‘Shooting at a moving target’ in 2022

The people and politics driving global health.

Dec 16, 2021 View in browser   By Carmen Paun THE BIG IDEA Children prepare to receive a vaccine against Covid-19 at a vaccination site on Nov. 18, 2021 in Wuhan, China. | Getty Images ANOTHER GROUNDHOG YEAR? — As we head into the second holiday season shadowed by the pandemic, the new year might feel like a repeat of 2021. "No cuddling the grandkids beneath the Christmas tree," Dutch Prime Minister Mark Rutte said Tuesday, as he extended Covid-19 restrictions until mid-January in fear of the Omicron march across Europe. So, how much will 2022 be like 2021? Five global health experts say these are the top issues to watch for soon after the New Year bubbly has worn off: Equitable vaccine distribution remains uncertain: Vaccinating people against Covid-19 will remain the toughest global challenge. For starters, it's unlikely the world will meet the goal of immunizing 70 percent of each country's population by September. Equitable vaccine distribution remains inadequate, variants complicate supply chains; authorities struggle with not only delivering shots but also convincing people to take them, and misinformation and disinformation proliferate. The global vaccine equity effort COVAX is ending the year with some 800 million vaccines delivered and hopes to have at least 1 billion more by March to distribute. That number is well below the initial target: access to 2 billion shots by now. And just when hopes were raised that vaccines would become available for all those in need, Omicron emerged, and with it, the potential need for boosters. The WHO is concerned this will lead to rich nations hoarding more vaccines, again. The world could be short of some 3 billion shots next year if rich nations aggressively boost adults and vaccinate children, a WHO official told the Financial Times. Defining full vaccination: Plus, the looming question is whether the definition of being fully vaccinated will change from having had two doses to three. "We're shooting at a moving target," said Lawrence Gostin, a global health law professor at Georgetown University. The rest of the world won't settle for two doses while rich countries go for three, he said. "Clearly, vaccinating 70 percent of the world means three doses for every person in the world," Gostin said. But another global health expert who spoke on condition of anonymity said the U.S. government, which has committed to the 70 percent target, should not trip over boosters. Getting two doses to countries lagging behind should still be the goal, even if a third one will have to be provided six months later, the expert said. Wave of waivers?: Expect poorer countries to continue to push for intellectual property waivers on vaccines, treatments and diagnostics at the World Trade Organization. That debate has stalled for more than a year amid opposition from rich countries — despite U.S. support for a vaccine waiver. Will that change in 2022? It remains unclear. Human Rights Watch and other groups said Wednesday they found more than 100 companies, mostly in India and China, that could produce mRNA vaccines if Pfizer-BioNTech and Moderna wouldn't oppose the waivers. That's pushing back against pharmaceutical companies which argue capacity is lacking outside of their factories. Thomas Cueni, the head of the international pharma lobby IFPMA, laughed at the number Thursday, calling it "voodoo economics." From the airport to the arm: The challenge starts with not having the special syringes needed for the Pfizer-BioNTech shot. Rich countries, including the U.S., donate vaccines but not the syringes, for which poor countries must scramble. And in countries like Zambia, for example, delivering vaccines also means ensuring fuel so they can be transported. "Harkening back to the United States situation, how much had to be done to make that operational system … that has to be done over and over again in multiple countries with varying levels of infrastructure, different economic hits from the pandemic and all of that," said Jennifer Kates, the director of global health & HIV policy at the Kaiser Family Foundation. WELCOME TO GLOBAL PULSE WELCOME BACK TO GLOBAL PULSE, where your host is saddened, but not surprised, that her early 2021 hope of Global Pulse becoming by now less about Covid-19 and more about learning and rebuilding from the pandemic didn't pan out. Programming note: Global Pulse won't publish Dec. 23 and 30. We'll be back in your inboxes on Thursday, Jan. 6. Global Pulse is a team effort. Thanks to my colleague Allan James Vestal and editors Eli Reyes and Barbara Van Tine. Follow me on Twitter: @carmenpaun. Send tips and ideas to cpaun@politico.com. THE BIG IDEA, PART 2 A woman gets her Covid 19 jab whilst other people queue at Buwi Secondary School on Dec. 15, 2021 in Chinhoyi, Zimbabwe. | Tafadzwa Ufumeli/Getty Images THE POST-PANDEMIC GLOBAL HEALTH ARCHITECTURE — While it will likely take years for countries to agree on a pandemic preparedness deal after the decision last month to negotiate one, 2022 will give us some direction. Eye the fine print: When negotiators gather in the spring, they will sift through what should be in the agreement, said Kate Dodson, vice president for global health strategy at the United Nations Foundation. "Is this about human rights? Is it about equitable access to countermeasures? Is this about early detection and obligations for early reporting? It could be about all three or none of the above or something different," she said. Whether the agreement is legally binding will be contentiously debated. The U.S. and other countries have said they first need to see the elements of an agreement before they can get behind it, while other nations push for legal obligations to ensure measures are implemented. The U.S. has been cold to a legally binding agreement because it would require Senate ratification, which likely won't happen. That's a safe bet given Washington's toxic politics and precedent from other popular international agreements in the U.S. that went nowhere, such as the Convention on the Rights of People with Disabilities or the Framework Convention on Tobacco Control. The FIF's make-or-break moment: Meanwhile, the U.S. has been pushing for the creation of a $10-billion-a-year worldwide fund for pandemic preparedness. "Next year is the year where it has to happen or it will never happen because all of our experience shows that political will is at its highest in a crisis," Gostin said.   DON'T MISS CONGRESS MINUTES: Need to follow the action on Capitol Hill blow-by-blow? Check out Minutes, POLITICO's new platform that delivers the latest exclusives, twists and much more in real time. Get it on your desktop or download the POLITICO mobile app for iOS or Android. CHECK OUT CONGRESS MINUTES HERE.     TWEET OF THE WEEK POLITICO Screenshot. World Health Organization Director General Tedros Adhanom Ghebreyesus arrives at the Élysée Palace for the inaugural dinner of the Paris Peach Forum on Nov. 11, 2021 in Paris, France | Kiran Ridley/Getty Images BEYOND THE PANDEMIC STICKING TO A FAMILIAR FACE — Other things beyond the pandemic response might look the same in 2022. For instance, Tedros Adhanom Ghebreyesus, the WHO director-general, will likely sail to a second five-year term. On the campaign trail: Two dozen WHO member countries, most from Europe, renominated Tedros, who's running unopposed. His home country of Ethiopia didn't back his re-election because he's a member of an ethnic group engaged in a civil war with the federal government. While Georgetown University's Gostin thinks an uncontested election harms the WHO, other global health experts who spoke to Global Pulse said continuity is key to managing a pandemic. "I think it would be very disruptive to have a different leader," said Ngozi Erondu, senior scholar at the O'Neill Institute at Georgetown University. She expects Tedros to communicate on critical issues such as the airborne transmission of coronavirus more boldly, given what he's learned in his first term. "And I think it's also important to see if [the WHO] will be successful in their advocacy for more funding," she said. Contributions to WHO: About 16 percent of the WHO's nearly $6 billion for two years is from mandatory contributions from member countries. The rest is made up of donations that countries often earmark for certain programs, and from other entities such as the Bill and Melinda Gates Foundation. A working group this week recommended that mandatory contributions increase to 50 percent of the WHO's base budget by 2028, but it's uncertain whether countries would agree. WILL THE MALARIA VACCINE ROLL OUT? — With Gavi announcing funding for countries to procure the first malaria vaccine, there's hope that countries in sub-Saharan Africa struggling with the disease will start receiving it in 2022. "Some countries have been acutely focused on not just Covid-19, but other infectious threats like malaria that have been long-standing challenges and leading killers of children," said the U.N. Foundation's Dodson. They may be keen for a solution like the malaria vaccine, she said. The challenges some African countries have delivering Covid vaccines won't necessarily translate into similar problems for the four-dose RTS,S vaccine. Unlike the shot against Covid, the malaria vaccine is much more targeted, destined only for children under age 2. However, that might pose its own problems in reaching children in remote areas to vaccinate four times before they turn 2. GLOBAL PULSE NUMBER $114 MILLION The amount by which rich countries' funding for family planning decreased in 2020 compared to 2019. It represents nearly a 10 percent cut from the $1.52 billion provided in 2019 and is mainly a result of decreased funding from the U.K., according to the Kaiser Family Foundation.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     WHAT WE'RE CLICKING The New York Times: Covid anxiety and depression take hold across the world. The Washington Post: CDC advisers to weigh limits on Johnson & Johnson vaccine because of continued rare blood clot issues, potentially impacting its use globally. POLITICO: U.S. government forecast shows Omicron stretching U.S. Covid testing supply. BBC: Trial begins of a needle-free Covid vaccine that targets new variants. Reuters : India's air pollution is hurting syringe production: The country's top syringe maker asks prime minister Modi to lift factory shutdown order.   Follow us

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