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Unravelling the commercial determinants of health

Via The Lancet, an editorial: Unravelling the commercial determinants of health. Excerpt:

In early March, in the wake of the COVID-19 pandemic, nearly 200 people—including former UN Secretary-General Ban Ki-moon—signed a letter strongly criticising pharmaceutical companies for putting a desire to make extraordinary profits before the needs of humanity. Selling publicly funded vaccines, treatments, and tests to the highest bidder resulted in inequities that cost more than a million lives, while private companies made billions of dollars. The signatories called on world leaders to ensure that such an injustice is never repeated.  

The conflict between profits and health equity is not new. The global health community fought for decades to provide access to antiretrovirals for patients with HIV/AIDS in less-resourced settings. Many commercial actors attempt to negatively influence national and international policies, undermine science, or to directly attack individuals calling out their actions. The recent Lancet Series on breastfeeding showed how an extensive network of lobbying by formula milk companies has derailed progress on breastfeeding education. 

This history speaks to the central importance to health equity of the commercial determinants of health, the subject of a Series published in this issue of The Lancet, led by Rob Moodie of the University of Melbourne, along with authors spanning 15 countries and six continents, with the support of the Victorian Health Promotion Foundation of Australia.  

The headline findings are startling: four industries (tobacco, unhealthy food, fossil fuel, and alcohol) are responsible for at least a third of global deaths per year. Yet much of the work to understand the harmful (or beneficial) impact of commercial actors has to date been done in health research silos. Each field faces many of the same tactical battles and strategies without a unified agenda to protect health. There is a lack of consensus across fields of health to define and understand the commercial determinants of health.  

The Lancet Series seeks to remedy this long-standing and complex situation with a consensus definition of the commercial determinants of health (“systems, practices, and pathways through which commercial actors drive health and equity”), a framing to understand commercial entities' impact on health, and a commitment to address its challenges in a holistic way.  

The Series authors set out a bold vision in which governments, commercial actors, and civil society contribute first and foremost to improving health and societal wellbeing. Such a vision is needed urgently. As the second paper in the Series outlines, commercial actors are diverse and many play a vital role in society, but the products and practices of many are having increasingly negative impacts on human and planetary health and equity.  

The Series provides a comprehensive agenda for action, recognising the need for regenerative business models and accountable transparent policies (including an end to commercial actors opposition to health regulation and policies).  

Moodie emphasises that the Series is not anti-business; it is pro-health. There are some notable good models of pro-health-acting businesses. For example, nearly 200 leading financial institutions (which together manage more than US$16 trillion) have signed a pledge to support tobacco-free policies across lending, investment, and insurance. However, although Environmental, Social and Governance frameworks are increasingly used to guide more responsible investment, they still lack specific health indicators.  

Health needs to become a crucial consideration of investor frameworks and global capital markets. Doing so will require the adoption of different economic models, new legislative and regulatory measures, civil society advocacy and accountability, and better corporate social responsibility. Governments must be empowered to encourage businesses to prioritise positive health impacts.  

As Tedros Adhanom Ghebreyesus, WHO Director-General, writes in an accompanying Comment, public health cannot progress without action on the commercial determinants of health. The Lancet welcomes the upcoming WHO Congress and first Annual Report on the commercial determinants of health, especially in helping to address non-communicable diseases. Given their huge unresolved impacts, the commercial determinants of health must be recognised—and funded—as a crucial field of research.

Oxfam: Response to Lancet Commission on lessons from COVID-19 for future pandemics

Via Oxfam International: Response to Lancet Commission on lessons from COVID-19 for future pandemics.

Responding to The Lancet COVID-19 Commission’s report on lessons for future pandemics, Anna Marriott, Health Policy Manager at Oxfam and Policy Co-Lead for the People’s Vaccine Alliance, said: 

“The Lancet Commission details the utter failure of rich country leaders and pharmaceutical companies to ensure the tools needed to end this pandemic were accessible to everyone, everywhere. The findings of this commission should shame the international community. Nationalism, racism, profiteering, and an overreaching intellectual property system all prevented lower-income countries from accessing or producing vaccines.  

“It is vital that we learn the lessons of this report, end pharma’s deadly monopolies, and build more capacity for the development and manufacturing of vaccines, tests, and treatments in low and middle-income countries. Governments need to act immediately to extend an agreement made earlier this year on overriding COVID-19 vaccine patents to cover lifesaving treatments and tests. And they must safeguard World Health Organisation backed efforts to produce mRNA vaccine manufacturing on every continent from the threat of litigation from companies like Moderna.  

"The pandemic treaty currently under discussion needs to make clear that saving lives must come before profits and decisions about who lives and who dies are never again outsourced to the CEOs of big pharma.”

Changes in life expectancy between 2019 and 2021: United States and 19 peer countries

Via medRxiv: CHANGES IN LIFE EXPECTANCY BETWEEN 2019 AND 2021: UNITED STATES AND 19 PEER COUNTRIES. The abstract" 

BACKGROUND Prior studies reported large decreases in US life expectancy during 2020 as a result of the COVID-19 pandemic, disproportionately affecting Hispanic and Black populations and vastly exceeding the average change in life expectancy in other high-income countries. Life expectancy estimates for 2021 have not been reported. This study estimated changes in life expectancy during 2019-2021 in the US population, in three US racial/ethnic groups, and in 19 peer countries.  

METHODS US and peer country death data for 2019-2021 were obtained from the National Center for Health Statistics, the Human Mortality Database, and overseas statistical agencies. The 19 peer countries included Austria, Belgium, Denmark, England and Wales, Finland, France, Germany, Israel, Italy, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, South Korea, Spain, Sweden, and Switzerland. Life expectancy was calculated for 2019 and 2020 and estimated for 2021 using a previously validated modeling method.  

RESULTS US life expectancy decreased from 78.86 years in 2019 to 76.99 years in 2020 and 76.60 years in 2021, a net loss of 2.26 years. In contrast, peer countries averaged a smaller decrease in life expectancy between 2019 and 2020 (0.40 years) and a 0.28-year increase between 2020 and 2021, widening the gap in life expectancy between the United States and peer countries to more than five years. 

The decrease in US life expectancy was highly racialized: whereas the largest decreases in 2020 occurred among Hispanic and non-Hispanic Black populations, in 2021 only the non-Hispanic White population experienced a decrease in life expectancy.  

DISCUSSION The US mortality experience during 2020 and 2021 was more severe than in peer countries, deepening a US disadvantage in health and survival that has been building for decades. Over the two-year period between 2019 and 2021, US Hispanic and non-Hispanic Black populations experienced the largest losses in life expectancy, reflecting the legacy of systemic racism and inadequacies in the US handling of the pandemic. 

Reasons for the crossover in racialized outcomes between 2020 and 2021, in which life expectancy decreased only in the non-Hispanic White population, could have multiple explanations.

Marmot: Studying health inequalities has been my life’s work. What’s about to happen in the UK is unprecedented

Via The Guardian, Sir Michael Marmot writes: Studying health inequalities has been my life’s work. What’s about to happen in the UK is unprecedented. Excerpt:

Dignity. It is fundamental to who we are and our place in society. One way to deprive people of the opportunity to lead dignified lives is to take away the means to meet their material needs. It is undignified to have to resort to food banks to feed your children; to wear two coats indoors against the cold; to plead against eviction because of an inability to pay the rent; to deny children a birthday party because of cost.  

The poorest people in the UK are about to experience a fresh wave of such indignities. These psycho-social assaults will be joined by the physical ill-effects of poverty.  

My life’s work has been studying the relationship between social conditions and inequalities in health. In the UK, a decade of austerity damaged public health and made health equity worse. But the cost of living crisis – and the chancellor’s failure to deal with it – is unprecedented, with its threats to the health and wellbeing of the nation. A 54% rise in the energy price cap will now mean an average household will pay £1,971 a year for gas and electricity, at the same time that council tax, water bills and car tax are all increasing. In October, a further rise pushing the annual energy bill up to £2,300 is expected.  

The typical working-age household will, according to the Resolution Foundation, experience a 4% fall in income, £1,100, in 2022-23. Surely, one might think, 4% is scarcely noticeable, hardly a matter of life and death? It is if you are on the margins.  

The Resolution Foundation gives the example of a single parent, with one child, working 20 hours a week at a low-to-medium wage. In September 2021, this person might have had an income of £18,265. The precipitate removal of the universal credit boost will have reduced income by £1,040. The cost of living rise to September 2022 will take another £1,198 off income. With the chancellor’s changes to taxes and allowances, and salary increases, this person’s income in September 2022 will be £17,681 – £584 less than it was a year earlier. (By contrast, a couple working full-time, both at the median wage, will see their net income fall by 1%, £392.)  

Inflation of more than 8%, and the government’s failure to deal with the cost of living crisis for the poorest people – an unemployed single person will see a 15% drop in income – will put an extra 1.3 million people, including 500,000 children, below the poverty line.

Future pandemics: Failing to prepare means preparing to fail

An editorial in The Lancet Respiratory Medicine: Future pandemics: failing to prepare means preparing to fail.

Governments of high-income countries with high SARS-CoV-2 vaccination rates have been encouraged by evidence of decreasing COVID-19-associated morbidity and mortality, and can begin to think about the change from pandemic to endemic and the prevention of future pandemics. Meanwhile, some low-income and middle-income countries (LMICs) are still grappling with high numbers of COVID-19 cases, hospitalisations, and deaths, and low vaccination rates. 

A similar pattern has been seen with previous pandemics, including HIV/AIDS, tuberculosis, and malaria. Although these diseases kill millions of people globally every year, they are often referred to as endemic. As stated by Prof Ali Zumla in a recent Perspectives article, “The pandemic exposes weaknesses of current leadership of global public health systems, inequities of resource allocation to Africa, and broken promises by wealthier nations for vaccine equity and resource allocation. This status quo is unacceptable.” 

Rather than allowing a splintering of attention and resources across the COVID-19 pandemic, other current pandemics, and future threats, we should move towards an integrated, multipronged approach that targets these threats collectively. We must learn from the way in which different countries responded to the COVID-19 pandemic and build on successful approaches to ensure equitable pandemic preparedness in the future. Tackling a pandemic requires a global response. Individual countries need to prepare, but success will be hindered if some countries are left without the capacity to respond to a new threat. 

An analysis in the BMJ examined 28 national responses in the first year of the COVID-19 pandemic. Countries that were considered to be high performing were able to “partner, coordinate, develop, and strengthen” various public health, health-care system, and socioeconomic measures. Ultimately, these actions led to decreased disease transmission and lower mortality rates. Government cooperation, effective community engagement, and coordination across all levels of response led to successful procurement of resources and transformation from evidence-based policy to practice. 

A recent Global Burden of Disease study also found that measures of trust in government, and less government corruption, were associated with lower infection rates and higher SARS-CoV-2 vaccination coverage in middle-income and high-income countries. Therefore, efforts to improve communication surrounding risk of disease and community engagement strategies could help to boost public confidence in pandemic response strategies. 

Low-performing countries identified in the BMJ analysis had four common themes: devaluation of effective pandemic preparedness plans through inadequate infrastructure and underfunded health systems; denial from heads of state of scientific evidence that COVID-19 was a severe risk to health, and lack of support for those most vulnerable to economic risks of COVID-19; delays in enacting rapid responses to different stages of the pandemic despite supporting evidence; and finally, distrust between the public, government leaders, and the scientific research community. Unfortunately, these factors have been compounded by the politicisation of many actions, including the use of facemasks and vaccines. 

At present, many countries are severely underprepared to enact any plans for future pandemic prevention or response. They face numerous challenges in providing universal health coverage for citizens and are not able to allocate adequate investment or resources towards, for example, an increased workforce equipped to deal with current or future pandemics.

The Global Fund is actively involved in pandemic preparedness and response with their COVID-19 Response Mechanism (C19RM), which provides grant support to LMICs for COVID-19 tests, treatments, personal protective equipment, and critical elements of health system strengthening. C19RM aims to mitigate the impact of COVID-19 on programmes to fight HIV, tuberculosis, and malaria, and initiates urgent improvements in health and community systems; as of Jan 25, 2022, total funds approved to support C19RM reached US$4·1 billion, made available through support from donors in the USA, Germany, the Netherlands, and Switzerland. The hope is that funding will not be diverted from current pandemic action and that separate income will be generated for future threats.

Increased investment in COVID-19 tests, treatments, and vaccines has been extraordinary. To fully prepare for future pandemics, investment in mechanisms to prevent, detect, and respond to emerging pathogens is crucial.

Tracking universal health coverage: 2021 global monitoring report

Via ReliefWeb: Tracking Universal Health Coverage: 2021 Global Monitoring Report. Excerpt:

DUBAI/GENEVA/WASHINGTON DC — 12 December 2021 — New evidence compiled by the World Health Organization and the World Bank shows that the COVID-19 pandemic is likely to halt two decades of global progress towards Universal Health Coverage. The organizations also reveal that more than half a billion people are being pushed into extreme poverty because they have to pay for health services out of their own pockets.  

The findings are contained in two complementary reports, launched on Universal Health Coverage Day, highlighting the devastating impact of COVID-19 on people’s ability to obtain health care and pay for it.  

In 2020, the pandemic disrupted health services and stretched countries’ health systems beyond their limits as they struggled to deal with the impact of COVID-19. As a result, for example, immunization coverage dropped for the first time in ten years, and deaths from TB and malaria increased.  

The pandemic also triggered the worst economic crisis since the 1930s, making it increasingly difficult for people to pay for care. Even before the pandemic, half a billion people were being pushed (or pushed still further) into extreme poverty because of payments they made for health care. The organizations expect that that number is now considerably higher.  

“There is no time to spare,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “All governments must immediately resume and accelerate efforts to ensure every one of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary health care systems that can provide essential care close to home.”  

He added: “Prior to the pandemic, many countries had made progress. But it was not robust enough. This time we must build health systems that are strong enough to withstand shocks, such as the next pandemic and stay on course towards universal health coverage.”  

The new WHO/World Bank reports also warn that financial hardship is likely to become more intense as poverty grows, incomes fall, and governments face tighter fiscal constraints.

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Via The Lancet, but also published in 200 other health journals around the world: Call for emergency action to limit global temperature increases, restore biodiversity, and protect health.

The UN General Assembly in September, 2021, will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the UN Climate Change Conference of the Parties (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1·5°C, halt the destruction of nature, and protect health.  

Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1·5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse. Despite the world's necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.  

Reflecting the severity of the moment, this Comment appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.  

The risks to health of increases above 1·5°C are now well established. Indeed, no temperature rise is “safe”. In the past 20 years, heat-related mortality among people older than 65 years has increased by more than 50%. Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.  

Global heating is also contributing to the decline in global yield potential for major crops, falling by 1·8–5·6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition. Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics.  

The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement, and zoonotic disease—with severe implications for all countries and communities. As with the COVID-19 pandemic, we are globally as strong as our weakest member.  

Rises above 1·5°C increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state. This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.  

Encouragingly, many governments, financial institutions, and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world's land and oceans by 2030.  

These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with credible short-term and longer-term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations. Concern is growing that temperature rises above 1·5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community. Relatedly, current strategies for reducing emissions to net zero by the middle of the 21st century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.

This insufficient action means that temperature increases are likely to be well in excess of 2°C, a catastrophic outcome for health and environmental stability. Crucially, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed. This is an overall environmental crisis.

Health professionals are united with environmental scientists, businesses, and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years that follow. We join health professionals worldwide who have already supported calls for rapid action.

Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the wider destruction of the natural world.

To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more. Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.

Many governments met the threat of the COVID-19 pandemic with unprecedented funding. The environmental crisis demands a similar emergency response. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes. These include high quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.

These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the COVID-19 pandemic. But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.

In particular, countries that have disproportionately created the environmental crisis must do more to support low-income and middle-income countries to build cleaner, healthier, and more resilient societies. High-income countries must meet and go beyond their outstanding commitment to provide US$100 billion a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.

Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low-income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.

As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient, and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this will mean changing clinical practice. Health institutions have already divested more than $42 billion of assets from fossil fuels; others should join them.

The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1·5°C and to restore nature. Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.

New findings on pandemic kids. And what they really tell us

The Tyee has published my article: New Findings on Pandemic Kids. And What They Really Tell Us. Excerpt:

A new report by Children First Canada takes a long and detailed look at the state of our kids in this second year of pandemic. Even if you don’t have children, but hope for a decent and dignified old age, you’d better take note the findings of Raising Canada 2021 — and take appropriate action in this and future elections. 

The report finds that COVID-19 has aggravated ten major threats to our children. Those threats have been still more aggravated by “cross-cutting themes”: access to education and child care, access to health care and social services, inequity and inequality, and climate change. 

The report points to a host of threats to children that are also threats to us all. And those threats are unlikely to be blunted short of the kind of social transformation we usually call a revolution. 

Let’s look at the threats first. Some are simply intensified forms of the pre-pandemic status quo. Kids are coming into emergency departments with opioid and other poisonings, and cannabis ingestions. Their parents’ attempts to cope with stress don’t work with the kids either. 

Pre-pandemic Canada was stressful enough, but the report finds that “the effects of school closures have accelerated this threat,” leading to more eating disorders, substance misuse and suicide attempts among adolescents.

Systemic racism and discrimination stress racialized families, and the pandemic has only stressed them more. So it should be no surprise that “status First Nations, Métis, Inuit and Black children are disproportionately overrepresented in the child welfare system.” 

So stressed parents with no support are taking it out on their kids: “In some jurisdictions, clinicians have seen twice as many infants for maltreatment-related concerns, specifically fractures and head trauma.” 

More work for the health-care system 

Meanwhile, even less-stressed parents have skipped routine childhood vaccinations, ensuring more work for our health-care system when kids start coming down with measles and other preventable diseases. While many Canadian and U.S. states try to vaccinate their kids from age 12 and up, the report says, for those under 12 “vaccines may not be available until 2022.” Cuba is already testing its homegrown vaccines on kids as young as three. 

The pandemic has worsened childhood poverty, notably in a third of female lone-parent families, and “households with children are more likely to face food insecurity compared to households without children.” In other words, kids aren’t getting enough to eat. We are “ranked 37th out of 41 countries when it comes to providing healthy food for children.” Failing to nourish our children today will have consequences for the rest of the century. 

Well, not for those who die in infancy. The report says, “Canada’s infant mortality rate has increased. It is now the second highest among 17 OECD countries, at approximately 4.4 infant deaths per 1,000 live births. This is a marked change from 1960, when Canada ranked fifth lowest.”

MSF in Haiti: Violence puts patients, staff, and medical activities at risk

A news release from MSF: Haiti: Violence puts patients, staff, and medical activities at risk.

Port-au-Prince, June 11, 2021—A spike in violence in Haiti's capital is putting medical activities in jeopardy, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, warning that medical care cannot be sustained while armed clashes and robberies affect patients, staff, health facilities, and vehicles. 

In the first week of June, clashes in the neighborhood of Martissant and other districts of Port-au-Prince caused many injuries and displaced more than 1,000 people, including MSF patients and staff. From June 2 to 4, MSF's emergency center in Martissant received 42 patients with gunshot wounds, many of whom were transferred to MSF's trauma hospital in the Tabarre neighborhood, which increased its capacity for trauma patients from 50 to 68 beds. 

"We are witnessing an extremely worrying deterioration in the security situation," said Alessandra Giudiceandrea, MSF head of mission. "Some armed clashes took place near MSF's emergency center and offices in Martissant, where staff had to take cover from stray bullets. Armed individuals robbed two MSF ambulance drivers among other vehicles traveling from Martissant. To protect our staff, we had to reduce our community activities, but we are still treating emergencies based on our initial admission criteria." 

Clashes also took place in the city's Cité Soleil and Bel Air neighborhoods from May 15 to 31, and MSF's Tabarre hospital reached the limits of its capacity after receiving 41 patients, including 32 with wounds from violence. In another incident, a staff member of the Tabarre hospital was shot and killed on May 25 while returning home from work. 

The increased level of chronic violence is taking place amid a broader political and economic crisis in Haiti that affects people in many ways. Health systems are strained not only by insecurity but by a current increase in COVID-19 cases, economic challenges, and a high level of medical needs. 

"At a time when we should be scaling up because of COVID-19 and other needs, we are struggling to keep our existing facilities open due to insecurity," Giudiceandrea said. "We ask everyone to respect the need for medical activities to continue." 

In Martissant, insecurity and displacement may be hindering patients' ability to reach health care services. While MSF's emergency center reported an influx of trauma patients following the largest incidents of violence last week, patient numbers have now dropped below the center's normal average. 

MSF also provides care to survivors of sexual and gender-based violence through clinics in Port-au-Prince and Gonaïves, but staff are now seeing fewer patients, as people may fear leaving their homes to seek medical attention. MSF is concerned that the general increase in violence in the country is affecting the ability of sexual violence survivors to seek much-needed care. 

MSF has provided life-saving medical care to communities in Haiti for 30 years, but to continue providing such services in any community, MSF must be able to ensure the safety of patients and staff en route to and inside health care facilities. MSF demands that all groups and individuals involved in incidents of violence in Haiti respect the safety of health care workers, patients, medical supplies and facilities and that health care vehicles are granted safe passage without risk of attack.

Latin America and the Caribbean surpass 1 million COVID deaths

A news release from PAHO: Latin America and the Caribbean surpass 1 million COVID deaths. Excerpt:

Washington, D.C., May 21, 2021 (PAHO) — Pan American Health Organization Director Carissa F Etienne of the Pan American Health Organization (PAHO) reported today that more than one million people in Latin America and the Caribbean have died from the disease and called on the world to intensify efforts to improve the region’s access to vaccines.   

“More than one million lives have been cut short because of COVID-19. This is a tragic milestone for everyone in the region,” said Dr. Etienne. “This pandemic is far from over, and it is hitting Latin America and the Caribbean severely, affecting our health, our economies, and entire societies. Yet only about 3% of our citizens have been vaccinated.”   

According to figures reported by countries as of May 21, 2021, 1,001,781 people have died as a result of the SARS-CoV-2 virus in Latin America and the Caribbean. Almost 89% of the deaths occurred in five countries: Brazil (44.3%), México (22.1%), Colombia (8.3%), Argentina (7.3) and Peru (6.7%). Three percent of the deaths were concentrated in Central America and 1% in the Caribbean.   

“The region is an epicenter for COVID-19 suffering. It should be an epicenter for vaccination, too,” Dr Etienne said. More than 153.5 million people have been immunized in the Americas, but only 21.6% of these are in Latin America and the Caribbean.   

In contrast, in the United States, vaccination has been widespread, and marked improvements are already being observed, Dr. Etienne pointed out. Almost half of Americans have received at least one COVID vaccine dose and nearly 85% of those over the age of 85 are fully protected, and the result has been a sharp reduction in COVID-19 infections, deaths and hospitalizations, she said.   

“The progress we’re seeing in the U.S. is a testament to the power of safe and effective COVID vaccines, but it underscores the vital importance of accelerating access to vaccines throughout our region, so that other countries can fully immunize their populations,” she continued. 

“We urgently need more vaccines for Latin America and the Caribbean, a region which has been sorely tested by this pandemic.” 

She has congratulated countries that have indicated a willingness to donate tens of millions of excess vaccine doses and called on other countries to follow suit. 

“We urge countries with extra doses to consider donating a significant portion of these to the Americas, where these life-saving doses are desperately needed and will be promptly used,” she has said.   

PAHO has delivered more than 12 million COVAX-procured vaccine doses to countries in Latin America and the Caribbean. Another 770,000 doses are on the way to Central American and Caribbean countries.