MisinfoRx: A Toolkit for Healthcare Providers

“MisinfoRx Toolkit” gives health care providers the knowledge and training to tackle patient-held medical misinformation 

November 16th, 2021

Boston, MA – To help counter the offline impacts of online medical misinformation, a team of collaborators from the Harvard Global Health Institute, the Technology and Social Change Project at the Shorenstein Center on Media, Politics and Public Policy at the Harvard Kennedy School, the University of Michigan School of Information, the Oakland University William Beaumont School of Medicine, and the Alfred Landecker Democracy Fellowship have created the MisinfoRx Toolkit. The Toolkit equips health care providers with knowledge and skills to counter medical misinformation and support patient health. 

The Covid-19 pandemic has shed new light on the challenge of online medical misinformation but this phenomenon is not new nor will it end with this current health crisis. Mis- and disinformation are longstanding challenges that operate at the interplay of psychological, social, economic, technological, and political dynamics. With the rapidly changing information environment, inaccurate and misleading health information has spread at unprecedented speed and scale. 

Harm lies in the power of false information to shape offline health behaviors and undermine individual and public health. Across a myriad of diseases and health crises, like the current covid-19 pandemic, we have seen how online misinformation negatively influences people’s decisions and behaviors, threatening individual and population level health.  For example, a recent study showed that even brief exposure to Covid-19 vaccine misinformation made people less likely to want a Covid-19 vaccine.

In clinical settings, providers have been forced to grapple with this challenge. Yet, addressing misinformation in person with patients has been largely left out of medical education and training. 

The MisinfoRx Toolkit was created to help support providers in addressing patient-held misinformation. It offers an overview of the science behind medical misinformation and why it can be so influential. Rooted in the latest evidence, the toolkit then provides strategies for addressing patient-held misinformation through empathetic and collaborative dialogue with patients, where they seek to understand what patients believe, why they believe it, and how they can best support the patient in making health-promotive decisions as a trusted partner.

Access the MisinfoRx Toolkit at misinforx.com/download

2021 Lancet Countdown on Health and Climate Change U.S. Policy Brief

On Wednesday, October 20th at 6:30pm EST the highly anticipated fifth annual Lancet Countdown on Health and Climate Change U.S. Policy Brief was released. 

The annual global report tracks the impact of climate change on human health and is a product of more than 100 experts from 40 global institutions and the companion U.S. Brief is supported by over 70 U.S. institutions, organizations, and centers. The 2021 U.S. Brief highlights the converging health crises of extreme heat, droughts, wildfires, exposes the inequitable health risks of climate change, and highlights opportunities to improve health through swift action. It also explores how expanding our understanding is essential for the United States’ ability to respond with evidence-informed policy recommendations.

You can now access the HTML version of the report, as well as the downloadable English and Spanish PDFs HERE.

2021 Lancet Countdown on Health and Climate Change Launch Event

On Thursday, October 21st, The Lancet Countdown U.S. Policy Brief Authors convened for the 2021 Lancet Countdown on Health and Climate Change U.S. Virtual Launch Event. 

The launch event included esteemed keynote presentations, dynamic panel discussions by top experts, and a Q&A by the Lancet Countdown authors, Renee N. Salas, MD, MPH, MS and Jeremy J. Hess, MD, MPH

You can access the event recording and learn more about our speakers HERE.

Summaries and Additional Materials

This year’s Brief was accompanied by a suite of supporting materials, including; an Executive Summary (English and Spanish), Summary for the General Public (English and Spanish), a Breakdown of the New Science, Summary for Medical Professionals, and Regional Summaries for the South, West, Midwest, and Northeast. 

These materials were generated to serve as living tools, meant to be used to strengthen and amplify existing work around climate change and health.

You can access and download this suite of supporting materials HERE.

See what others are saying about the report and how officials are responding HERE!

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Protecting forests and changing agricultural practices are essential, cost-effective actions to prevent pandemics

Boston, Mass. – As the world struggles to contain COVID-19, a group of leading, scientific experts from the U.S., Latin America, Africa, and South Asia released a report today outlining the strong scientific foundations for taking actions to stop the next pandemic by preventing the spillover of pathogens from animals to people. The report provides recommendations for research and actions to forestall new pandemics that have largely been absent from high-level discussions about prevention, including a novel call to integrate conservation actions with strengthening healthcare systems globally. 

The report from the International Scientific Task Force to Prevent Pandemics at the Source makes the case that investments in outbreak control, such as diagnostic tests, drugs, and vaccines, are critical but inadequate to address pandemic risk. These findings come as COVID-19 vaccinations availability in many low- and middle-income countries remains inadequate—and even in wealthier nations vaccine coverage is far from reaching levels needed to control the Delta variant. 

“To manage COVID-19, we have already spent more than $6 trillion dollars on what may turn out to be the most expensive band-aids ever bought, and no matter how much we spend on vaccines, they can never fully inoculate us from future pandemics,” said Dr. Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health and leader of the Scientific Task Force for Preventing Pandemics at the Source. “We must take actions that prevent pandemics from starting by stopping the spillover of diseases from animals to humans. When we do, we can also help stabilize the planet’s climate and revitalize its biosphere, each of which is essential to our health and economic welfare.”

Previous research by Dr. Bernstein and colleagues found that the costs of preventing the next pandemic—by reducing deforestation and regulating the wildlife trade—are as little as $22 billion a year, 2% of the economic and mortality costs of responding to COVID-19.

The task force found that spillover of possible pandemic pathogens occurs from livestock operations; wildlife hunting and trade; land use change—and the destruction of tropical forests in particular; expansion of agricultural lands, especially near human settlements; and rapid, unplanned urbanization. Climate change is also shrinking habitats and pushing animals on land and sea to move to new places, creating opportunities for pathogens to enter new hosts.

Agriculture is associated with greater than 50% of zoonotic infectious diseases that have emerged in humans since 1940. With human population growing, and food insecurity on the rise because of the pandemic, investments in sustainable agriculture and in the prevention of crop and food waste are critical to reduce biodiversity losses, conserve water resources, and prevent further land use change while promoting food security and economic welfare.

A key recommendation from the task force calls for leveraging investments in healthcare system strengthening and One Health to jointly advance conservation, animal and human health, and spillover prevention. A successful example of this integrated model comes from Borneo where a decade of work resulted in ∼70% reduction in deforestation and provided health care access to more than 28,400 patients and substantial decreases in diseases like malaria, tuberculosis, and common diseases of childhood.

Additional recommendations for investments and research include:

Investment priorities:

  • Conserve tropical forests, especially in relatively intact forests as well as those that have been fragmented.
  • Improve biosecurity for livestock and farmed wild animals, especially when animal husbandry occurs near large or rapidly expanding human populations.
  • Establish an intergovernmental partnership to address spillover risk from wild animals to livestock and people from aligned organizations such as FAO, WHO, OIE, UNEP, and Wildlife Enforcement Networks.
  • In low- and middle-income countries, leverage investments to strengthen healthcare systems and One Health platforms to jointly advance conservation, animal and human health, and spillover prevention.

Research priorities:

  • Establish which interventions, including those focused on forest conservation, wildlife hunting and trade, and biosecurity around farms, are most effective at spillover prevention.
  • Assess the economic, ecological, long term viability and social welfare impacts of interventions aimed at reducing spillover. Include cost-benefit analysis that considers the full scope of benefits that can come from spillover prevention in economic analyses.
  • Refine our understanding of where pandemics are likely to emerge, including assessments of pandemic drivers like governance, travel, and population density. 
  • Continue viral discovery in wildlife to ascertain the breadth of potential pathogens and improve genotype-phenotype associations that can enable spillover risk and virulence assessments.

The task force was convened by Harvard Chan C-CHANGE and the Harvard Global Health Institute (HGHI). The findings laid out in their inaugural report will be translated into international policy recommendations to inform the G20 summit in October and the 26th United Nations Climate Change Conference (COP26) in November.

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About Harvard Global Health Institute

The Harvard Global Health Institute is committed to surfacing and addressing some of the most persistent challenges in human health. We believe that the solutions to these problems will be drawn from within and beyond the medicine and public health spheres to encompass design, law, policy, business, and other fields. At HGHI, we harness the unique breadth of excellence within Harvard and are a dedicated partner to organizations, governments, scholars, and committed citizens around the globe. We convene diverse perspectives, identify gaps, design new learning opportunities, and advise policy makers to advance health equity for all. You can learn more at globalhealth.harvard.edu.

About Harvard Chan C-CHANGE

The Center for Climate, Health, and the Global Environment at Harvard T. H. Chan School of Public Health (Harvard Chan C-CHANGE) increases public awareness of the health impacts of climate change and uses science to make it personal, actionable, and urgent. Led by Dr. Aaron Bernstein, the Center leverages Harvard’s cutting-edge research to inform policies, technologies, and products that reduce air pollution and other causes of climate change. By making climate change personal, highlighting solutions, and emphasizing the important role we all play in driving change, Harvard Chan C-CHANGE puts health outcomes at the center of climate actions. To learn more visit https://www.hsph.harvard.edu/c-change/

By Toochi Uradu, HGHI Intern and Carissa Novak, HGHI Program Manager

The HGHI Lead Fellowship for Promoting Women in Global Health is designed to equip women leaders in global health with the skills and networks to mentor future female leaders and to affect far-reaching change in their communities. This unique program offers an opportunity to for fellows to advance their knowledge across a host of global health issues and cultivate their leadership and mentorship skills. Although the COVID-19 pandemic transformed the fellowship into a virtual experience this past year, the 2020 LEAD fellows engaged in a rich curriculum, took part in personalized leadership training and closely collaborated with faculty mentors throughout the fellowship year.

As Aida Kurtovic, Carmen Contreras, and Cynthia Mambo wrap up their fellowship this summer, we asked them to reflect on their time as LEAD fellows and to share how the fellowship has shaped their personal and professional journeys. We were given a glimpse into the profound impact the LEAD Fellowship has had on each of the fellows, and how they will collaborate as a network of women leaders to inspire and support other aspiring global health leaders around the world.

Aida Kurtovic 

Aida joined the fellowship program from Bosnia as the Head of Partnerships in Health (PH). As a LEAD fellow, Aida engaged in several impactful courses, including Negotiation Strategies: Building Agreements Across Boundaries and Women Leading Change at the Harvard Kennedy School, as well as The Art of Communication and Advanced Negotiation and Conflict Resolution Strategies: Mastering the Science and Art at the Harvard Extension School. Through a variety of workshops and events, Aida was able to enhance her communication, policy development, and mentorship skills. A highlight from her time as a fellow was when Aida spoke at a Brown Bag Seminar with the Harvard T.H. Chan School of Public Health; her presentation “Civil Society Organization Support to the Bosnian Health System under COVID-19 Pandemic Circumstances: How to Maintain the HIV Response in Focus,” explored interventions designed to increase the accessibility of ARV treatment and streamline new clinical testing protocols in Bosnia. 

Watch Aida’s full interview below to hear her takeaways from the 2020 fellowship year.

At the conclusion of the fellowship year, Aida plans to expand the scope of her work, shifting her focus from a national perspective on HIV/AIDS policy development to new regional initiatives. Aida credits her mentors, Margaret Bordeaux, Annemarie Sasdi, and Salmaan Keshavjee, who have empowered her to continue advocating for marginalized communities. Ultimately, she hopes to “contribute to the development of future women leaders in global health, but also in our societies.”

Cynthia Mambo

Cynthia joined the fellowship program as the Deputy PEPFAR Coordinator in Malawi. For Cynthia, “the beauty about this fellowship is that [she] could design [her] own program.” With this mindset, she engaged in courses that would further develop her leadership skills such as, Influence and Persuasion in Leadership at the Harvard Extension School, and Women Leading Change at the Harvard Kennedy School. Leveraging her expertise and position to empower young women in global health is of fundamental importance to Cynthia. For this reason, she provided mentorship to several undergraduate students throughout the year. Cynthia’s HSPH Brown Bag presentation, “Promoting Access to HIV Services among Adolescent Girls and Young Women (AGYW) in Malawi,” reflected her dedication to equipping young women with health promotive resources.

Watch Cynthia’s full interview below to hear her takeaways from the 2020 fellowship year.

Cynthia is looking forward to transitioning into her new role with the Global Fund in Geneva at the conclusion of the fellowship year. She intends to continue working with her mentors, Wafaie Fawzi and Mojisola Odeku, to adapt her fellowship project, which aims to support interventions that promote health-seeking behaviors among adolescents. Cynthia has enjoyed building a sisterhood with both former and current LEAD Fellows, and with their influence hopes to support young Malawian women.

Carmen Contreras

Carmen joined the fellowship program from Perú, where she is the Director of Mental Health for Socios En Salud, Partners in Health. Carmen’s background in mental health inspired her coursework selection during the fellowship year. Courses she completed include Case Studies in Global Mental Health Delivery, Women, Gender and Health: Critical Issues in Mental Health, and Foundations of Global Mental Health through the Harvard T.H. Chan School of Public Health. Over the year, Carmen shared her wealth of knowledge through speaking engagements, including Integrating TB and Mental Health Services to End the Epidemic, and Salud para todos: 25 años de salud y esperanza para las comunidades más vulnerables del Perú

Watch Carmen’s full interview below to hear her takeaways from the 2020 fellowship year.

As the fellowship year concludes, Carmen will continue to work with Partners in Health on her grant projects that promote mental health development in vulnerable communities in Perú. She will also continue working with her fellowship mentors, Ana Langer and Shekhar Sekena, to design interventions for mental health providers. Join Carmen this October at the Youth Tech Health Initiative Live Global 2021 Event, where she will speak on efforts to link youth to mental health care in communities affected by COVID-19 in Perú.

Learn More About The LEAD Fellowship

While the 2021-2022 LEAD cohort has been selected, you can learn more about the fellowship program and how to apply for future years on our website

In an effort to support the development of a diverse pool of women leaders in global health, the Harvard Global Health Institute (HGHI) and the Women and Health Initiative (W&HI) within the Global Health and Population Department at the Harvard T.H. Chan School of Public Health offers the Harvard LEAD Fellowship for Promoting Women in Global Health, a year-long program designed to advance the leadership skills of talented global health leaders from low- and middle-income countries who are committed to the mentorship of future women leaders in medicine and public health.  

HGHI and the W&HI are thrilled to introduce and welcome the 2021 Cohort of Harvard LEAD Fellows. 

Based on their specific goals, our 2021 fellows will spend their time at Harvard University engaging in tailored leadership training, mentoring, and networking opportunities, including independent work supported by Harvard-based faculty mentors. During the fellowship year, the fellows will have access to world-class faculty, classes, and executive education programs. They will be both encouraged and challenged in new and inspiring ways. 

The full fellowship curriculum, including leadership workshops, mentorship relationships, and classes will begin virtually in the fall of 2021 due to COVID-19 pandemic-related restrictions. In early 2022, we are looking forward to welcoming the fellows to Cambridge and Boston, MA. 

Learn more about the 2021 Cohort of Harvard LEAD Fellows:

Bridget Msolomba Malewezi, MD, MPH | Malawi

“As a leader of various local women’s organizations, I believe the skills and knowledge I will gain from participation in the fellowship will elevate the quality and standard of work that I individually as well as the organisations I work with produce. The executive leadership training and courses will help build cohesive and collaborative teams as I intend to share what I learn with my fellow women and leaders and generate thriving and active women-led organizations that will contribute as entities to the women’s health agenda in Malawi and globally.”

Bridget Msolomba Malewezi is a medical doctor, public health practitioner, motivational speaker, activist & health columnist. She is a graduate of the University of Malawi College of Medicine & Emory University, where completed her MPH with a focus on Global Health. She is currently the Vice President of the Malawi Chapter of Women in Global Health (WGH) as well as Acting Chair of the task force for the establishment of the Women Doctors Association of Malawi (WDAM). She is one of the founding members and currently an executive member and chairperson of Public Relations and COVID Public Awareness for the Society of Medical Doctors Malawi (SMD).

She has worked in various capacities including Country Director for Seed Global Health Malawi focusing on health systems strengthening and human resources for health (HRH). Prior to that, she served in various roles including Program Manager at Clinton Health Access Initiative (CHAI) providing technical assistance to several government departments on the introduction of new vaccines for childhood illnesses as well as reproductive health.

Her health column in the national newspaper is now in its 11th year and she has broadened this into social media pages on Facebook & Instagram – ‘DrBonHealth’ – sharing information on health and most recently on COVID. In November 2020, she was awarded a Doctor of Excellence award by the College of Physicians and Surgeons of Malawi (CPSM) in recognition for her dedication, leadership, and years of service to the medical fraternity. 

Mareli Claassens, PhD, MBChB | Namibia

The Harvard LEAD fellowship will hone my expertise in organizational leadership for a founding presidency of WoNam, in networking with organizations with similar aims and objectives, and in preparation for a leadership position in Global Health.”

Mareli Claassens is a clinical epidemiologist with a passion for Africa and its many peoples. She is enthusiastic to address the interesting challenges of finding drug-resistant tuberculosis (DR-TB) cases, map the transmission of Mycobacterium tuberculosis complex, investigate pharmacogenomics and pharmacokinetics of DR-TB treatment in African populations, and the interface between COVID-19, TB, and HIV. While employed at the Desmond Tutu Tuberculosis Centre, Stellenbosch University, she had been involved in many research studies, focusing on TB case finding, TB infection control, TB in healthcare workers, initial loss to follow-up in presumed TB cases, antiretroviral treatment in TB patients and modeling studies investigating TB prevalence and incidence. 

Currently, she is an Associate Research Professor at the University of Namibia (UNAM), funded as an African Research Leader by the UK Medical Research Council and the UK Foreign, Commonwealth and Development Office, and as a Senior Fellow by the European and Developing Countries Clinical Trials Partnership, to investigate DR-TB case finding in three regions of Namibia. She is a Research Fellow at Stellenbosch University, a Research Associate at the South African Centre for Modelling and Epidemiological Analysis, a member of the Global Burden of Disease Collaborator network, and a member of the Global Young Academy. She is collaborating with colleagues from Stellenbosch University, Imperial College London, Research Centre Borstel, University of Bern, Emory University, National Taiwan University, and others, with the aim of building local research capacity by involving local students who will have the opportunity to participate in study activities at UNAM and collaborating centers.

Preethi John, PhD  | India

“It is a privilege and honour to be a Harvard LEAD Fellow and I expect it will offer a life-changing transformative experience. I hope to utilise this period to expand my leadership skills to not only build sustainable institutes but also further enhance my capability in mentoring and capacity building. It would be my dream if this could inspire and motivate several others to join the women in global health movement and strengthen the resilience of the health system. The learning I will get from world class resources at Harvard will not only develop my calibre to be a better teacher, trainer, and researcher but also equip me to give back to my organisation, healthcare professionals, women, and to India.”

Preethi John is a health and development management professional with 25 years of experience in public and private sector organizations. Her expertise and experience have groomed her as a leader and institution builder. Her career track started with the Institute of Health Management Pachod, Pune, India where she was able to contribute to the spectrum of rural and urban healthcare management and action research programs. A long stint at Aravind Eye Care System (A WHO Collaborating Centre) enabled her to gain expertise in capacity building of healthcare human resources from developing countries across South Asia, Africa, and Latin America. At Chitkara University, Punjab, India she got the opportunity to pilot a model for the development of allied health professionals and establish the Chitkara School of Health Sciences as its Founder Dean.

She is currently the Director of the Chitkara Global Health Institute. She also serves as Advisory Board Member to Health and Development NGOs and is the Co-Founder of the Women in Global Health India Chapter. She holds a Ph.D. from IIT Madras and a postgraduate degree from TISS, Mumbai, India.

Alice Kayongo, MPH | Uganda

This LEAD Fellowship comes at the perfect time when I am taking on a new senior leadership role at WACI Health, an organisation deeply committed to improving health policy and outcomes in Africa. I strongly believe in the under-utilized potential for women in Africa to lead and inspire future generations and the LEAD fellowship simply has all the ingredients I believe are critical to this aspiration. I am therefore deeply honoured and privileged to be part of the next cohort and will take this once-in-a lifetime opportunity to make a difference in my country, continent and globally.”

Alice Kayongo is a public health practitioner and human rights advocate with 16 years of development experience working largely with civil society where she has held several positions. In addition to her academic training, she has more than 13 years of experience working with extremely vulnerable and voiceless grassroots communities affected by HIV on health literacy, advocacy, and empowerment. Together with these communities, she has worked to identify key advocacy priorities in a manner that triggers ownership and increases the communities’ meaningful participation.

Alice is an active researcher within the health, women’s, and children’s rights development sector in Uganda, Africa, and internationally. Her research interests for the health development sector are in: Health Financing, Intellectual Property Rights and Access to Medicines, the impetus for community mobilization and engagement in monitoring and evaluation of health service delivery at the community level. She has a proven record in conducting research on Health Systems Strengthening with particular emphasis on task shifting to improve indicators on Prevention of Mother to Child Transmission of HIV. She has vast experience conducting research amongst and for young women and adolescent girls in vulnerable communities of the region specifically focusing on predictors of loss to follow-up amongst young people enrolled in HIV Treatment and Care. She holds a Bachelor’s Degree in Sociology as well as a Master of Public Health.

Alice volunteers on several boards including the Public Health Ambassadors Uganda board, the Health GAP board as well as the Uhuru Institute Board. 

Julieta Kavetuna, MPhil | Namibia

“Life is a school which gives us opportunities to learn every day, thus I am ready to explore new avenues and improve on my current abilities and capabilities of leadership. I will capitalize on acquiring additional skills aiming to elevate Maternal and Mental Health among the top priority in our healthcare system. Namibia will be the Center of Excellence, with a global standing in issues of Maternal Mental Health in Africa. The policy I will be drafting during this fellowship will be a model instrument, which will ensure that every expecting mother receives the desired physical and mental care during and after birth.”

Julieta Kavetuna has been a community activist her entire life. Her activism is centered on the promotion of gender equity and the provision of quality health care for all, especially in the area of mental health. She has spent more than 13 years as a parliamentarian, where she was politically assigned for 5-year terms as Deputy Minister in the Ministry of Youth, and the Ministry of Health and Social Services. During her tenure in the Ministry of Youth, she launched a campaign “Operation Hope”, which successfully inspired hundreds of unemployed young people to identify their needs and pave their own ways to take up studies or create their own employment. While with the Ministry of Health she became a Mental Health champion.  She has also served as Secretary General of the National Youth Council, where she established the Credit for Youth Scheme and the Young Women Leadership structures.

She is a Registered Nurse and holds a string of post-graduate qualifications including; a diploma in gender and development, an Honors Public Management and Policy Planning certificate, and a Master of Philosophy in Public Mental Health from the University of Cape Town.

To learn more about the LEAD Fellowship for Promoting Women in Global Health, click HERE.

The Burke Global Health Fellowship program at the Harvard Global Health Institute provides funding for Harvard junior faculty members from across the University for innovative research and curriculum development and teaching in global health. The Fellowships are made possible through the generous support of Harvard alumna Katherine States Burke, AB ’79, and her husband, T. Robert Burke, who established the Burke Fund to help launch and advance the careers of promising junior faculty in global health.

We are thrilled and honored to introduce the 2021 Burke Global Health Fellows:

Kavitha Ranganathan, MD

Dr. Kavitha Ranganathan is the Assistant Professor of Surgery at Harvard Medical School and Director of Craniofacial Reconstruction within the Division of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital. She is also part of the Center for Surgery and Public Health and Program of Global Surgery and Social Change. 

Matthew Gartland, MD

Matthew Gartland, MD, is the Director of the MGH Asylum Clinic at the MGH Center for Global Health and a faculty member in the MGH for Children Division of Pediatric Global Health. Dr. Gartland is also a Hospitalist at Brigham and Women’s Hospital and an Instructor at Harvard Medical School. 

Oludare Odumade, MD, PhD

Dr. Oludare (Dare) Odumade, MD/PhD, is a clinical instructor and attending physician in the Division of Medical Critical Care Intermediate Care Program at Boston Children’s Hospital and Harvard Medical School in Boston, MA. Currently, she works as a faculty member for the Boston Children’s Hospital Precision Vaccines Program.

John Naslund, PhD

Dr. Naslund is an Instructor of Global Health and Social Medicine at Harvard Medical School. He holds expertise in psychiatric epidemiology, implementation science, and digital mental health. He currently leads the scientific activities of ESSENCE, Enabling Science to Service to ENhance Depression CarE.

To learn more about our 2021 Burke Fellows, including their full bios and project descriptions, please click here.

In partnership with the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health (Harvard Chan C-CHANGE), HGHI is excited to announce the launch of a new task force composed of experts from across the world who will work together to identify the most effective ways to prevent new infectious diseases before they start. Members of the Scientific Task Force for Preventing Pandemics at the Source hope to elevate the link between planetary and public health to inform actions that may forestall the next pandemic. The task force is led by Dr. Aaron (Ari) Bernstein, interim director of Harvard Chan C-CHANGE and Assistant Faculty Lead to HGHI’s Climate and Health Initiative.

Every year, two viruses jump from animals to humans, leading at times to severe disease outbreaks, including the MERS, SARS, and 2009 H1N1 epidemics. Despite the risk posed by these “spillovers,” current discourse around future outbreaks has focused heavily on pandemic preparedness and response, rather curbing spillover and stopping pandemics at the source.

Experts estimate the costs of preventing the next pandemic are as much as $22 billion a year, or 2 percent of the economic and mortality costs of responding to the COVID-19 pandemic. Pandemic prevention interventions that decrease spillover risks—such as curbing deforestation, as Dr. Bernstein shared in a recent interview with WBUR or regulating the wildlife trade—offer the dual benefit of helping to prevent future zoonotic outbreaks like COVID-19 and combating climate change.

“Every conversation about preparing for the next pandemic must include how to prevent it at its source,” said Dr. Bernstein. “The current narrative on pandemic prevention is heavily weighted towards health system preparedness, containment, and vaccinations. This presumes the best we can do is prevent a disease from spreading once it emerges, but the evidence shows that our best forms of prevention stop these viruses from spilling into humans in the first place.”

Read more on the Task Force here!

By Haruka Margaret Braun, HGHI Intern and Megan Diamond, HGHI Affiliate

In April 2020, the Access to COVID-19 Tools (ACT) Accelerator was launched by the World Health Organization (WHO) and its partners with the aim of providing innovative and equitable access to the most recent diagnostics, treatments, and vaccines. A fundamental initiative of ACT is the COVID-19 Vaccines Global Access (COVAX), a global collaborative created to accelerate the development, manufacturing and distribution of COVID-19 vaccines worldwide. The underlying hypothesis: if countries worked together, COVAX could provide equitable access to COVID-19 vaccines; critical for low and middle-income countries that are unable to self-finance vaccine deals. While COVAX was originally created to leverage global collaboration for good, the lack of funding, coupled with the hoarding of vaccines by wealthy countries has undermined that goal. 

From the early stages of the COVID-19 pandemic, experts have emphasized the importance of global partnership and equitable access to COVID-19 diagnostics, treatments and vaccines. Global health governance refers to “the use of formal and informal institutions, rules, and processes by states, intergovernmental organizations, and non-state actors to deal with challenges to health that require cross-border collective action to address effectively”, and has long been proposed as an essential mechanism to facilitate effective international partnership in times of health crises and pandemics. In the context of an international public health emergency, such an approach is essential to mitigating the spread of disease and preventing future disasters.

Calling on global partnership in the context of a disease outbreak is not novel.  From SARS to Ebola, global health governance has been a prominent approach to tackling the spread of disease. In some cases, such as the WHO Framework Convention on Tobacco Control (FCTC) it has resulted in incredible successes. In others, such as during SARS and Ebola, repeated failures to collaborate led to insufficient, and at times, harmful results. As global inequities in the allocation of resources to prevent and treat COVID-19 continue to widen, a careful examination of these lessons – both good and bad – can help strengthen pandemic preparedness.            

The case for strengthening global health governance structures was made during the SARS epidemic in 2003. The absence of a functioning global governance surveillance system contributed to over 8,000 infections, and 700 deaths across 29 countries. After the initial outbreak of SARS in Guangdong province, China, the Chinese government failed to openly report the scale of China’s SARS outbreak to the WHO and the broader international community. This reporting failure was repeated by other countries as the virus spread, downplaying the extent of the virus’s toll and eliminating opportunities to adequately respond as a global community. Even if cases were more accurately reported, national pride and security consciousness would have acted as a secondary barrier, as they affected much of the political decision-making during the epidemic. SARS exposed failures within the global governance system, some of which were subsequently addressed, including the expansion of the WHO authority and regulatory power through the revision of the WHO’s International Health Regulations (IHR) in 2005. The expansion gave the WHO the power to declare a public health emergency of international concern (PHEIC).

Overall, minimal progress has been made in improving global governance systems, as many mistakes made during the SARS epidemic have been repeated during the COVID-19 pandemic response. Failures in transparency and communication regarding COVID-19 cases early in the pandemic contributed to the inability to contain the spread of disease across borders. The Chinese government did not immediately notify the international community about the outbreak of COVID-19 in Wuhan, China, and was reluctant to share raw data to WHO investigators. After the first reported case of a coronavirus disease in Wuhan on December 1, 2019, the WHO sounded its highest alarm by declaring the virus to be a PHEIC on January 30, 2020. Through this declaration, the WHO advised governments to implement public health measures such as testing and social distancing to curb the spread of the virus, a recommendation which was ignored by many countries. Preliminary investigations from the WHO and another independent panel point to the need for clearer communication regarding the immediate guidance and recommendations to countries once an event is declared a PHEIC. The failure of the PHEIC declaration to spark global action leads to the question of its power and enforceability and whether it’s creation post-SARS has been able to successfully alert countries of public health risks and create a coordinated international response to such crises.

Global surveillance reporting failures have been widely witnessed during the COVID-19 pandemic and have been largely discussed by researchers and journalists. In addition, these systems have failed to establish a clear precedent to push countries to monitor probable cases. Despite public health surveillance guidance from the WHO and US Centers for Disease Control and Prevention (CDC), many US states do not report such data of probable cases. Similarly across the globe, surveillance failures were witnessed because governments failed to build the capacities of IHR core health systems, including a system of surveillance and detection of diseases that is prepared for testing and national contact tracing efforts.

Over a decade after the SARS outbreak, the 2014 – 2016 West Africa Ebola outbreak yet again highlighted weaknesses in global governance structures as a mechanism to mitigate disease spread. Ebola highlighted the implications for when a country does not have the minimum core capacity to detect, report, and rapidly respond to outbreaks. The three most affected states, Guinea, Liberia, and Sierra Leone had a historically vulnerable public health infrastructure, and were in the aftermath of a civil war that had devastated the healthcare system and access to basic sanitation. While the WHO declared the epidemic to be a PHEIC in August 2014, little was done to mobilize resources to support WHO recommendations for treatment centers, personal protective equipment, and health worker compensation. Second, Ebola highlighted the need for transparent and open collaboration on new therapeutics and vaccines to support low- and middle-income countries. While the WHO provided technical leadership regarding the ethical use of unproven therapies during Ebola, there lacked guidance about how limited quantities of drugs should be delivered and rationed. Because of this, West African health workers and patients were often denied access to the available drugs that were at times available to international staff, highlighting the inequity in securing access to such resources. The Ebola crisis demonstrated how unprepared the multilateral system was to respond in fragile states and highlighted the need for rapid responses to emergencies and long-term capacity-building for infrastructure, a health workforce, and increased healthcare funding.

Again, clear comparisons between the Ebola response and COVID-19 response can be made.  Global governance systems failed to inform the production, procurement and distribution of resources needed to test and treat COVID-19 infected individuals; revealing vulnerabilities within health systems globally. The lack of global supply chain oversight of essential frontline medical devices and PPE has highlighted the need for a new governance system that supports intervention by public-health authorities during critical emergencies. For resource limited states, the shortage of intensive care beds, ventilators, and specialist staff have revealed challenges in the capacity to care for COVID-19 infected individuals. As of May, 2021, amid an unrelenting surge in India with reports upwards of 350,000 cases per day, a national shortage has caused India to rely on global partners for medical devices such as oxygen concentrators and ventilators. While the Biden administration announced last week that they would make available the raw materials needed for India’s vaccine production, wealthy nations continue to be accused of hoarding COVID-19 vaccines.

The inequitable distribution of resources during the COVID-19 pandemic has not been limited to testing and treatment. Since the development of COVID-19 vaccines, LMICs have been pushed to the back of the line with regards to vaccine access, and vaccine nationalism in the form of hoarding vaccines has undermined global vaccine equity efforts. Despite global calls for vaccine equity, wealthy governments partnered with pharmaceutical companies and purchased a surplus of supplies, creating a reality in which ninety percent of the 400 million vaccines delivered by March 2021 went to wealthy and middle-income countries. This points to the repetition of past global health governance failures and has exacerbated inequities during the COVID-19 pandemic. 

Despite failures seen in past epidemics, there are success stories that clearly demonstrate the power of global governance for health. The FCTC has proven that a unified and evidence-based approach to health crises can result in incredible global successes when the role of actors are clearly defined and accountability measures are put in place. It is estimated that nearly 22 million premature smoking-attributable deaths were saved due to the strong implementation of tobacco demand-reduction measures enforced by countries between 2007 and 2014. As an international treaty the WHO FCTC is unique, as Article 19 details the concept of liability, which had yet to be included in the provisions of any other framework convention. Under this article, parties agreed to consider taking legislative action or promoting their existing laws to deal with liability and collaborate to keep the tobacco industry liable for its abuses, creating a clear accountability system. Success stories such as this and others should be critically examined to inform how multinational organizations can strengthen collaboration and accountability, both in chronic and acute public health crises. 

Overcoming failures in global health governance structures will be no easy feat. Growing nationalism and the politicization of scientific rhetoric continues to threaten the capabilities of global partnership and effective global health governance. Many point to the rise of far-right politicians and leaders in the contribution to nationalism, and that the crisis has heightened nationalist attitudes. As noted by the rise of the term ‘vaccine nationalism’, the current pandemic has shed light on countries who have foregone multilateral partnerships to more immediately protect their own citizens. This is a dangerous reality as COVID-19 vaccine inequities worsen, virus variants continue to flourish, and global herd immunity becomes a more distant dream.

Moving forward, it is critical that global governance structures are built under the framework of social and health equity, and that they enable the global community to more readily respond to health crises. To this end, key questions remain: Is global health governance inevitably set up for failure? How can we better learn from the past? Will we continue to fail at establishing global equity in times of public health crises due to nationalistic attitudes and failures of global governance? Addressing past failures and preparing for future global health crises will require a unified strategic international response to disease outbreaks that center transparency, collaboration, and equity.

The rapid development of safe and effective COVID-19 vaccines signifies a new era in the fight against the pandemic. Yet while there is incredible potential to save millions of lives globally, vaccine nationalism is curtailing equitable vaccine distribution; paving a path that has been described as a “catastrophic moral failure.” While countries such as the UK, Canada, and USA have secured contracts to vaccinate their populations several times over, millions of people living in the Global South will not be able to get vaccinated until 2024.

As‌ ‌COVID-19‌ ‌continues‌ ‌to‌ ‌ravage‌ ‌populations‌ ‌around‌ ‌the‌ ‌world,‌ ‌these‌ ‌vast‌ ‌and‌ ‌ongoing‌ ‌inequities‌ ‌in‌ ‌vaccine‌ ‌rollout‌ ‌have‌ ‌made‌ ‌clear‌ ‌the‌ ‌urgent‌ ‌need‌ ‌for‌ ‌global‌ ‌vaccine‌ ‌equity.‌ ‌In‌ ‌view‌ ‌of‌ ‌this‌ ‌issue,‌ ‌the‌ ‌Harvard‌ ‌Global‌ ‌Health‌ ‌Institute‌ ‌is‌ ‌supporting‌ ‌efforts‌ ‌across‌ ‌several‌ ‌fronts‌ ‌to‌ ‌make‌ ‌clear‌ ‌the‌ ‌critical‌ ‌nature‌ ‌of‌ ‌this‌ ‌issue‌ ‌and‌ ‌advance‌ ‌insights‌ ‌for‌ ‌equitable‌ ‌and‌ ‌efficient‌ ‌vaccine‌ ‌development,‌ ‌allocation,‌ ‌and‌ ‌distribution‌ ‌policies.‌

Here is how you can get involved:

WATCH: Tune in to practical, timely discussions around the issues of vaccine distribution, confidence, and pandemic preparedness with HGHI’s Spring 2021 webinar series on global vaccine equity, hosted in partnership with Ariadne Labs and the Harvard University Center for AIDS Research (CFAR). 

READ: Consider the scope of and strategies for mitigating this global, ethical crisis in “From Vaccine Nationalism to Vaccine Equity — Finding a Path Forward,” a NEJM Perspective by HGHI Interim Faculty Director Dr. Allan Brandt, HGHI Associate Faculty Director Dr. Ingrid Katz, and colleagues Dr. Rebecca Weintraub and Dr. Linda-Gail Bekker. 

LISTEN: Hear directly from Dr. Ingrid Katz, as she reflects on the key takeaways from her article,  “From Vaccine Nationalism to Vaccine Equity — Finding a Path Forward.”

ACT: Join HGHI in signing an open letter to the Biden administration and pharmaceutical company leaders urging the adoption of strategies to address the profoundly inequitable global distribution of vaccines & join A Week of Action to Free the Vaccine!

WATCH

The Harvard Global Health Institute has partnered with Ariadne Labs and the Harvard University Center for AIDS Research (CFAR) to host a three-part webinar series on global vaccine equity. Catch up to speed on the first two webinars, and register for the 3rd and final session, below:

March 11th – Promoting Vaccine Equity: A Global Perspective on COVID-19 Vaccine Distribution

April 8th – Building Vaccine Confidence: Global Trends and Practical Solutions

April 29th, 9 AM EST – Reimagining Pandemic Preparedness: Making Equity a Strategic Priority

Register here!

READ

In their NEJM Perspective piece, a team of Harvard-based health experts lay out the current bottlenecks and barriers to equitable vaccine distribution, offer a forward-looking analysis of equity-advancing policy imperatives, and share key considerations for future pandemic preparedness. Read the full article here!

LISTEN

In this interview, HGHI Associate Faculty Director Dr. Ingrid Katz joins NEJM Executive Managing Editor Dr. Stephen Morrissey to discuss the threat of vaccine nationalism and dive deeper into the recommendations offered in the NEJM Perspective piece. Listen now!

ACT

Sign: In an open letter to President Biden and leaders of the US pharmaceutical industry, public health and medical experts are calling for urgent, concrete steps towards supporting global vaccine equity. The letter raises key policy imperatives around vaccine production, delivery, and pricing. HGHI stands in full support of these recommendations. We encourage readers to sign the letter & retweet today!

Participate: Join A Week of Action to Free the Vaccine happening now! We invite those located in the United States to email their congressperson to ask them to sign the Congressional TRIPS Waiver Letter. Find your representative here.

Sample email for your congressperson:

“Dear [Representative],

I am writing as a member of the medical community in your district who is deeply concerned about global inequity in COVID-19 vaccination. I urge you to support the emergency COVID-19 TRIPS waiver by signing the Schakowsky-Blumenauer-DeLauro letter to President Biden. The pace of global vaccine production and distribution is inequitable; it leaves us vulnerable to the alarming rates of COVID-19 spread and new variants that may make vaccines and treatments ineffective.

The global vaccine roll-out has resulted in vaccination of residents in high-income countries while leaving billions of people in low- and middle-income countries without access. This is immoral and medically unsound. Delivering vaccines only to wealthy countries is like trying to extinguish a house fire by pouring water in only one room.

We must remove the barriers to expanding global vaccine production and distribution. I am asking you to join the call for the US to support “Waiver from Certain Provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19”, supported by more than 100 nations at the World Trade Organization. The congressional sign-on letter has received signatures from several Massachusetts members of the U.S. House of Representatives, and I urge you to do the same.

We are in a race against time. If vaccines, testing and treatments are only provided to residents of the world’s wealthiest countries, one of this generation’s greatest biotechnological achievements will go down as its greatest moral and public health failing.

Sincerely,

[Your Name]”

Dr. Ashish K. Jha, Director of the Harvard Global Health Institute, on June 30, 2020 testified before members of the Senate Committee on Foreign Relations that U.S., withdrawal from the World Health Organization (WHO) “will harm not only the health of people around the world, but also US leadership and scientific prowess. And ultimately […] will harm the health of the American people at a time when Americans are getting sick and dying at an unprecedented rate.”

Dr. Jha, M.D., MPH, is the K.T. Li Professor of Global Health at the Harvard T.H. Chan School of Public Health and the Faculty Director of the Harvard Global Health Institute. He is a practicing General Internist and also Professor of Medicine at Harvard Medical School. In September, he begins as Dean of the Brown University School of Public Health.

HGHI recently released new data on state targets for COVID-19 testing, showing the vast majority of states are failing to test enough people to know where the virus is spreading and break the chains of infection.

Key points from Dr. Jha’s testimony:

“WHO’s response has been imperfect, but that doesn’t mean it is in our interest – or the world’s interest – for the US to leave WHO. Instead, we should stay involved to encourage improvement of the organization as an active member.”

“WHO’s role in helping countries, particularly low- and middle-income countries (LMICs), cannot be overstated. These nations’ ministries of health are heavily dependent on WHO for technical expertise and guidance on pandemic response. WHO is deeply embedded in LMICs— whereas local health officials in the US turn to the CDC for help, health officials in most other countries turn to WHO during an outbreak. For example, WHO has distributed tests to 126 countries around the world,[14] many of which lack the capacity to develop their own test kit quickly enough and thus rely on WHO’s technical expertise.”

“The US’s partnership plays an important role in ensuring that WHO has the capacity to do these things. The US provides about 15% of WHO’s funding.[15]10% of WHO’s collaborating centers for research and development are hosted in the US.[16] And the US CDC has played a critical role in facilitating public health emergency management training events and supporting the deployment of staff and resources to respond to crises. It’s clear that cutting US ties with WHO significantly hampers WHO’s ability to execute on its mission.”

“The decision to leave WHO doesn’t just harm the rest of the world—it hurts the United States, as well. By ending our relationship with WHO at this critical moment, the US is removing itself from the most important decisions surrounding this virus. We are sending a message that the US is an undependable partner, that we cannot be counted on for collaboration in a global crisis. And we are leaving a leadership vacuum within WHO for other countries to fill.”

“Leaving WHO also separates the US from much of the leading research and development around COVID-19. Scientists from countries around the world turn to WHO to share samples and collaborate on quickly building an evidence base. A notable example of this is WHO’s SOLIDARITY Trial, the world’s largest clinical trial of COVID-19 therapies.”

“There is no substitute for WHO. Its unique position as an international agency made up of 194 member states gives it an unparalleled legitimacy and capacity to facilitate collective action and political will. Because of its international leverage, WHO is uniquely positioned to set and communicate public health norms and coordinate critical research and development across countries. It also has the ability to coordinate with international institutions from other sectors, like the World Trade Organization or the World Bank— an important asset for an interdisciplinary field like global health.”

Dr. Jha’s full testimony follows here.

Watch the Hearing Live
Testimony of Dr. Ashish K. Jha
Senate Committee on Foreign Relations
June 30, 2020

We are the middle of the greatest global public health crisis in a century. The COVID-19 pandemic has wreaked havoc on lives, healthcare systems, and economies around the globe. In most countries around the world, cases and deaths are still rising, and an effective, widely deployed vaccine is likely at least a year away. Yet at this critical moment in global public health, U.S. leadership is lacking. The most striking example of this lack of leadership is our Administration’s decision to withdraw the US from the World Health Organization (WHO). This is a decision that will harm not only the health of people around the world, but also US leadership and scientific prowess. And ultimately, the withdrawal from WHO, if it is to be finalized, will harm the health of the American people at a time when Americans are getting sick and dying at an unprecedent rate.

WHO has a unique and incomparable ability to coordinate and support international pandemic response. Now more than ever, we should be investing in and supporting this organization that is uniquely poised to tackle COVID-19.

The Pandemic is Not Over

The COVID-19 pandemic is still accelerating. We are continuing to see record-breaking daily increases in COVID-19 cases, and deaths are also rising worldwide. The pandemic is still in its early stages in most parts of the world, with cases still on their first uphill climb in Latin America, Africa, and large parts of Asia, as well as a resurgence of cases right here in the US.

The Latin American region recently reached 2.2 million cases after infections doubled over the past two months, and its combined death toll passed 100,000 last week.[1] Brazil has been described as a “worst-case scenario,” with overflowing hospitals and morgues;[2] last week, they saw their largest rise in daily infections and passed 50,000 deaths.[3] India is now recording record numbers of single-day cases after easing the strict national lockdown that had been imposed.[4] Reports of overwhelmed hospitals and lack of access to tests or treatment reveal the dire state of the pandemic there.[5] South Africa is also seeing an uphill trend and new daily records of confirmed cases.[6] They are now reporting about 7,000 new cases per day, about four times the number of daily new cases from a month ago.[7] Israel has seen a rise in cases since easing restrictions at the end of May. During the month of May, they were seeing only dozens of new cases each day; now, daily cases counts hit 400 and 500.[8]

And these are just a few examples. Globally, we are still early in the crisis. Most nations are in the middle of an uphill climb in cases, and some countries that did have some success in battling the virus early are now seeing second peaks after lifting their lockdowns. While the scientific community has made remarkable progress on diagnostics, vaccines, and therapeutics, the disease remains deadly for many. The pandemic is far from over.

The Critical Role of WHO

The World Health Organization’s response to the COVID-19 pandemic has been highly visible and at times, less than ideal. WHO is not perfect, by any means. I have historically criticized WHO a number of times, particularly following their leadership failures during the 2014 Ebola outbreak in West Africa.[9] Then, WHO’s response was slow and diffuse and contributed directly to several thousand preventable deaths. Indeed, the United Nations even created a new entity to coordinate the response, typically WHO’s prerogative, when it created the UN Mission for Ebola Emergency Response. I co-chaired a commission that examined the failures of the global community to respond effectively to Ebola, and our report specifically called out WHO’s shortcomings and failures as a major contributor to the poor outcomes we saw in West Africa.

While the shortcomings of the global Ebola response went far beyond WHO, its poor performance was one critical element. To that end, our commission made a series of recommendations about WHO reforms, many of which have indeed been taken up and implemented, while others have not. As a result, WHO’s response to the COVID-19 pandemic has been much stronger than its Ebola response.

But that is still not enough. WHO has made important mistakes in its response to the COVID-19 pandemic.  WHO excessively praised China’s early response to its outbreak, calling it “transparent” and “responsible” despite early clues that China’s response was anything but that.[10]

Some have argued that WHO should have refused to take China’s claims at face value and done more to independently investigate the early outbreak. For example, WHO probably should have considered it a greater possibility that human transmission was already occurring, even when officials in Wuhan said otherwise.[11] Although WHO does not have the power to forcibly investigate their own member states, it may have been beneficial for them to not have so quickly accepted China’s data and statements as truth.

Furthermore, WHO remained opposed to implementing travel restrictions until late February. While travel restrictions have not been proven to stop the spread of disease, some studies have found that they may delay its spread,[12] and some have argued that countries could have bought more time to prepare their response if they had not been encouraged to keep their borders open.

So yes, WHO’s response has been imperfect, but that doesn’t mean it is in our interest – or the world’s interest – for the US to leave WHO. Instead, we should stay involved to encourage improvement of the organization as an active member. After WHO’s failures during the Ebola crisis— which were far more dismal than any failures related to COVID-19— the US government engaged deeply with the organization and helped implement necessary changes. These changes included establishing a unified WHO platform for outbreaks and emergencies, creating the WHO Health Emergencies Programme, and implementing a framework for R&D preparedness and capacity.[13] WHO also worked to address shortages in funding that limited its ability to respond to the outbreak, including through the establishment of a Contingency Fund for Emergencies.

WHO’s role in helping countries, particularly low- and middle-income countries (LMICs), cannot be overstated. These nations’ ministries of health are heavily dependent on WHO for technical expertise and guidance on pandemic response. WHO is deeply embedded in LMICs— whereas local health officials in the US turn to the CDC for help, health officials in most other countries turn to WHO during an outbreak. For example, WHO has distributed tests to 126 countries around the world,[14] many of which lack the capacity to develop their own test kit quickly enough and thus rely on WHO’s technical expertise. When countries receive help from non-governmental organizations (NGOs), it is WHO that helps provide coordination. When countries need access to scientific expertise to inform policies, conduct disease surveillance, and acquire necessary resources and supplies, they turn to WHO. And given the longstanding relationship that local WHO offices have in many LMICs, they are uniquely able to collect and collate new data coming out of these countries. WHO is the primary hub of the knowledge and skills needed to prevent cross-national infectious disease outbreaks. Now is a time when LMICs are relying on WHO the most.

The US’s partnership plays an important role in ensuring that WHO has the capacity to do these things. The US provides about 15% of WHO’s funding.[15] 10% of WHO’s collaborating centers for research and development are hosted in the US.[16] And the US CDC has played a critical role in facilitating public health emergency management training events and supporting the deployment of staff and resources to respond to crises. It’s clear that cutting US ties with WHO significantly hampers WHO’s ability to execute on its mission.

Leaving WHO Harms the US

The decision to leave WHO doesn’t just harm the rest of the world—it hurts the United States, as well. By ending our relationship with WHO at this critical moment, the US is removing itself from the most important decisions surrounding this virus. We are sending a message that the US is an undependable partner, that we cannot be counted on for collaboration in a global crisis. And we are leaving a leadership vacuum within WHO for other countries to fill. Some European countries are already starting to step up to fill the space the US has left behind—last week, Germany pledged $560 million and France pledged $100 million to support WHO’s work.[17] And China may also seize the opportunity to exert more influence over WHO.

Leaving WHO also separates the US from much of the leading research and development around COVID-19. Scientists from countries around the world turn to WHO to share samples and collaborate on quickly building an evidence base. A notable example of this is WHO’s SOLIDARITY Trial, the world’s largest clinical trial of COVID-19 therapies.[18] Over 3,500 patients have already been recruited into this trial, and WHO is actively supporting 60 countries with ethical and regulatory approvals, identification of participating hospitals, training on usage of the online data system, and procurement of necessary medications. The SOLIDARITY Trial is believed to reduce the time needed to design and conduct a randomized controlled drug trial by 80%.

WHO is also playing a key role in COVID-19 vaccine development and manufacturing.[19] They have created a coalition of 300 scientists, developers, and funders with the goal of expediting exchange of scientific results and reducing duplication of research efforts. They are designing a large international vaccine trial that would ensure faster turnaround of results—around 3-6 months to determine the efficacy of each vaccine candidate. An expert group convened by WHO is working to prioritize the vaccine candidates with the most potential and develop a protocol for later trial phases that can be used around the world. WHO also played a role in creating the ACT-Accelerator, which, in addition to several other goals, is working to ensure that a vaccine will be manufactured and distributed quickly and equitably once it is developed.[20] This level of international scientific cooperation is critical to allowing us to rapidly develop tools to fight this virus—but the US will no longer be able to shape or participate in this work.

In addition to hindering US scientific and global health leadership, the decision to leave WHO threatens the health of Americans. As we have so clearly seen during this pandemic, diseases do not respect borders. We can’t keep travel restrictions in place forever, and until this pandemic is under control globally, we will continue to be at risk of spread in the US. If low- and middle-income countries continue to have large outbreaks, they will become the sources of spread of the disease globally. No level of fortified borders will prevent disease spread from other nations. Unless we shut off all travel and trade from every other nation in the world, a physical impossibility, we will continue to import cases from other countries (and export cases as long as our outbreak remains large). Importing more cases of COVID-19 from other nations puts Americans’ health at greater risk. If we really want to protect the health of the American people, a central feature is to control the disease in the US and help other countries control their outbreaks as well.

These implications don’t only apply to this current outbreak, but also future ones. WHO provides critical information on most major public health threats, including influenza season and emerging diseases, and we will no longer have the same access to that information. We will no longer be able to inform the global scientific and political response to those outbreaks. Collaborating with other countries to keep future diseases from entering our own borders will be more difficult. While COVID-19 is our major concern currently, the harms to the US of pulling out of WHO are far-reaching.

There is no substitute

There is no substitute for WHO. Its unique position as an international agency made up of 194 member states gives it an unparalleled legitimacy and capacity to facilitate collective action and political will. Because of its international leverage, WHO is uniquely positioned to set and communicate public health norms and coordinate critical research and development across countries. It also has the ability to coordinate with international institutions from other sectors, like the World Trade Organization or the World Bank— an important asset for an interdisciplinary field like global health.

The leadership of WHO is chosen by member states. The deep relationship between individual nations and WHO, as I have outlined above, makes the organization essential for many countries around the world. If we were to get rid of WHO today, we would have to recreate a WHO tomorrow with many of the same features. There is no substitute for the essential work that WHO does.

A US-based global health organization, or even other international organizations like the World Bank, are no substitutes for WHO. There are no other organizations with the same reach into ministries of health. No other organizations have earned the same level of trust from healthcare organizations and frontline health workers here in the US and around the world. WHO’s role as a membership organization made up of nearly every nation in the world makes its presence accepted and welcomed in many countries in a way that the presence of a US government organization or even World Bank would not be, at least not in the health sector. And for global issues, you need truly global collaboration.

Conclusion

The U.S. potentially leaving WHO has dire consequences for both global health and for the health and well-being of the American people. WHO plays a critical role in providing support during health emergencies and accelerating scientific research. It is irreplaceable. During this pandemic, its response has been extraordinary, although not without some missteps. Some of the urgent reform efforts laid out in the post-Ebola period have yet to be completed. But there is no substitute for WHO. If we were to leave WHO, we would have no legitimacy or ability to make WHO a stronger organization. Instead, we should engage with WHO, support its important mission, and work to improve and strengthen it. Our ability to beat this pandemic—and to improve the health of people in the U.S and around world —depends on it.

[1] Henley J. Global report: India has highest rise in Covid-19 cases as Latin America toll passes 100,000. The Guardian. https://www.theguardian.com/world/2020/jun/24/global-report-india-has-highest-rise-in-covid-19-cases-as-latin-america-toll-passes-100000
[2] Leite J, Preissler Iglesias S, Viotti Beck M, Bronner E. The pandemic’s worst-case scenario is unfolding in Brazil. Bloomberg Businessweek.https://www.bloomberg.com/news/features/2020-06-24/coronavirus-pandemic-brazil-faces-worst-case-scenario
[3] Otte J, Gayle D, Quinn B, Perraudin F, Sullivan H. Bolsonaro silent as Brazil passes 50,000 deaths; global cases reach 9 million – as it happened. The Guardian.https://www.theguardian.com/world/live/2020/jun/22/coronavirus-live-news-covid-19-update-china-us-uk-brazil-latest-updates
[4] Henley J. Global report: India has highest rise in Covid-19 cases as Latin America toll passes 100,000. The Guardian. https://www.theguardian.com/world/2020/jun/24/global-report-india-has-highest-rise-in-covid-19-cases-as-latin-america-toll-passes-100000
[5] Dewan A, Woodyatt A. A surge in cases shows the coronavirus won’t go away soon. CNN. https://www.cnn.com/2020/06/23/world/coronavirus-spikes-after-lockdown-intl/index.html
[6] Coronavirus in South Africa: Restrictions ease as Covid-19 cases rise rapidly. BCC News. https://www.bbc.com/news/world-africa-53093832
[7] Johns Hopkins University Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html
[8] Johns Hopkins University Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html
[9] Jha AK. A race to restore confidence in the World Health Organization. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20170406.059519/full/
[10] Rauhala E. Chinese officials note serious problems in coronavirus response. The World Health Organization keeps praising them. Washington Post. https://www.washingtonpost.com/world/asia_pacific/chinese-officials-note-serious-problems-in-coronavirus-response-the-world-health-organization-keeps-praising-them/2020/02/08/b663dd7c-4834-11ea-91ab-ce439aa5c7c1_story.html
[11] Pérez-Peña R, McNeil DG. WHO, now Trump’s Scapegoat, warned about coronavirus early and often. New York Times.https://www.nytimes.com/2020/04/16/health/WHO-Trump-coronavirus.html
[12] Narea N. Coronavirus is already here. Blocking travelers won’t prevent its spread. Vox. https://www.vox.com/2020/3/12/21176669/travel-ban-trump-coronavirus-china-italy-europe
[13] Chan M. Learning from Ebola: readiness for outbreaks and emergencies. Bulletin of the World Health Organization. https://www.who.int/bulletin/volumes/93/12/15-165720/en/
[14] Rolling updates on coronavirus disease (COVID-19). World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
[15] Joseph A, Branswell H. Trump: U.S. will terminate relationship with the World Health Organization in wake of Covid-19 pandemic. STAT. https://www.statnews.com/2020/05/29/trump-us-terminate-who-relationship/
[16] The United States of America: Partner in global health. World Health Organization. https://www.who.int/about/planning-finance-and-accountability/financing-campaign/us-impact
[17] Schmitz R. Germany and France promise new financial support to World Health Organization. NPR. https://www.npr.org/sections/coronavirus-live-updates/2020/06/25/883302474/germany-and-france-promise-new-financial-support-to-world-health-organization
[18] “Solidarity” clinical trial for COVID-19 treatments. World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
[19] Accelerating a safe and effective COVID-19 vaccine. World Health Organization.https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/accelerating-a-safe-and-effective-covid-19-vaccine
[20] Access to COVID-19 Tools (ACT) Accelerator. World Health Organization.https://www.who.int/publications/m/item/access-to-covid-19-tools-(act)-accelerator

As COVID-19 outbreaks grow more severe, most U.S. states still fall far short on testing

From Mitigation to Suppression: In collaboration with NPR, HGHI is publishing new state testing targets for July. This new data shows only 18 states meet minimum targets for mitigation, and only three reach suppression level testing. 

(more…)

By Kate Raphael

We’ve talked about racism as a driver of health in previous posts; indeed, the toll of racism on BIPOC (Black, Indigenous, People of Color) bodies has gained increasing national attention in recent weeks, especially in light of the coronavirus, which exacts disproportionate economic and health tolls on racial minorities and immigrants, and police killings of Black people. Here are some recent  publications that caught our eye and highlight the connections between racism and other social determinants and health.

Racism In My Medical Education

Michelle Ko, Health Affairs, June 2020

Moving between Drew and UCLA taught me that there is no way that our health care systems will care about black, brown, or other marginalized minority lives until we change who enters the profession and ascends to its leadership. Lack of racial and ethnic diversity throughout all institutions is why the Black Lives Matter movement in 2013 was so necessary; why, until the past few years, almost no one discussed the glaring tragedy of black maternal mortality; and why, most recently, our policies and systems have collectively and catastrophically traumatized black communities communities during the COVID-19 epidemic. Even though California expanded eligibility for Medicaid under the Affordable Care Act in 2014, and the Martin Luther King, Jr. Community Hospital opened near the site of the former King/Drew Medical Center in 2015, no one expects these changes to produce an influx of majority physicians into south Los Angeles. The persistent segregation of communities by race, combined with our lack of diversity in medicine, will continue to result in chronically underserved minority populations.

Trends in Racial/Ethnic Representation Among US Medical Students

Lett et al, JAMA Network Open, September 2019

RESULTS: The number of medical school applicants increased 53%, from 33 625 to 51 658, and the number of matriculants increased 29.3%, from 16 488 to 21 326, between 2002 and 2017. During that time, proportions of black, Hispanic, Asian, and Native Hawaiian or Other Pacific Islander male and female individuals aged 20 to 34 years in the United States increased, while proportions of white male and female individuals decreased and proportions of AIAN male and female individuals were stable. From 2002 to 2017, black, Hispanic, and AIAN applicants and matriculants of both sexes were underrepresented, with a significant trend toward decreased representation for black female applicants from 2002 to 2012 (representation quotient slope, −0.011; 95% CI, −0.015 to −0.007; P < .001).
CONCLUSIONS AND RELEVANCE: Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study’s findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.

The Effects of Gentrification on the Well-Being and Opportunity of Original Resident Adults and Children

Quentin Brummet and David Reed, Federal Reserve Bank of Philadelphia, July 2019

Overall, we find that gentrification creates some important benefits for original resident adults and children and few observable harms. It reduces the average original resident adult’s exposure to neighborhood poverty by 3 percentage points, with larger (7 percentage points) reductions for those endogenously choosing to stay and no changes for those endogenously choosing to move. Gentrification also increases the average original resident homeowner’s house value, an important component of household wealth, with effects again stronger for stayers. Importantly, less-educated renters and less-educated homeowners each make up close to 25 percent of the population in gentrifiable neighborhoods, and 30 percent and 60 percent, respectively, stay even in gentrifying neighborhoods. Thus, the benefits experienced by these groups are quantitatively large.

Social determinants of health and survival in humans and other animals

Snyder-Mackler et al., Science Magazine, May 2020

The available evidence indicates that social impacts on life span are a shared phenomenon across humans and other social mammals and that the health-related outcomes of social adversity in nonhuman animals parallel socially patterned pathologies in humans. To some degree, the mechanisms that underlie these observations are also similar across species.

These findings suggest a shared biology underlying the influence of social gradients and a coherent evolutionary logic for when these gradients tend to be shallower versus steeper—arguments that have been made in various forms over the years.

A shared biology in turn suggests that integrating human and nonhuman animal studies can help address longstanding questions about the social determinants of health. Research at this interface should open several new opportunities.