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The global health decisions awaiting Biden — The slow climb to herd immunity — Ebola lessons learned

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The people and politics driving global health.
Jan 14, 2021 View in browser
Global Pulse

By Carmen Paun

This week we're looking at the global health decisions awaiting U.S. President-elect Joe Biden upon taking office next week.


President-elect Joe Biden delivers remarks in Wilmington, Del., on Jan. 8, 2021.

President-elect Joe Biden delivers remarks in Wilmington, Del., on Jan. 8, 2021. | Chip Somodevilla/Getty Images

A GLOBAL HEALTH TRANSITION IN REAL TIME — At the same time U.S. President-elect Joe Biden takes over from Donald Trump next Wednesday, more than 30 top global health officials will be in the middle of a week-long Zoom conference discussing the state of the world in the pandemic’s second year. Among their biggest unanswered questions: What will the U.S. bring to the international stage after four years of Trump?

The 30 or so members of the World Health Organization’s executive board — tasked with carrying out health decisions the world body agrees to every May — will be watching to see when Biden keeps his promise to rejoin the WHO. It probably won’t take long — Biden has pledged to do so on Day One, and it will probably come via a letter from Biden to U.N. Secretary General Antonio Guterres telling him to basically ignore Trump’s withdrawal notice from July. But that’s just the start.

Show me the money: An immediate question for Biden is what to do about the $80 million in U.S. contributions Trump withheld from WHO last year.

Funding will also be a sticking point in discussions about WHO reform, with member countries aiming for consensus by May. The Biden administration has a few months to influence that process, which officially starts at next week’s executive board meeting and will focus on WHO’s emergency response.

The U.S. point person on WHO reform will be the global affairs boss in the Department of Health and Human Services, who also oversees the U.S. position on anything from reproductive rights to global coronavirus vaccine distribution. Until Wednesday, that’s Garrett Grigsby, but the Biden administration will bring in a new official who has not yet been named.

Vaccine cash: Biden could also soon make clear whether the U.S. joins COVAX, the global effort to manufacture and equitably distribute coronavirus vaccines. U.S participation would be a big boost for the initiative.

Congress last month opened the door to U.S. participation by approving $4 billion for Gavi, one of the organizations running COVAX, to buy and deliver vaccines to countries whose health systems are overwhelmed by the pandemic. Congress didn’t specifically say that the money would go to COVAX, leaving it up to Biden to frame the U.S. participation.

With Democrats now controlling Washington, more global health aid is likely to follow, said Tim Rieser, senior foreign policy aide to Patrick Leahy (D-Vt.), the incoming chairman of the Senate Appropriations Committee. “Sen. Leahy has been urging for months that we help the poorest countries stop the spread of the virus, especially now that there’s a vaccine and the Republicans were willing to support it,” Reiser said.

President-elect Joe Biden receives the second dose of a Covid-19 vaccination from Chief Nurse Executive Ric Cuming at Christiana Hospital in Newark, Del.

WILMINGTON, DELAWARE - JANUARY 11: President-elect Joe Biden receives the second dose of Pfizer's Covid-19 vaccine on January 11, 2021 in Newark, Delaware. (Photo by Alex Wong/Getty Images) | Getty Images

Rebuilding the CDC: The Biden administration is expected to work on restoring the Centers for Disease Control and Prevention’s presence and reputation abroad. The CDC has been beset by a lack of funding and Trump’s antipathy toward international collaboration – the CDC scaled back its presence in almost 40 countries, and that affected its work in China. Global health experts have also been dismayed at how political appointees interfered with and dismissed the agency’s work during the pandemic. Incoming CDC chief Rochelle Walensky in an op-ed this week acknowledged the need to restore public trust at home and abroad.

Other countries have tried to fill the void left behind by the CDC. The agency’s German equivalent, the Robert Koch Institute, has helped at least 60 countries during the pandemic after gaining in recent years the legal right to deploy its people abroad, according to its boss Lothar Wieler. And China’s CDC is financing the construction of the African CDC headquarters south of the Ethiopian capital.

Other countries stepping up could ultimately help the CDC rely on more international partners going forward, said David Heymann, an American epidemiologist based in London who for decades worked at the CDC and led WHO’s SARS response in 2003. “Once political leaders begin to listen to the CDC and respect what it says, I think the issues will work themselves out,” Heymann said.


WELCOME BACK TO GLOBAL PULSE! In the mad world we live in, I will take any good news I can get, like this story pretty much confirming what we saw coming in November – the measures to fight the coronavirus have been successful in stopping one virus: influenza.

Global Pulse is a team effort. Thanks to Adam Cancryn and my editors Jason Millman and Joanne Kenen.


HAPPENING TODAY - THE COVID-19 VACCINE ROLLOUT: What are the logistical challenges facing the coronavirus immunization campaign? Who is overseeing the process and working to overcome obstacles to ensure that vulnerable groups have access to the vaccine? Join POLITICO for a virtual discussion on the outgoing Trump administration's plan to prioritize lower-income, rural, and communities of color for vaccine distribution and what the Biden administration can do to streamline plans and fill in any gaps. REGISTER HERE.


Samantha Powers

United States U.N. Ambassador Samantha Power speaks during her final press conference at U.N. headquarters. | AP Photo/Bebeto Matthews

POWER TO MANAGE USAID — Biden added another key player to his global health team on Wednesday, picking former U.N. ambassador Samantha Power to run the United States Agency for International Development (USAID). The federal agency distributes billions of dollars in foreign aid, including the $4 billion Congress just approved for Gavi.

A former war correspondent, Power served on President Barack Obama’s National Security Council before becoming his U.N. representative in his second term. In his book released in November, Obama called Power “a temperature check on my conscience”.

Biden also announced that he would elevate the USAID administrator to have a seat on the National Security Council. Power must still be confirmed by the Senate.

Also joining the NSC is Elizabeth Cameron, who will be the senior director for global health security and biodefense. She previously set up that office during the Obama administration, and then the Trump administration disbanded it before the pandemic. She also authored a pandemic playbook that the Trump administration ignored.

Cameron previously worked on global threat reduction at the State Department and was a policy director with the American Cancer Society.


More than 50 countries have started inoculations against Covid-19.

THE LONG CLIMB TO HERD IMMUNITY — About a quarter of the world’s countries have started Covid-19 vaccinations, with a vast majority of them (43) using the shots developed by Pfizer and BioNTech. Moderna, the other vaccine authorized in the U.S., is also being used in Canada, the tiny island nation of Palau and will be rolled out in Europe starting today.

Three countries — Argentina, Belarus and Russia — have begun vaccinating with Russia’s Sputnik V. China is relying on vaccines manufactured by two of its domestic companies, China National Biotec Group and Sinovac. The latter is also being used in Indonesia and Turkey, while the latest clinical trial results from Brazil show it was only 50.4 percent effective.

Some countries that have done well containing the virus, such as New Zealand and Australia , haven’t yet started immunization. New Zealand’s government said virus hotspots should get the shots first, while Australia – after saying there was no rush to greenlight vaccines – is now aiming to start by mid-February rather than March.


DImitri Eynikel tweet

Dimitri Eynikel tweets about the contrast between Covid-19 cases in Southern Africa and vaccine purchases in Europe. | Twitter


STOCKPILING EBOLA VACCINE — Fresh off quashing the 11th Ebola outbreak in the Democratic Republic of Congo in November, the World Health Organization and other international organizations have started stockpiling Merck’s Ebola vaccine for future outbreaks. Almost 7,000 doses are available now, with a goal of storing a half-million doses within three years, the WHO said this week.

The world health body is working with UNICEF, the International Federation of Red Cross and Red Crescent Societies, and Doctors Without Borders to set up the stockpile, which is located in Basel, Switzerland. The stockpile is receiving financial support from Gavi, and the first deliveries of doses are funded through $20 million USAID committed back in 2017.

February 2015 file photo of man holding Ebola vaccine vials.

John Moore/Getty Images

Lesson learned: The stockpile seems to be the supply management mechanism the WHO promised in fall 2019, when it was being criticized for moving too slowly to contain an Ebola outbreak ravaging the Congolese provinces of North Kivu and Ituri near the Ugandan border. Doctors Without Borders, which was fighting the outbreak on the ground at the time, criticized the WHO’s tight controls on vaccine supplies and vaccination eligibility.

Merck’s one-dose vaccine, Ervebo, was still in an experimental stage during that outbreak. By the end of 2019, it was licensed by U.S. and European drug regulators as well as WHO to protect adults at risk of infection with the virus.

Price tensions: “As Ebola outbreaks are relatively rare and unpredictable, there is no natural market for the vaccine,” WHO said this week. The market for Ebola vaccines is for now limited to this stockpile and one kept by the U.S. government, so the costs of producing the vaccine are not offset by widespread procurement by different countries.

The poorest countries, which are usually eligible for subsidized vaccines by Gavi, will get vaccines from the stockpile for free and will also receive help with vaccination campaign costs. Similar to the coronavirus vaccine from Pfizer/BioNTech, Ervebo must be stored at -76 Fahrenheit, and health care workers responding to Ebola outbreaks have used portable storage devices to ensure it’s kept at that subarctic temperature.

Richer countries dipping into the stockpile will need to pay $98.60 per dose, a price that Gavi called “reasonable” given development costs and limited demand for the shots.

Doctors Without Borders doesn’t agree, arguing that the vaccine was developed with a lot of public funding so there’s no need to recoup high R&D costs.


KEEP UP WITH THE FIRST 100 DAYS OF THE BIDEN ADMINISTRATION WITH TRANSITION PLAYBOOK: It was a dark week in American history, and a new administration will have to pick up the pieces. Transition Playbook brings you inside the last days of this crucial transfer of power, tracking the latest from President-elect Biden and his growing administration. Written for political insiders, this scoop-filled newsletter breaks big news and analyzes the appointments, people, and the emerging power centers of the new administration. Track the transition and the first 100 days of the incoming Biden administration. Subscribe today.


BBC: A Burundian refugee’s soap business is helping fight the coronavirus in one of the world’s largest refugee camps.

New York Times: Rockefeller Foundation boss Raj Shah talks about how the pandemic has shifted the focus of his philanthropic work.

The Lancet: Countries who’ve donated to the Covid-19 vaccination effort are still neglecting weak health systems.

The Guardian: Argentina will drop criminal charges against women accused of having abortions following the government’s decision to legalize the procedure.

POLITICO: A data-exchange agreement with Pfizer is helping to drive Israel’s vaccination success, but the Washington Post notes that Palestinians have been excluded from Israel’s effort.


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