News Flash 447: 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 447

Weekly Snapshot of Public Health Challenges


From food insecurity to the UN’s future: What we’re watching at the UNGA 

Meeting Registration: Reclaiming Public Health – Experiences & Insights from Europe Sep 29, 2021 02:30 PM in Brussels

High Level Dialogue: TRIPS Waiver – Challenges & Opportunities

2021 State of the Union Address by President von der Leyen

State of the European Union: More hollow promises about a global COVID-19 vaccine equity?

European Health Emergency preparedness and Response Authority (HERA): Getting ready for future health emergencies

We don’t have to fly blind into the next pandemic

What is the missing ingredient in global pandemic preparedness and response?

How Parents Can Support Kids’ Mental Health During COVID-19

Equipping Health Workers on the Front Lines With Adaptable COVID-19 Digital Resources

Coronavirus disease (COVID-19) Weekly Update

FDA panel votes against Pfizer’s Covid-19 booster jab application

COVID-19 vaccine alliance chair: African political leadership lacking

Opinion | Booster Shots Would Be Better Spent Saving African Lives

Africa hinges hopes for COVID-19 vaccine equity on US

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Now we know: typhoid conjugate vaccines are highly effective in African children

The quality of medical products for cardiovascular diseases: a gap in global cardiac care

The Medicines Patent Pool secures its first licence on promising long-acting technologies for malaria, tuberculosis, and hepatitis C

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

Taliban ban girls from secondary education in Afghanistan

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White House, House Homeland Security chair denounce “horrific” mistreatment of Haitian migrants by Border Patrol officers

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The Corporate Capture of the UN Food Summit

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Over 200 companies pledge net-zero emissions by 2040 as pressure on private sector mounts

Germany: Five Areas for COP and G7 Climate and Development Leadership














Interview: Dr. Trudy Masembe, CINTA Foundation Uganda

CINTA Foundation – Uganda is a Kampala based Non-Government 0rganization founded in 2014 and registered in 2015, registration No. 11351. CINTA core programs include education support, skills training, economic empowerment and reproductive health& HIV/AIDS. Currently, the Foundation is operating in regions of Central and Eastern Uganda. 

In this connection, PEAH had the pleasure to interview CINTA Executive Director Dr. Gertrude Masembe

 By Daniele Dionisio

PEAH – Policies for Equitable Access to Health


  Dr. Gertrude Masembe*

Executive Director, CINTA Foundation

Kampala, Uganda 


PEAH: Dr. Masembe, CINTA Foundation is an NGO working with implementation of core programs such as education support, skills training, economic empowerment and reproductive health& HIV/AIDS. Tell us more, please, around CINTA story and profile.

Masembe: CINTA Foundation Uganda is a registered Non-Government Organization (NGO), implementing activities in various districts of the country. Our vision is “Empowered communities for holistic development” and all programs and hinged on this. Participatory approaches, developing community resource pools and implementing impact based projects for continued sustainability are the main pillars of our work.

The organization was founded by two women, Trudy (Gertrude) and Christine, who had earlier worked with NGOs in various parts of the country implementing and managing community, based projects at  grass root levels. After their official tenure of work they both agreed that they needed to continue working with communities to help address their problems/challenges something they were passionate about. This is how CINTA Foundation Uganda was born, officially registered in 2015 and now looking forward to its 6th anniversary.

Under our education support component we supplement government efforts of ensuring achievement of Social Development Goal No. 4 of “Inclusive and equitable quality education”.  Our programs provide for capacity building of teachers for improved methods of teaching and children performance while reduced absenteeism and increased children participation are achieved through provision of scholastic materials, supplementing feeding programs and sanitary -pad provision for girls.

The program is enriched with mentorship and career guidance for students and it’s during these sessions that we are able to create awareness about Sexual Reproductive Health issues and HIV/AIDS. During these dialogues/ sessions, we focus on Identifying challenges adolescents are likely to face, type of required support, sensitizing about myths and realities about SRH and Menstrual Hygiene management.

CINTA-Uganda also realizes that achievement and sustainability of long term impact goals in communities would be impossible without a multi-pronged approached that embraces skills development, financial support, business management training and establishment of market networks. It’s for this reason that community economic empowerment is taken as the core program, a building block for many of our achievements. This is done with a gender bias because women have been proven to be pivotal points of development and many advantages like education for children, reduced domestic violence, increased participation of women indecision making and overall quality of life have their bearing on increased incomes.

PEAHDr. Masembe, recent achievements by CINTA Foundation include, as declared, pad distribution, skills development for Kawuga Women’s Group, education support, as well as staff capacity building. Can you explain in detail?

Masembe: The organization over the past 5 years has made great strides in terms of achievements in the districts of operation. SRH was our flagship project and to date we have distributed over 3,500 kits of re-usable pads to adolescent girls in Mayuge, Iganga, Mukono and Kayunga districts to ensure they don’t skip school because of lack of sanitary provisions. Over 4,500 adolescents in these districts mainly in secondary schools have benefited from our SRH dialogues and can now handle a number of adolescent challenges and practice proper menstrual hygiene.

These dialogues have been supplemented with career guidance and mentorship sessions to help align learners to their desired goals for the future. In this regard, we are grateful to the Rotaract clubs of Nakawa and Natette that partnered with us to reach out to students in Jinja under their Kakuba Literacy program and outreaches at Kiswa Community Children’s Center.

Another area of intervention has been education support, a program under which we build the capacity of teachers and provide scholastic materials to children and supplemented their school feeding programs for better attendance and performance. Under this arrangement we have worked with Natetta Primary school, Kiswa Community Children center and individual primary school learners in Iganga district.

For the success of our programs, it is critical to have communities supported to increase their incomes so they can independently carry the mantle of family provision and support. It’s for this reason that we partnered with Krochet4Life and trained two (2) women’s group including Kawuga Women’s Group in production of sandal parts for increased household income. CINTA- Uganda after training the beneficiaries provided materials and linked them to buying company for continued production and market. However, it goes without saying that families too need support for basic requirements especially those trapped in the poverty cycle and at stages of fending for survival. This is a story for Katanga Slum Dwellers who could hardly feed their families. CINTA –UG in partners with Christ our Sure Foundation provided home use materials to families to help them cope with life and sustain their children.

Despite the achievements, CINTA-UG faces some challenges with the evolving NGO approaches both in fundraising and project implementation. This calls for continuous capacity building to enable us stay afloat amidst fierce competition for grants and professional staff. It’s therefore with great appreciation that I write about Front Runners League (USA headed by Mary Kurek which offered capacity building for our staff. As a funder, they carefully analyzed each of the staffs challenges and roadmap for better performance and provided mentors with specialties where we had need for training to improve service delivery. Despite the fact that it was a short term arrangement of three months, we can ably say we greatly benefited from this venture.

PEAHOn this wavelength, what about CINTA main purpose?

Masembe: CINTA Uganda’s main purpose is to have “Empowered communities for self-reliance”. This calls for holistic development approaches by not only training beneficiaries and providing financial and education support but also developing capacity within communities so they can continue to handle their own development agenda. Core to our approach is focusing on impact and sustainability as opposed to figures in terms of achievement. 

PEAHIn depth, as regards CINTA activities and approach to sexual and reproductive health issues and strategies of avoiding gender-based violence?

Masembe: True, there was reported Gender Based Violence (GBV) in schools and surprisingly the male gender was equally affected in communities of operation. Many programs have placed great emphasis on the girl child but evidence from our field work suggests boys need to be given equal attention when handling gender based violence. We have therefore brought on board some male volunteers with specialty in handling gender based violence to attend to the matters male students. We also got some literature from World Health Organization (WHO) and Ministry of Health (MoH) to help us address this issue.

To drive our resource pool development agenda, the organization during its outreaches works together with “senior women & men” mandated to handle SRH issues in schools. This helps them build capacity to ably handle both gender based violence and SRH issues among adolescents in a school environment. In the near future we are looking at interfacing with UNICEF so they can work hand in hand with other grass root organizations to address this issue.

At organization level, we are strict about ethics when it comes to conducting office business and have a set of guidelines and rules to be followed by any person employed to work with CINTA-UG as a way of ensuring that GBV issues don’t occur. 

 PEAHAll of this takes into close consideration the devastating effects of COVID-19 pandemic to the lives of the young generation in Uganda, as just stressed in your last article on PEAH. Some additional reflections about? 

Masembe: As earlier highlighted many girls have fallen prey to sexual activity at a young age as they endure long periods out of school and a number transitioned into young mothers. Boys on the hand have resorted to petty jobs for income which greatly affects the mindset of any young child still following through their academic journey. There is therefore need to rebuild social support systems and offer psycho social support to these children if they are to become beneficial members of the communities. It’s also inevitable that vocational skills training is strengthened and promoted to absorb those unable to rejoin the education system but willing to get new skills so they can engage in profitable Income Generating Activities. 

PEAHDoes CINTA work together with national and/or international partners?

Masembe: CINTA Foundation Uganda partners with National Women Council (NWC), a national body mandated to spearhead empowerment of women in Uganda. NWC offers technical support to enable us achieve impact in our programs and sometimes partners with us for smooth delivery of community services. We also appreciate AfriPads and PulseNetwork that offered both technical and financial support for our SRH projects, Crochet4Life for working with us to change the lives of women, and Rotaract clubs of both Nateete & Nakawa that enabled us reach out to populations in areas where we have no coverage. Internationally, we have worked with partners in Australia, USA and currently working with ACWW-UK.

We are grateful to the Local District Administrations of Iganga, Kayunga, Kampala, Mukono and Mayuge that enabled us fulfill our dream of empowering communities for holistic development. 

 PEAHWhat are your duties and tasks in CINTA?

Masembe: As the CEO of the organization, I provide leadership, management oversight, and coordination to a national network of the organization programs in the areas of strategic development, staff management, fundraising, financial management, programmatic management, establishment of accountability standards and partnership management. I am humbled to be at the helm of this young organization and privileged to chase my dream of making a difference in the lives of others. 

PEAHThank you Dr. Masembe for enlightening answers and commendable engagement


* Gertrude (Trudy) Masembe is an executive leader with proven management background; effective problem-solving skills with ability to work in rapidly changing environments. She has demonstrated expertise in strategic planning, organizational development, project management and business intelligence across diverse spaces in the development sector. She attended Makerere University and specialized in Social Sector Planning and Management. Her passion is community development which cuts across various sectors like health, education and economic empowerment.



By Dr. Masembe recently on PEAH:

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

Interventions to Curb Covid-19 Spread in a Low-Income Country: Feasibility Challenges 

Public Health or Poverty Alleviation? What are Mosquito Nets for?

News Flash 446: 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 446

Weekly Snapshot of Public Health Challenges


Public health round-up

Coronavirus disease (COVID-19) Weekly Update

Pandemic Treaty: US Proposes Amending Existing International Health Rules First; Germany Presses for Sanctions

Q&A: Multilateralism ‘failed badly’ during COVID-19

G20 leaders must demonstrate real-time international cooperation and action to control the ongoing COVID-19 pandemic

Bilateral Deals Will be Key to Nailing Down G20 Health Ministers’ Declaration


Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 30 August – 2 September 2021

EMA evaluating data on booster dose of COVID-19 vaccine Comirnaty

Transparency of COVID-19 vaccine trials: decisions without data

End Vaccine Apartheid

Majority of African nations won’t meet vaccination goal this month

MSF demands Cepheid justify inadequate price reduction of COVID-19 tests

Strengthening the evidence base for decisions on public health and social measures

Predictors of COVID-19 epidemics in countries of the World Health Organization African Region

Lessons from COVID-19: Strengthening the public health system in India or accelerating privatisation?

Mental health in the pandemic

Few Countries Have Plan to Support People With Dementia

The cost and burden of cancer: Report gives a wake-up call to avert healthcare crisis

Thailand’s national strategic plan on antimicrobial resistance: progress and challenges

Subnational inequalities in diphtheria–tetanus–pertussis immunization in 24 countries in the African Region

Lifesaving TB medicines must be affordable and available to make all-oral treatments for children a reality

HIV treatment dolutegravir arrives in more upper-middle-income countries

Colonialism in speech-language pathology: Moving forward

Indigenous leaders push new target to curb Amazon deforestation

Climate Czar Kerry Fails To Clinch Climate Deal With China

Social cost of plastic pollution more than GDP of India

A fair share of climate finance: apportioning responsibility for the $100 billion climate finance goal

Mitigating climate change must be a priority for public health

Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health

UNEP Calls for Robust Governance as Air Quality Regulations Lag Behind In 37% Of Countries

Shipping industry proposes levy to speed up zero carbon future




News Flash 445: 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 445

Weekly Snapshot of Public Health Challenges


What’s going on between African nations and the EU?

‘War and Peace’? Why Armed Conflicts Rise and Democracy Declines – An Excerpt from George Lueddeke’s Lastest Book SURVIVAL

One Health – a symphony of effort…a health exigency worldwide!

Germany’s Role in Global Health After the September 2021 Election

WHO Webinar registration: Strengthening Infection Prevention and Control Activities and Embedding IPC in AMR NAP Implementation (2PM CET) 8 September 2021 14:00 – 15:00 CET

Tackle excessive use of antibiotics and introduce mandatory animal welfare labelling for more sustainable animal farming, EPHA says

Webinar registration: What actions should be taken to improve maternal and newborn health outcomes in Europe?  Thu, Sep 9, 2021 12:00 PM – 1:30 PM CEST 

Medical deserts – A growing problem across Europe

Coronavirus disease (COVID-19) Weekly Update

Coronavirus: 70% of the EU adult population fully vaccinated

ECDC and EMA highlight considerations for additional and booster doses of COVID-19 vaccines

New SARS-CoV2 Variant Identified in South Africa Does Not Appear to be Increasing in Circulation

WHO releases new compendium of innovative health technologies for COVID-19 and other priority diseases

From Monkey Pox to COVID-19: New WHO Pandemic Hub Head Dr Chikwe Tackles Global Health Challenges

The COVID-19 pandemic and the reshaping of the international public health order

The EU and its members must learn the lessons from COVID-19 for our health systems

A perfect storm for the European health workforce

Monopolies on Covid vaccines are killing people in poorer countries

10 Images That Illustrate The Shameful Global Vaccine Inequity

How to integrate community leaders into pandemic preparedness

The lab leak hypothesis — true or not — should teach us a lesson

What does a future with AI-aided TB screening look like?

PLOS ONE: Public investments in the development of GeneXpert molecular diagnostic technology


Innovative Use of World’s First Malaria Vaccine Generates Remarkable Results and a Life-Saving Opportunity

World failing to address dementia challenge

Over half of the global population lack social protection

Racism doesn’t just exist within aid. It’s the structure the sector is built on

Four years on, Rohingya refugees in Bangladesh are losing hope

Fiddling in Nairobi While Africa Goes Hungry

U.S. climate envoy John Kerry in Japan to discuss efforts to cut carbon emissions

Highly polluting leaded petrol now eradicated from the world, says UN

Secret Electricity Contracts Hurt Consumers, Citizens, and Climate

IPCC Special Report: The Ocean and cryosphere in a changing climate




News Flash 444: 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 444

Weekly Snapshot of Public Health Challenges


International Digital Health & AI Research Collaborative (I-DAIR): Call for Expressions of Interest (EOI)

Meeting Registration: Conectando movimientos por los servicios públicos: hacia una estrategia y narrativa global // Conectando movimentos para serviços públicos: em prol de uma estratégia e narrativa global Aug 31, 2021 11:00 AM in Sao Paulo

REGISTRATION: Decolonising Peacebuilding Practice October 5th –6th 2021

Innovation Strategy and Economic Development

Clinical Trials In Crisis: Building On COVID-19’s Lessons Toward A Better Future

Coronavirus disease (COVID-19) Weekly Update

EMA: monthly safety update for COVID-19 vaccines

Increase in vaccine manufacturing capacity for COVID-19 vaccines from BioNTech / Pfizer and Moderna

Final US FDA Approval of Pfizer-BioNTech COVID Vaccine – Likely to Drive More Voluntary Jabs & Mandates

Following full FDA approval, Pfizer and BioNTech must urgently share COVID-19 vaccine know-how to increase global production and supply

Vaccine equity: where are the voices of those with no access?

WHO Africa Chief Warns that COVID-19 Booster Shots Threaten Continent’s Ability to Fight the Pandemic

COVID Booster Vaccines Gain Traction with New US Campaign – Despite WHO Appeals for Moratorium

The Case for Covid-19 Boosters Is as Shaky as Ever

ANALYSIS- Here’s why there may be no need for boosters for everyone just yet

Breastfeeding and COVID-19 Vaccines

Delayed Wuhan Report Adds Crucial Detail to Covid Origin Puzzle

Ethical considerations of phone-based interviews from three studies of COVID-19 impact in Bihar, India

Lessons on COVID-19 from Indigenous and remote communities of the Arctic

KFF Dashboard: Progress Toward Global HIV Targets in PEPFAR Countries

Control of visceral leishmaniasis in East Africa: fragile progress, new threats

EU tightens limits on cancer-causing cadmium, lead levels in food

Smartphone App Helps Fijians to Grow and Eat Healthier Food

PHM: Resistance_to_privatisation

Earthquake relief. Mexico. 2051. A glimpse into tomorrow’s humanitarian world

On World Humanitarian Day: Invest in Climate Adaptation to Reduce Future Humanitarian Need

Environmental Racism and Climate Change — Missed Diagnoses

A billion children at ‘extreme risk’ from climate impacts – Unicef

Climate change’s impact on health

AR6 Synthesis Report: Climate Change 2022

The plastic waste fuelling fungal diseases

Evidence-informed policy for tackling adverse climate change effects on health: Linking regional and global assessments of science to catalyse action




News Flash 443: 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 443

Weekly Snapshot of Public Health Challenges


The World Health Organization Regional Office for the Western Pacific is hosting the Health Futures Forum: Shaping the Future of Health, 24-26th August 2021

Webinar registration: What actions should be taken to improve maternal and newborn health outcomes in Europe?  Thu, Sep 9, 2021 1:00 PM – 2:30 PM CEST

Coronavirus disease (COVID-19) Weekly Update

Covid-19 Cases Surging Across Africa

Soaring cases and little vaccination: A COVID-19 Middle East snapshot

India COVID vaccinations near record, new cases at five-month low

Southeast Asia is an emerging hotspot for COVID-19

EMA starts evaluating use of RoActemra in hospitalised adults with severe COVID-19

Joint Statement from Unitaid and the World Health Organization (on behalf of the Access to COVID-19 Tools Accelerator) regarding availability of tocilizumab

WHO Issues Urgent Appeal For US $11.5 Billion For COVID Tests, Treatments, and Vaccines

Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant

Gordon Brown hits out at EU’s ‘neocolonial approach’ to Covid vaccine supplies

Patent Protection and Access to Covid-19 Medical Products in Developing Countries Ω

Three Key Gaps in the Health Economics Research on COVID-19, and Why It Matters

COVID-19, Mask Mandates, And The Case For Physician Political Engagement

COVID-19 and palliative care capacity, African Region

Kenya Mandates COVID-19 Vaccines for Civil Servants as Africa’s Vaccine Rollout Gathers Speed

Côte d’Ivoire declares Ebola outbreak after traveler arrives from Guinea

Cote d’Ivoire starts Ebola vaccination of frontline workers

Malaria mosquito thriving in cities

World’s largest catalogue of tuberculosis samples identifies 17,000 mutations

As the Taliban Returns, 20 Years of Progress for Women Looks Set to Disappear Overnight

In Afghanistan, aid groups wrestle with the new reality of Taliban control

Girls’ Education: A Casualty of the Disastrous Withdrawal from Afghanistan?

Equity and expertise in the UN Food Systems Summit

Feeding the future

Toward Planet and Species’ Sustainability: ‘A Road Not Taken’?

What Might Help Save Our Planet? Different Approaches to Desertification

Can Greater Health Focus at Glasgow Climate Conference Motivate Tougher Action on Global Warming?

The UK will host the 26th UN Climate Change Conference of the Parties (COP26) in Glasgow on 31 October – 12 November 2021

The role of central banks in tackling climate change






News Flash 442: 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 442

Weekly Snapshot of Public Health Challenges


WEMOS: TERMS OF REFERENCE FOR CONSULTANCY WORK: RWANDA COUNTRY CASE STUDY. The deadline for submitting the proposal and CV is August 29th, 2021.

Biomimetics provides lessons from nature for contemporary ways to improve human health

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Coronavirus disease (COVID-19) Weekly Update

DNDi: COVID-19 Policy Report. Another triumph of science, but defeat for access?

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

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Bangladesh begins COVID vaccination drive for Rohingya refugees

‘WHO call on emergency nod for Covaxin in September’

WHO’s Solidarity clinical trial enters a new phase with three new candidate drugs

COVID-19 and palliative care capacity, African Region

A Political Economy Analysis of the Impact of COVID-19 Pandemic on Health Workers

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


Amal Saif Al-Maani: tackling drug-resistant pathogens

Progress towards antibiotic use targets in eight high-income countries

An integrated surveillance network for antimicrobial resistance, India

Water, sanitation and hygiene in national action plans for antimicrobial resistance 

Palestinian health NGO leader detained

Ghana LGBT+ bill would threaten fight on HIV/AIDS, says UNAIDS

Hungary anti-LGBTQ law to apply around churches

Social health protection to improve access to health care for people with disabilities

Narrowing the mobile gender gap

Addressing The Maternal Health Crisis Through Improved Data Infrastructure: Guiding Principles For Progress

How major economies are funding ‘carbon lock-in’ abroad

Climate change: Curbing methane emissions will ‘buy us time’

Climate Scientists Issue ‘Red Alert’ for Humanity – and Health

IPCC climate report: Earth is warmer than it’s been in 125,000 years

Code Red for Humanity and the Planet

World shudders at ‘terrifying’ UN climate report

IPCC report: No further proof needed of our planetary emergency

Australia rejects climate targets despite damning UN report

Glasgow Summit is the ‘Last Chance to Get Runaway Climate Change Under Control’

C20 POLICY PACK 2021 Building a sustainable future for all






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

Everyone has the right to access essential, lifesaving vaccines. Rabies pre-exposure prophylaxis (PrEP) is available to most international travellers to endemic regions, but not to those who are born there. This gap in access is morally questionable, even more now that simplified PrEP schedules and new modes of administration can lower costs and increase feasibility in LMICs

By Raffaella Ravinetto

Institute of Tropical Medicine, Antwerp, Belgium

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


Rabies is a Neglected Tropical Disease (NTD)[1] which, despite being fully preventable, still causes at least 59.000 deaths per year in over 150 countries – particularly in rural Africa and Asia, where over 40% of individuals bitten by a suspect rabid animal are children[2]. In 2015, the World Health Organization (WHO) called for action to achieve zero dog-mediated rabies deaths in humans by 2030[3]. To do so, we need to enhance prevention, diagnosis, control and treatment – and human vaccination obviously plays a key role here.

Rabies vaccination include pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PEP is life-saving, if given as soon as possible after exposure; but “priming” with PrEP allows to simplify the PEP vaccination schedule, and it increases the likelihood of survival, particularly in case of severe exposure or of delayed PEP[4]. Given the life-saving potential of the prime-and-boost approach, it may be surprising that the rabies PrEP is not included in expanded immunization programmes (EPI) in endemic countries. Traditionally, this was at least partly explained by doubts about cost-effectiveness, but new elements such as the availability of schedules shorter than the traditional one (three shots over one month), new modes of administration, and focus on specific risk groups could change the equation.

First, since 2018 the WHO recommends a simplified two-visit schedule for PrEP; and new research suggests that further simplified regimens can improve feasibility and adherence in endemic low- and middle-income countries (LMICs), thanks to longer time-intervals in the schedule or by making it fit in the EPI schedule[5]. These are promising developments, and more research is needed to evaluate single-visit schedules, particularly in vulnerable groups like children in endemic settings. Second, PrEP would be cheaper if vials and needles were manufactured for administration with ID devices, which allow reducing the volumes of vaccine used[6] – while in the longer term, needle-free injection devices could be trialled. Third, an explicit demand from endemic countries could trigger manufacturers’ interest to increase production (in exchange for a secured market), leading in turn to economies of scale and -hopefully- preferential prices to LMICs. Forth, there are promising vaccines in the pipeline[7] that could further improve the thermostability, shelf-life and packaging volume. Last not least, ongoing plans to build or strengthen vaccine manufacturing capacity in some LMICs as part of the COVID19 response, could hopefully be further expanded, to improve the national and regional capacity to scale up access to other vaccines.

Sensitization and education of those at risk, caregivers and communities, will obviously remain critical to ensure awareness of how to avoid exposure, and of how to access health services after exposure. Also, dog vaccination campaigns remain critical, and they could be linked to PrEP vaccination campaigns for humans.

Everyone has the right to access essential, lifesaving vaccines[8]. Rabies PrEP is available to most international travellers to endemic regions, but not to those who are born there. This gap in access is morally questionable, even more now that simplified PrEP schedules and new modes of administration can lower costs and increase feasibility in LMICs. Our group contend that low-cost ID PrEP (followed by ID PEP in case of exposure) should be offered to all infants and children in high endemic countries, either as part of the EPI or through mass campaigns, as part of the collective moral obligation to promote and support universal health coverage.



[1] World Health Organization. Neglected Tropical Diseases., accessed 6/8/2021

[2] World Health Organization. Fact-sheet Rabies., accessed 6/8/2021

[3] World Health Organization. Zero by 30: the global strategic plan to end human deaths from dog-mediated rabies by 2030. WHO | Zero by 30: the global strategic plan to end human deaths from dog-mediated rabies by 2030, accessed 6/8/2021

[6] Van Mulder T, Verwulgen S, Beyers K, Scheelen L, Elseviers M, Van Damme P, Vankerckhoven V. Assessment of acceptability and usability of new delivery prototype device for intradermal vaccination in healthy subjects. Hum Vaccin Immunother 2014; 10(12): 3746-53.

[7] Fooks AR, Banyard AC, Ertl HCJ. New human rabies vaccines in the pipeline. Vaccine. 2019 Oct 3;37 Suppl 1:A140-A145.

[8] WHO. Universal Health Coverage Factsheets., accessed 5/8/2021


What is COVID-19 Revealing to Us?

It is not enough for public health professionals and those fighting for the right to health to help contain COVID-19 epidemic and respond to the needs of those affected by the virus. It is equally essential, in fact, to analyse how the pandemic plunges its roots in a global political and economic system characterized by inequality, disease and poverty, thus identifying the opportunities that the crisis presents to change it for the better. This need for transparency and collaboration requires us to answer a fundamental question: what is COVID-19 revealing to us?

 This way of re-contextualizing the pandemic is very important because the solution to COVID-19 will not emerge from a laboratory, but from the vision of how we protect people in our society

By Angelo Stefanini* MD, MPH

Retired Faculty at University of Bologna, Italy


"The tradition of the oppressed teaches us that the 'state of emergency' in which we live is not the exception but the rule." 

Walter Benjamin 


We have sunk into a tragedy whose numbers can only give us arid accounting, certainly at fault. To define it, it is not enough to count the deaths or infected cases. As “not everything that can be counted counts and not everything that counts can be counted” (attributed to Albert Einstein), the numbers mask an unbearable amount of pain, disease and suffering that cannot be measured with the quantitative indicators available to us. For this it is necessary to probe deeply the paradoxes that this historical moment presents to us.

To this end, it is not enough for public health professionals and those fighting for the right to health to help contain the epidemic and respond to the needs of those affected by the virus. It is equally essential, in fact, to analyse how the pandemic plunges its roots in a global political and economic system characterized by inequality, disease and poverty, thus identifying the opportunities that the crisis presents to change it for the better.

An obstacle to this type of analysis, in my opinion, is represented by the military language that the speech on the pandemic introduces using military metaphors that describe the epidemic crisis as “a war that must be won”, “fighting in the trenches against the virus”, honouring “the doctors who fell at the front”.  Uncritically accepting the lexicon of the “war on the virus”, on the one hand makes you lose sight of the overall picture by hiding its complexity, on the other hand it entails the risk of militarizing society, plastering it up, and thus ending up starting over as before.

In reality the issue is not whether winning or losing a war but about renegotiating our relationship with a disturbing and still largely unknown host known as SARS-CoV-2 virus. To this end, it is necessary to interpret the current crisis as a political, social and cultural challenge as well as a health one, in a climate of collaboration and mutual protection to be consolidated, with choices that are difficult to share with citizens who have the right to know and to be protected and cared for adequately.

This need for transparency and collaboration requires us to answer a fundamental question: what is COVID-19 revealing to us?


1 – It is revealing to us the total unpreparedness of the regional health “system”. It is not just a matter of individual oversights or incompetence in the face of an event that still continues to elude us in its complexity, but of a “systemic error”, the result of decades of dismantling the public service and which reached its apotheosis in Lombardy with the “Maroni reform” (LR 23/2015).

The effects of chronic de-financing of the public service, of hospital-centrism, of the absence of territorial medicine and general practitioners, of the introduction of corporate privatization logic in the health sector are manifested throughout the country. In short, we are experiencing first-hand the importance of public health, primary care, community participation, the role of the state.

2 – It is revealing to us how our society is profoundly fragile, of a fragility that the philosopher Luigi Alici describes as “a constitutive and not just an occasional condition of humanity”. At a time when we were convinced that frailty was only the marginal and episodic dysfunction of the unfortunate few in a global context dominated by power and efficiency, we are realizing that it is not only the individual who can get sick but also the whole.

As Pope Francis said, “We thought we would always remain healthy in a sick world.” It is not true that fragility is an accidental and transitory state that science will eventually be able to bring under control. Fragility is an essential constitution of each of us and of the world we inhabit.

3 – It is revealing to us that the body is a bio-political reality. According to the French philosopher Michel Foucault (1926-1984), with the birth of capitalism in the eighteenth century, the body was understood as a instrument of economic production, of workforce, thus becoming an object of significant political interest. Medicine and public health were legitimized as tools of social control so that people were fit for work, thus transforming health from a right to be guaranteed into a tool to protect the economy. Health as a political problem, therefore, which requires political control.

Similarly, the medical doctor and academic Giulio A. Maccacaro (1924-1977) stated that “medicine, like science, is a mode of power”, in the sense that, within the social clash between capital and labour, ” medicine is entrusted with the task of resolving, within scientific rationality, this contradiction of the capitalist mode of production, which on the one hand consumes and extinguishes the workforce but on the other hand needs it to continue to feed itself. ”

The growing importance of health for industrial societies has led to the enhancement of doctors and the growth of medical science, forming a powerful alliance between medicine and the state.

4 – It is revealing to us how a health and social crisis can influence in a sinister way the ability to judge a situation with balance and reasonableness. It is now deemed acceptable to argue, as Governor Toti did, that senior citizens at risk of COVID-19 are somehow less valuable to society than young people. The Italian debate evidently reflects ancient conflicts in the distribution of power within society (central government against local government, young people against the elderly, rich against poor, Italians against foreigners) and in the scientific world itself, with scientists taking two opposite sides.

On the one hand, there are those who propose a return to normal life, albeit with greater risks, for young people, but with selective protection of the most fragile population, as the only way to protect the economy and individual freedom (Great Barrington Declaration). On the other hand, those who propose maximum protection and total closure to get to the suppression of the virus (John Snow Memorandum). Between these opposing positions, sometimes truly ferocious controversies have erupted, revealing how what began as a fair scientific confrontation has turned into a political duel with sides that reflect the traditional positions of a liberal right and a pro-solidarity left.

5 – It is revealing to us that there is always a trade-off, a give-and-take exchange between my personal good and the collective good. My security, in fact, is always the result of a compromise that I have to reach with the rights I intend to claim. This contrast (which is basically between public health and freedom of choice) reflects different philosophies and a misunderstood concept of freedom: “I do what I want” or “responsibility towards others”?

Governments have taken extraordinary measures, invoking a state of emergency, to limit our behaviour by confronting us with the choice between freedom and security. We followed the case of the philosopher Giorgio Agamben who, beyond not so hidden denialism allusions, accused the Italian government of using the pandemic to normalize the “state of exception” through the instrument of the DPCM (Decree of the President of the Council of Ministers).

What we are witnessing, in fact, is the ‘securitization’ of health. Securitization is what happens when an actor (the state), claiming to be facing an existential threat, demands urgent and extraordinary countermeasures to be taken and persuades the population that such action is necessary. Securitization legitimizes the circumvention of the normal rules of the political game such as public debate and the normal democratic process. In this way, the epidemic, from a health problem and therefore regulated by authorities and health professionals, becomes a security problem, and therefore regulated by political authorities, the public force, the judiciary.

6 – It is revealing to us that this crisis is not simply caused by an infectious disease. All our efforts are focusing on blocking viral transmission and the “science” that is guiding public opinion through the televised debates is mainly composed of infectious disease specialists, indeed virologists, the real media stars of the COVID-19 era. Basically, a collective and social pathology, as is an epidemic, is publicly narrated by those who spend their professional life on the microscope: virtually a modern metaphor of the prevailing bio-medical hegemony.

However, what we are discovering is another story, and not that simple. This is not a ‘trivial’ pandemic but a much more complex phenomenon than a virus that simply affects people. In reality, it is the synthesis of two epidemics: one (a biological type) transmitted by a virus and one (a social type) carried by the vulnerability of that part of the population suffering from underlying conditions such as diabetes, cardiovascular disease, cancer and / or those who live in the shadow of inequalities: minorities without rights, poor not only beggars but with a job that does not allow mere survival.

This synthesis of biological and social is what the medical anthropologist Merryl Singer in the 90s proposed to call ‘syndemia’, a crasis of the words synergy and epidemic, a synergistic interaction between disease and social circumstances. Once these dynamics are understood, it is clear that emergency management based only on safety and epidemic curves cannot achieve the goal of protecting health and preventing deaths.

COVID-19 is neither the black plague nor a level: it is a disease that usually kills disadvantaged people, because they have low incomes and are socially excluded and / or suffer from chronic diseases. During the peak of the epidemic, in the nine provinces of Emilia-Romagna Region the risk of death, both in absolute and relative terms, was consistently higher among those living in the most disadvantaged census sections.

Without recognizing the causes and without intervening on the conditions in which the virus becomes lethal, no measure will be effective. Not even a vaccine. This way of re-contextualizing the pandemic is very important because the solution to COVID-19 will not emerge from a laboratory, but from the vision of how we protect people in our society.

7 – It is revealing to us that before the arrival of COVID-19 we were already sick in different ways with a social pathology called individualism, one of the guiding principles of neo-liberalism that has been predominant for at least forty years, almost a sovereignty of the Ego that is added to nationalistic souverainisms. “There is no society, there are only individuals” proclaimed British Prime Minister Margaret Thatcher boldly. On the contrary, we are discovering that in order to survive, both individually and collectively, inter-dependence is necessary.

From this consideration the relevance of the “global health paradigm” is emerging; a new approach, heretical for the bio-medical establishment, which studies health as the result of processes not only biological but also economic, social, political, cultural and environmental, overcoming individual nations’ standpoint. This perspective helps to understand the need for an authoritative World Health Organization (WHO) with the required resources to take charge of global health governance.

The attacks to which it has been subject in recent months must ask us the question “who benefits from a weak WHO?”. In the past, WHO has championed fundamental agreements for the right to health in the world such as the List of Essential Medicines (1977), the International Code on the Marketing of Breast Milk Substitutes (1981), the Framework Convention on Tobacco Control (WHO FCTC) (2005) and other various initiatives to contain the pathogenic power of multinationals (e.g. recommended limits on the consumption of free sugars, air pollution standards and drinking water, …).

Seen under these guises of veritable ‘political dynamite’, it is not difficult to imagine who would rather favour a fragile and under-funded WHO. Yet the lack of international collaboration and the abandonment of the WHO by some member states embodied an unprecedented fact that limited WHO’s capacity for global coordination and its leadership through the sharing of information and resources. In reality, each of the 194 countries decided, each on its own, how to set up its own response and strategy.

8 – Finally, it is revealing to us that the global economic system in which we live, considered by many to be the best and only possible, called capitalism, is at the root of the rapid spread of COVID-19 around the world. From 2011 to 2018, the WHO monitored 1483 epidemic events in 172 countries, declaring an international public health emergency six times since 2007, five since 2014, four of which due to viruses of zoonotic origin.

Today we know that the main factors that trigger zoonotic epidemics are the increase in human demand for animal proteins, the intensification of unsustainable agriculture, urbanization, the increase in travel and transport, climate change, human invasion of natural habitats, and changes in land use and extractive industries. Global travel has more than quadrupled since 1990, from one billion people traveling by air to 4.2 billion in 2018.

The spread of COVID-19 is also facilitated by privatization and austerity policies that diminish the capacity of health and social systems to respond effectively. Rising precariousness and low wages leave many workers without protections or liveable wages, while deregulation reduces the ability of governments to respond forcefully and effectively. The growing domination of multinationals at all levels over our political system, culture and media gives them a veto power over any policy that threatens their interests.

In conclusion, COVID-19 is opening our eyes to vital challenges of great complexity that require a multidisciplinary and integrated approach between different fields of knowledge. Understanding these complex relationships is an urgent task both for public health professionals seeking to mitigate the negative consequences of the epidemic and for activists aiming to promote social justice, equity and human and planetary health.

As Luigi Alici still urges us, the discovery of our vulnerability could be the stimulus to find the glue to overcome this crucial moment together by learning to reconcile autonomy and responsibility. Only in this way will it be possible to bring the individual closer to the community, giving birth to a new idea of ​​coexistence on the ashes of individualism that the pandemic is blowing up.

Before we were very close in the streets, in bars, in public places but spiritually distant. Now we are re-learning the value of spiritual proximity even if physically distant: you can live next to each other without being physically close. In the current emergency, “Philosophers, not scientists, might be of more use to us if we are seeking informed contemplation. And a few are now thinking the pandemic.”



This paper is the English translation of a post published March 5, 2021 on

News Flash 441: 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 441

Weekly Snapshot of Public Health Challenges


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