Virtue Ethics in the Healthcare Practice: Reflection Note

In this personal reflection, the Author turns the spotlight on virtue ethics as a key pillar of healthcare practice. Relevantly, plenty of insights are offered about basic concepts like fairness, respect, trustworthiness, compassion, courage, caring, integrity, wisdom, among others. 

… ‘in the practice of public health, practitioners are expected to pose these character traits at higher levels than ordinary people because of the vulnerability of the people who seek healthcare services both directly as in the clinical practice and indirectly as in public healthcare’…

By Florence Gune

Human Resources Intern

United Nations Population Fund – UNFPA

New York, USA

Reflection Note

Virtue Ethics in the Healthcare Practice 


Teaching duty Vs virtue ethics to make health workers more professional in their practice

Professionals are groups of self-regulating capable of legally prohibiting others from practicing. They must have a group identity, shared education and training, special uncommon knowledge used in services of others, adherence to certain values, penalties for certain performance, and some individual judgment- autonomy in decision making. Professions need a lot of training and intellectual ability to provide services to the community. And this specialized knowledge gives them a monopoly over overuse and teaching allowing them to develop their own code of ethics and regulate them. Ethics for professionals help them to choose what is right when faced with a problem at work that raises moral issues.

What kind of person should I be? Do what is right but not necessarily because they want me to or do what is right because they want me to?

Virtue ethics is considered one of the oldest systems of ethics in the eastern and western cultures and it concentrates on a person’s morals and what kind of person they ought to be. So, it takes human character to be at the center of morality and hence puts less emphasis on the act itself since the moral status of an act depends on the character of the person performing it. That means good people do the right thing automatically to produce good and minimize harm in the world. Virtuous people are very different; they face different basic problems with the same basic needs and have. They will need courage where danger always arises and generosity where others are less well-off and loyalty since they all need friends.

The virtues in the public health practice: a virtuous person is that who bends on doing what is morally acceptable to the majority, so the expectations of the public are very high about healthcare professionals. Therefore, healthcare practitioners are expected to remember these expectations the public has about them for example, to be respected. The character traits of virtue in most societies include but are not limited to being:

  • Just, by ensuring that fairness is exercised in all matters related to planning and delivering healthcare services to individuals and the community at large. The service provider should be such that every person has the right to respect therefore allowing every person to get what they deserve on weighing all situations surrounding the needs of this person and others. Applying it in the field of public health means that there is fairness in resource distribution to and within the population, otherwise, if one group gets everything and others get nothing conflict may result.
  • Trustworthy; is by being truthful and worthy of the trust which lies in the heart of the relationship between service providers and the users of the services. This means that the consumers of the health service normally assume that the service providers are committed and competent in performing their jobs and they will not harm them. So, if the service users are to be comfortable, the service providers should conduct themselves in a way that they are worthy of trust and reliability.
  • Courageous; courage is the ability of an individual not to give up when faced with a challenge. It is necessary for a professional practice that is associated with endurance and the ability to confront fear and act ethically. In the healthcare practice, there is a wide range of fear-inducing situations which can evoke fear of failure, litigation, disapproval, and embarrassment to the clients. Courage is very important in the healthcare practice to respond timely to severely injured persons and outbreaks, for example, to amputate a crashed limb.
  • Caring; by being concerned and taking necessary steps when faced with a challenge. In the practice of public health, it involves being attentive to the actual or potential needs of the community considering their identified needs and showing appropriate responses in meeting these needs. When a person is caring, it means being responsive to the health needs of the people, so the service provider is expected to show compassion, gentleness, and thoughtfulness when providing the service to the clients.
  • Respectful; is to have positive consideration of a person or group of persons’ individuality, autonomy, confidentiality, dignity, values, and privacy as complete human beings.
  • Wise; having wisdom means that a service provider is alert, innovative, and proactive as they carry out their duties in their field of practice. The practitioner should be able to address the concerns of their clients at any time and professionally. This implies that the service provider has the capacity to apply skills and knowledge to suit the situation in which they find themselves. Like in public health practice, wisdom is incorporated in meeting the health needs of the people they serve, for example, making decisions about issues and executing these decisions in an appropriate way. So, wisdom commands people to do the right what they have deliberated and decided to do in a given situation. Therefore, practitioners need to and should be wise in making their decisions and actions.
  • Integrity: is to be upright even when tempted to do wrong by being sincere, consistent, telling the truth, not abusing one’s position, and keeping a promise. So, a practitioner needs to stick to acceptable principles and values of practice even when confronted with a challenge. Integrity is for example when a health worker refuses to terminate the life of a patient because someone wants them dead.

So, in the practice of public health, practitioners are expected to pose these character traits at higher levels than ordinary people because of the vulnerability of the people who seek healthcare services both directly as in the clinical practice and indirectly as in public healthcare. Hence it is sought and considered essential in promoting the wellbeing of individuals and the population at large. Therefore, this requires that public health practitioners take deliberate actions to ensure that their conduct conforms to desirable character traits by avoiding non virtuous behaviors.

To protect the common good of the person or people, one must consider avoiding all behaviors that are considered vice- the opposite of virtue to safeguard the spirit of communitarianism and solidarity. In view of the African ethical thought, actions are generally considered moral if they reflect positive outcomes for the whole community which is suitable for public health practitioners given its expectations on the providers. Though in today’s real life, many people including health workers hardly want to do anything just for the sake of humanity, with self-aspect becoming the norm.

Duty or Deontology ethics is concerned with what people do and not the consequences of their acts. When considering duty ethics, some acts are considered wrong while others are right, and people have the duty to act accordingly regardless of the good or bad consequences the act may produce. A deontologist considers what action is right and then they proceed no matter what its consequences are. It emphasizes the value of every human being by focusing on giving equal respect to them and forces due regard to be given to the interests of a single person even when those are at odds with the interests of the larger group. It also identifies some acts as always wrong no matter what good they can produce- reflecting the way humans think. It also provides certainty because it is concerned with actions, so if an action is right, then a person should do it and if it is wrong, they shouldn’t do it. It also deals with the intentions and motives of the service provider, for example, if the person didn’t intend to do wrong then the act was an accident. On other hand, duty ethics sets absolute rules and allows for acts that make the earth less a good place because it is not interested in the results it can lead to courses of action that can produce a reduction in the overall happiness of the world. It is also difficult to reconcile conflicting duties with duty ethics because it does not deal with cases where duties are in conflict.


News Flash 464: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 464

Weekly Snapshot of Public Health Challenges


Short Course GLOBALISATION & HEALTH ITM Antwerp 25 April – 13 May 2022 (Apply before 1 feb 2022)

PHM PMAC 2022 – Building Equitable Health Systems

PHM PMAC 2022 – Rethinking the SDGs

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Child asthma cases linked to cities’ dirty air











Eight indicators of global knowledge and response to COVID-19 pandemic are analysed in this study aimed at contributing to clarity about the current dynamics of information and decision making which lack evidence based and comparative logic, and levels of injustice that the pandemic has revealed or even accentuated

By Juan Garay

Professor of Bioethics, Chiapas University, Mexico




Indicators of the Objective Analysis of the Pandemic and Decision-Making

Any cause of loss of health (risk factor or disease) is measured in relation to others by incidence (cases/population), fatality (deaths/cases), “burden of disease” (healthy life years lost by that cause, in the population) and distribution by geographical and population variables.

Any public health intervention (prevention, treatment and rehabilitation) is decided in relation to others (given the resources always limited) according to risk/benefit (harm vs. good), cost-utility ( cost of intervention in relation to the prevention or recovery of healthy life years that would be lost without such action) and opportunity-cost ( relation to the impact of other potential interventions with the same level of resources).

The distribution of a health problem, including the effect of decided interventions, is measured by unfair or preventable inequalities (inequity) through the “burden of health inequity” (excess deaths or loss of healthy life years in relation to feasible and sustainable levels of health for all).

These eight parameters for understanding a health problem are uncertain in the global knowledge and response to the COVID-19 pandemic and reveal dynamics of information and decision making which lack evidence based and comparative logic, and levels of injustice that the pandemic has revealed or even accentuated.

Analysis of the Magnitude (and Distribution) of the Pandemic

  1. Incidence: Diseases causing acute infections such as COVID-19 are better measured by regular seroprevalence studies which allow the estimate of the cumulative proportion of people which have been already infected (with presence of IgG antibodies). During 2020, the pandemic without vaccination, these studies would have made it possible to ascertain the real incidence of the disease. In contrast, the reporting systems varied between countries as they screened either symptomatic cases, serious cases or primary or secondary contacts. Those daily reports of “new infections”, largely biased and non-comparable between countries have received the focus of the media and the attention of societies around the world. Even in the same country, the case detection system varied, so the comparison between pandemic waves is also biased. In the few[i] (and very poorly disseminated and discussed) seroprevalence studies conducted, the real incidence of the pandemic could be estimated to be between 2 and up to 10 times higher[ii] than the officially reported one. Although the official WHO consolidated data show a cumulative incidence of 323 million cases, applying the ratio of seroprevalence studies/reported cases in the populations thus studied and on a weighted basis (according to population sizes), the real cumulative incidence may be of more than 1,600 million, as shown in Figure 1. The distribution of the incidence rate in the population is uncertain due to the lack of population studies, but it seemed to have been affecting more young people as the pandemic evolved.

Figure 1: Incidence of COVID-19 data and estimation by seroprevalence studies

  1. Case-Fatality: In addition to the underestimation of the cases described above (denominator of case fatality), the number of deaths by COVID-19 has been very possibly also biased, in many cases overestimated[iii]. After two years of pandemic, the question of either death with COVID-19 or death by COVID-19 arises. Following infection or vaccination it seems the virus genome can, by reverse transcriptase, integrate into the human genome and express mRNA (PCR positive) and Receptor Binding Protein (positive antigen test) without the presence of active viruses[iv]. On the other hand, even in the presence of active infection (if demonstrated by viral culture), the virus may be asymptomatic or only cause mild (as shown in the seroprevalence studies described above) symptoms and not be the main or direct cause of severity or death. Most of the deaths attributed to COVID-19 have been in the elderly and with base pathologies (more than 90 %) many of them potentially also lethal. As the pandemic has been affecting a larger cumulative proportion of the population and many other clinical symptoms and tables have been attributed to the virus than the initial most specific bilateral pneumonia, the presence of antigen or PCR and therefore the attribution to the virus as the main or single cause of death, has been possibly overestimated. The target figure could only be known by autopsy series, which has hardly been done during the pandemic. In the few unpublished autopsy series, 40 %[v] and even up to 80 % of the deaths attributed by COVID-19 were actually due to other causes, in particular the complications of hypertension, obesity and diabetes and undiagnosed cancers. On the other side, there may be countries where there is an under-reporting of mortality in general and of mortality certificates with accurate diagnosis of cause of deaths. As regards the assumptions that there is an underestimation of COVID-19 deaths in relation to the excess morality observed by the pandemic in the most affected countries, it would have to be ascertained whether this excess mortality is in fact mainly due to lockdown measures and their multiple health effects, as mentioned below. Taking into account the previously estimated incidence according to population seroprevalence studies and the mortality adjusted to the proportion of deaths directly caused by COVID-19 among those attributed to it, the case fatality would be 0.33 %, very similar to seasonal flu.  The distribution of the case fatality rate in the population is, in any case, very uneven, showing variations from less than 1 per 1,000 cases for children under 30 to more than 20 % for those over 80 years of age. Case fatality of the disease has been decreasing, due to a growing share of infections in the youth, the effects of the pathogenicity of evolving variants, the effects of natural and induced immunity and the effectiveness of treatments.

Figure 2: Fatality calculated by official data and estimated by the adjustment of COVID-19 mortality and the highest estimated incidence level

  1. Burden of disease: The loss of life years is measured in each disease by the difference between the age of death for the cause studied, in this case the COVID-19 infection, and the average life expectancy in a given population[vi]. The highest national average life expectancy has been used for global comparative studies, which for more than two decades has been that of Japan (questionable reference as below argued in the equity analysis). This burden of disease due to premature death, has hardly been studied, published or disseminated. The average age of death has been (according to studies in the United States) 71.63 years hence on average each death by COVID-19 has caused the loss of 12.73 life years in relation to the mentioned reference. As the average number of deaths per year has been around 2.56 million in 2020-2021, the pandemic has caused the loss of around 32.58 million life years due to premature death, i.e. 0.0041 life years per person and year (day and a half per person and year). This burden of disease is higher in the countries with the highest death rate per COVID-19. Peru, with the highest rate – 6,200 deaths per million inhabitants- would have a burden of disease of around annual 0.0124 life years per person (about 4.5 days per person per year). The burden of disease also varies according to age, with some100 times less in those under 60 (90 % of the world’s population and less than 10 % of COVID-19 deaths). While the long-term impact on disability is still poorly known, its impact on the burden of disease may be counterbalanced by the very controversial lower weight of life years in old age and, in any case, the disability of a high proportion of COVID-19 deaths in patients with co-morbidity due to other causes and thus already a baseline degree of disability. Compared to the overall burden of disease (some 1,706 million life years due to premature death)[vii] COVID-19 caused on average 1.9 % of the overall burden of disease in the last two years. In relation to the most important causes of loss of life years due to premature death, the following list shows the proportion that COVID-19 accounts for each of the causes, according to the diagnostics with COVID-19 and the estimated direct deaths by COVID-19 (60 % of the latter)[viii].

Table 1: Overall loss of life years due to pandemic related to other diseases

Cause YLLs (000s) COVID-19 as% of top channels Estimated 60 % due to COVID-19
All Causes 1706631 1.91 % 1.14 %
Neonatal conditions 183207 17.79 % 10.68 %
Ischaemic heart disease 175605 18.56 % 11.13 %
Stroke 122115 26.69 % 16.01 %
Lower respiratory infections 105006 31.03 % 18.62 %
Diarrhoeal diseases 68394 47.65 % 28.59 %
Road injury 62279 52.33 % 31.40 %
Tuberculosis 61751 52.77 % 31.67 %
Chronic obstructive Pulmonary dis. 54573 59.71 % 35.84 %
Congenital anomalies 45199 72.10 % 43.26 %
Cirrhosis of the liver 42111 77.39 % 46.43 %
Trachea, bronchus, lung cancers 40849 79.78 % 47.87 %
HIV/AIDS 36131 90.19 % 54.12 %
Diabetes mellitus: 34171 95.37 % 57.23 %
COVID-19 32588 100.00 % 60.00 %
Kidney diseases 32023 101.76 % 61.07 %
Self-harm 30937 105.34 % 63.20 %
Malaria 30855 105.62 % 63.38 %
Interpersonal violence 25699 126.80 % 76.08 %
Colon and rectum cancers 20570 158.42 % 95.06 %
Hypertensive heart disease 20482 159.10 % 95.46 %
Stomach cancer 19893 163.81 % 98.30 %

Compared to the loss of life years due to risk factors, the table below shows that the burden of COVID-19 disease is lower than that of 17 risk factors, even if all deaths with COVID-19 are attributed to COVID-19 deaths. It is striking and worrying to see that most of the risk factors that lose human life not only do not trigger, as COVID-19 has done, drastic measures of major investment or loss through lockdown. They neither attract research funds even close to those invested for COVID-19. In fact, for many of those risk factors, the private sector marketing invests large amounts to promote unhealthy life styles leading to sedentary, obesity, glucose intolerance and hypertension from processed foods high in sugar and salt, tobacco — including second-hand tobacco —, air pollution, interruption of breastfeeding and hyper-medication, among other causes related to the urban, competitive and consumer-style of life. Among the causes of highest loss of human life are also those related to global inequities such as malnutrition, lack of access to safe water and sanitation or the shortage of iron and vitamin A. The lockdown measures imposed to control the pandemic by COVID-19 may have significantly increased the loss of life years due to sedentary lifestyles. It remains to be seen whether the control measures have been responsible for less or more life years lost than the virus would have caused itself. Interestingly, as the main mechanism of severe disease and death in COVID-19 infections is the severe inflammatory response (“cytokines’ storm”) it remains to be seen whether the social response causing greater damage than the pandemic itself.

Table 2:  Overall loss of life years due to pandemic for the main risk factors

Cause YLLs (000s) COVID-19 as% of top channels Estimated 60 % due to COVID-19
 High blood pressure — 217963088 14.95 % 8.97 %
 Smoking — 182478302 17.86 % 10.71 %
 High fasting plasma glucose — 170573442 19.10 % 11.46 %
 High body-mass index — 147694484 22.06 % 13.25 %
 Air pollution — 147418240 22.11 % 13.26 %
 Child wasting — 90994816 35.81 % 21.50 %
 Environment particulate matter pollution — 83047567 39.24 % 23.55 %
 Diet high in sodium — 70398895 46.29 % 27.78 %
 Diet low in fruits — 64806281 50.29 % 30.17 %
 Unsafe water source — 63892348 51.00 % 30.60 %
 Household air pollution from solid fuels — 59472096 54.80 % 32.88 %
 Drug use — 41658227 78.23 % 46.94 %
 Unsafe health — 41474867 78.57 % 47.15 %
 Second hand smoke — 36316502 89.73 % 53.84 %
 Diet low in vegetable— 34210780 95.26 % 57.15 %
 Iron deficiency — 33661690 96.81 % 58.08 %
 Vitamin A deficit — 28992388 112.40 % 67.44 %
 LOW physical activity — 23655862 137.76 % 82.65 %
 Child stunting — 19406872 167.92 % 100.76 %
 Non-exclusive breastfeeding — 14248898 228.71 % 137.22 %
  1.  Distribution – By age: Half of all deaths have occurred in patients aged over 85, above the highest national average of life expectancy (Japan, 84.36), two-thirds in patients aged over 80 (above the average of high-income countries), 80 % in patients aged over 72 (above the international average of life expectancy) and 95 % in patients aged over 60 years[ix]. By country: The following map shows the distribution of deaths per million by national averages.

Cumulative mortality rate per Covid per national average [x]

As shown in the graph below, the cumulative mortality rate for COVID-19 is unrelated to the GDP per capita (r2 = 0.023).

Figure 3: Cumulative mortality 2020-2021 per million per COVID-19 vs GDP bc, by country

The clearest link we have found between the distribution of the mortality rate by country is the median age, which would explain, as the following graph shows, one third of the international variability.

Figure 4: Cumulative mortality 2020-2021 per million per COVID-19 vs median age, by country

The following table summarises the above indicators of magnitude of the pandemic by official data (reported by countries and WHO) and the estimates by population studies and in-depth analysis of cases described above:

Table 3: Measures of the magnitude of the COVID19 pandemic: official vs estimate data

cumulative impact annual mortality Fatality3 Annual Sickness Load (FMC)4
official data 323000000 2770000 1.72 %
estimates 16150000001 16620002 0.33 % 33240000

(1.1-1.9 % of the total)

1: Estimates by multiplying the reported incidence rate by the weighted average incidence ratio of population seroprevalence studies/official case reports.

2: The average annual mortality attributed to COVID-19 is multiplied by the proportion of deaths seen in autopsy series as directly caused by COVID-19 (60 %)

3: This is the ratio between deaths and incidence.

4: Here only estimated for life yearslost as a result of premature death: Number of deaths due to the difference between the maximum life expectancy and the average death age during the pandemic.

Analysis of the Anti-Pandemic Measures

  1. Risk-benefit: Prevention and treatment measures against COVID-19 have mainly been lockdowns on mobility and contact in the population, vaccination and treatment. There are significant uncertainties in the level of positive impact of each of these measures disaggregated by age and health conditions, and even more in their negative impact. To study the impact of a public health measure, a population group (cohort) is monitored over time or compared between a population in which (case) the measure is applied and a population with similar demographic and epidemiological characteristics without such intervention (control). As regards lockdown measures, in most cases, they were taken on a generalised basis, independent of the social and household composition by age, health baseline situation and incidence and case fatality in each group (not well known or published, as described above), so it is not easy to analyse the disaggregated positive impact by population groups. On the other hand, the evolution of natural or induced immunity (since 2021) and the pathogenicity of evolving variants of the virus makes it difficult to estimate by cohorts the impact of each preventive measure. When comparing two populations, in general countries, with different prevention policies (as within one country it is considered unethical to expose part of the population to supposedly preventable risks), we find the bias of different demographic, socio-economic and epidemiological situations, and even of the information systems themselves. For example, the evolution of incidence and mortality following the lockdown measures between countries in Europe (with high lockdowns) and Africa (with low lockdowns or means to do so) does not indicate a benefit in lockdown measures, while the comparison between China and the United States or Europe indicates the opposite. As regards the comparison of incidence and mortality risks among persons using or not using different types of masks, there is not enough study and relative risk statistically significant to claim that their individual use protects against infection or reduces mortality, especially in open and ventilated spaces[xi]. As regards the adverse effects of these measures, it can be estimated that global lockdowns accounted for at least 3.363 % of economic contraction. Such economic loss has been highly uneven (see the inequity analysis below), increasing by possibly up to 10 % the burden of health inequity, some 1.6 million deaths per year and some 56 million life years lost, higher than the COVID-19 direct burden of disease. Another risk of lockdown measures lacking enough analysis is the impact of sedentarism[xii] and social isolation on the state of health, especially of older people and youth, with an increase in chronic disease morbidity in the elder and anxiety, depression and suicide rates, particularly among young people[xiii]. The risk/benefit of the lockdown measures should therefore be weighed at individual level according to age and risk factors, and at the population level according to the disaggregated impact and the direct and indirect negative health effects. In terms of vaccination, efficacy studies have been carried out in cohorts (phase III clinical trials by pharmaceutical corporations) which rendered national and WHO pre-qualification through clinical, laboratory and production practice evaluation. The WHO prequalified vaccines demonstrated a reduction in mortality of more than 90 % in vaccines based on mRNA channelled through nano-particles (Pfizer, Moderna) or viral vectors (Astra Zeneca and Jansen -DNA in this case-) and 60-80 % in attenuated virus-based vaccines (Sinopharm, Sinovac)[xiv]. Only one protein/based vaccine, Novavax, has been WHO pre-qualified but its coverage is still minimal. Other vaccines awaiting approval by the WHO, such as the Cuban and Corbevax, also based on proteins, have been shown to be more than 90 % effective after three doses, but have not been pre-qualified by the WHO and their overall distribution is minimal. Vaccine induced immunity decreases over time and requires revaccination[xv]. In addition to the individual benefit of vaccination in reducing mortality, there is a potential benefit in transmission to third persons (externality), if it reduces the viral burden on mucous membranes. This benefit is limited in vaccinated people[xvi], who continue to carry the virus on mucous membranes with viral loads that have not been statistically proven to be lower than in unvaccinated pre-infected (with natural immunity). There is very little published and socialized information on natural immunity but cohorts of people infected with COVID-19 demonstrate better[xvii] and longer duration[xviii] (by memory cells in bone marrow studies) than induced immunity. The state of pre-infection could or should exempt the need for vaccination, but any country nor WHO have not considered such rationale[xix]. Some predict that by March 2022, 60 % of the world’s population will have been infected with COVID-19 variant Omicron[xx]: Their exemption from vaccination would have a very important social, economic and political impact. As regards the risk of vaccines, there is lack of transparency in pharma vaccine clinical trial dossiers[xxi]. On the other side, the very short duration of their follow-up before approval disables any mid or long-term safety assurance. There are reports of serious side-effects and deaths directly linked to vaccination[xxii] and myocarditis in young[xxiii] people, indicating 0.0000462 deaths (46 per million) per vaccine[xxiv]. These data enable estimates of risk-benefit, even with only one year of evolution after vaccination, and by age groups, given their very different fatality rate as above mentioned. These data pose the question on their use in young people and even more in children. Given the short monitoring period, the risk of vaccination in the medium to long term is even more uncertain, in particular by the novel mechanism of mRNA or DNA based vaccines and their potential interaction with the human genetic structure[xxv]. Fragments of viral mRNA are known to find reverse transcriptase enzymes and integrate into the human genome in the natural infection process, so vaccination with mRNA copies at much higher concentration than a natural infection may potentially mean reverse transcription into DNA and integration into the human genome of germ cells and even haploid gametes, with potential long term reproductive effects. Although this risk has been considered minimal given the volatility of mRNA in blood circulation, the risk of genetic alteration and its long-term effects in relation to oncogenesis (e.g. HBV[xxvi], HCV, papilloma[xxvii])[xxviii], autoimmune or degenerative processes (as recently seen between Epstein Bar virus and multiple sclerosis[xxix]) cannot be fully excluded. In terms of treatments, statistically significant effect on reducing mortality has been proven in intensive care and ventilation (CPAP[xxx] and assisted) in cases of respiratory failure and with nirmatrelvir-ritonavir[xxxi] in severe cases (every 12 hours for 5 days) at a cost of about USD 500 per patient[xxxii] (although a pool of patents has been opened). In such treatments, the most important issue is equity of access rather than the risk benefit deemed sufficient to justify such therapies in severe cases.
  1. Cost utility: Utility is measured in healthy life years (DALYs) that an intervention protects (prevents loss) or recovers (by treatment). As mentioned above, there is no absolute evidence of the usefulness of the generalised lockdown measures, as there are no case studies on control and validity of cohorts to demonstrate this, even less disaggregated by age and risk factors, and the uncertainty of risk-benefit for groups with lower risk of COVID-19 related mortality, as discussed above. Even assuming that the lockdown measures could have halved the transmission of the virus and its consequent mortality, the burden of the disease prevented would have been around 32.58 million life years. The global lockdown has caused at least 3.363 % on average annual GDSP[xxxiii], or about USD 2.85 trillion. Therefore, the cost utility of the overall lockdown may be around $87,210 per life year potentially lost by COVID-19. Compared to other public health measures, the World Bank and WHO consider relevant interventions of less than $150 per life year in low-income countries and below $500 per ADV in middle-income countries[xxxiv]. By comparison, the threshold for utility cost of interventions in the UK public system is $27,400[xxxv] and can reach $100,000 in US private insurance[xxxvi], governed by studies of intention to pay by life year. It is striking to see what is the value (or the cost worth investing) of one year of life according to the income levels and the strong correlation with GDP per capita. It is even more telling when we estimate that value to a human life taking into account the world average life expectancy: from some $10,500 in a low- income country to some $ 7 million in high income groups in high income countries. The global lockdown has been most expensive public health intervention in history and at a highest cost per life year, over 5,800 times higher than public health interventions advised by WHO and World Bank in low-income countries. In terms of vaccination, the cost of the available vaccines together with that of distribution by the health system is about $50 per dose. At one dose per six months according to current frequency, the annual cost is around $100 per person. Assuming efficacy rates of 90% in preventing mortality, it could prevent some 29.3 million life years meaning that the of the overall cost utility would be around $26,620 per life year, which is less than the lockdown but still far above the recommended cost utility of public health programmes in middle and low-income countries. Vaccination of the population over 60 years of age or with risk factors would cost ten times less (as it accounts to 10% of the world’s population) and result in an impact of 90 % of the overall vaccination (as 90% of deaths take place in older than 60 years). Such strategy would also ease the concerns of the risk-benefit considerations described above. The cost utility of vaccination of the population over 60 years of age would therefore be $2,957 per life year. Taking into account the reported benefits of vaccine manufacturing corporations (around $30,000 million for the 12,000 million doses sold), the possible production cost of the vaccines would be around $1.3 per vaccine (sold now at $15-25 per dose). Hence, the cost utility of vaccination over the age of 60 in the world with off-patent vaccines would be $147 per life year, in the affordability range of public health interventions regardless the income levels. In terms of treatment, the cost of entering ICUs and applying mechanical ventilation (CPAP and assisted) during the average 6-day duration, is about $7,500 per patient (in high-income countries the average is $30,000 per admission). Pfizer’s nirmatrelvir-ritonavir is sold at about $500 per treatment course in severe cases. Reducing the mortality of severe cases by 80 % would prevent the loss of some 26 million life years at a cost of about 144,000 million, (10 % of the 160 million cases diagnosed per year x 8 days of average stay in ICUs and treatment of nirmatrelvir-ritonavir). The cost utility of the treatment of severe cases is around $5,538 per life year, beyond the economic reach of low-income or middle-income countries.

Figure 5: Estimates of cost utility of the measures taken to fight the COVID-19 pandemic in relation to the utility cost thresholds used in countries according to income per capita


  1. Opportunity Cost: Comparing the cost of COVID-19 control strategies (or loss of economic income) and its impact on the prevention or recovery of healthy life years with those of other public health interventions lacking coverage enables to estimate the cost in life years, and in saved lives, of an excessive cost utility to tackle the COVID-19 pandemic. There are still many prevention and treatment interventions for the main causes of loss of healthy life years (see Table 1: Infectious diseases – including diarrhoea, respiratory, malaria, tuberculosis, HIV- and chronic non-infectious diseases – including diabetes, hypertension and its consequences of cardio and cerebrovascular diseases, kidney diseases, lung, colon, prostate and breast cancer). The average cost utility of those interventions is around $1,000 per life year in low- and middle-income countries. The cost and economic loss of the global lockdown could have reduced half of the economic inequity gap and prevent around 224 million indirect life years. Regarding vaccination, the full coverage of vaccination would cost some $780,000 million for the protection of some 29.3 million life years. The selective coverage of all people over 60 years of age in the world -10 % of the global population – would cost some $78,000 million for the protection of some 27.8 million life years while easing mobility of the youth and, monitored by periodic IgG testing, enabling the development of natural immunity. This option is considered highly controversial but the risk benefit, cost utility opportunity cost and –see below- equity analysis call for age-selective vaccination to be considered. The opportunity cost of vaccinating all under-60 years could have been protected some more than 700 million life years, some 20 million preventable deaths.

Figure 6: Opportunity cost in life years and deaths avoided by decisions of high utility cost vs different COVID 19 measures

The following chart summarises the indicators analysed in relation to the measures taken and currently in force and imposed even through mandatory compliance laws:

1: Estimating that half of the deaths that have occurred may have been prevented by lockdown

2: Estimating 90 % average efficacy of the current available vaccines

3: Taking into account that over 90% of deaths are in people over 60 years old, and that they account for 10 % of the world’s population.

4: Taking into account that < 10 % of deaths are in people under the age of 60, and that they account for 90 % of the world’s population.

5: Taking into account 60 % effectiveness of intensive care treatment in patients with COVID-19 severe disease..

6: Assuming that the lockdown has increased the overall burden of health inequity by 10 %.

7: By attributing the mortality rate observed in the United States attributed to COVID -19 vaccination.

8: The former applied to the proportion of people over 60 years of age..

9: The former applied to the proportion of people below 60 years of age...

10: It results from applying 5 % mortality rate due to side effects of ICU treatments in severe cases.

11: Overall economic loss divided by the potential benefit described above.

12: It results from applying the vaccine and distribution system cost of approximately $50 per dose and two doses per year to the entire world population and divided by the potential benefit described above.

13: Idem at 10 %, over the age of 60.

14: Same as 90 % below the age of 60.

15: Same as for severe cases.

16: It results from applying the economic losses of the overall lockdown to equitable economic redistribution and its potential impact.

17: The cost of each intervention is applied to measures with a weighted average utility cost among high-income countries (10 % of the world’s population), a cost utility of $30,000 per life year, middle-income countries (40 %), of 500 $ and low-income countries (50%) of $150.

18: This is the result of subtracting the potential impact on other interventions from the measure itself for COVID-19.

19: It results from estimating preventative deaths by dividing the opportunity cost in life years by the average age of premature deaths (half of the world average life expectancy: 35 years).
  1. Equity: It is the fair distribution of inequality. It is the measure of the only international commitment in global health, Article 1 of the Constitution of the World Health Organisation: “the best possible health for all”. We have defined the best feasible level of health as the one of countries or regions with life expectancy higher than the international average (H: healthy), flow of economic resources (GDP per capita) and wealth (assets) below the international average (R: Replicable in terms of economic resources) and with availability (bio-capacity per capita) and use of natural resources (carbon footprint and ecological footprint) below the ecological sustainability thresholds- or planetary boundaries (S : Sustainable in the use of natural resources). The disaggregated mortality rates by age and sex of such HRS references are compared to those observed in each country. The resulting excess mortality constitutes the net (number of deaths) or relative (proportion of deaths in excess of the total) burden of health inequity. Based on available data on national averages, the net burden of inequality between 2016-2020 was on average 16.11 million deaths and the relative burden 28 % (32 % for women and 23 % for men)[xxxvii]. 84 % of the net burden/excess mortality (13.53 million) occurred in countries with GDP per capita lower than the healthy-replicable-sustainable (HRS) references, which defined the ‘dignity threshold’, of around $10.7 per day (5.7 times higher than the ‘poverty threshold’ defined by the World Bank. The symmetrical level of GDP per capita from the dignity threshold and over the international average marks the threshold above which other countries do not have enough economic resources to enable the feasible level of health-for-all, are not compatible with planetary boundaries and do not improve life expectancy or wellbeing beyond the mentioned threshold. More than half of the world’s population lives in countries with GDP bps below the dignity threshold (in the deficit area) and therefore without the possibility to have a life expectancy that is feasible (indeed, with less than half of global economic resources) and sustainable for the next generations. The economic redistribution needed to prevent those 13.5 million deaths per year is equivalent to 7.77 % of global GDP, 10.6 % of the GDP above the excess threshold (as opposed to the current 0.18 % ODA). Regarding the COVID-19 pandemic and as previously mentioned in Figure 3, there is no statistically significant relationship between GDP per capita and COVID-19 mortality rate, both in 2020 without vaccines and in 2021 with vaccines. However (Figure 7), there is a clear correlation between GDP per capita and COVID-19 vaccination coverage (r2 = 0.4769: Almost half of the change can be explained by GDP per capita). Assuming its effectiveness in reducing morality by 90 % for those infected, the vaccination deficit would have resulted in an unjust and preventable excess of 2,056,462 deaths to date.

Figure 7: Vaccines vs COVID-19 per 100 inhabitants vs GDP pc, by country


While we cannot be sure (partly due to the absence of population sero prevalence studies) of the real COVID-19 incidence (most probably underestimated by official data) or its case fatality (most probably overestimated), available data during 2020 (without vaccination) and 2021 (with availability of vaccines even with high unjust access) point at a loss of around 32,580,000 life years in the world population. This loss (burden of disease without taking into account disability weight) is 1.96 % of the loss of life years for all diseases. Moreover, recent studies suggest that direct virus mortality may really be some 60 % of the reported (co-morbidity with positive PCR), so the proportion of the loss of life years due to the pandemic would be lower, some 0.76 % of the total. In relation to the risks that cause the greatest loss of life years, the pandemic has resulted in less than 10 % of the loss of life years due to the effect of tobacco, agro-industry diets (in both cases with massive marketing funding) or sedentarism, exacerbated by the widespread lockdown measures. The evolution of the pandemic, both in countries with high vaccination and low vaccination coverage, suggests that, through natural and induced immunity together with mutations in new variants -as the latest Omicron-, the virus is adapting and reducing its morbidity and human mortality, as it happened in previous coronavirus pandemics.

As regards the measures taken against the pandemic at global level and at national and sub-national levels, these have led to an unprecedented cost or economic loss in the history of public health, which deserves consideration without prejudice or ideological, economic or political bias. The benefit of lockdown and vaccination has not been studied disaggregated by age groups, general and COVID-19-specific immunity status and risk factors. On the other side, the short, medium and long-term side-effects of lockdown on physical, mental and social health and indirect health due to economic contraction, as well as those through vaccination, are not entirely known, less so in the medium and long term. On the other hand, the cost utility of the measures taken has been up to $87,210 per year of life protected by the lockdown, $23,620 for vaccination and $5,538 for treatment of severe cases, far from the thresholds of cost utility recommended by the WHO and the World Bank -and the influence of the latter by conditional credits- for low-income countries ($150 per life year) and even for high levels of private income (as recommended by the WHO and the World Bank (and the influence of the latter by conditional credits) for low-income countries ($500 per life year) and even for high income countries. The opportunity cost of such interventions in relation to the lack of economic fair redistribution (in the case of lockdown) and the lack of coverage of other much more efficient (cost-effectiveness) public health interventions -in particular in low-income countries-, may have resulted in 5.2 million deaths due to the lockdown measure and around 4 million deaths due to the vaccination strategy of the whole population (which has been limited to half and 80 % in middle-income and high income countries) in relation to selective vaccination for older than 60 years.

The impact of the pandemic on global equity suggests that, while there is no higher burden in low-income countries (discriminated against in the right to health as described above), the effects of the economic contraction will most likely increase overall economic inequity and hence inequity in health, and vaccination coverage, biased towards middle-income and high income countries, has led to an unfair and preventable excess of 2,056,462 deaths in lower-middle-income countries and low-income countries.

Lack of Space for Evidence-based Debate on Pertinence of Strategies to Confront COVID and Potential Conflicts of Interest of media and Political Decision Makers

Big tech in alliance with major social networks have banned what they judge[xxxviii] as fake news and even questions on vaccine safety[xxxix]. In fact, the main social media and big pharma share capital interests through Black Rock and Vanguard (soon to manage $ 20 trillion[xl]) major asset management firms[xli],[xlii] who exert major influence on governments worldwide[xliii] As a result, the space for open and transparent debate on pros and cons of the political decisions -mainly adhering to systematic lockdown and universal vaccination (with exclusive access to mRNA vaccines in high-income countries)- is very narrow[xliv] and hard to find. Big Pharma invested some $6.6 billion in advertising alone in the USA[xlv], which is more than the overall budget of the World Health Organization and six times its baseline budget from country contributions[xlvi]. The link to the overall political and media powers relates to the major gains of pharmaceutical corporations boosted by the COVID-19 pandemic which has meant direct profits of more than USD 30,000 million[xlvii]. Moreover, the public access to the information on protocols and side effects of the corporations’ clinical trials, and their contracts with purchasing countries, has been limited[xlviii]. The mentioned contracts include disclaimer clauses, which exonerate the companies’ responsibilities in case of severe side effects[xlix]. Such secrecy is even more bothering when the COVID vaccine producer leading the market, Pfizer[l], has paid during the last 20 years $4.7 billion in penalties and settlements for false marketing claims and health safety violations.

Parallelism with the Global Reaction to the AIDS Pandemic

What the world has experienced with the COVID-19 pandemic echoes what happened thirty years ago with the global expansion of AIDS in some respects:

  1. No systems were established and no attitudes were promoted to know the individual and collective serological status in order to gain a better understanding of their epidemiological dynamics and to steer public health and individual responsibility actions. Whereas conscious and ethical HIV seropositive persons should have prevented infecting seronegative persons (mainly through the use of condom, hampered by the Catholic Church and the US government through its PEPFAR programme), in the case of COVID-19, those without IgG antibodies (rather than volatile PCR or antigen negative status) should have been subject to lockdown and vaccination while sero positives could have avoided the extreme degree of economic contraction, strengthened social services for older people and possibly led to herd immunity.
  2. At that time and now, there was no comprehensive funding system for research into global public goods against the pandemic, i.e. universal access to effective and safe diagnostic tests, treatments and vaccines. In the case of AIDS, from the discovery in 1996 of anti-retroviral combined therapies that prevented death, to the establishment of the patent pool in 2004, around two million people died per year while corporations shielded patents, charged unaffordable treatment[li] prices, and gained some $20,000 million profits even after recovering research investments (to a large extent originally financed by public systems). In the case of the COVID-19 pandemic, since the knowledge of effective vaccines in 2021 (even with the uncertainty of medium and long-term side effects), the main private Pharma corporations producing COVID mRNA vaccines distributed in high income countries have also protected patents and rejected to join any knowledge and patent pool. The high margins and the patent monopoly has fuelled profits while paying low tax revenues[lii]. The high prices, together with the need of expensive ultra-cold chains, has de facto prevented most of the population in low and low-middle income countries from access to COVID vaccination. According to the efficacy rates some two million deaths could have been prevented had the COVID vaccine covered all persons over 60 years of age in the world regardless their country of origin or income level.
  3. The stigma during the AIDS pandemic fell on those infected who came forward revealing their status while during the COVID pandemic the stigma is falling on those who question the systematic lock down and the vaccination to all age groups in terms of risk benefit and opportunity cost.


  1. Global redistribution of economic resources towards global economic equity that can prevent more than 10 million unfair deaths per year.
  2. Promote healthy lifestyles correlated with sustainable ecological and carbon footprint for new generations and prevent more than two million deaths per year due to the effects of climate change in the rest of the century, hitting the least polluting countries harder.
  3. Global equitable financing of a globally accessible research and public goods fund, outlawing knowledge patents for vital and life-saving knowledge and goods (oxygen, water, natural food, essential medicines).
  4. Access to serological tests on a regular (monthly?) basis to identify persons and groups at risk and their responsibility — moral and legal — to avoid infecting other persons, in particular higher risk groups (over 60 years old and with risk factors).
  5. Comprehensive access to effective and safe vaccines (support to pre-qualification processes for Cuban vaccines and Corbevax) with global sequential coverage staring with the priority for people over 60 years old and with risk factors.
  6. Assess the pertinence of vaccination in younger age groups in terms of risk/benefit, cost-effectiveness and opportunity in relation to other global health challenges.

This must be based on an open and uncensored, evidence-based debate based on the universal right to health and the ethical principle of equity.



[i] Https://

[ii] Https:// (20) 30544-1/fulltext.

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[xvi] Https:// (21) 00690-3/fulltext.


[xviii] Turner, J.S., Kim, W., Kalaidina, E. et al. SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans. Nature 2021

[xix] Https://

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Indirect Effects of Covid-19 on Mothers in Low and Middle-Income Countries

Global society needs time to clarify the exact effect of Covid-19 on maternal mortality , preterm birth rate, stillbirth and other negative pregnancy outcomes in LMICs. It is clear, however, that pregnant women or new mothers have been noticeably hit by Covid-19. This pandemic won't be the last one. It is therefore imperative that governments and the global society consider appropriate strategies in order to mitigate the risks and results of Covid pandemic on vulnerable populations 

By Sevil Hakimi

Rm. PhD. Associate Professor of Maternal and Newborn Health. Tabriz University of Medical Science. Tabriz, Iran


Beyond the Waives

Indirect Effects of Covid-19 on Mothers in Low and Middle-Income Countries


Covid-19 pandemic continues to make health system overwhelmed. However, the tremendous direct and indirect effects of this virus on most vulnerable population are always neglected. Pregnant women or new mothers in low and middle-income countries (LMICs) are among the populations that have been noticeably hit by Covid-19. Unfortunately, we have no precise information on pandemic-related indirect effect in the mentioned sector. Every conclusion in this area is based on uncertain data.

LMICs are struggling with a couple of problems including human resource and budget shortfall, weak health system, poverty, inequality, etc.

Older age and systemic disease are among the top predictors of Covid-19 fatality rate. However, there are evidences that weakness of the health system can be a remarkable factor in fatality rate prediction. The majority of LMICs have young population, however their health system is not as strong as high-income countries. The effect of health system weakness can be powerful as it erases young population advantage.

While resources are scant, health care delivery is constrained in this period. Hospitals face considerable challenges for providing standard care. Within this condition, mothers are the most deprived population group. They are young and almost always are healthy. So, it is very probable that while their needed care is shifted to other parts of the hospital, they eventually receive care below standard.

It is more than likely that maternal ward is allocated to Covid patients. So, midwives and nurses working in maternal wards are transferred to other parts of hospital for caring of Covid patients. Seeking care and timely transferring for pregnant mothers, damaged during lockdown, comes as no surprise on the grounds of the limited budget, which is allocated to personal protective equipment (PPE), so that other equipment is not provided. Covid related burnout and mental stress among midwives and nurses have an impact on the quality of care provided.

Covid-19 leads to consider the “separation” policies by the policy makers for the protection of health care providers, newborns and mothers as well. Hence, direct skin to skin contact, breastfeeding and presence of parents in the neonatal intensive care unit (NICU) have been completely disrupted or seriously limited in several countries. Separation policies can have devastating effect on maternal mental health, preterm newborns development and exclusive breastfeeding rate.

In the middle of current Covid pandemic it seems that mothers, as part of most vulnerable population, are obtaining less care than they deserve.

In the heart of communities, and following the policy of “stay at home”, domestic violence (DV) has increased against women. There is no clear data about comparison of DV against women between developed and developing countries. Regarding to economic insecurity role in prediction of DV, we can anticipate that the problem is more severe in LMICs.

Gender based violence on expecting or new mothers can lead to catastrophic physical and emotional results including miscarriage, stillbirth, preterm birth and post-partum depression.  Child marriage is another social negative outcome of current pandemic, which has burst in a few countries including Indonesia, India, Brazil, Bangladesh and Ethiopia according to national reports.


Global society needs time to clarify the exact effect of Covid-19 on maternal mortality, preterm birth rate, stillbirth and other negative pregnancy outcomes in LMICs. This pandemic won’t be the last one, definitely. It is, therefore, imperative that governments and the global society consider appropriate strategies in order to mitigate the risks and results of Covid pandemic on vulnerable populations.

News Flash 463: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 463

Weekly Snapshot of Public Health Challenges


Application for Intern, Global Health Programme Chatam House (closing date January 31st, 2022)

Meeting registration: 24-29 January 2022: EB TODAY, Civil society lounge (or call it “executive boardwalk) during the 150th session of the WHO Executive Board

Announcement: WFPHA GLOBAL PUBLIC HEALTH WEEK 4-8 April 2022

Meeting registration: Workshop DIH Be-cause health – Decolonising global health Jan 27, 2022 02:00 PM in Paris

African continent experiences shortest COVID-19 wave


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COVID-19: latest safety data provide reassurance about use of mRNA vaccines during pregnancy

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COVID program delivers 1 billion doses to poorer countries

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WHO approves two new Covid-19 treatments

MSF responds to latest WHO recommendation for a COVID-19 therapeutic, baricitinib

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France Approves COVID-19 Vaccine Pass Law, Joins Other EU Countries With COVID Fines and Mandates

Wealth of world’s 10 richest men doubled in pandemic, Oxfam says

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COVID-19 vaccine uptake ‘a matter of words’


Adolescents Left Behind Global AIDS Response – Experts

More People Die of Antibiotic-Resistant ‘Superbugs’ Than HIV/AIDS In 2019, Sub-Saharan Africa Worst Affected

Suicide increasing amongst Europe’s youth, governments underprepared

Strengthening Patient-Centered Addiction And Mental Health Care In The United States

Menstrual health is a public health and human rights issue

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Sanzioni economiche e salute

Fix the Common Framework for Debt Before It Is Too Late

Undercurrents: The US-China rivalry in an age of crisis

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FIND VACCINE NOW Platform: Covid Vaccine Near Me

A presentation here of Find Vaccine Now platform which is available in 104 countries, making Covid-19 vaccine access and availability information within reach of more than 5 billion of the world’s population by connecting people to available doses, in addition to building their confidence in vaccines

In several low income countries, following information is not available or is not easily accessible …our goal is to bring the latest, and most accurate Covid-19 vaccine information to our communities from reliable sources. We hope that providing fast, accurate and timely Covid-19 vaccine information to our communities will help match Covid-19 vaccine seekers with Covid-19 vaccine providers, making it easier to vaccinate more people while reducing long vaccine lines…

By Syed Ahmad

Founder and CEO, Find Vaccine Now

USA  Phone: +1 4329781998


Covid Vaccine Near Me


Access to Covid-19 vaccine information, location, and availability is essential if we are going to increase vaccinations worldwide. In high income countries availability of vaccines and access information is widely available, however, in low – and lower middle-income countries access information is either not available or very difficult to find even when vaccine availability is becoming better.

Find Vaccine Now platform started working on making the access to Covid-19 vaccines easier for people in the United States when vaccines became available in December 2020. We soon realized if finding a vaccine appointment was harder in the United States, it will be even harder in other countries. With that in mind we expanded our platform to other countries.

Find Vaccine Now simply connects people to available doses in 104 countries, in addition to building their confidence in vaccines with WHO health messages.

WHO called the Find Vaccine Now platform “A critical step in connecting people to available doses and enabling the last stretch of vaccine delivery.

Find Vaccine Now helps people with following information:

  1. Vaccine information from trusted sources
  2. Nearest location information
  3. Vaccine availability information
  4. Types of vaccines available
  5. How to make an appointment
  6. Where to make an appointment
  7. Where to call for more information

To show how effective and important their tool is, Find Vaccine Now team compiled a sample list of a dozen countries with a combined population of about one billion people. The list of countries and the size of the global population without access to this critical information is much bigger.

Please try finding a vaccine location in major cities in any of the following countries using tools available to a common user: Ethiopia, Egypt, Nigeria, Vietnam, DR Congo, Tanzania, Spain, Kenya, Morocco, Nigeria, Angola, Ghana, Chad. Unfortunately, it will be very difficult.

News Flash 462: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 462

Weekly Snapshot of Public Health Challenges


WHO: Public health round-up

Global Health Matters podcast/Navigating digital health waves

2021: a Year in Review through PEAH Contributors’ Takes by Daniele Dionisio 

Webinar registration: The Case for a New Bretton Woods Jan 20, 2022 09:30 AM in Eastern Time (US and Canada)

Meeting registration: Decolonising Global Health: What Does It Mean For Asia? Jan 24, 2022 02:00 PM in Singapore

Webinar registration: Our future at stake: The corporate capture of multilateralism Wednesday, January 19, 14.00-15.30 CET

Webinar registration: Beyond the agenda of the WHO Executive Board: People’s realities, determinants of health, democratic governance…. G2H2 meetings, Wednesday 19 January – Friday 2 January 2022

Accelerating Clinical Trials in the EU (ACT EU): for better clinical trials that address patients’ needs

Coronavirus disease (COVID-19) Weekly Update

Preliminary data indicate COVID-19 vaccines remain effective against severe disease and hospitalisation caused by the Omicron variant

EU drug regulator expresses doubt on need for fourth booster dose

Global regulators discuss path towards regulatory alignment on response to Omicron variant

Nose or Throat Swabs? Antigen Tests for Omicron Are Under Examination

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Omicron Infection Curve ‘Staggering’ – 36 Countries Have Vaccinated Less than 10% of Citizens

THE LANCET COVID-19 COMMISSION GLOBAL HEALTH DIPLOMACY AND COOPERATION TASK FORCE Global diplomacy and cooperation in pandemic times: Lessons and recommendations from COVID-19 DECEMBER 2021

BOOK BY THE SOUTH CENTRE, 2022: Vaccines, Medicines and COVID-19 How Can WHO Be Given a Stronger Voice?

Interim Statement on COVID-19 vaccines in the context of the circulation of the Omicron SARS-CoV-2 Variant from the WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC)

India Covid: Booster shots start for priority groups as cases surge

A synopsis of current global support for Africa’s vaccine manufacturing roadmap

Bangladesh Produces First Generic of Pfizer’s Antiviral But Indian Company Hits Snag with its Merck Generic

Message for World Leprosy Day 2022

Antibiotic Resistance Could Turn Treatable Conditions Deadly

Unequal coverage of nutrition and health interventions for women and children in seven countries

Building climate-sensitive nutrition programmes

People’s Health Dispatch Bulletin #16: New hope for people-centric healthcare with incoming progressive governments

Achieving sustainable health equity

Covid-19 Disrupts UN & Threatens Potential Cash Crisis in World Body

Conflicts to Watch in 2022, Preventive Priorities Survey Results

World Bank warns of record debt levels in low-income countries

Opinion: Securing land rights is key to fulfilling the COP 26 pact

The Time to Protect Our Oceans is Now

The IMF’s Surveillance Role and Climate Change

‘Acidifying, warming seas affecting seafood supplies’






2021: a Year in Review through PEAH Contributors’ Takes

Now that we just turned the corner on another challenging year, we wish to share here all 2021 PEAH published articles by committed top thinkers, stakeholders and academics worldwide aimed at sparking debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings 

by Daniele Dionisio*

PEAH – Policies for Equitable Access to Health

2021: a Year in Review through PEAH Contributors’ Takes


As we just turned the corner on another challenging year, we wish to share here all 2021 PEAH published articles by committed top thinkers, stakeholders and academics worldwide aimed at sparking debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings. PEAH deepest gratitude goes to all of them.

Find out below the relevant links:

An Article on Persons with Disabilities Tanzania by Rick Kyando

Covid-19, the Omicron Variant and the “Butterfly Effect” by Stella Egidi

SARS-Cov-2 Omicron Variant: Holding Our Leaders Accountable by Raymond Saner

COHRED Global R&D Equity Initiative: Invitation to Act

Tinnitus: is It a Lifelong Companion / a Foe for Life or does It have a Promising Future? by Tanushree Mondal 

Tackling the Root Causes of Climate Change. If Not Now, WHEN? by George Lueddeke 

Living with COVID in a Transformed World by Brian Johnston 

5 Reasons to Support the European Citizens’ Initiative No Profit on Pandemic by Julie Steendam 

The Cut to Universal Credit in the UK is a Threat to the Health of the Most Deprived by Rebecca Barlow-Noone 

Access to Corona Vaccination only for the Rich by Christiane Fischer 

What is COVID-19 Revealing to Us? by Angelo Stefanini 

A Short Reflection on Access to Rabies Vaccination in Times of (COVID-19) Vaccine Inequity by Raffaella Ravinetto 

Venomous COVID-19: Ripping the Country of its Valuable Young Generation by Gertrude Masembe 

Risk Factors, Mental Health and Psychosocial Needs, and Coping Among the Children Under the Care of Female Sex Workers and Adolescent Girls Surviving in Sex Work Settings: a Rapid Assessment by AWAC-Alliance of Women Advocating for Change

Decriminalizing Sex Work and Enhancing Equitable Access to Health, Justice and Social Protection by Female Sex Workers in Uganda by AWAC-Alliance of Women Advocating for Change

Apropos of COVID-19: Shall We Question Ourselves? by Francisco Becerra 

Barriers To Exclusive Breastfeeding In Western Kenya by Charity M’mbaga 

Corona-Policy-Chaos and Health for All by Judith Richter 

Death in the Time of COVID by Brian Johnston 


A Global Health Crisis To Shape a New Globalisation by Enrique Restoy 

Regional Security in Times of Health Crisis – A Look at the East African Community by Becky Adiele 

Rwanda Global Healthcare Summit: 9th to 11th August 2021 by Memory Usaman 

Bundle of Joy or Cause for Shame? Just What Mothers in the Kenyan Informal Settlements Face. A Tale of Inequalities in Maternal Health Service Delivery by Reagun Andera Odhiambo 

Diversionary Measures for Children in Conflict with the Law by Philip J Gover 

Commentary on ‘More for The World Organisation for Animal Health (OIE) – Impakter’ by George Lueddeke 

Unleashing the True Potential of Data – COVID-19 and Beyond by Brian Johnston 

Open Letter: Justifying Emergency Measures to Tackle Covid-19 Crisis in Europe by Raymond Saner 

Covid-19 Vaccines – On Fairness and Distribution by Iris Borowy 

More Funds Are Required To Promote Migrants’ Health by Olga Shelevakho 

Inland Transit Applications: Improved Welfare at Affordable Prices or Increased Traffic and Air Pollution – Case of Iran by DJavad Ghoddoosi-Nejad 

International Debates: What Does the 2020 Seventy-third World Health Assembly Mean For Socio-economic Survival of Countries, Food Security, and International Cooperation in the COVID-19 Pandemic by Michael Ssemakula 

Nourishing India – What Needs to Be Done by Veena S Rao 

New Year, New Lockdown in the United Kingdom: ‘The Great Deception’ by Ted Schrecker 

Defending and Reclaiming WHO’s Capacity to Fulfil its Mandate: Suggestions from a Perspective of Language and Power by Judith Richter 

The ISOHA Europe Virtual Conference 2021

Contributions From APAN During Disasters by Tanushree Mondal 


The contributions highlighted above add to PEAH internal posts published throughout the year. Find the links below:

Eyeing COVID Through PEAH Independent Lens: Which Takeaways? by Daniele Dionisio 

Interview to Dr. Trudy Masembe, CINTA Foundation Uganda by Daniele Dionisio 

Damn Covid Pandemic, Let’s Begin Exploiting You For Fairer World by Daniele Dionisio 

Newly Launched: 2021- Year of Equitable Research Partnerships by Daniele Dionisio

2020: a Year in Review through PEAH Contributors’ Takes by Daniele Dionisio


Moreover, as part of PEAH scope and aims, the column titled ‘Focus on: Uganda’s Health Issues‘ continued to serve as an observatory of challenging health issues in Uganda from a comprehensive view encompassing the policies, strategies and practices of all involved actors. 

In the meantime, our weekly page PEAH News Flash has been serving as a one year-long point of reference for PEAH contents, while turning the spotlight on the latest challenges by trade and governments rules to the equitable access to health in resource-limited settings.



*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. Former director of the Infectious Disease Division at the Pistoia City Hospital (Italy), Dionisio is Head of the research project  PEAH – Policies for Equitable Access to Health. He may be reached at:


PEAH collaborates with a number of non-profit entities. These include, among others:


G2H2Geneva Global Health Hub

CEHURD – Center for Human Rights and Development 

Center for the History of Global Development 

Viva Salud 

Asia Catalyst 



The 53rd Week Ltd 


Social Medicine Portal 

Health as if Everibody Counted 

COHRED’s Research Fairness Initiative (RFI) 

AFEW International 


Medicines and Ethics, Institute of Tropical Medicine, Antwerp

Alliance of Women Advocating for Change (AWAC) 



News Flash 461: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 461

Weekly Snapshot of Public Health Challenges


Meetings registration: Beyond the agenda of the WHO Executive Board: People’s realities, determinants of health, democratic governance… G2H2 meetings, January 2022 Register here for civil society workshops Monday 17 January and Tuesday 18 January 2022

China, the West, and the Future of Global Health Security

USA Prescription Drug Policy, 2021 And 2022: The Year In Review, And The Year Ahead

Coronavirus disease (COVID-19) Weekly Update

Audio Interview: Covid-19 — The Outlook in Europe

COVID-19 cases on the rise across the continent following festive period

COVID-19 Could Become Endemic in Africa if 70% Vaccination Coverage is not Achieved by 2022 – Africa CDC

Prospects for local manufacturing of COVID-19 vaccines in Africa

Advocates call for 22 billion more mRNA vaccine doses to ward off global omicron threat

Gloomy New Year Prognosis – WHO Experts Warn Omicron Could Also Spawn More Dangerous Variants

Tie pharma CEO pay to fair global COVID-19 vaccine access, investors say

New Data on Side Effects of Second Pfizer Shot in Children Shows Fewer Adverse Effects than for Teens


Australia to donate 60 million COVID vaccines to developing nations

‘There is no money left’: Covid crisis leaves Sri Lanka on brink of bankruptcy

Lessons From COVID-19 Vaccines To Improve Malaria Vaccine Acceptance In Africa

Covid-19’s Devastating Effect on Tuberculosis Care — A Path to Recovery

Underfunded and Deadly Tuberculosis Needs its Own Bill Gates

TB epidemic ‘could flare in near future’

72 million people to miss treatment for NTDs due to UK aid cuts

How protecting health can foster peace

Opinion: There’s a better way to reach millions of unschooled children

Q&A: How can a global treaty to end violence against women succeed?

Violence against women: tackling the other pandemic

Planet Earth: Averting ‘A Point Of No Return’? by George Lueddeke

Environmental Disasters Creating More Migrants Within Countries – Podcast

Syrians turn war missiles into heaters as winter grips

Urban Air Pollution Responsible for Nearly 2 Million Excess Deaths in 2019, Says Study

Too Harmful: The March of Salt and Plastics on World Soils

Nkosi, B., Zanoni, B., Seeley, J., & Strode, A. (2021). The ethical‐legal requirements for adolescent self‐consent to research in sub‐Saharan Africa: A scoping review. Bioethics, 1–11




Planet Earth:  Averting  ‘A Point Of No Return’?

The world is in a very dangerous place right now and things can (will?) get out of hand. In terms of the recommendations at the end of the piece, the UN Security Council (UNSC) simply is not working and reform of its membership now has to be considered a key option so that the voice of people most impacted by poverty, inequities and conflicts  is heard loud and clear in particular engaging our Youth who have the most to lose but also  the most to gain by taking steps 'to save the world from itself.'
George Lueddeke
Global Lead International One Health for One Planet Education & Trandisciplinarity Initiative (1 HOPE-TDI)

Planet Earth:  Averting  ‘A Point Of No Return’?

First published: Impakter January 4, 2022


As we look forward to 2022 (and beyond), the issues we face have become existential. One may well ask, as climate change turns into a climate emergency, whether our home on planet earth can be preserved from environmental destruction. In short, can we avert a point of no return?

Don’t Look Up

In the final moments of the Netflix movie, Don’t Look Up, Leonardo DiCaprio, a formidable environmentalist in his own right, playing astronomy professor Dr. Randall Mindy,  sensing that  Armageddon is near, ruefully utters ‘’We really did have everything, didn’t we?”   His words of disbelief could well sum up a future worldwide regret for the fate of our ‘blue’ planet unless we learn to change our trajectory from a path of self-destruction to ensuring life enhancement of all species and planet survival.

The film is ostensibly a parody of how politicians, media, and the public ignore the reality of the planetary threats facing us – in this case a huge asteroid hurtling toward earth capable of extinguishing all life.  (The last one hit the earth about 65 million years ago, wiping out the dinosaurs).

Shop on Impakter Eco


But the message of Don’t Look Upconsidered by some to be the most important movie of 2021, could be more revealing. Parallels with our responses to climate change (neglecting, rejecting) –  including the coronavirus – are clearly at the heart of the storyline. Unquestionably, WE have metaphorically become the comet and, scientists tell us, our species has about ten years before reaching ‘a point of no return’  when the destruction of our biosphere (land, sea, air) becomes inevitable.

Resetting the world geopolitical clock

There are of course other crisis scenarios of significant global risks that may be coming to a head in 2022 and that we need to treat very seriously rather than with arrogance or indifference.

China, an example of ‘the emergence of a first-rank economic and military power that respects neither democracy nor the rule of law that underpins it,’ tops the list. Seeking to establish  a new world order based on totalitarianism, it is becoming apparent that ‘Beijing intends not only to abide by its own rules but expects others to follow –them.’ Other potential flashpoints in 2022 include Russia’s troop build-up around Ukraine,  Iran’s escalation of its nuclear programme, and North Korea’s disruptive cyberattacks and military threats.

Considered collectively, it is clear that the lead time to reset the world geopolitical Doomsday Clock  (a metaphor created by the Bulletin of the Atomic Scientists in 1947) is even shorter than that for climate change – 100 seconds to midnight – as ‘autocrats everywhere have been using their lockdowns to plot mischief,’ which may, by design or accident, also lead to global catastrophe.

Calling out  ‘rogue leaders’ and  pulling together for planet sustainability

To safeguard our civilisation, global decision-makers who care about the future of the planet alongside the public at large are now tasked to call out (rein in) ‘rogue leaders’ (or political aspirants) who have the power to destabilise, indeed destroy, c. 4.54 billion years of  Planet Earth evolution.  The stakes for not doing so are very high indeed.

Individuals (and groups) in question include those who :

  • place their own self-interests, ambition and power ahead of  planet survival;
  • believe ‘image’ is more important than ‘character’;
  • engage  deliberately  in disinformation rather than Truth; 
  • lack understanding, trust and compassion; 
  • instigate  division and chaos over inspiring unity; 
  • deny the root causes of global instability (e.g., climate change, inequality); 
  • maintain that ‘might is right’; 
  • support a culture of ‘them and us’;
  • engage in physical and cultural assaults on individuals and democratic institutions;   
  • flout the rule of law; 
  • espouse totalitarian principles over democratic rights and freedoms. 

Unquestionably, the United Nations has a key lead role to play here but may be constrained politically and strategically.

One of its main weaknesses lies in the composition of the United Nations Security Council (UNSC) with its core remit to ensure global peace and security.  The main problem is that the same five permanent members with veto power – China, France, Russia, United Kingdom, United States – appointed in 1946 at the end of WWII now represent only about two billion people out of c. 7.8 billion. Close to 1.3 billion in  Africa and 1.4 billion in India alone are not permanently represented although some of the poorest and the most disadvantaged live in these regions and will be most affected by climate change.

The UNSC’s ‘win-lose’  conflict resolution approach informed (biased) by political ideologies and hegemony lead the Council to veto or simply neglect key global political issues including humanitarian disasters (e.g., Afghanistan, Myanmar, Covid-19 deaths, migration) and are morally indefensible in light of continuing and needless human suffering.

Covid-19 reminds us that the only way we and particularly Heads of State can achieve planet sustainability is ‘to pull together’ and ‘to stop behaving as if we live in a limitless world.’ It also challenges us to consider what kind of future we want and how to achieve it.

Important initial  steps toward ‘a more just, sustainable and peaceful world’ would be:

  • to rise above the political and social ideologies WE have created over millennia resulting in divisions and conflicts with millions of innocent lives sacrificed;
  • to shape core values to ensure the sustainability of the planet and all life;
  • to replace the outdated (‘Age of the Strongman’) amoral plans for global conquest (i.e.,  advancing national and personal self-interests at the expense of others) with ones that optimise planet sustainability and the health & wellbeing of all life.

History has clearly shown us over millennia that free societies tend to flourish while those that dictate or enslave fail or have short lifespans – socially, economically, politically.  

Adopting a new worldview 

A recurring theme of my previous Impakter articles is that our greatest challenge as a species is to adopt a new mindset / mental models that shift our thinking, policies, and strategies from human-centrism (it’s all about us) to eco-centrism: it’s about all species and the environment and the sustainability of the planet.

This pressing paradigm shift – defining a renewed moral purpose? – in our worldview is encapsulated in the concept called One Health  (& Wellbeing-OHW) that recognises the critical interdependence of humans, animals, plants in a shared environment. The  underlying point is that the planet will thrive without us but will surely perish if we continue to erode ‘the fabric of the ecosystems which sustain life on earth.’

The One Health approach ‘shifts from reactive sectoralised’ interventions ‘to multi-sector preventive actions at social, ecological, economic and biological levels of society.’ Applying OHW in societal settings involves identifying the root causes of complex issues (e.g., climate change) and finding ways to mitigate these especially in light of potential disastrous consequences.

Source: A Blueprint to Evaluate One Health, Frontiers in Public Health

Enabling actions 

There is no Plan B for climate change. We either get it right in the forthcoming decades or we disappear. Simple as that!

The same holds true for other global threats – nuclear war, deadly pandemics, food security and others if pushed to extremes. The United Nations remains our best hope for a sustainable future but changes would need to be made to ensure that all nations have an equal voice and are able to speak freely about their challenges unencumbered by political interference or economic manipulations.

Recommendations flowing from this commentary include the need to:

(1) restructure the composition of the UNSC to ensure that the veto power of future permanent members (some conditional) does not lead to political paralysis, that all regions are fairly and equitably represented in terms of numbers and needs, as determined by annual reviews of risks and SDG progress, and that members are held publicly accountable in terms of enabling global peace, security and sustainability.

(2) adopt the One Health & Wellbeing concept/approach and establish a UN One Health and Wellbeing Sustainability Council with a strong Youth voice (e.g., representatives  from the Sustainable Development Sustainable Solutions Network-Youth) to review and operationalise global propositions for global sustainability (socio-economic, geopolitical, environmental – aligned with the OH concept and the SDGs (summarised below) :


(3) promote the OHW concept and the UN SDGs at academic, government, and at all societal levels across all global regions through a process of change and education – formal and non-formal – addressing challenges we face in particular how we can better relate to the planet and to each other.

Our choice in 2022: Accept societal transformation or face extinction

The world faces hard choices in the days ahead. After 13.5 billion years of evolution from the Big Bang to the present, in 2022 we are at a turning point. Our choice is stark: acceptance of the societal transformations required to sustain the planet or face possible extinction as a species.

Considered ‘a modern-day heir to Charles Darwin,’ after a lengthy career, evolutionary biologist, conservationist, world-leading naturalist and author of more than 30 books,  Edward O. Wilson (1931-2021) ‘felt optimistic that humanity had ‘the potential to solve its crises.’ On the other hand, he cautioned in 2019 that ‘our species was dysfunctional’: we  carry Paleolithic emotions, we still depend on medieval institutions and have acquired god-like power – ‘a very dangerous and unstable combination.’

Cover Photo: Last scene from Don’t Look Up as the comet plunges toward Earth (screenshot) – film streaming on Netflix.