H5N1

The global community needs to do more to tackle the inequality crisis

Via The BMJ, an opinion piece by Sir Michael Marmot, Monica Geingos, and Joseph E. Stiglitz: The global community needs to do more to tackle the inequality crisis.

Progress on health inequalities is now at risk, argue Michael Marmot and colleagues, the chairs of a new Global Council on Inequality, AIDS, and Pandemics.

The climate emergency and the global rise in inequalities are putting us all at risk. Both will damage health. The global community, with successive climate change conferences (COPs), is taking faltering steps to tackle the climate emergency but is doing little about the inequality crisis. In some countries, political and economic forces are increasing social and economic inequalities, with potentially dire consequences for health inequalities and for people’s vulnerability to pandemics. Unfair distribution of power, money, and resources are driving inequalities in health. 

We’ve been through a good period. Global progress in improving health has been impressive throughout the 20th and early 21st centuries, and health inequalities between countries have diminished. Within countries, too, absolute inequalities in health have lessened, although that picture is more mixed.   

But this progress is now at risk. If the AIDS and covid-19 pandemics did nothing else, they showed how fragile these health improvements are. These pandemics have, to some extent, been driven by social and economic inequalities, and their effects have been to expose and exacerbate health inequalities. The effects of the pandemics have also been disproportionate in some communities and related to socioeconomic circumstances, gender, LGBTQ+ identities, and race and ethnicity.  

To deal with the effects of inequalities on pandemics and of pandemics on health inequalities, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has convened the Global Council on Inequality, AIDS, and Pandemics. We are the co-chairs of this global council. The announcement of the new council was made in Brazil at a meeting hosted by the Brazilian Ministry of Health. Our backgrounds as co-chairs are highly relevant to the council’s mission. We seek to bring the perspectives of international and national economic arrangements, social determinants of health, and human rights to bear on our central questions. The need is great as the following examples show.  

Analyses indicate that countries with greater income inequality have higher rates of HIV infection and of death from AIDS and covid-19. In most, but not all, African cities the urban poor are much more likely to live with HIV than those from higher socioeconomic groups.

HIV and AIDS have also exposed gender inequalities. In the west African countries of Cote d’Ivoire, Ghana, and Liberia, HIV prevalence in people aged 20-24 was five times higher in women than in men.

The unequal effect of the AIDS pandemic on men who have sex with men is a political choice. In Thailand, for example, where identifying as LGBTQ+ is not criminalised, the prevalence of HIV is 12 times higher among men who have sex with men than among other adults. In Malaysia, where identifying as LGBTQ+ is criminalised and subject to arrest, the HIV prevalence rate among men who have sex with men is more than 70 times higher than among other adults.

In Brazil, where racial inequalities were not openly acknowledged for a long time, the evidence of the effects of this on health inequalities is stark. Rates of new HIV infections have been falling among white people, while rising among black people.

The United States provides an important case study of the role of socioeconomic influences and racism on health, including during the covid-19 pandemic. Life expectancy had been falling in the years 2016-18, in part owing to deaths of despair, which show a social gradient—the fewer the years of education, the bigger the effect. The decline stopped, and life expectancy rose slightly in 2019, but then fell sharply in the first two years of the covid-19 pandemic. Covid mortality was higher among socioeconomically disadvantaged communities and black people. In New York City, in the first year of the pandemic, life expectancy fell by three years among white residents, 5.5 years among black residents, and six years among Hispanic residents.

The AIDS and covid-19 pandemics send two clear messages, and hopefully the global community is open to receiving them. The first is that inequalities drive the likelihood and consequences of pandemics, and pandemics amplify health inequalities. This is the problem that this global council is set up to tackle.

The second is that medical and technical responses are crucial but are only part of the story. Inequities in access to care are needless, harmful, and immoral, and should be relatively easy to solve. Could there have been a global rollout of covid vaccines, entailing higher levels of production? Most certainly. Technically, it should be possible in future pandemics to have the capacity to vaccinate the world as needed. The money is certainly there. In the first year of the covid-19 pandemic, the rich world found $18tn to protect the economies of high income countries. Against this amount, $25bn for a global rollout of the vaccine is coffee money. And the technology that would have made it even easier to rollout the vaccine more widely wasn’t shared, even though governments had put up the vast majority of funds for vaccine development. As the old saying has it, this was penny wise but pound foolish because everyone would have benefited from dampening down covid-19 globally.

The effects of transnational economic inequalities are striking. During the covid-19 pandemic, high income countries put trillions into health and social spending to fight the pandemic’s effects, including supporting their economies, but low and middle income countries lacked the fiscal resources to make this choice. In 2021, almost half of all low and middle income countries cut healthcare spending, and about 70% cut spending on education.

The clear lessons from pandemics are that paying attention to the social determinants of health, respecting human rights, and involving communities are critical. Inequalities in health this vast are not inevitable. They are the result of policies—both what we do and what we fail to do. To achieve a world with better health and fewer health inequalities we need knowledge, resources, and political will. One of the tasks of the Global Council on Inequality, AIDS, and Pandemics is to synthesise the knowledge we already have. As the example of the money found by high income countries to protect their economies shows, “we”—the global community—also have the resources. The problem is the skewed distribution of financial and other resources. Political will is the great challenge. The global council will work with partners in governments, agencies, and communities to build the political will and public demand for change. Social justice requires it.

When will the pandemic end? Here is scientists' six-month outlook on COVID-19

Via Bloomberg.com: When Will the Pandemic End? Here’s Scientists Six Month Outlook on COVID-19. Excerpt, with a comment at the end:

For anyone hoping to see light at the end of the Covid-19 tunnel over the next three to six months, scientists have some bad news: Brace for more of what we’ve already been through.  

Outbreaks will close schools and cancel classes. Vaccinated nursing home residents will face renewed fears of infection. Workers will weigh the danger of returning to the office as hospitals are overwhelmed, once again.

Almost everyone will be either infected or vaccinated before the pandemic ends, experts agree. Maybe both. An unlucky few will contract the virus more than once. The race between the waves of transmission that lead to  new variants and the battle to get the globe inoculated won’t be over until the coronavirus has touched all of us.   

“I see these continued surges occurring throughout the world,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, and an adviser to U.S. President Joe Biden. “Then it will drop, potentially somewhat precipitously,” he said. “And then I think we very easily could see another surge in the fall and winter” of this year, he added.   

With billions of people around the world yet to be vaccinated and little chance now of eliminating the virus, we can expect more outbreaks in classrooms, on public transport and in workplaces over the coming months, as economies push ahead with reopening. Even as immunization rates rise, there will always be people who are vulnerable to the virus: Newborn babies, people who can’t or won’t get inoculated, and those who get vaccinated but suffer breakthrough infections as their protection levels ebb.

The next few months will be rough. One key danger is if a vaccine-resistant variant develops, although it is not the only risk ahead. In the coming months, Bloomberg will explore the pandemic’s long-term impact on economies and markets, the pharmaceutical industry, travel and more.  

“We’re going to see hills and valleys, at least for the next several years as we get more vaccine out. That’s going to help. But the challenge is going to be: How big will the hills and valleys be, in terms of their distance?” Osterholm said. “We don’t know. But I can just tell you, this is a coronavirus forest fire that will not stop until it finds all the human wood that it can burn.”  

Covid Compared to Other Pandemics  

The five well-documented influenza pandemics of the past 130 years offer some blueprint for how Covid might play out, according to Lone Simonsen, an epidemiologist and professor of population health sciences at Roskilde University in Denmark. She is an expert on the ebb and flow of such events.  

While the longest global flu outbreak lasted five years, they mostly consisted of two to four waves of infection over an average of two or three years, she said. Covid is already shaping up to be among the more severe pandemics, as its second year concludes with the world in the middle of a third wave — and no end in sight.   

It’s possible that the virus known as SARS-CoV-2 won’t follow the path set by the pandemics of the past. After all, it is a different, novel and potentially more transmissible pathogen. And with a death toll of more than 4.6 million people so far, it’s already more than twice as deadly as any outbreak since the 1918 Spanish flu.

That's the official death toll as of mid-September 2021—pretty impressive for a virus no one ever heard of two years ago. The Economist estimates the true death count as 15.4 million. But the HIV/AIDS pandemic emerged 40 years ago, and has so far killed an estimated 33.6 million people. COVID-19 is just going to have to try harder.

How Senegal fought Covid-19 with lessons learned from Ebola and HIV/AIDS prevention

Via Vox.com: How Senegal fought Covid-19 with lessons learned from Ebola and HIV/AIDS prevention. Excerpt:

DAKAR, Senegal — Aissatou Diao talked about Covid-19 a lot. How to socially distance, what to do if you have a cough or a fever. But when the first coronavirus case arrived in Yeumbeul, a village outside Dakar where she does health outreach as a community relay, she couldn’t believe it. 

“I almost died when I heard I was on the list of people who were in contact with the Covid patient,” Diao recalls. 

That single contact brought Diao to Novotel, an upscale hotel in Dakar with Atlantic Ocean views. As part of its pandemic response, Senegal sought to provide a bed to everyone with Covid-19 — including mild or asymptomatic cases — and their direct contacts. In the spring of 2020, for about six months, Red Cross volunteers replaced hotel staff at Novotel, and rooms filled with people like Diao, exposed to Covid-19 and sent away to isolate. 

Her fellow community relays, who did Covid-19 outreach with her, kept calling and calling to check her status. They wanted to know if they’d be next. “We all got ready with our luggage, waiting for the results,” one of them said. 

Diao tested negative, twice, and she left quarantine after just four days. A year later, she calls it a funny story: a short stay in quarantine as she tries to make others aware of the seriousness of Covid-19. 

Diao’s experience captures both sides of Senegal’s Covid-19 response. The West African country used aggressive interventions like this isolation policy to slow transmission. At the same time, community and local health actors bolstered the public health response from the bottom up, relying on longstanding relationships and trust to convince people to wear masks, seek out testing, and get treatment.

“We have what we call a ‘chain of solidarity’: The nation joined hands together,” Moussa Seydi, chief of infectious disease service at Dakar’s University of Fann Hospital Center, said. “Religious leaders came to join the political decision-makers, and also, the community involved themselves in giving this response to Covid-19.”

To end covid-19, we must end discrimination and inequality

An opinion piece in The BMJ: To end covid-19, we must end discrimination and inequality.

Inequalities, fueled by stigma and discrimination, have for decades obstructed proven solutions in HIV prevention and treatment. For example, at least 92 countries still criminalize HIV transmission, exposure, or nondisclosure, and at least 68 countries and territories criminalize consensual same-sex sexual relations, exacerbating stigma in such a way that hinders key populations’ access to prevention and care. 

Research shows that punitive laws and discriminatory policies fuel HIV transmission among key populations, which includes people living with HIV, gay men and other men who have sex with men, sex workers, transgender people, people who use drugs, and people in prisons and other closed settings. 

The covid-19 pandemic and accompanying response measures are also compounding inequities for marginalized groups, particularly in LMICs, disrupting access to HIV and other services and threatening decades of progress. Women and key populations, for example, are reporting an elevated risk of domestic and family violence, increased social isolation, and difficulties accessing HIV and health services. 

Typically, marginalized communities in high income nations have not been spared either: a new report from the US Centers for Disease Control and Prevention confirms that gay, lesbian, and bisexual people experience stigma and discrimination in their lives that “can increase vulnerabilities to illness and limit the means to achieving optimal health and wellbeing,” leading to higher covid-19 risks overall. 

We need global solidarity to support strong systems for health, for everyone 

Ensuring that discriminatory laws, policies, practices, and inequalities do not hinder lifesaving tools from reaching all who need them requires strong systems for health and inclusive governance built on trust. As with HIV, covid-19 responses should be grounded in data, evidence, and human rights, and communities are central to ensure people have continued access to the services they need to survive. 

That is why in July 2020 the United Nations Development Programme (UNDP), World Health Organization, UNAIDS, and the O’Neill Institute launched the COVID-19 Law Lab to support evidence and rights based legal frameworks for covid-19 responses. It is also why UNDP and the Global Fund work with community led organizations, such as those in Panama, to ensure marginalized groups have access to HIV services during covid-19. 

But there is still much more to be done—we need to walk the talk on global solidarity to prevent millions more deaths. It is critical that countries increase funding and support for international cooperation. We must marshal the full strength and capacity of the multilateral system to deliver equity—now.

Second wave of COVID-19 could jeopardize 4 decades of work on HIV/AIDS, expert warns

Via CBC News: 2nd wave of virus could jeopardize 4 decades of work on HIV/AIDS, expert warns. Excerpt:

New HIV infections are at their lowest rate since the disease first hit British Columbia, according to top researcher Dr. Julio Montaner. 

Last year, on Dec. 1, World AIDS Day, Montaner declared the epidemic of HIV/AIDS over in B.C. because infection rates had fallen so low.  This year, despite concerns that COVID-19 restrictions would get in the way, the spread of HIV has declined even further.  

Montaner is the executive director and chief physician at the B.C. Centre for Excellence in HIV/AIDS and the head of the HIV/AIDS Program at St. Paul's Hospital. 

He was instrumental in turning HIV infections from a death sentence to a manageable condition. Now, he is concerned the success he has helped create in B.C. is not happening elsewhere.  

"The rest of the country and the rest of the world are falling behind," said Montaner. 

In April, after pandemic restrictions came into place, Montaner and others were concerned. HIV testing rates fell and people struggled to access health care.  

After four decades of hard work on the AIDS pandemic, to Montaner, it was "unthinkable."  

Now, he worries, we squandered the opportunity to prepare for the second wave of COVID this past summer, when new COVID infections were low.   

"We wasted the summer celebrating our success without taking responsibility collectively that we need to be cautious," he said. "I am very concerned that the way things are going with shutdowns and lockdowns and competition for health-care resources." 

Montaner worries B.C. is not up to speed on contact tracing, hasn't managed to expand testing and implement rapid testing, approaches he calls "game-changers" in controlling HIV. 

"We don't seem to learn from the past," he said. "It's very frustrating."

Honigsbaum: How do pandemics end? In different ways, but it’s never quick and never neat

In The Guardian, Mark Honigsbaum writes: How do pandemics end? In different ways, but it’s never quick and never neat. Excerpt:

On 7 September 1854, in the middle of a raging cholera epidemic, the physician John Snow approached the board of guardians of St James’s parish for permission to remove the handle from a public water pump in Broad Street in London’s Soho. Snow observed that 61 victims of the cholera had recently drawn water from the pump and reasoned that contaminated water was the source of the epidemic. His request was granted and, even though it would take a further 30 years for the germ theory of cholera to become accepted, his action ended the epidemic. 

As we adjust to another round of coronavirus restrictions, it would be nice to think that Boris Johnson and Matt Hancock have a similar endpoint in sight for Covid-19. Unfortunately, history suggests that epidemics rarely have such neat endings as the 1854 cholera epidemic. Quite the opposite: as the social historian of medicine Charles Rosenberg observed, most epidemics “drift towards closure”. It is 40 years since the identification of the first Aids cases, for instance, yet every year 1.7 million people are infected with HIV. Indeed, in the absence of a vaccine, the World Health Organization does not expect to call time on it before 2030.  

However, while HIV continues to pose a biological threat, it does not inspire anything like the same fears as it did in the early 1980s when the Thatcher government launched its “Don’t Die of Ignorance” campaign, replete with scary images of falling tombstones. Indeed, from a psychological standpoint, we can say that the Aids pandemic ended with the development of antiretroviral drugs and the discovery that patients infected with HIV could live with the virus well into old age.  

The Great Barrington declaration, advocating the controlled spread of coronavirus in younger age groups alongside the sheltering of the elderly, taps into a similar desire to banish the fear of Covid-19 and bring narrative closure to this pandemic. Implicit in the declaration signed by scientists at Harvard and other institutions is the idea that pandemics are as much social as biological phenomena and that if we were willing to accept higher levels of infection and death we would reach herd immunity quicker and return to normality sooner. 

But other scientists, writing in the Lancet, say the Great Barrington strategy rests on a “dangerous fallacy”. There is no evidence for lasting “herd immunity” to the coronavirus following natural infection. Rather than ending the pandemic, they argue, uncontrolled transmission in younger people could merely result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccines.

It is no coincidence they have called their rival petition “the John Snow memorandum”. Snow’s decisive action in Soho may have ended the 1854 epidemic, but cholera returned in 1866 and 1892. It was only in 1893, when the first mass cholera vaccine trials got under way in India, that it became possible to envisage the rational scientific control of cholera and other diseases. The high point of these efforts came in 1980 with the eradication of smallpox, the first and still the only disease to be eliminated from the planet. However, these efforts had begun 200 years earlier with Edward Jenner’s discovery in 1796 that he could induce immunity against smallpox with a vaccine made from the related cowpox virus.

With more than 170 vaccines for Covid-19 in development, it is to be hoped we won’t have to wait that long this time. However, Professor Andrew Pollard, the head of the Oxford University vaccine trial, warns that we should not expect a jab in the near future. At an online seminar last week, Pollard said the earliest he thought a vaccine would be available was summer 2021 and then only for frontline health workers. The bottom line is that “we may need masks until July”, he said.

The other way the pandemic could be brought to a close is with a truly world-beating test-and-trace system. Once we can suppress the reproductive rate to below 1 and be confident of keeping it there, the case for social distancing dissolves. Sure, some local measures might be necessary from time to time, but there would no longer be a need for blanket restrictions in order to prevent the NHS being overwhelmed. Essentially, Covid-19 would become an endemic infection, like flu or the common cold, and fade into the background. This is what appears to have happened after the 1918, 1957 and 1968 influenza pandemics. In each case, up to a third of the world’s population was infected, but although the death tolls were high (50 million in the 1918-19 pandemic, about 1 million each in the 1957 and 1968 ones), within two years they were over, either because herd immunity was reached or the viruses lost their virulence.

The nightmare scenario is that Sars-CoV-2 does not fade away but returns again and again. This was the case with the 14th-century Black Death, which caused repeated European epidemics between 1347 and 1353. Something similar happened in 1889-90 when the “Russian influenza” spread from central Asia to Europe and North America. Although an English government report gave 1892 as the official end date of the pandemic, in truth the Russian flu never went away. Instead, it was responsible for recurrent waves of illness throughout the closing years of Queen Victoria’s reign.

Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries

Via The Lancet Global Health: Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. The summary:

Background 

COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. 

Methods 

Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. 

Findings 

In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. 

Interpretation 

Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic.

Dr. Tedros on COVID-19: 'We have clearly not reached the peak of the pandemic'

WHO has published WHO Director-General's opening remarks at the media briefing on COVID-19 - 7 July 2020. Excerpt:

It took 12 weeks for the world to reach 400 thousand cases of COVID-19. 

Over the weekend, there were more than 400 thousand cases across the globe.  

There have now been 11.4 million cases of COVID-19 and more than 535,000 lives have been lost. 

The outbreak is accelerating and we have clearly not reached the peak of the pandemic.  

While the number of deaths appears to have levelled off globally, in reality some countries have made significant progress in reducing the number of deaths, while in other countries deaths are still on the rise. 

Where there has been progress in reducing deaths, countries have implemented targeted actions toward the most vulnerable groups, for example those people living in long-term care facilities. 

=== 

Over the past few months, there has been a lot of discussion about the origins of COVID-19. 

All preparations have been finalised and WHO experts will be traveling to China this weekend to prepare scientific plans with their Chinese counterparts for identifying the zoonotic source of the disease.   

The experts will develop the scope and terms of reference for a WHO-led international mission.  

The mission objective is to advance the understanding of animal hosts for COVID-19 and ascertain how the disease jumped between animals and humans.

===

WHO is deeply concerned about the impact of COVID-19 on the global response to HIV.

A new WHO survey showed access to HIV medicines has been significantly curtailed as a result of the pandemic.

73 countries have reported that they are at risk of stock-outs of antiretroviral medicines (ARVs).

To mitigate the impact of the pandemic on treatment access, WHO recommends all countries prescribe ARVs for longer periods of time.

Up to six months while supply chains for all medicines are fully functioning.

Similarly, shortages of condoms and pre-exposure prophylaxis can prove costly and WHO calls for countries to ensure uninterrupted prevention, testing and treatment services for HIV.

The disruptions in access to life-saving commodities and services come at a critical moment as progress in the global response to HIV stalls.

Over the last two years, numbers of new HIV infections stabilised at 1.7 million annually and there was only a modest reduction in AIDS-related deaths.

More than 25 million people now have access to ARVs but global targets for prevention, testing and treatment are off target.

Progress is stalling because HIV prevention and testing services are not reaching the groups that need them most.

What the growing rift between the US and WHO means for COVID-19 and global health

Via Nature.com: What the growing rift between the US and WHO means for COVID-19 and global health. Excerpt:

Experts in health policy are contending with the real possibility that the United States will pull away from the World Health Organization (WHO), fracturing a relationship that began in the wake of the Second World War. 

They say that the repercussions could range from a resurgence of polio and malaria, to barriers in the flow of information on COVID-19. Scientific partnerships around the world would also be damaged, and the United States could lose influence over global health initiatives, including those to distribute drugs and vaccines for the new coronavirus as they become available, say researchers.  

A fissure between the US and the international health agency opened further last week, when US President Donald Trump tweeted a letter to WHO director-general Tedros Adhanom Ghebreyesus, threatening to make permanent the US freeze on WHO funding that began in April, unless the organization “can actually demonstrate independence from China” within 30 days. He added that he will reconsider the United States’ membership of the organization. “I don’t think this is an idle threat,” says Kelley Lee, a global health-policy researcher at Simon Fraser University in Burnaby, Canada. 

Proposals for new US-led initiatives for pandemic preparedness abroad do little to quell researchers' concerns. Some say these efforts might even add incoherence to the world's response to COVID-19, and global health more generally, if they're not connected to a fully-funded WHO. “It’s surreal to even be having this conversation, since it’s so hard to get one’s head around the massive implications,” says Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University in Washington DC. 

The acrimony is poorly timed, given the need for international coordination and cooperation to contend with the coronavirus. “In this pandemic, people have said we’re building the plane while flying,” Katz says. “This proposal is like removing the windows while the plane is mid-air.”  

Balance due 

Trump’s letter, which he tweeted on 18 May, alleges that the WHO intentionally ignored reports that COVID-19 was spreading between people in Wuhan, China, in December. “I cannot allow American taxpayer dollars to continue to finance an organization that, in its present state, is so clearly not serving America’s interests,” he wrote. A few of Trump's points were immediately debunked. For example, he claimed that the medical journal The Lancet had published on the new coronavirus in December. The next day, the journal issued a statement calling the claim factually incorrect because their first reports on COVID-19 were published on 24 January. The journal also refuted other allegations in the letter, concluding that the claims are "damaging to efforts to strengthen international collaboration to control this pandemic." 

Tedros has reiterated his commitment to a comprehensive and independent evaluation of the WHO's response to COVID-19, and an assessment of the organization's operations in the first part of 2020 is already public. But when reporters asked Tedros about additional, immediate investigations in response to Trump's allegations at a WHO press briefing, he said, “Right now, the most important thing is fighting the fire, saving lives.”

Trump does not need Congressional approval to withhold funds from the WHO, and global health researchers say the gap left by the US is a big deal. Last year, the US government gave the WHO roughly US$450 million. Nearly 75% of that was voluntary, and the other quarter was mandatory — a sort of membership fee expected from the 194 member countries, adjusted by the size of their economies and populations. 

The United States is the biggest donor, representing about 15% of the WHO budget. So far this year, it has paid about one-quarter — $34 million — of its membership dues, according to a WHO spokesperson. Voluntary funds are more complicated because a large portion were paid last year, however the spokesperson says that the freeze has put a hold on new agreements, meaning that the full-blown effects of the decision will be felt in 2021. 

The US government provides 27% of the WHO’s budget for polio eradication; 19% of its budget for tackling tuberculosis, HIV, malaria and vaccine-preventable diseases such as measles; and 23% of its budget for emergency health operations. If these initiatives shrink, researchers say, death and suffering will surge. David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine, says this will also amount to squandered investment for the United States, particularly for polio. Gains won through vaccination campaigns that cost hundreds of millions of dollars would be lost, he says.

‘Finally, a virus got me.’ Peter Piot, who fought Ebola and HIV, reflects on facing death from COVID-19

In an interview with Science, Peter Piot describes his personal encounter: ‘Finally, a virus got me.’ Scientist who fought Ebola and HIV reflects on facing death from COVID-19. Excerpt:

Virologist Peter Piot, director of the London School of Hygiene & Tropical Medicine, fell ill with COVID-19 in mid-March. He spent 1 week in a hospital and has been recovering at his home in London since. Climbing a flight of stairs still leaves him breathless. 

Piot, who grew up in Belgium, was one of the discoverers of the Ebola virus in 1976 and spent his career fighting infectious diseases. He headed the Joint United Nations Programme on HIV/AIDS between 1995 and 2008 and is currently a coronavirus adviser to European Commission President Ursula von der Leyen. But his personal confrontation with the new coronavirus was a life-changing experience, Piot says.  

This interview took place on 2 May. Piot’s answers have been edited and translated from Dutch: 

 “ON 19 MARCH, I SUDDENLY HAD A HIGH FEVER and a stabbing headache. My skull and hair felt very painful, which was bizarre. I didn’t have a cough at the time, but still, my first reflex was: I have it. I kept working—I’m a workaholic—but from home. We put a lot of effort into teleworking at the London School of Hygiene & Tropical Medicine last year, so that we didn’t have to travel as much. That investment, made in the context of the fight against global warming, is now very useful, of course.  

I tested positive for COVID-19, as I suspected. I put myself in isolation in the guest room at home. But the fever didn’t go away. I had never been seriously ill and have not taken a day of sick leave the past 10 years. I live a pretty healthy life and walk regularly. The only risk factor for corona is my age—I’m 71. I’m an optimist, so I thought it would pass. But on 1 April, a doctor friend advised me to get a thorough examination because the fever and especially the exhaustion were getting worse and worse. 

It turned out I had severe oxygen deficiency, although I still wasn’t short of breath. Lung images showed I had severe pneumonia, typical of COVID-19, as well as bacterial pneumonia. I constantly felt exhausted, while normally I’m always buzzing with energy. It wasn’t just fatigue, but complete exhaustion; I’ll never forget that feeling. I had to be hospitalized, although I tested negative for the virus in the meantime. This is also typical for COVID-19: The virus disappears, but its consequences linger for weeks. 

I was concerned I would be put on a ventilator immediately because I had seen publications showing it increases your chance of dying. I was pretty scared, but fortunately, they just gave me an oxygen mask first and that turned out to work. So, I ended up in an isolation room in the antechamber of the intensive care department. You’re tired, so you’re resigned to your fate. You completely surrender to the nursing staff. You live in a routine from syringe to infusion and you hope you make it. I am usually quite proactive in the way I operate, but here I was 100% patient.  

I shared a room with a homeless person, a Colombian cleaner, and a man from Bangladesh—all three diabetics, incidentally, which is consistent with the known picture of the disease. The days and nights were lonely because no one had the energy to talk. I could only whisper for weeks; even now, my voice loses power in the evening. But I always had that question going around in my head: How will I be when I get out of this?

After fighting viruses all over the world for more than 40 years, I have become an expert in infections. I’m glad I had corona and not Ebola, although I read a scientific study yesterday that concluded you have a 30% chance of dying if you end up in a British hospital with COVID-19. That’s about the same overall mortality rate as for Ebola in 2014 in West Africa. That makes you lose your scientific level-headedness at times, and you surrender to emotional reflections. They got me, I sometimes thought. I have devoted my life to fighting viruses and finally, they get their revenge. For a week I balanced between heaven and Earth, on the edge of what could have been the end.

I was released from the hospital after a long week. I traveled home by public transport. I wanted to see the city, with its empty streets, its closed pubs, and its surprisingly fresh air. There was nobody on the street—a strange experience. I couldn’t walk properly because my muscles were weakened from lying down and from the lack of movement, which is not a good thing when you’re treating a lung condition. At home, I cried for a long time. I also slept badly for a while. The risk that something could still go seriously wrong keeps going through your head. You’re locked up again, but you’ve got to put things like that into perspective. I now admire Nelson Mandela even more than I used to. He was locked in prison for 27 years but came out as a great reconciler.

I have always had great respect for viruses, and that has not diminished. I have devoted much of my life to the fight against the AIDS virus. It’s such a clever thing; it evades everything we do to block it. Now that I have felt the compelling presence of a virus in my body myself, I look at viruses differently. I realize this one will change my life, despite the confrontational experiences I’ve had with viruses before. I feel more vulnerable.

One week after I was discharged, I became increasingly short of breath. I had to go to the hospital again, but fortunately, I could be treated on an outpatient basis. I turned out to have an organizing pneumonia-induced lung disease, caused by a so-called cytokine storm. It’s a result of your immune defense going into overdrive. Many people do not die from the tissue damage caused by the virus, but from the exaggerated response of their immune system, which doesn’t know what to do with the virus. I’m still under treatment for that, with high doses of corticosteroids that slow down the immune system. If I had had that storm along with the symptoms of the viral outbreak in my body, I wouldn’t have survived. I had atrial fibrillation, with my heart rate going up to 170 beats per minute; that also needs to be controlled with therapy, particularly to prevent blood clotting events, including stroke. This is an underestimated ability of the virus: It can probably affect all the organs in our body.