Seventy-three countries have warned that they are at risk of stock-outs of antiretroviral (ARV) medicines as a result of the COVID-19 pandemic, says a new study on Monday.
Twenty-four countries reported having either a critically low stock of ARVs or disruptions in the supply of these life-saving medicines, according to a new WHO survey conducted ahead of the International AIDS Society’s biannual conference.
The survey follows a modelling exercise convened by the World Health Organization (WHO) and UNAIDS in May which forecasted that a six-month disruption in access to ARVs could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.
In 2019, an estimated 8.3 million people were benefiting from ARVs in the 24 countries now experiencing supply shortages.
This represents about one third (33%) of all people taking HIV treatment globally.
While there is no cure for HIV, ARVs can control the virus and prevent onward sexual transmission to other people.
A failure of suppliers to deliver ARVs on time and a shut-down of land and air transport services, coupled with limited access to health services within countries as a result of the pandemic, were among the causes cited for the disruptions in the survey.
“The findings of this survey are deeply concerning,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“Countries and their development partners must do all they can to ensure that people who need HIV treatment continue to access it. We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.
According to data released today from UNAIDS and WHO, new HIV infections fell by 39% between 2000 and 2019.
HIV-related deaths fell by 51% over the same time period, and some 15 million lives were saved through the use of antiretroviral therapy.
However, progress towards global targets is stalling. Over the last two years, the annual number of new HIV infections has plateaued at 1.7 million and there was only a modest reduction in HIV-related death, from 730 000 in 2018 to 690 000 in 2019.
Despite steady advances in scaling up treatment coverage – with more than 25 million people in need of ARVs receiving them in 2019 – key 2020 global targets will be missed.
HIV prevention and testing services are not reaching the groups that need them most. Improved targeting of proven prevention and testing services will be critical to reinvigorate the global response to HIV.
WHO guidance and country action
COVID-19 risks exacerbating the situation. WHO recently developed guidance for countries on how to safely maintain access to essential health services during the pandemic, including for all people living with or affected by HIV.
The guidance encourages countries to limit disruptions in access to HIV treatment through “multi-month dispensing,” a policy whereby medicines are prescribed for longer periods of time – up to six months.
To date, 129 countries have adopted this policy.
Countries are also mitigating the impact of the disruptions by working to maintain flights and supply chains, engaging communities in the delivery of HIV medicines, and working with manufacturers to overcome logistics challenges.
New opportunities to treat HIV in young children
At the IAS conference, WHO will highlight how global progress in reducing HIV-related deaths can be accelerated by stepping up support and services for populations disproportionately impacted by the epidemic, including young children.
In 2019, there were an estimated 95 000 HIV-related deaths and 150 000 new infections among children. Only about half (53%) of children in need of antiretroviral therapy were receiving it.
A lack of optimal medicines with suitable pediatric formulations has been a longstanding barrier to improving health outcomes for children living with HIV.
Last month, WHO welcomed a decision by the U.S. Food and Drug Administration to approve a new 5mg formulation of dolutegravir (DTG) for infants and children older than 4 weeks and weighing more than 3 kg.
This decision will ensure that all children have rapid access to an optimal drug that, to date, has only been available for adults, adolescents and older children.
WHO is committed to fast-tracking the prequalification of DTG as a generic drug so that it can be used as soon as possible by countries to save lives.
“Through a collaboration of multiple partners, we are likely to see generic versions of dolutegravir for children by early 2021, allowing for a rapid reduction in the cost of this medicine,” said Dr Meg Doherty, Director of the Department of Global HIV, Hepatitis and STI Programmes at WHO.
“This will give us another new tool to reach children living with HIV and keep them alive and healthy.”
Tackling opportunistic infections
Many HIV-related deaths result from infections that take advantage of an individual’s weakened immune system.
These include bacterial infections, such as tuberculosis, viral infections like hepatitis and COVID-19, parasitic infections such as toxoplasmosis and fungal infections, including histoplasmosis.
The WHO is releasing new guidelines for the diagnosis and management of histoplasmosis, among people living with HIV.
Histoplasmosis is highly prevalent in the WHO Region of the Americas, where as many as 15 600 new cases and 4500 deaths are reported each year among people living with HIV. Many of these deaths could be prevented through timely diagnosis and treatment of the disease.
In recent years, the development of highly sensitive diagnostic tests has allowed for a rapid and accurate confirmation of histoplasmosis and earlier initiation of treatment.
However, innovative diagnostics and optimal treatments for this disease are not yet widely available in resource-limited settings.
Two high-ranking Myanmar military generals involved in the systematic and brutal violence against the Rohingya people and other ethnic minorities have been designated for sanctions under a powerful new regime established by the UK.
Forty-nine individuals and organisations including two Myanmar military generals involved in some of the most notorious human rights violations and abuses in recent years have been designated for sanctions, under a powerful new regime established today by the UK, British Foreign Secretary Dominic Raab has announced.
It is the first time that the UK has sanctioned people or entities for human rights violations and abuses under a UK-only regime, and will allow the UK to work independently with allies such as the US, Canada, Australia and the European Union.
The individuals and organisations are the first wave of designations under the new regime, with further sanctions expected in the coming months, according to the British Foreign & Commonwealth Office.
The ground-breaking global regime means the UK has new powers to stop those involved in serious human rights abuses and violations from entering the country, channelling money through UK banks, or profiting from our economy.
The measures will target individuals and organisations, rather than nations.
The UK’s first wave of sanctions under this new regime targeted:
25 Russian nationals involved in the mistreatment and death of auditor Sergei Magnitsky, who uncovered widespread Russian corruption by a group of Russian tax and police officials
20 Saudi nationals involved in the death of journalist Jamal Khashoggi
Two high-ranking Myanmar military generals involved in the systematic and brutal violence against the Rohingya people and other ethnic minorities
Two organisations involved in the forced labour, torture and murder that takes place in North Korea’s gulags
Underlining the UK’s position as a global force for good, this new regime showcases our commitment to the rules-based international system and to standing up for victims of human rights violations and abuses around the world.
Foreign Secretary Dominic Raab, said: "Today we’re designating 49 people and organisations for responsibility in some the worst human rights abuses in recent memory."
This is a demonstration of Global Britain’s commitment to acting as a force for good in the world, Raab said.
Following his announcement in Parliament, the Foreign Secretary will meet with Sergei Magnitsky’s widow and son Natalia and Nikita, along with his friend and colleague Bill Browder, at the Foreign and Commonwealth Office.
The regime will allow the UK to target individuals and organisations around the world unlike conventional geographic sanctions regime, which only target a country.
It could also include those who commit unlawful killings perpetrated against journalists and media workers, or violations and abuses motivated on the grounds of religion or belief, according to the British government
A special unit will consider the use of future sanctions, with teams across the department monitoring human rights issues.
They will ensure targets under the landmark regime will have to meet stringent legal tests before the UK decides to designate, ensuring the sanctions are robust and powerful.
The suite of measures can also apply to those who facilitate, incite, promote, or support these violations/abuses, as well as those who financially profit from human rights violations and abuses.
The UK will continue to utilise a range of tools to tackle serious human rights violations and abuses around the world, including the UN and EU multilateral sanctions regimes.
Bangladesh has said that certain quarters are purposefully doing harm to the government against the backdrop of its recent success in curbing human trafficking.
"There are reasons to believe that," said the Ministry of Foreign Affairs in a clarification mentioning that law enforcing agencies in Bangladesh are already working to arrest traffickers involved in illegally sending people to Vietnam.
The Ministry of Foreign Affairs came to know from its Mission in Hanoi that 27 Bangladeshis who were lured by human traffickers to Vietnam recently are now temporarily staying at a hotel provided by the Vietnam authorities.
Those people who illegally go abroad lured by traffickers are also responsible for tarnishing the image of Bangladesh abroad, MoFA said.
Bangladesh government, as a recognition to all its hard work, has recently been upgraded to tier-2 in the Trafficking in Persons (TIP) country report released by US State Department.
Vietnam is not a country where much work opportunities are available for prospective foreign workers. Brokers traffic Bangladeshi workers there in the hope of landing them in prosperous countries such as Australia, New Zealand and other rich parts of South East Asia, according to the MoFA.
In the close collaboration between Bangladesh Embassy in Hanoi and the Vietnamese government, a special flight was operated in the Hanoi-Dhaka-Hanoi route on July 2.
Eleven Bangladeshi returned from Vietnam on that flight.
Twenty-seven people were also listed for repatriation but they declined to avail the flight stating that Bangladesh government has to pay their airfare.
Bangladesh does not have a provision to pay the airfare of returning illegal workers, said the government.
In all repatriation flights, it is the passengers themselves who pay for their passage rather than from tax payers money.
In case of flights carrying workers, the employer country pays for the airfare.
They do not fall under either category as they did not go with employment visas; they went to Vietnam as visitors.
After the departure of the flight to Dhaka, later in the day on July 2, they attempted to forcibly enter the premise of Bangladesh Embassy in Vietnam which is a violation of both international law and Vietnam’s local law, MoFA said.
These "unruly people" first declined to fly home, and secondly, if they had anything to say, they could state that in a disciplined manner rather than attempting to forcibly occupy the embassy in a foreign country tarnishing the image of the country, said MoFA.
They are now threatening on social media that if their demands are not met they will similarly occupy all Bangladesh embassies abroad, the statement reads.
They went live on social media and made derogatory remarks against the country.
Such subversive activities staying in friendly foreign country is not acceptable by any standard, MoFA said.
Because of the flight restrictions caused by COVID-19 pandemic, it will take time to resume flights on the Dhaka-Hanoi route.
A UN human rights expert has urged states, the civil society, psychiatric organisations, and the World Health Organisation to change the way they understand and respond to mental health challenges.
“I welcome the international recognition of mental health, but much more is still needed,” the UN Special Rapporteur on the right to physical and mental health, Dainius Pūras, said during the presentation of a new report to the Human Rights Council on Monday.
The global mental health status quo should move away from the outdated ‘mad or bad’ approach which seeks to prevent behaviours deemed as ‘dangerous’ or provide treatment considered ‘medically necessary’ without consent, he said.
Pūras said that the dominance of the biomedical model has resulted in an overuse of medicalisation and institutionalisation, according to a message received here from Geneva.
He warned against the exaggerated benefits of psychotropic medications and highlighted that their effectiveness is not comparable to other medicines that are essential for certain physical conditions, such as for example, antibiotics for bacterial infections.
“I appreciate the progress made to understand the role of psychotropic medications, but also recognise that there are no biological markers for mental health conditions,” he said. Hence the specific mechanisms by which psychotropic drugs might be effective, are simply unknown,” the Special Rapporteur said.
Pūras said that the status quo in mental health care has ignored the social, political or existential context that contributes to the high prevalence of feelings of sadness, anxiety, fear and other manifestations of mental distress.
“There is no simplified mechanistic solution to mental distress,” he said. “For the majority of mental health conditions, psychosocial and other social interventions are the essential option for treatment.”
He highlighted that systemic obstacles, such as power asymmetries in mental health care, the dominance of the biomedical model and the biased use of knowledge, need to be addressed by changes in laws, policies and practices
The UN expert reiterated his call for mental health care action and investment to be redirected to rights-based supports, to non-coercive alternatives that address the psychosocial determinants of health, and to the development and strengthening of practices that are non-violent, peer-led, trauma-informed, community-led, healing and culturally sensitive.
“I’m calling once again for the ultimate elimination of segregated psychiatric institutions that reflect the historic legacy of social exclusion, disempowerment, stigma and discrimination.”
To achieve this, realisation of the principles and values of the Convention of the Rights of Persons with Disabilities should guide mental health policies and services, and discriminatory laws and practices should be abandoned.
“COVID-19 has exacerbated the failures of the status quo in mental health care. The pandemic provides the global community with a unique opportunity to demonstrate political will to move away from medicalisation and institutionalisation in mental health-care,” the Special Rapporteur said.
Lee Jang-keun, Ambassador-designate of the Republic of Korea to Bangladesh arrived here on Sunday.
Lee, a career diplomat, previously served as Ambassador and Deputy Permanent Representative of the Republic of Korea’s Permanent Mission to the United Nations Office and other International Organizations in Geneva, Switzerland, from 2018 to 2020.
He also served as Director-General for International Organizations, Ministry of Foreign Affairs, in Seoul from 2016 to 2018.
Ambassador Lee served at Korean embassies in Austria, Morocco, and Hungary and at the Permanent Mission to the UN in New York.
The diplomatic ties between Bangladesh and South Korea was established in December 1973.
Since the opening of the resident embassy of the Republic of Korea in Dhaka in March 1975, seventeen Ambassadors of the Republic of Korea have served in Dhaka so far, said the Korean Embassy in Dhaka on Sunday.
Ambassador Lee is the eighteenth.
During the past four decades the two countries have enjoyed close ties and strengthened cooperative relations in all areas, said the Embassy.
The volume of bilateral trade reached around 1.7 billion US dollars last year and around 150 Korean companies are now investing in Bangladesh.
Under the special arrangement between the two countries, more than 10,000 Bangladeshis are working in Korea under the Korea’s Employment Permit System (EPS).