malaria, or breast cancer, or from war and homicide, according to WHO

Warning signs 

Some of the verbal or behavioural warning signs for suicide include talking about wanting to die, feeling immense guilt or shame, or feeling like a burden to others.  Other signs are feeling empty, hopeless or trapped, or having no reason to live, or feeling extremely sad, anxious, agitated, or full of anger. 

Among behavioural changes that can also be warning signs, are researching ways to die, staying away from friends, giving away important items, showing extreme mood swings, eating or sleeping too much or too little, and using drugs or alcohol more often. 

Anyone who detects warning signs of suicide, whether in themselves or in someone they know, should seek help from a health care professional as soon as possible. 

Hope through action 

World Suicide Prevention Day is organized by the International Association for Suicide Prevention (IASP) and endorsed by WHO.  

This year’s theme ‘Creating hope through action’, focuses on the need for collective action to address the issue. 

WHO recently published guidance that supports national efforts to help reduce the global suicide rate by one-third by 2030, in line with the Sustainable Development Goals (SDGs). 

Key prevention measures include limiting access to means of suicide, such as firearms and pesticide, as well as early identification, assessment, management and follow-up of people affected by suicidal thoughts and behaviours. 

Other actions include fostering adolescent social-emotional skills, and educating the media in responsible reporting on suicide

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