How vaccinations help protect all ages of the population

This oped was originally published on Media Planet Value of Vaccines Q4 2020 Campaign on 10 December 2020

The COVID-19 pandemic has reminded us how vulnerable the world is in the face of deadly pathogens.

Vaccines have been an essential tool offering protection from diseases like diphtheria, tetanus, pneumonia, and polio, diseases that once harmed or killed thousands of children every year.

Thanks to these essential tools, over the past decades, while often forgotten, adults can also benefit from vaccines. The benefits of a life-course approach to immunisation have been heavily documented and endorsed in a new vision of immunisation globally.

But COVID-19 is having a detrimental impact on the delivery of essential immunisation services, threatening to reverse hard-won progress to reach people of all ages with a wide range of vaccines.

The WHO and UNICEF warn that 2020 could be the first time in 28 years that the world sees a reduction in the annual childhood immunisation coverage rate. Gavi estimates that at least 13.5 million persons will miss out on vaccinations due to postponement of campaigns and interruptions in routine vaccinations in the short-term, and millions more will miss out in the longer-term.

Public health officials have also been sounding the alarm that adults also need to stay up-to-date on recommended and catch-up vaccinations for infectious diseases. As we approach winter, we need to ensure we do not overwhelm healthcare systems, already dealing with COVID-19, with vaccine preventable diseases, such as influenza.

The unique circumstances brought about by the current situation call attention to the importance of investing in vaccination coverage across the life-course to improve population health, promote health system sustainability, and strengthen pandemic preparedness and responsiveness.

Now is the time for stakeholders in the healthcare system to come together and put in place the necessary building blocks to recover from the negative impacts of the pandemic.

Building vaccines delivery platforms

 

One the key aspects will be strengthening public health systems for future mass vaccination with COVID-19 vaccines. This will be implemented by expanding vaccination delivery channels to include pharmacies, community delivery points and other non-clinical settings such as schools and residential homes.

Providing a more convenient access point to immunisation, closer to home, has been found to both reduce inequalities in access to healthcare and to help counter vaccine hesitancy.

Encouraging catch-up campaigns for all interrupted vaccine schedules not just the childhood ones will be as critical to prevent an overall great number of deaths in older adults and to contribute to longer, healthier lives.

Stakeholders need to collaborate across the board to ensure that COVID-19 and routine vaccines are delivered and administered in a timely and safe manner.

Getting serious about life-course vaccination in countries around the world will help make that a reality.

This #UHCDay, the Confederation of Meningitis Associations, the International Pharmaceutical Federation (FIP), the Global Coalition on Aging, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the International Federation on Ageing and the International Longevity Centre UK join forces to show how governments can strengthen pandemic preparedness and responsiveness by taking a life-course immunization approach which will expand access to vaccines, improve uptake, and help #ProtectEveryone.

Q&A with… Charles Kwanin

Q&A with Charles Kwanin on occasion of the Launch of the Africa Young Innovators for Health Award

Charles Kwanin is a young professional working in global health and former nurse practitioner from Ghana

Today, IFPMA and Speak Up Africa are launching the Africa Young Innovators for Health Award to highlight and support the work of pioneering young African entrepreneurs in the health sector. The Award is an investment in the human capital of Africa’s promising young entrepreneurs, providing financial and in-kind support to three winners of the Award so they can advance their healthcare solutions and develop their great potential as enablers of change. The 2021 edition of the Award will focus on supporting innovations that can make a difference for healthcare workers. The COVID-19 pandemic has amplified our awareness of the critical role doctors, nurses, healthcare professionals and community care workers play. At the resumed, virtual 73rd World Health Assembly, WHO Member States recognized the dedication and sacrifice of the millions of health and care workers at the forefront of the COVID-19 pandemic, unanimously designating 2021 as the International Year of Health and Care Workers. Moreover, the longstanding shortage of human and financial resources across the continent put a strain on healthcare workers and the healthcare system: Africa represents 25% of the global disease burden but concentrates only 3% of the global health workforce.

We asked Charles Kwanin, a former nurse practitioner from Ghana currently working at IFPMA’s Africa Engagement Committee and Graduate Student at the Graduate Institute of Geneva, how innovation can help solve some of the most pressing challenges faced by health workers on that continent.

Why did you decide to become a health worker and for how long have you been working as such?

This might sound a bit cheesy, but what motivated me is to aim for a world free of disease but, you know, that’s not simple. I took that path to help care for the clients and alleviate suffering from disease. I have practiced as a professional nurse for about seven years in total, including four years as a student nurse, in both rural and urban areas.

Was your training adapted to the reality of your job once you started?

My training provided me with the basic tools that enable me to provide appropriate, safe care to my patients. Nurses in Ghana are equipped to deal with the usual challenges that you might face as a health professional in your practice and at the hospital. We learn how to improvise, how to work under time constraints. Nevertheless, there are no specific ways that we can keep learning once in practice. This is where innovation can help bridge challenges we face as health workers and by health systems more generally, to bring us closer to finding solutions to enormous problems, especially in emergency situations as we have seen with the COVID-19 pandemic.

What are some of the biggest challenges you face in your daily job? What support is available to help you with these challenges?

I remember that when working in a rural area in Ghana, it was so hard to get blood stock in our laboratory because of inadequate storage capacity. This is quite a usual challenge for many rural areas in Africa. This issue was worrisome. The question was always when we can solve this. Thanks to Innovative solutions that are improving healthcare globally. When I spoke to my former colleagues, they told me now they can order through a system for a drone to send them blood at any point in time. Innovations like Zipline, a drone delivery service that delivers blood, vaccines and medical supplies precisely where and when they are needed, could have helped us save more lives if they had existed before. Another example is LifeBank, a company that uses data and technology to deliver blood, oxygen and essential medical products to hospitals in Nigeria and in Kenya. They deliver all these products by bikes, boats, trucks, tricycles, drones, etc. It’s so frustrating when you know what to do to save lives, but due to lack of the tools or resources you end up losing lives. I believe that’s where innovation comes in.

It’s extremely important that innovation is adapted to the local context, and that specific locals’ needs and capacity have to be considered when designing innovation solutions. For example, a lot of rural areas in Africa have regular power shortages that hamper healthcare services overall, which bigger cities might not face, so it’s important to look at what matters on the ground and what sectors have an impact on our health systems beyond health facilities.

What would you need to be able to carry out your job better?

I think that there are three main things that would really help nurses and health professionals:

  • First, patient data storage. It is really challenging to retrieve your patient’s information and history. Healthcare workers in Ghana faced this challenge. When a patient goes to different hospitals or to different doctors because they can’t access all the services they need in one place and because there are not enough specialist healthcare providers to allow people to have the same doctor each time, patient’s data stays in each facility and you can’t access it. It would be extremely helpful to have a network system where health providers can access their patients’ health data at all times, reach patients easier, and share information with other health providers, while of course respecting confidentiality and data privacy. That would make human resources management easier too.
  • Second, there are lots of apps that can connect the patient to healthcare providers, for example by using wearables, to enable remote care and monitoring. This kind of innovation can make the work of healthcare providers easier and faster, improving patient care. It also fosters patient-centered care, so we can more easily work with the patient on the care plan. It’s particularly important as in Ghana we see a rising burden of NCDs but at the same time infectious diseases like malaria, HIV/AIDS are still very prevalent–with connected platforms, we could monitor and retrieve patients history for all their conditions in one place, avoiding them going to different places. In the end, it would improve quality of care and make planning processes easier for health workers. This also promotes effective patient centered care.
  • Third, the issue of access to quality, safe and affordable medicines is very important. Medicines are intended to cure or relieve patients from their symptoms but, if it ends up causing adverse reactions putting clients lives in danger, they begin to lose confidence in the healthcare workers and the system. Falsified medicines remain a big challenge on the African continent. Ghana is of no exception. There is the need for a strong regulatory system to check and monitor this issue in countries. If you look at the whole Africa continent, we have a lot of porous borders so smuggling of fake drugs around becomes so easy. Considering Innovative solutions like the mPedigree application which is helping to detect fake and counterfeit products. It is important to keep integrating these kinds of innovative solutions into hospital systems and make them available to as many facilities as possible. With this nurses and other healthcare workers can help identify falsified and substandard medicines. Furthermore, a continental body to serve as a liaison between countries on the continent to harmonize and regulate products like drugs, vaccines and others is a step in the right direction.

In what ways do you think the healthcare system in Ghana could be improved to facilitate the work of health workers?

There is always room for improvement in our health management and information systems. Connected platforms are key for information sharing. Also, identification of hotspots of different outbreaks, emergencies can easily be shared for alertness and necessary actions to be taken. We have seen with the COVID-19 pandemic that we can use existing platforms and integrate them with new ones. In addition, it is of course very important that a bigger proportion of people have an insurance package even though others are still missing on the health insurance lists. The government also has to expand the conditions covered by the insurance to help reduce out of pocket spending. We need to improve upon infrastructure and capacity, to help prepare for emergencies.

Finally, I realized that only teaching hospitals prioritize research into their work. I think that research and development centers should be integrated into all facilities in the country no matter the location, to improve evidence based care and solutions. With this local problem would be easily identified and innovative solutions would be developed to solve these challenges. In the end, it is really about the readiness of the health systems to integrate innovative solutions and leveraging technology that is adapted to each situation.

We believe in the power of young people as changemakers, innovators and leaders of today. To learn more about the Africa Young Innovators for Health Award and how to take part, please click here. We are looking forward to receiving applications starting 11 January 2021!

HIV and tuberculosis: Ensuring people’s access to treatment during the pandemic

This was originally published on Global Cause on the 2020 HIV & TB Awareness campaign on 1 December 2020.

As the global coronavirus pandemic continues, we need to maintain continued access to HIV and TB essential medications worldwide.

The COVID-19 pandemic has claimed more than 1.2 million lives, and many more deaths have likely gone unreported. The life science industries, governments, researchers, and numerous public health organisations are all working together to find vaccines, treatments and diagnostics to battle the pandemic.

However, we also know that the pandemic has created challenges in maintaining supply of essential medicines in other treatment areas such as HIV and tuberculosis (TB).

Communities help bridge the gap

In response, partners throughout the supply chain have worked endlessly to keep HIV and TB treatments available. This includes collaboration with innovative bio pharmaceutical industry, manufacturers, freight companies, regulators, procurement agencies, multilateral agencies governments, NGOs and on-the-ground distributors.

This collaboration, paired with robust supply chain management systems and experienced in-country distribution, has helped. The role of communities, and the use of digital tools and well-established partnerships, have been key to ensuring access to treatment. As a senior employee of ViiV Healthcare told me “it’s really clear the communities have been key to bridging gaps and driving continuity of treatments and services during the pandemic”.

Managing supply chain

Rapid in-country response to the severe supply gap projections has been significant in limiting the impact and/or ensured timely “bounce-back” of prevention services, testing and prevention of mother-to-child transmission (PMTCT). Those who responded quickest could benefit from the infrastructure built on years by initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and Global Fund aid.

In the field of TB, the Global Drug Facility (GDF) has been critical, working with companies and organisations on the ground to prevent shortages and create a stockpile of first line treatments.

Numerous business and healthcare stakeholders also made resounding demands to stop treatment nationalism which threatened severe disruption especially on the African continent.

In addition to its strong supply management, the innovative biopharmaceutical industry has also made a significant effort to keep research and development programmes on track so innovation in HIV and TB is not slowed by the pandemic.

Innovation and collaboration will lead to prevention

At the last Global Fund Replenishment conference the industry committed to step up the fight, do more, innovate more, and partner more to ensure access to innovative treatments for people living with HIV and TB. The pandemic makes this commitment even more urgent.

In July, the Stop TB Partnership and Johnson & Johnson announced a new initiative with involvement from multilateral agencies and governments, which aims to enable countries to scale up access to oral treatment regimens for drug-resistant TB (DR-TB) in lower income countries. This is not only helping to enable home-based care for people with DR-TB who are especially vulnerable to COVID-19, but also helping to relieve pressure on already overstretched healthcare systems.

Innovative partnerships clearly remain essential to effectively address HIV and TB treatment supply during the pandemic but also provide key lessons in the global response to address COVID-19 itself.

Greg Perry is Assistant Director General of IFPMA, and the former Executive Director of the Medicines Patent Pool (2013-18).

5 questions to… Cary Adams, CEO of the Union for International Cancer Control (UICC)

For World Antimicrobial Awareness Week (WAAW), Dr Cary Adams shares with us the importance of raising awareness on the growing threat of antimicrobial resistance and how it affects the cancer community.

  1. In what circumstances and how often are antibiotics used for cancer treatment and care?

The treatment and care of cancer involves a wide range of interventions namely surgery, radiotherapy, chemotherapy, novel targeted therapies, and medicines for palliative care. Antimicrobials, which include antibiotics, play a role in the treatment protocols for almost all of these interventions. For example, they are given to patients following chemotherapy as a measure to protect them from infections due to a weakened immune system. Furthermore, antibiotics are an essential part of treatment for certain cancers like multiple myeloma and acute leukaemia. Treatment for many cancers, like those of the breast, thyroid, testis, and urinary bladder involves a surgical intervention that require antibiotics to prevent surgical site infections.

  1. Is antimicrobial resistance an issue for cancer treatment and care? What impact can it have on patients?

AMR, including antibiotic resistance, adversely affects cancer treatment and could undermine key advances being made in cancer care. People with cancer are more susceptible to infections due to the lowering of immune defences, while surgery and treatments like bone marrow transplants, radiotherapy and chemotherapy put the immune system under immense pressure. As many as 1 in 5 cancer patients undergoing treatment are hospitalized due to infection and antibiotics are the main line of defense for these patients. Due to AMR, these infections are becoming harder to treat which results in poor treatment outcomes for these patients. A recent survey of 100 oncologists in the UK revealed that 95% of the oncologists surveyed are already very concerned about the threat of drug resistant bacteria on the future of cancer treatment and care.

Furthermore, country examples also reveal disturbing data. For example, in India almost 73% of patients with haematological malignancies carried bacteria resistant to carbapenems, which is a last line antibiotic.

  1. In what way is this year’s WAAW theme “United to preserve antimicrobials” relevant to cancer care and treatment?

Cancer is the second leading cause of death globally and about 1 in 6 deaths is due to cancer. This growing cancer burden, in combination with the increasing threat of AMR, is a global public health issue that needs to be addressed urgently.

Currently, knowledge and awareness of the impact of AMR on cancer outcomes within the cancer community is low.  It is therefore urgent that oncology professionals, cancer advocates, programme managers, patient groups and other stakeholders working in the field of cancer understand and address the factors that contribute to the development and spread of AMR and strategies for infection control.

This year’s WAAW is an opportunity to raise awareness on the impact of AMR on cancer care and a call to action for all relevant stakeholders.

  1. What is the cancer community doing to slow down antimicrobial resistance? and what can the healthcare industry do to help?

Addressing AMR is a priority for UICC. To this effect, we have convened a Task Force on AMR and Cancer Care whose aim is to highlight the current evidence on AMR, identify areas where research and knowledge about AMR and cancer care can be strengthened, share best practices, facilitate collaboration within the cancer community, and help bring about policy change on AMR.

In this regard and as a first crucial step, UICC is releasing information in the form of news articles and blogs, as well as virtual dialogues on the impact of AMR on cancer care. These resources have been developed for our members, the cancer community and the AMR community and will be our focus for World Antimicrobial awareness week (WAAW) 2020.

One of the key areas that UICC is committed to is the availability, affordability and sustained access to quality assured medicines and diagnostics, for existing essential medicines and diagnostics, but to also include R&D for new medicines and diagnostics. The healthcare industry should collaborate with governments and civil society to ensure this happens. Furthermore, stronger investment and a collaborative approach is needed for the research and development of new antibiotics, vaccines, diagnostics, and other tools to combat AMR.

  1. Do you understand why there is so much innovation for cancer care, but such little progress in finding new antibiotics?

Yes, there has been huge advances with treatments for cancer care, especially with the novel targeted therapies. Unfortunately, the same cannot be said for antibiotics. This is because incentives for industry to invest in antibiotics are declining.  In fact, many large pharmaceutical companies have dropped antibiotics from their portfolios due to the unfavourable return on investment.

Furthermore, any new products that come to the market will most likely be heavily controlled due to efforts aimed at reducing AMR.

There is therefore, an urgent need for governments and other key players to come together and explore innovative ways to fund R&D, increase collaborative networks and ensure there is sustainable supply of antibiotics, especially in LMICs.

2020: A game-changing year for AMR?

Dame Sally Davies, UK AMR Special Envoy and Thomas Cueni, IFPMA’s DG have shared platforms on panels.  This time at the World AMR Congress, saw the duo in a different format, with Dame Sally pitching questions at Thomas Cueni and asking him if industry has done enough to tackle AMR.  Global Health Matters has reproduced the highlights of this lively exchange.

(Listen to the full discussion here)

Dame Sally Davies:  It is my pleasure to introduce my colleague, sparring partner and friend: Thomas Cueni, the Director of IFPMA, as my guest.

For the World AMR Congress audience here today, academics, biotechs as well as other more established companies, what can you tell them about what pharma is doing to tackle the spread of antimicrobial resistance?

Thomas Cueni:  In 2017, the biopharmaceutical industry signed the Davos AMR Declaration and the subsequent policy framework which was launched at UN High Level Meeting that same year on AMR.  Industry called for the reduction of antibiotic discharge into the environment; the appropriate use of antibiotics; a better management of access to antibiotics and last but not least, the need to get new antibiotics, which means R&D.

These initiatives led to the creation of the AMR industry Alliance which brings together 100 companies from the worlds of biotech, diagnostics, generics, and major biopharmaceutical companies.  The Alliance tracks the companies’progress every two years. Over the past four years, the Alliance showed progress is being made in educating health professionals to use antibiotics sparingly, it showed that we are making improvements in manufacturing to reduce environmental discharge as well as companies ensuring access even when new antibiotics are still in the pipeline.  But the Alliance members have warned that strong signs of innovation could be stopped dead in its tracks if the issue of commercial incentives is not addressed.

That is why we have launched the AMR action fund this year.

Dame Sally Davies:  What is the AMR Action fund and why did industry make the move?

Thomas Cueni: The AMR Action Fund is a unique initiative. I’ve been involved in the pharmaceutical industry for many years and I do not recall any collective initiative where more than 20 companies have worked together to provide one billion dollars to invest in something where there’s no money to be made.

One of the reasons for launching the initiative is that the industry has been criticized for exiting the antibiotics field and for not understanding the public health expectation.

As an industry, we noticed that despite the G20, G7 and other UN interagency coordination group meetings pondering on World Bank and OECD reports on the matter, not much was happening. And at the same time, we realised that if we continued to wait for governments to make a move, we would not get anywhere, and the pharmaceutical industry would be criticized for its inaction.

Moreover, throughout the years we have witnessed a decline of research into novel antibiotics from big pharma while there was a flourishing pipeline of biotech companies in the field. We were seeing big pharma companies exiting the antibiotics field. But we also noticed that there had been much more promise in discovery and early antibiotic research, but then there was the “valley of death” with venture capital exiting the field and none of the big pharma companies interested in stepping in and investing in biotech companies since there was no market.

This is where the AMR Action Fund will really make a difference as it will provide a bridging fund to bring 2 to 4 novel antibiotics to market approval within the next 10 years based on the WHO and CDC list of pathogens. And all this will buy us time to drive policy change.

Dame Sally Davies:  If cancer drugs are among the industry’s more profitable areas, then why don’t companies want to protect their production lines by making new antibiotics available to protect people who will inevitably get infections? If the whole health system is threatened as antimicrobial resistance increases, why is it that investors fail to see the return on investment?  I think they are being very short term. What do you think?

Thomas Cueni: It is a question of moral hazard. If you need to convince your shareholders to invest in antibiotic research, the truth of the matter is that within the current market, the worst that can happen is that you succeed with novel antibiotic research, rather than just having to write off your investment. Therefore, even if there is an attractive market in oncology or in dementia research, which is another example which I use quite often, you have a 99.7% chance of failure. But you still have billions of dollars invested in dementia research because if you do hit the target, it will be a deserved return on investment. Whereas in the antibiotic field, if you do hit the target, you will lose more money than if you never got involved and that is not that easy to explain to your shareholders.

Therefore, of course I strongly agree with you that there is a broader public good and we need to make sure that we do get novel antibiotics off the ground. However, if the market economics do not change, it will be hard. That is why I think it was a tough act to convince big pharma to come up with an initiative where nobody expects to make money, at least not in the short term.

Dame Sally Davies:  Who stands to receive these funds? I’m sure many are eager to send you their proposals.

Thomas Cueni:  Before launching the Fund, I had companies asking why they should cross subsidise the development of other companies and why companies that are still in the antibiotic space should invest even more.

One thing is clear, the Fund will not cross subsidise research from big pharma. The Fund is looking to invest in assets from small biotech companies and will invest into phase 2 and later, phase 3 development. We do not want it to overlap with what CARB-X and others are doing.

This is clearly not about money because if it was only about money one could go for Plan B and nationalise antibiotic research but that would be the wrong response because big pharma is better equipped to invest in risky research and making sure there is a return on investment.

Moreover as an engaged investor, the Fund, will provide skill sets and support to biotech companies in terms of development, skills and discipline (for example, the ability to write off an investment instead  continuing to lose money) and bring its expertise in regulatory, formulation and scalability.

We have made sure that the Fund has very strict conflict of interest rules with a world-class Independent Scientific Advisory Board that will ensure its independence. The investors on the Board will set the overall strategy but not delve into individual investing decisions.

Dame Sally Davies: Will 2020 be a game changing year for AMR?

Thomas Cueni: I believe that we do have a chance.

Some asked if we should wait until after COVID-19 to launch the Fund and my argument was to the contrary: COVID-19 was a wakeup call for the world. The COVID-19 pandemic caught many countries ill prepared, whereas AMR is something we have known about for a long time and we can do something about.

Like Kevin Outtersen once said, “AMR is not a tsunami like SARS-COV-2, AMR is like a melting glacier where you know the doom you are in.”

Fortunately, we know what needs to be done, we know we need to get our act together in terms of appropriate use and research. To borrow the title of the OECD Report on AMR “Stemming the tide just a few dollars more” if you compare the impact of COVID-19, where the world economy is losing $375 billion per month – to stem the tide of AMR would take just a few dollars more. However, we do need incentives and we need to recreate the market.

I hope that we will see change in the next three to five years, because if we don’t see change, I’m not sure that 2020 would have been a game changer which I think you and I hope it is.

Dame Sally Davies: Do you think we can use COVID-19 and if so, how should we use it to get governments to move and innovate around AMR?

Thomas Cueni: I think COVID 19 will help us because I now see a lot of people talking about future pandemic preparedness and agreeing that a strong pharma industry is the only one that can provide scalable solutions. We know that COVID-19 treatments and vaccines will come from big pharma in collaboration with academics and biotech companies.

COVID 19 has opened our eyes to the importance of pandemic preparedness and has given us a chance to prioritise AMR on the global agenda.

I call AMR a “silent killer” because there are no patient groups sounding the alarm. However, I am pleased to see that consumers are increasingly mobilising. For example, UICC has started talking about AMR and cancer care because many cancer patients are dying of secondary infection and not of cancer. Therefore, we need to mobilise consumers. I believe a coalition of the willing will have a faster and bigger impact on the incentive to invest. But there also needs to be strong public health and access provisions – and that is why we teamed up with the Wellcome Trust, the European Investment Bank and WHO early on, because if whatever comes out of the research is shared without clear certified stewardship prohibitions, we might run into new resistance much faster. But I am optimist and I do believe that 2020 can be a game-changing year for the positive.

Dame Sally Davies: This is a very good point to finish on, with the agreement that this year could be an important year for AMR.

Let me call on the audience: You can make a difference, join in, and help us turn the tide on AMR.

Interview – Al Jazeera – How COVID-19 vaccine manufacturers are collaborating with governments to ensure that an effective and safe vaccine is available everywhere in the world

Watch full interview hereThomas Cueni, IFPMA Director General, spoke to Al Jazeera English, on the side lines of the World Health Summit, about collaboration between the pharmaceutical industry and governments to make sure COVID 19 vaccines are available in poorer countries; as well as industry’s commitment to the most rigorous regulatory scrutiny.

Maryam Nemazee

Also taking part in the World Health Summit is Thomas Cueni the director general of the International Federation of pharmaceutical manufacturers, joining us live from Basel, Switzerland.

As you know, there has been a great deal of concern about vaccine nationalism. I’m just wondering about the discussions that are taking place where you are and what you can tell us about collaboration between governments and the private sector to make sure that a vaccine is effective and available in poorer parts of the world, as well as in richer countries.

Thomas Cueni

Indeed, not just effective and available but also safe because, obviously, we want to have a vaccine as fast as possible but also make sure that we proceed as slow as needed, because we want to make sure that the vaccines are tested for safety and ethics once they reach the people.

Maryam Nemazee

But of course, if and when a vaccine is found, assuming that that that will happen, tell us about the challenges logistically in distributing so many doses.

Thomas Cueni

There are multiple challenges. Although you read about more than 200 vaccine projects in the world, there are probably not more than a handful of big pharma companies able to manufacture large scale, hundreds of million doses.

To give you a perspective, the largest vaccine volume ever produced is 450 million doses per year for polio. Now, for COVID-19 we are talking about a need of potentially 12 to 15 billion doses of a vaccine. This causes daunting challenges. For example, you need specialized glass vials, which are scarce. So instead of having single dose vaccines, you will need to have multi doses in one vial. You will need sufficient number of syringes, and you will also need specialized transportation and storage, because some of the most promising vaccines, and particularly those who are the most advanced, need ultra-cold chains (up to minus 80 degrees Celsius). Therefore, even in industrialized countries you cannot expect that this will be easy to get in your General Practitioner’s office.

Maryam Nemazee

Do you fear that in this rush to produce a vaccine that speed will take precedent over the safety?

Thomas Cueni

No, vaccine speed cannot compromise safety and efficacy.

I think that it is remarkable that the leaders of the biggest vaccine manufacturers have come out and expressed publicly when there was concern about political meddling in emergency use licensing, in speed and trumping vaccine safety or efficacy.

They have come out and said that they want to submit to the most rigorous regulatory scrutiny, to independent expert advisory committees and to go far beyond what’s normally needed in regulatory processes in terms of transparency and in terms of publishing safety data with good, as well as the bad, results of vaccines. Therefore, the companies are deeply conscious of this need – not just because of COVID-19 but also because of the number of anti vaxxers in the world.

We do not want to create a disaster by going too fast. We really need to move as fast as possible and as slow as needed.

Maryam Nemazee

Thank you very much. It was good to talk to you, Thomas B. Cueni

Watch full interview 

Stimulating innovation in Africa, supporting the emergence of new technologies

On Saturday October 17, I was honoured to take part in the 8th edition of the African Invention and Technological Innovation Fair organized by the Organisation Africaine sur la Propriété Intellectuelle (OAPI). Innovation, creativity and intellectual property are linked to socio-economic development.

The African Invention and Technology Innovation Fair plays a key role in stimulating innovation, and I would like to congratulate the organizers and participants for their efforts.

We were very pleased and honoured to present a Special Award to recognize, encourage and support the emergence of new technologies that respond to concrete needs in the community, to Dr. Adama Ndayane Faye, for his “Automatic Blood Sedimentation Rate Meter”. We really hope that this award will help him bring his invention to life and thus propose a new solution to medical analysis laboratories that is adapted to the African context. It is in fact essential to develop local talent in order to imagine new solutions for healthcare systems, and to enable innovators to protect their intellectual property in order to transform their creativity into an economic force.

I was also pleased to announce a brand we initiative promoted by IFPMA and Speak Up Africa which will be launched in December: the “Africa Young Innovator for Health Award “. It is essential to help the new generation of young entrepreneurs, and this initiative aims to stimulate the spirit of entrepreneurship and advance promising healthcare solutions.

Supporting the emergence of a new generation of industry leaders for sustainable global health

Since the beginning of the COVID-19 crisis, innovative players and industries operating in the health sector have been pressed to collaborate, innovate, and accelerate their research and development efforts in response to these unprecedented times.  The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), the trade association that represents biopharmaceutical companies around the world, has been at the forefront of this effort. IFPMA members stated and demonstrated their strong sense of responsibility to act –putting their resources and expertise, to develop potential treatments and vaccines, in partnerships with biotechnology companies, public agencies and academic institutions.

As healthcare companies and, the private sector at large, are working towards solutions to address the COVID-19 pandemic, a common theme is emerging – young professionals are rising up, joining forces, and facing these challenges head on with unwavering confidence, in order to contribute to a solution now and shaping a sustainable future. Reflecting on this trend, we identified the need for a platform that allows young professionals, in the innovative healthcare industry, to connect and grow in response to an ever-changing global health landscape.

That’s how HYPER came about. The full name describes our main intent – HYPER Healthcare | Health: Youth Perspectives. EmpoweRed a platform serving to mobilize, equip, and connect young representatives in the healthcare sector. HYPER Healthcare will aim at empowering young professionals by increasing their exposure to and understanding of global health issues. By doing so, it will leverage and reinforce the culture of networking and will enable young professionals to share their stories and learn from each other.

As organizations seek to build informed coalitions that are better equipped to tackle global health challenges, an initiative like HYPER is a clear solution. For some time, young aspiring leaders have been expressing the importance of youth and collaboration in addressing great global challenges, such as climate change. In the process of setting up the new platform, young professionals from more than ten companies and trade associations expressed the need for the industry to be strongly connected to issues in public health, with an ensured share of voice for youth. HYPER can be the answer that the leaders of tomorrow have been looking for.

Beyond the COVID-19 pandemic, we have identified several thematic areas for further discussions, including sustainability of health systems, strengthening of regulatory systems, vaccines policy, entrepreneurship, access to medicines, combating antimicrobial resistance. This new kind of platform will connect and empower the voice of young professionals for advancing global health policies in a forward-looking and sustainable direction.

2020 will without a doubt be remembered as the year that COVID-19 tested health systems globally, but also as a time of unprecedented cooperation, in which research-based biopharmaceutical companies spearheaded the global efforts to provide innovative solutions to tackle one of the most complex threats humanity has ever faced. New data from the 2020 Goalkeepers Report reveals that the COVID-19 pandemic has a dramatic impact on progress toward the SDGs. Decades of progress controlling diseases such as malaria, TB and HIV art at risk. Young people have been particularly affected by the repercussions of the pandemic, especially when it comes to employment, education and of course their health. A more sustainable future with holistic policies and robust healthcare systems cannot be built without considering young people’s perspective. The youth of today are the leaders of tomorrow—we need youth leadership if we are to catch up with the ambition laid out in the Sustainable Development Goals. As young leaders rise to the challenge and contribute to leading the response through these trying times, it is more important than ever that they connect, learn, and innovate—and HYPER is the platform to do it.

5 Questions… to Wendy Orchard on mental health & COVID-19

In the lead up to World Mental Health Day we sat down with Wendy Orchard, Executive Director of the International Association for Suicide Prevention (IASP) as she prepares to hold a virtual March for mental health, to find out what has been the impact of COVID-19 on mental health and what are the global efforts to curb suicide rates worldwide and what resources exist at a time of heightened concerns for people’s mental health.

1. What has been the impact of COVID-19 on mental health and more specifically on suicide-related risks?

There is currently limited evidence about the impact of the Covid-19 pandemic on suicidal behaviour.  Because of a lag between suicide mortality data and the sensitivities that surround suicide, it is likely that the true figures are hidden through underreporting and misclassification. What’s more, there are few data registries on suicide attempt and self-harm globally.

At International Association for Suicide Prevention IASP we are concerned.  Whilst limited, there is evidence relating to previous public health emergencies.  Historically, deaths by suicide increased in the USA during the 1918–19 influenza pandemic. Fast forwarding to today,studies on Severe Acute Respiratory Syndrome (SARS) found an increase of suicide among the elderly associated with social disengagement, mental stress, anxiety, and fears of being a burden on the family.

Mental ill-health, social isolation, entrapment, grieving, loneliness, hopelessness, unresolved anger, stigma, unemployment, financial strain, domestic violence, and excessive alcohol consumption are all known factors that increase suicidal behaviour. The COVID-19 pandemic may be associated according to recent informed commentaries with increase in suicidal behaviour due to these factors.

We are certainly concerned, and as a result IASP have built a Covid-19 Resource Centre which provides information for those seeking resources related to the pandemic and suicidal behaviour. We also are working in partnership with the International Covid-19 Suicide Prevention Research Collaboration (ICSPRC) with the aim to enhance good quality collaborative research on the prevention and management of suicide and suicidal behaviours in relation to the COVID-19 pandemic; and the Covid-19 Resource Centre hosts a COVID-19 suicide research study register with details of current studies being undertaken globally.

 

2. Every 40 seconds someone takes their life – what needs to be done so that suicide prevention strategies can reach more people who need help?

The reduction of suicide mortality must be a global imperative and a vital public health consideration.

Suicide remains a universal challenge with millions impacted by suicidal behaviour. Suicide is among the top 20 causes of death globally for people of all ages; limited data means the true extent of suicidal behaviour remains hidden.  Associated with this, suicide is far-reaching leaving many affected and/or suffering intense grief.

National, multi-sectorial suicide prevention strategies are essential to address suicide effectively and are a vital tool to help meet targets for suicide reduction.  Around 40 countries, mostly high-income, have developed national suicide prevention strategies which provide a structural framework to support the delivery of a comprehensive and integrated national response to suicidal behaviour (suicide and non-fatal self-harm).

The World Health Organization (WHO) has made preventing suicide a global imperative and encourages all countries to take effective action to prevent suicidal behaviour. But it recognises that there is no single way forward: “the steps a country should take next will depend on where the country is on the way towards suicide prevention”.

Whether it is in high or in lower and middle Income countries, the World Mental Health Day theme “Mental Health For All: Greater Investment – Greater Access” is a call to action to ramp up vital for suicide prevention activities and strategies to effectively reach and help people. IASP joins this global call for action.

 

3. How has IASP been working to draw attention to the high rates of suicide worldwide?  

For World Mental Health Day this year, IASP is contributing to the world’s first virtual March for Mental Health. This 24-hour virtual event (due to COVID-19) will focus on suicide prevention and mental health with a specific call to urge governments to decriminalise suicidal behaviour so that it can be recognised and treated as a public health issue, bolstering suicide prevention efforts. Join us and come together to call on the world to move on and invest in mental health for all.

In addition to World Mental Health day, there is also a World Day focused on raising awareness of suicide. World Suicide Prevention Day  is IASP’s primary awareness campaign.  As IASP President, Murad Khan said in his message for World Suicide Prevention Day “The theme of this day, ‘Working together to prevent suicide’ highlights the most essential ingredient for effective global suicide prevention: collaboration”.

Preventing suicide requires the efforts of many. It takes family, friends, co-workers, community members, educators, religious leaders, healthcare professionals, employers, political officials and governments.  Suicide prevention requires integrative strategies that encompass work at the individual, systems and community level.

IASP puts out numerous resources around its World Suicide Prevention Day campaign but one of the most important is the resource “Take a Minute” which encourages individuals to reach out to someone in their community as this may change the course of their life.  We find that people are often reluctant to intervene even when they suspect something is wrong. There are many reasons for this, including a fear of not knowing what to say and the worry of making the situation worse. This hesitancyy is understandable as suicide is a difficult issue to address.  There is also amyth that suggests talking about suicide may prompt vulnerable individuals to contemplate the idea or trigger the act. Evidence points to this is not being the case and that the offer of support, and a listening ear, are more likely to reduce distress, instead of exacerbating it.  Take a Minute directs people to reputable resources to help them gain confidence in reaching out to others who may be at risk of suicide.

Similarly, “Step Closer” a short awareness film released this year builds on this with empathy and compassion around the physical metaphor that ‘every step closer can connect someone to life’.

With World Mental Health Day, is an opportunity to reinforce this message to connect with people in distress and that we all have a role to play in preventing suicide by reaching out to a friend or family member.  As ensuring mental health and suicide prevention are included within Universal Health Coverage efforts, we are also eager to join forces to lobbying governments to commit to suicide prevention efforts and develop National Suicide Prevention Strategies.

 

4. Why is it important to focus on mental health in the SDG2030 agenda?

One billion people across the world are thought to have a mental or substance use disorder and anyone, anywhere, can be affected. Depression alone is on track to be the leading disease burden in the next ten years. 1 in 10 of us have a mental health condition and those with severe conditions die 10 -20 years earlier than the general population. Suicide is claiming the lives of up to 800,000 people every year – 1 person every 40 seconds – and it’s the second leading cause of death for young people aged 15-29 years.

 

The Sustainable Development Goals (SDGs) were adopted by the United Nations General Assembly in September 2015 and Goal 3 of the SDGs is to: ‘Ensure healthy lives and promote well-being for all at all ages’.   The importance of mental health is finally being recognised universally and this is represented by its inclusion in SDG Target 3.4 to: ‘By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being’ and of suicide prevention, with the inclusion of suicide rate as an indicator (3.4.2).

There has been historical under-investment in mental health globally and access to quality mental health services remains limited for many worldwide. The extra challenges brought by COVID-19 have highlighted the essential part mental health services play.   This is why the call for “Greater Access and Greater Investment” this World Mental Health Day is so timely, we must act now if we are to meet these goals.

5. What are the main barriers to achieve progress on mental health and suicide prevention and how can the private sector help?  

Whilst awareness for mental health and suicide prevention has grown, funding and resources are still lacking.  This funding is all the more at risk with Covid-19 and the prioritisation of competing health concerns; at a time when many people are potentially at greater risk of suffering from conditions that threaten their mental health.  Mental health and suicide prevention must be included in current priorities and funding streams and should be integral to Covid-19 response and recovery plans as highlighted by the UN Policy Brief: Covid-19 and the Need for Action on Mental Health.

Businesses around the world (employers, employees and clients) all have a role to play by prioritising mental health and suicide prevention in the workplace.  With global economic losses estimated to be US$1 trillion per year in productivity due to depression and anxiety, businesses that invest in building and maintaining good mental well-being report higher productivity and sales, more creativity and customer satisfaction.

Workplaces can be a source of well-being and much has and can be done to prioritise mental health and suicide prevention by businesses.  I would encourage all to read the article “A Global Effort in Workplace Health and Safety: Suicide Prevention” by IASP Special Interest Group Co-Chair Sally Spencer Thomas.

Mental health and suicide prevention are therefore not only a government issue or a public health issue but one that we all have a role to play in investing in and moving forward.

5 Questions to … Eric de Roodenbeke

Hospitals have been at the forefront in fighting the COVID-19 pandemic. We sat down with Eric de Roodenbeke, CEO of the International Hospital Federation to talk about how hospitals have adapted to the new normal as we continue to grapple with the pandemic.

5 Questions to … Eric de Roodenbeke

The IHF has celebrated its 90th anniversary in 2019, would you have imagined that just a few months later hospitals would be in the forefront in fighting a pandemic?

 

When reflecting on health service providers priorities at the end of 2019, there was very limited interest on the role of hospitals in the fight against communicable diseases. After the massive mobilization against AIDS, the attention has shifted to non-communicable diseases and ageing population as well as making sure that health services are providing value for money and paid accordingly. All this now seems trivial with the global mobilization against COVID.

Most countries, especially in the Global North, were not prepared to face COVID. In the initial stages of the pandemic, most hospitals were fully mobilized to respond to COVID patients and in several countries the lack of intensive care beds, medical devices and supplies (especially personal protective equipment for health workers) made headlines but at the same time a large part of hospital capacities and activities were frozen because of lockdown measures and/or patients were afraid to come to the hospitals.

Can you be more specific about how health services are impacted by COVID?

The health status of the populations has not changed because of COVID and chronic conditions for middle and high-income countries demands the majority of need for health care. Hospitals have therefore had to adapt to respond to the health needs of all these patients but with an additional layer of measures for infection control that is creating severe constrains for delivering care. Putting in place physical distancing in all its forms takes more time and requires more space and equipment. In other words, the productivity of health services is significantly impeded by COVID for all conditions considering that anyone can have COVID while seeking help for any other health condition.

The mobilization of health workers to respond to the crisis was remarkable, however it is understandable that after the pandemic there will be a need for personal and psychological recovery and for moving from crisis response mobilization to a new routine. This is part of the challenge health services are currently facing with high uncertainty on whether to put in place an organization that is for mitigating the consequence of COVID or if we need to transform all practices for the long term. The paradigm shift will happen if we cannot win the fight against COVID and have to live with COVID for years to come. Currently the dominant approach is driven by the idea that we will eventually win the fight against COVID especially with immunization.

With COVID a lot of innovation have been put forward, do you believe that they will transform healthcare provision?

The agility of hospitals and their capacity to innovate has been praised. The idea that we have to live with COVID-19 also draws a lot of attention to getting ready for the “next normal” or the “new normal”. At IHF, we have quickly responded to the COVID situation in line with our mission to share best practices and knowledge leading to action. We organized webinars for hospital leaders to share how they have organized response to the crisis and put in place continuity of care.

Additionally, the IHF has created the ‘Beyond COVID-19’ Task Force to reflect and recognize these innovations and to ensure that we contribute to sustain those that are working towards performance improvement. This task force is multinational and multisectoral and this should provide robust recommendation beyond just what could be described as local adaptation to face a crisis. Task force members have identified key domains where COVID has contributed to transformations that will be part of tomorrow’s regular practice regardless of the evolution of the pandemic. What’s interesting about this approach is it considers contributions that accelerate existing trends for evolution and innovations that will transform practices.

You mentioned how hospitals have been praised, is this making a difference to the future of hospitals?

We hope that the public health agenda will take hospitals into consideration for the health and wellbeing of a population. To give credit to the WHO, the Astana Declaration on Primary Health Care (PHC) has brought forward a renewed vision on PHC that has made more room for all providers including hospitals to unite in a single effort to achieve Better Health to All under Universal Health Coverage. Hospitals are hubs for supporting the care of the population in coordination with other providers. In many countries, hospitals are part of the greater health system and are no longer stand-alone facilities delivering services inside their walls. This is a heavy trend and COVID won’t change that.

As previously mentioned, the lack of intensive care beds has become a political debate beyond what is rational. Governments may have focused too much on beds as a unit for health service planning while the focus should be on capacity to treat health conditions leaving more flexibility for hospitals and their internal organizations; avoiding the use of beds as a key indicator.

COVID has demonstrated how flexibility and responsiveness is important. The IHF is collecting stories; calling all facilities that have created unique and exemplary actions or responses to share them and be recognized at the Beyond the Call of Duty for COVID-19.

As an international NGO did COVID change the course of your activities?

Like all organizations, we had to take the pandemic into account and develop new programs in response to the situation, and to put on hold a number of our activities. IHF has developed a full portfolio of COVID related activities such as; a database of information in relation to COVID-19, podcasts for experience sharing, specific e-newsletters, social media posting and dedicated blogs. Instead of switching our global congress from face-to-face to virtual, the IHF board has decided to fully postpone the World Hospital Congress to next year and to organize a fully dedicated IHF Virtual Forum: Learning from COVD, Transforming Health Services.