Nina Schwalbe
@nschwalbe
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Strategist • Researcher • Advocate • CEO at Spark Street Advisors • Faculty @columbiamsph and @unu_iigh • Dyslexic (typos mine) • Tweets on public health
New York, NY
Joined February 2009
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Pinned Tweet
🎬It's a wrap. The Intergovernmental Negotiating Body for a
#PandemicAccord
is concluding its work and mandate.
⌛️Treaty negotiations were not completed.
📑The current draft of the text (as far as they got) will go to the World Health Assembly to decide the next steps.
🏁After two+ years, today is the final day for
#PandemicAccord
Intergovernmental Negotiating Body.
🙋🏽♀️What next?
📝Either a weak text goes to WHA for approval or the current draft with yellow, green, and [brackets] goes to WHA for a decision to continue or stop negotiations.
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🔥The WHO has just published a release on the Mpox (monkey pox) outbreak in Democratic Republic of the Congo (DRC)
The case fatality rate is nearly 5%, and already 600 people have died.
While there are effective vaccines, they are not available to those in DRC.
🧵
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✔️ Deliver essential health services and other assistance (e.g. cash) to those affected
✔️Mobilise the polio infrastructure to identify disease outbreaks
✔️Finance and coordinate the response
✔️Provide mental health services, including safe spaces for children
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What does it mean when public health authorities are finding
#monkeypox
,
#COVID19
and
#polio
in wastewater?
It means surveillance efforts are working and can help us pick up potential hot spots and monitor community spread.
Learn more in this 🧵
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Accountability for Pandemic Preparedness and Response is not about Geneva or New York – it’s about Geneva AND New York.
And Cape Town and Rio. And Stockholm and Bangkok.
It’s about everyone everywhere.
It’s about taking responsibility at the highest level of government.
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Never heard of the deadly Nipah virus outbreak stopped in southern India last year? Or the rabies outbreak prevented in nomadic Masai communities in Tanzania?
@snolen
reports on how effective public health responses make a positive difference.
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One of the best examples of this is
@Ehsaas_Pk
a flagship program engineered by public health visionary
@SaniaNishtar
.
This emergency cash program gave people most at risk of extreme poverty due to COVID-19 cash to buy food and other staples.
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There is a
#Polio
outbreak in Malawi.
This is a direct result of stopping primary care services during the
#COVID19
pandemic.
Read more by
@JoanneKenen
in
@politico
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"We dream of a fairer world where no one lives without the health services they deserve. Health is not a luxury, it’s a fundamental human right."—
@DrTedros
That’s a wrap on
#WHS2022
!
Thank you WHO and M8 Alliance for a week of dialogue, reflection & action at
@WorldHealthSmt
.
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As soon as COVID-19 vaccines were made available, authorities tried many ways to get people vaccinated.
One of them was giving 💵 or even a 🐄
How useful are incentives in increasing adult vaccination coverage?
We reviewed the evidence and here’s what we found 🧵
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The reason behind the shortage of cholera vaccines is quite straightforward.
“Because it’s a disease of poverty."
Thanks to
@missanabeem
for her excellent coverage and analysis.
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The WHO paper on Strengthening the Global Architecture for Health Emergency, Response and Resistance (HEPR) has just been posted.
The main takeaway? WHO is positioning itself as the leader of the global effort.
Short summary and a few questions (🙋🏽♀️) in this 🧵.
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COVID-19 uncovered the devastating consequences of neglecting primary health care (PHC).
Just as all governments have crisis management plans for data systems when electricity fails, PHC needs a pandemic contingency plan.
🚨Read more in our new
@TheLancet
piece with
@Arush_Lal
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🚨Countries are meeting in Geneva right now to discuss a new
#PandemicTreaty
.
Early language repeats past mistakes, treating compliance as an afterthought.
This won't generate the oversight needed—
@elliothannon
& I explain why for
@WashingtonPost
🧵
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🔥 New York just declared a
#polio
state of emergency following the detection in sewage in a fourth county (Nassau).
They also report that the unvaccinated resident with paralytic polio contracted the virus locally.
In many parts of the State, coverage is dangerously low.
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59
93
Why is gender such a big deal for COVID-19?
The extreme burden on women during the pandemic has made them disproportionally affected besides and beyond the epidemiology.
Thanks to Terry Martin
@tmnewsstream
and
@dwnews
for asking the question.
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🚨The proposed WHO
#PandemicAccord
is released.
💥It has no provision for monitoring compliance or details on state reporting requirements other than “periodically.”
🛑This leaves Member States with no accountability for any of their treaty commitments (weak or strong).
🧵
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What if PCR testing to diagnose tuberculosis was as ubiquitous as PCR testing for COVID-19?
Maybe...
❌TB would not be the 2nd leading infectious killer
❌1.6 million people would not die each year from a curable disease
❌ there would be less stigma
✅ we give it try?
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🔥 WHO declared that
#MonkeyPox
is a public health emergency of international concern (PHEIC).
There have been over 14000 cases reported from 71 countries.
Declaring a PHEIC helps countries work together to address outbreaks, including through vaccine production.
Read this 🧵
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🚨Member States have begun negotiating a new
#PandemicAccord
for approval at the World Health Assembly in May 2024.
📝It's a pivotal moment for the agreement's future.
In this week's
@LancetGH
, we explain how accountability can be baked into the text from the get-go.
🧵
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📰The World Bank has formally established a financial intermediary fund (FIF) for pandemic prevention, preparedness, and response (PPR).
18 governments, the European Union and 3 Foundations have already committed $1.4 billion in funding.
Details in this 🧵
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🚨💉 Vaccine equity requires an ecosystem that supports sustainable local manufacturing capacity.
📓 The knowledge is there.
💶 What is needed now is bold political will and the financing to make it happen.
In this week’s
@TheLancet
,
@okaars
and I explain how.
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Improving public health requires fixing underlying problems that make people vulnerable to disease.
☑️Crowding housing drives infections
☑️Lack of access to food and nutrition exacerbates illness
☑️Poverty and discrimination impede access to care
#TB
is a case in point.
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🚨 The "Zero Draft" political declaration for the UN General Assembly High-Level Meeting on Pandemic Preparedness and Response is out.
There is little new. Most content reiterates ongoing discussions.
At 14 pages, it is not the "short" document many had called for.
Quick 🧵
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This ground-breaking cash transfer program in Pakistan demonstrates how to help alleviate extreme poverty during a crisis.
The use of digital technology enhances transparency, prevents abuse and increases the engagement of the 34 million participants.
Ehsaas’ Registry enabled the Govt to target
#Ehsaas
' social benefits effectively, target subsidies and respond to shocks. Here are some insights from the survey across multiple dimensions and unique attributes of the registry.2/3
Watch key results here:
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The
#PandemicTreaty
is on life support.
Nearly 2 years after negotiations started, the prospect of an ambitious new pandemic treaty has almost slipped away.
I explain why in the
@FT
🧵
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We need a new global compact on vaccines.
COVID-19 and monkeypox show that wealthy countries hoard jabs needed around the world.
The good news? The problem is fixable.
I explain how in the
@FT
and in this🧵
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🚫 🚨 Stop the press.
Formal objection was lodged to the political declarations of 4
#UNGA78
High-Level meetings (SDG Summit, TB, Universal Health Coverage, and Pandemic Preparedness and Response (PPR)).
More in this 🧵
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35
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In this week's
@TheLancet
, we explain why primary health is the cornerstone of pandemic prevention, preparedness and response.
Thank you
@Arush_Lal
, for the writing partnership.
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11
67
🔥 Polio was just confirmed by CDC in wastewater in New York City.
New York's Governor extended the polio state of emergency.
Read our piece with
@DrJayVarma
in
@bmj_latest
on how to protect New Yorkers and stop the spread👇🏼
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32
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The Intergovernmental Negotiating Body (INB), negotiating a WHO pandemic treaty, will launch publicly broadcast "informal, focused consultations" (IFCs) on elements of the treaty.
The first is scheduled for 21 Sept starting at 2 pm CET.
Details in this 🧵
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18
43
At
#WHS2022
, Japan discusses the health priorities for its upcoming G7 leadership
✔️Pandemic preparedness and response
✔️Universal health coverage and the need to highlight longstanding health challenges
✔️ R&D and innovation
More in this 🧵
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WHO posted papers for the 30 January to 7 February executive board meeting.
The paper on Pandemic Preparedness and Response (PPR) elaborates on 10 proposals Dr. Tedros presented at the WHA last spring.
It is supportive of independent monitoring, with some caveats.
🧵
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WHO has announced the second round of public hearings in preparation for the December meeting of the International Negotiating Body for a new pandemic instrument.
The submission period is between 9 and 13 September.
WHO will curate what is ultimately broadcast.
More in this 🧵
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🔥 Johnson & Johnson and Serum Institute of India charged South Africa more than the European Union for COVID-19 vaccines.
@HealthJusticeIn
has just secured the release of South Africa's vaccine procurement contracts.
Analysis by
@kerrycullinan11
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10 April 2022 marked the beginning of a measles oubreak in Zimababe, which resulted in 747 deaths.
As of the 18 December, no new suspected cases or deaths have been reported.
A second mass vaccine campagn is planned for Monday.
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In-kind or money in humanitarian emergencies?
This new study by the
@worldbank
,
@usaid
and
@wfp
shows that cash transfers work best.
Cash transfers are effective and give people the freedom, dignity and independence to take control of their own lives.
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Uganda marks 105 days since the ebola virus (Sudan strain) outbreak and 33 days since the last confirmed case.
The outbreak will soon be declared over if no new cases are identified.
Vaccine trials will not go forward as there are no new eligible contacts to enrol.
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Wednesday was a wrap on the third meeting of the Intergovernmental Negotiating Body (
#INB3
) for the
#pandemictreaty
.
Some clear dividing lines for future negotiations
💊 IP and access
🟰 operationalizing equity
📖 definitions and terms
🖥 monitoring
Also, some consensus 🧵
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Ready to provide input to the
#pandemicaccord
?
The portal is open!
✔️Pepare your transcript for a 90-second video (about 75 words).
✔️Have an ID ready
✔️Register below 👇🏼
✔️Record your message on the platform (you can practice)
✔️Upload!
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🔥Tomorrow morning, Sept 2, the UNGA is scheduled to debate and ideally adopt a resolution calling for a high-level meeting on pandemic preparedness and response - to be held no later than 'high-level week' at next year's UN General Assembly.
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A tale of vaccine inequity.
Testing vaccines in low-income communities but not making them available is unethical.
In 2017, JYNNEOS studied the safety & effectiveness of its monkeypox vaccine among health workers in the DRC.
Results are not yet available — nor is the vaccine.
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"Jacinda has done an extraordinary job leading New Zealand through major crises delivering on a large social policy agenda aimed at rebuilding opportunity and fairness."
Inspiring tribute from one great woman leader to another.
One small country. Two exceptional role models.
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The case-fatality rate among suspected and confirmed Ebola patients in Uganda is nearly 50%.
Since the outbreak began, 3867 contacts have been registered, of which over 30% have NOT completed the 21-day follow-up period, says WHO
The epidemic is spread across the country.
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Existing vaccines offer 66-90% protection and are recommended for those at risk.
Despite global attention as a public health emergency of international concern, only a few countries maintain vaccine stocks.
That's just plain, not fair.
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⏰As
#PandemicAccord
negotiations continue, we remind delegates:
Without an explicit accountability mechanism built into the treaty, there’s NO way to assess if parties fulfill their commitments.
We can’t rely on good faith.
Our latest in
@TheLancet
.
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Thanks to
@JennyLeiRavelo
for excellent and perseverant coverage of the
#UNGA79
and UN discussions on pandemic preparedness and response.
Great article on the disappointment of the political declaration and on what comes next.
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🚨 A new draft of the UNGA Pandemic Prevention, Preparedness and Response Political Declaration text was circulated today (a day earlier than expected).
It's 58 pages, reflecting new text and edits from member states.
Informal consultations take place in NY on 26-27 June.
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14
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The drafting group of the International Negotiating Body (INB) for a
#PandemicAccord
is convening this week in Geneva.
The meeting is closed with no public webcast.
Although discussions are “informal”, the agenda is heavy.
More in this 🧵
6
23
51
Universal Health Coverage (
#UHCDay2022
) is at the heart of health and security.
It's key to equitably confronting the health challenges of today and preparing the systems for the emergencies of tomorrow.
It's an imperative for today and a down payment for the future.
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Today in
@statnews
, I propose a way forward for vaccine equity and call for:
☑️A new contract with the pharmaceutical industry
☑️Doubling down on vaccine delivery
☑️Giving more weight to voices from low-income countries and the Global South
Opinion: Leveraging its power and influence as an alliance and building on lessons learned, Gavi can get global vaccination back on track while shaping a new model to enable equitable global vaccination.
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17
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🚨 The working draft for the pandemic instrument being negotiated at WHO has just been released.
The breadth of issues covered shows cognizance of the scale of the challenge (the "what") but there is little detail on actions (the "how").
Summary in this 🧵
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🔥"Politicians of G7 countries must put aside vested industry interests."
💥"Heads of states and the INB might not see pandemic governance as a priority now, but it is fundamental to the success of any agreement."
@TheLancet
speaks truth to power.
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Wednesday, UN Member States received a new draft of the High-Level Political Declaration on Pandemic Preparedness and Response to be discussed next week in New York.
It's a struggle to find much positive to say
🧵
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🔥The UNGA just adopted a resolution calling for a high-level meeting on pandemic preparedness and response - to be held no later than 'high-level week' at next year's UN General Assembly.
More than 100 countries co-sponsored the resolution.
A strong sign of support!
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14
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🚨“There is no rational reason why vaccine manufacturers should be allowed to keep lifesaving manufacturing information secret in the face of an international public health emergency.”
@SenSanders
urges equity over profit in the
#PandemicAccord
2
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🚨Update on the
#PandemicAccord
Today, the Co-Chairs of the Intergovernmental Negotiating Body (
#INB
) gave an update to “relevant stakeholders.”
What did we learn?
More in this 🧵
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14
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Tomorrow is the first informal consultation on the UN high-level meeting on Pandemic Prevention, Preparedness and Response zero draft political declaration.
Many countries are preparing block positions (Africa, EU, Can/Aust/NZ).
Please post any readouts from the room 👇🏼
1
21
46
🔥The
#PandemicAccord
co-chairs held a briefing to explain how they arrived at the proposed text and the working modalities of the 9th Intergovernmental Negotiating Boddy meeting (INB9).
In short, they propose a “take it or leave it approach.”
Details in this 🧵
10
29
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🚨 NEW report from Spark Street Advisors and
@UNU_IIGH
🚨
WHO member states are negotiating a new legally binding pandemic accord for pandemic preparedness and response.
That requires a commitment to accountability.
Here is our proposal 🧵
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Next week, in New York, the
#UNGA78
will review three political declarations related to TB, HIV and pandemic prevention, preparedness, and response (PPR).
Whether they will be adopted is anyone’s guess
More in this 🧵
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43
What factors do shift attitudes?
✔️trust between patients and providers
✔️clarity about safety and efficacy
✔️honesty around side effects
✔️clarity around both community and individual benefits
Incentives to providers may also help.
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14
43
The UN Political Declaration on Pandemic Preparedness and Response was posted this week under a COVID-era "silence procedure."
A long, dull read with few actual commitments.
Member states had 72 hours to object (rumoured to have happened).
2
14
42
Today and tomorrow, the Working Group on Amendments to the International Health Regulations (2005) (WGIHR) will meet for the first time.
The WGIHR is tasked with negotiating "targeted" amendments for discussion at the World Health Assembly in 2024.
More in this 🧵
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Congratulation to
@CarolynBertozzi
for the
@NobelPrize
in chemistry!
Amazing when the smartest person you knew in college is actually one of the smartest people in the world!
She fought for women in science back then. Clearly she is still fighting (and won)!
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Next week all eyes will look towards Geneva.
Member states will meet at WHO to discuss a “conceptual draft zero” of a new
#PandemicAccord
.
The need to include language on independent monitoring of state compliance is evidence-based and non-negotiable.
🧵
3
23
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A recent study in
@TheLancet
confirms a high degree of protection and immunity against the monkeypox virus following vaccination with various smallpox vaccines.
However, current smallpox vaccines are not optimized for outbreak response.
Summary in this 🧵
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“The Global Community will only be as successful as the lowest common denominator. If we are too focused on consensus only, we will drive down the level of response.”
A call for bold by action by
@jacindaardern
speaking to
@HelenClarkNZ
and
@PandemicAction
network at UNGA.
0
11
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So excited to be in UAE with Andrew Marshall and see John Kerry and US leadership at the
@AtlanticCouncil
Global Energy Forum.
Setting the stage for COP28 and the critical intersections between pandemics, climate change mitigation and public health!
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⏰The clock is ticking on
#PandemicTreaty
negotiations, with many sticky topics still to unpack.
@DrTedros
warns of the erosion of trust caused by false information.
🗺It will take political will to drive it over the finish line.
Read
@bmj_latest
for coverage.
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14
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🚨Will be in safer hands with a new
#PandemicAccord
?
🛑Not without strong governance.
📝A treaty without a robust compliance mechanism built-in is simply a well-meaning piece of paper.
Our Spark Street view in the
@bmj_latest
4
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💥Deadly
#cholera
outbreak continues in Malawi.
According to WHO, there have been nearly 37,000 cases and over 1200 associated deaths.
Every distinct is affected.
In the face of the deadliest cholera outbreak in the country’s history, vaccines are in (too) short supply.
🧵
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Interested in attending the High-Level Meeting on Pandemic Preparedness and Response in New York this September?
Here's the registration for the meeting -
open now through June 19th!
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🦠 The Working Group on Amendments to the International Health Regulations (WGIHR) has just published proposed amendments.
While the next steps are not yet outlined, the Working Group is due to submit a final report by January 2024.
Summary in this 🧵
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Humbled to have met WHO's Dr. Janet Diaz.
@diazjv
led a weekly COVID-19 working group that brought together researchers and clinicians from around the world to share information, practices and experiences.
She deserves a 🏅 for her work and the lives she helped save.
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2
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🗺Countries are going to extra rounds of negotiations for the
#PandemicAccord
.
I talked to
@BBCJamesM
on
@BBCNewshour
on why this matters.
🔥Bottom line: Nobody knows when the next pandemic will hit — this time we need to have a strong legal instrument to keep the world safe.
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19
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🚨
@WHO
has announced an informal briefing on the Pandemic Accord negotiations and International Health Regulations reform on Monday, Jan. 22, from 1:00pm to 2:00pm (CET).
📺The briefing will be public and streamed live on WHO's website.
🧵
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14
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Heading offline for a week. Hope others are doing the same.
Wishing everyone everywhere some rest and relaxation.
Happy holidays to all!
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🗓 In May, the UN will hold consultations to get input on the High-Level Meetings on Universal Health Coverage (
#UHC
) and Pandemic Prevention, Preparedness and Response (PPR) planned for September.
Why do we need both? They are mutually reinforcing!
More in this 🧵
2
19
38
In a new
@TheLancet
study,
@clarewenham
and Liam Stout explain the legal weakness of WHO pandemic declarations ("PHEIC") in spurring national response.
They conclude that instilling accountability will strengthen global health governance.
Read more in
4
13
38
Seems it's a wrap.
The UN High-Level Declaration on Pandemic Preparedness and Response is now final - what was posted last week under the silence procedure.
No objections after all.
Unfortunately, not the political lift hoped for.
The UN Political Declaration on Pandemic Preparedness and Response was posted this week under a COVID-era "silence procedure."
A long, dull read with few actual commitments.
Member states had 72 hours to object (rumoured to have happened).
2
14
42
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23
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The fact that Pfizer did not plan ahead on introducing its new vaccine for RSV in low-income countries should NOT be headline news.
The real headline? Yet again, pharma ignores low-income countries. All the "hurdles" were foreseeable and avoidable.
Shame on them 🧵
1
15
39
💬 Want to comment on the design of a future medical countermeasures platform for pandemics (e.g. Act-A+)?
WHO has released a document requesting input on the process.
🗓 But the document is already somewhat outdated. And the process seems well underway.
More in this 🧵
1
22
38
The Intergovernmental Negotiating Body for a
#PandemicAccord
has its first draft!
It contains a proposal for an "Implementation and Compliance Committee" (Chapter III, Articles 20-22).
An improvement to previous drafts - but the devil is in the details (which are TBD).
🧵
2
18
38
📜 Negotiations began this week in Geneva on a new
#PandemicAccord
.
🌐In our new analysis for
@GlobalHealthBMJ
, we review the governance of international treaties.
🗝 We found that enforcement mechanisms are key to compliance.
🧵
5
18
37
WHO Member States are in the final stages of the
#PandemicAccord
negotiations.
Under which article of the WHO Constitution should the instrument be adopted?
@alexandraphelan
and I review the options: articles 19, 21 and 23.
1
15
37
The Intergovernmental Negotiating Body (INB), negotiating a new pandemic treaty at the WHO, meets this week to discuss the "zero draft" of the treaty.
Most proceedings are taking place behind closed doors.
Here is a re-cap of the public sessions so far 🧵
4
15
37
When ex-world leaders
@MaEllenSirleaf
and
@HelenClarkNZ
are "gravely concerned," we all should be.
“The opportunity presented by the High-Level Meeting and the expected Political Declaration on Pandemic Prevention, Preparedness and Response is being squandered"
More by
0
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Gender data are not optional. They are fundamental to policy analysis and decision making.
To learn more read this.
COVID-19 has highlighted the need for gender data to guide effective decision making by governments. How important is this requirement to help build back after the pandemic?
By
@ronaldmussi
and
@cabreulopes
, read the article here to know more: 📑
0
11
17
1
16
35
Confidence in vaccines has dropped in 52 of 55 countries (for which data are available), according to Unicef's just published State of the World's Children.
Overall, the statistics on childhood immunization are grim.
A few highlights (or lowlights) in this 🧵
5
20
35
See 👇 the time line for negotiation of the UN Political Declaration on pandemic preparedness and response.
The zero draft will drop to Member States on June 5th.
The deadline for the first round of comments is June 14th.
It's a tight schedule! Watch the space!
1
22
36
⏰ What’s next for the Intergovernmental Negotiating Body for a
#PandemicAccord
?
A draft accord will be circulated by mid-October, according to
@FilesGeneva
Timeline of key dates 👇🏼
8
21
35
The outbreak is primarily spreading among men who have sex with men and sex workers.
This is the highest number of annual cases ever reported, with new cases in geographic areas that had previously not reported Mpox.
There are currently no plans to vaccinate.
2
10
34
🗓March is already here. The deadline for the
#PandemicAccord
is around the corner.
⏲Today, the Intergovernmental Negotiating Body closed its 8th and penultimate meeting with no mention of adding one (e.g, INB10)
Here’s what you need to know 🧵
1
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"With fewer than two weeks of talks remaining, negotiators are not even sure what legal status the pandemic deal will have — if one is ever reached."
With release of a new
#PandemicAccord
draft imminent, Rory O'Neill &
@GPeseckyt
explain what's ahead in
@politico
.
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