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Coronavirus may have temporarily deflected attention, but the pandemic has accentuated the short-term dangers and underlined the long-term risks of ignoring another looming public health crisis: that of antimicrobial drug resistance.

Some reports have indicated a surge in unnecessary and inappropriate use of antibiotics for Covid-19, compounded by online prescribing and unscientific promotion of drugs such as azithromycin. This is intensifying the growing problem of antibiotic resistance, which already claims an estimated 35,000 lives a year in the US alone.

It adds to the pressure on a weak pipeline of experimental drugs and the failure of existing projects that have already been approved, reflecting both the scientific complexity of antibiotic development and the lack of financial incentives for medicines. As Emma Walmsley, the head of GlaxoSmithKline wrote in the FT, just a handful of projects in development are new or original.

A $1bn AMR Action Fund unveiled last month by the pharmaceutical industry is one sign of progress, providing additional “push” funds to help biotech companies support drugs through clinical trials.

But as Jim O’Neill, who headed the UK government’s review on antimicrobial resistance, argues, transformation will also require “pull” incentives, signalling a willingness by healthcare systems to pay for new products and carefully steward their prescription to avoid overuse.

That still needs greater innovation and initiative, from the proposed “Pasteur” legislation in the US to create subscription-style models for payments to “insurance” policies paid by people undergoing surgery to fund new treatments for those needing antibiotics.

Three questions

Muhammad Ali Pate, Global director, health, nutrition and population at the World Bank.

© Grant Ellis/World Bank

What has been your focus over the past year?

I saw the need to connect more to the context of countries: you can’t hold leaders accountable at 30,000 feet. Then Covid-19 hit. We were fortunate that the bank’s board disbursed an unprecedented $10bn within 100 days, the single largest platform for the distribution of resources to respond to the pandemic. It used to take months to prepare projects. Now we are working on a road map around policy, regulation and preparing health workers.

What are your main concerns today?

With the science and technology we have, the development of tools like vaccines is the relative easy part. Financing is tough. Human behaviour needs to be considered as equally important. I saw that with polio eradication work. The anti-vaccine movement has been able to channel conspiracy theories. We will need community engagement country by country. Vaccine hesitancy is still a real infodemic [of misinformation]. There are low levels of trust. Once a vaccine is found to be efficacious and safe, that will require a lot of thinking.

What are the broader risks in the coming months?

The impact of Covid-19 for health is not only about the emergency itself but the secondary impact on basic healthcare services. Immunisation for measles and other infectious diseases is being disrupted and there is quite a high impact on maternal mortality. How to tackle the disruption of commodities like medicines is equally important. And we need to bring in other organisations to pool resources to support the most vulnerable countries.

News round-up

Surge in Latin America means global daily death toll on the rise once again. Streamgraph and stacked column charts, showing regional daily deaths of patients diagnosed with coronavirus

Focus on . . .Covid-19 trajectory Six months after declaring Covid-19 a “public health emergency of international concern”, WHO chief Tedros Adhanom Ghebreyesus said it was “easily the most severe” the organisation had ever dealt with. Covid-19 is also having a major impact on other diseases and affecting immunisation, cancer screening and mental health services. The organisation has launched an independent inquiry into the global response. Here’s an interactive timeline of its own response. You can track the spread of the disease in the FT’s free charts and data hub. (WHO, Reuters, FT)

WHO saga continues The US gave formal notice it would quit the WHO, but the one-year notice period leaves open the possibility that a win for Joe Biden in November’s presidential election could mean the decision is reversed. The candidate tweeted: “On my first day as president, I will rejoin the @WHO and restore our leadership on the world stage.” (FT)

Vaccine politicking intensifies. The search for a Covid-19 vaccine and dealmaking between rich countries and the pharma industry — much of it quite opaque — threatens to leave poor countries at a disadvantage. “Vaccine nationalism” could also mean countries bidding against one another and driving up prices. The head of Russia’s sovereign wealth fund lamented the situation where “political barriers and political biases prevent the best technologies being used”. Wellcome Trust chief Jeremy Farrar warned that the virus could not be “defeated by insular nationalism, blaming others or drifting into a more polarised world — all this only leaves everyone more vulnerable”. (FT, The Conversation, Foreign Affairs)

. . . as vaccine science edges forward Here’s a summary of the current state of the vaccine race. The UK has received plaudits for its Recovery trial but the chair of its vaccine task force damped hopes of a “silver bullet” providing lifetime immunity. Covid-19 is probably here to stay. Or as the FT’s editorial board put it: “Living with spikes is the new normal.” (Guardian, BMJ, The Atlantic, FT)

Financing the fight The World Bank ditched the idea of a second round of “pandemic bonds” after critics said the schemes were too slow to pay out to poorer countries. IFC, the bank’s private sector arm, launched a $4bn initiative to boost the supply of critical products such as PPE and ventilators to developing countries. OECD and G20 countries have responded to the pandemic with a stimulus package estimated at over $11tn. The additional cost for protecting the most vulnerable 10 per cent of the world is estimated to be $90bn — or less than 1 per cent of the stimulus rich countries have spent on themselves. (FT, Reuters, ReliefWeb)

Testing times As Catharina Boehme of the Foundation for Innovative New Diagnostics pointed out in last month’s FT Health, low- and middle-income countries have particular difficulties affording tests for Covid-19. Of the $2bn needed to make sure diagnostics reach poorer countries, only $250m has been pledged by donors so far. “When we look at the testing rates, for example, in Africa, it's only about 0.1% to 1% of the testing that's being done in high-income countries,” she said. (FT, Devex)

Focus on . . . Africa and Covid-19 The pandemic is gaining ground in Africa and dashing hopes that its younger population would spare it from the worst. Lockdowns have had a disproportionate impact on its many informal workers while remittances and revenues from commodity exports have plummeted. Yemen is fighting not just Covid-19, but war, floods, locusts and mass hunger. The FT’s editorial board called for more help. Here’s the WHO Africa dashboard. (FT, Independent)

A bubble chart of African nations showing number of cases per 100,000 and % of Covid-19 tests that are positive. The WHO has previously suggested a positive test rate of 3-12% is indicative of adequate testing - many African countries, including Sudan and Algeria are well above that level, leaving cause for concern

Economic toll mounts The World Bank warned the crisis could undo decades of global poverty reduction. The downturn caused by the pandemic, combined with rising health spending, have made budget deficits soar in developing countries. (World Bank, FT) Browse the FT global economic recovery tracker.

Bar chart of  Primary fiscal balance by type of economy (% of GDP) showing Pandemic worsens emerging economies' fiscal position

Pandemic amplifies food crisis The UN’s State of Food Security and Nutrition said 690m people went hungry in 2019, a jump of 10m from the previous year. The report says Covid-19 could tip more than 130m into chronic hunger by the end of this year. The World Food Programme and Oxfam issued similar warnings. Lockdowns are also exposing food insecurity in places like this city in Bangladesh. (FAO, WFP, Guardian, The Conversation)

Tackling obesity The UK launched another push to combat obesity — including a National Food Strategy — after a Public Health England report showed it left people more susceptible to coronavirus. The FT’s editorial board agreed with restrictions on marketing unhealthy foods but the royal medical colleges said the plan must be part of a wider strategy to reduce health inequalities. A commercial backlash is under way. (PHE, FT, BMJ)

Drug tests David Pilling, FT Africa Editor, says more medicine testing should be done in the developing world, as long as the resulting drug is available to these countries at affordable prices. It would also build expertise in places that need it: Vietnam’s “Sars dividend” has so far helped keep its Covid-19 deaths minimal.

Covid-19 and indigenous peoples Some of the world’s poorest and most vulnerable groups such as Kenya’s Maasai and the peoples of the Amazon have been badly hit. (UN News, Thomson Reuters Foundation, New York Times)

Refugee camps at risk The UN and aid agencies warned of a looming disaster in refugee camps. This Guardian interactive shows the impossibility of any social distancing in camps such as those in Cox’s Bazar. (FT video, Guardian)

Best from the journals

Warning over ‘Big Three’ Another study warned of a surge in deaths from malaria, TB and HIV in poorer countries because of Covid-19 disruption to health services. Over a five-year period this could mean HIV deaths increasing 10 per cent, TB deaths rising 20 per cent, and malaria deaths up 36 per cent.

In Kenya, many people suffering from malaria are staying away from health facilities, while in Jamaica it is the fight against HIV that is being hampered. A post-coronavirus downturn is likely to herald even more cases of TB, a disease prevalent among the poor. (Lancet Global Health, Al Jazeera video, Thomson Reuters Foundation, New York Times)

Sexual and reproductive health A study spanning 30 years showed unintended pregnancy rates have fallen across the world while the proportion of pregnancies ending in abortion has increased. Progress is unequal: women in poorer countries are three times as likely to experience an unintended pregnancy than those in richer nations. A separate report says significant improvements can be achieved with minimal extra spending. USAID’s annual report on maternal and child deaths says hard-won gains are at risk. (The Lancet Global Health, Guttmacher Institute, USAID)

Vaccine trade-offs The benefits of maintaining routine childhood vaccination programmes in Africa during the pandemic far outweigh the risk of contracting the virus. Sticking to regular schedules could prevent more than 700,000 deaths of children from the time of immunisation until they reach the age of five. Pharma giant GSK said separately that vaccination rates for many diseases were falling. (The Lancet, FT)

Wasting warning The pandemic could lead to an additional 6.7m children affected by wasting this year: 58 per cent of victims would be in south Asia and 22 per cent in sub-Saharan Africa. Leaders of four UN agencies called for action. (The Lancet Global Health)

Covid-19 and mental health A new study quantifying the effect on mental health in the UK shows a disproportionately big impact on women and people living with young children. Researchers say the situation must be monitored closely as the country goes into a post-pandemic recession and circumstances deteriorate for many people. (The Lancet)

Pick of the pods

Vaccine update Peter Piot, director of the London School of Hygiene and Tropical Medicine, discusses recent developments in Covid-19 vaccines. (NEJM, 27m)

How did the Kiwis do it? How and why did New Zealand succeed in locking down the country, winning public support, and eliminating the virus? (CSIS Take as Directed, 34m)

Foreign aid Interview with Gary Forster of Publish What You Fund, a campaign for transparency in aid and development. (UN Global Dispatches 28m)

Racism in health systems A discussion on “colonial undertones” to contraception policymaking, how doctors remaining silent on racial issues are seen as complicit, and the lack of diversity in medical school resources. (BMJ, 63m)

Sniffing out Covid clues What can sewage tell us about Covid-19? (Guardian, 15m)

End notes

Previous issue Sharing work could ease mental health impact of pandemic

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Final thought

Health workers at risk More details are emerging of the risk for health workers of contracting Covid-19 or suffering burnout from the stress of dealing with the pandemic. Even more worryingly, in some countries they have been detained or attacked for voicing concerns. (Jama, The Lancet, The Independent)

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