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Dr Alexandra Phelan Profile picture
Dr Alexandra Phelan
@alexandraphelan
Associate Professor @JohnsHopkinsSPH Senior Scholar @JHSPH_CHS International Law, Planetary Health, Pandemics & Equity 余雪莲 She/They 🏳️‍🌈
2 subscribers
Aug 14 • 17 tweets • 3 min read
🚨WHO Director-General @DrTedros has just determined that the 2024 upsurge of mpox is a Public Health Emergency of International Concern (PHEIC).

🌍The global community must rapidly respond w financial & tangible support (inc vaccines & therapeutics) to affected countries.

🧵1/ Image DG Tedros: "The spread of a new clade in DRC, its detection in neighboring countries, and spread to neighboring countries...is worrying"

A [PHEIC] "is the highest level of alarm under international health law"

2/
Apr 29 • 9 tweets • 2 min read
One area of contention for this week's #PandemicAgreement negotiations is the phrase "Mutually Agreed Terms" (MAT). This phrase is common in international biodiversity law.

🧵Here's a short thread on why MAT may be suitable for biodiversity but not for intellectual property. The draft #PandemicAgreement contains 7 references to MAT:
Art 9 - Research & Development
Art 10 - Sustainable & Diversified Production
Art 11 - Tech Transfer & Know-How
Art 19 - International Cooperation
Apr 28 • 5 tweets • 2 min read
There are reports out of Ranchi, India of 8 human H5N1 cases: 6 poultry farm workers & 2 doctors (which is of particular concern if accurate as canaries of H2H spread)

Clusters of limited H2H H5N1 spread are not unheard of: v. different to sustained H2H.
timesofindia.indiatimes.com/city/ranchi/bi… WHO has reportedly been informed and a local rapid response team activated. Those infected have been isolated (articles incorrectly use the term quarantine) & contact tracing is underway.

Reports of impending lockdown in this article:
thailandmedical.news/news/breaking-…
Sep 19, 2022 • 6 tweets • 2 min read
There's no formal process under international law or governance for declaring a pandemic over.

For influenza, the post-pandemic phase is defined by a return to seasonal levels, but we don't know (1) if that will occur for COVID19 (albeit likely) & (2) what those levels will be. Image With the continued transmission of COVID19 and emergence of new variants, we are clearly not in the "pandemic's over" phase. There's clear guidance (again, that can be modified from flu) with what we should be doing Image
Jul 23, 2022 • 7 tweets • 2 min read
As we wait to hear if the WHO Director-General will declare #monkeypox a Public Health Emergency of International Concern, it’s a good time to reflect:

What happens when a PHEIC is declared?

tldr: 🚨💰🧾🌎⚖️

🧵 1/7 First: 🚨

A PHEIC is a global alert and call to action.

Health matters aren’t necessarily on country leaders’ radars: PHEICs are intended to address this.

2/7
Nov 30, 2021 • 6 tweets • 2 min read
WHO has issued advice to countries on 🌍international traffic🌍 in relation to the omicron variant. It is nuanced and well considered.

Full text here: who.int/news-room/arti…

Key points in 🧵below: WHO commends South Africa🇿🇦 & Botswana🇧🇼 for surveillance and genetic sequencing capacities, transparency, and rapid reporting under the IHR.

WHO calls on all countries to show solidarity w 🇿🇦 & 🇧🇼, & rapid & transparent info sharing, noting omicron likely in more countries🗺️
Nov 30, 2021 • 11 tweets • 2 min read
As Dante wrote in Paradiso, “Fate’s arrow, when expected, travels slow”.
The emergence of concerning variants, arbitrary rather than risk based travel restrictions, global vaccine injustice, ableism in endemicity, are not only our present, but our future w/o political action. Early in the pandemic, those of us in global public health would entreaty “this will be a marathon, not a sprint”.

Some days, it feels as though we’ve entered an ultramarathon with no conditioning.
Nov 8, 2021 • 8 tweets • 5 min read
📰New Study🔬 out in @TheLancet!

By building a moment by moment chronology, we analyze how an outbreak became a pandemic & priorities for international reform.

So excited to share this huge team effort led by the amazing @sudhvir!

Link: thelancet.com/journals/lance…

Explainer🧵1/8 Image 2/8
 In this paper, we:
1⃣ build a 50pg moment by moment chronology from outbreak to pandemic
2⃣ identify & analyze 5 key phases of events
3⃣map actions against IHR obligations under international law
4⃣propose 5 key areas for #GlobalHealthLaw reform, inc. IHR & #PandemicTreaty
Apr 1, 2021 • 4 tweets • 2 min read
Some of the big questions we try to teach in Epidemiology for Lawyers, whether students go to a firm, the Hill, WH, judiciary or elsewhere: what principles & processes help us make decisions on limited data & how do we change decisions (but keep trust) as evidence evolves? Two quick examples:

for the first question,
1) what is the quality of the evidence (systematic review, cohort, case study)
2) is better evidence possible
3) could it do harm to wait or act (e.g. should we apply a precautionary approach)
Feb 20, 2021 • 6 tweets • 2 min read
Unofficial reports so far state that the subtype is H5N8 – this would be a novel influenza subtype in humans.

The IHR require immediate reporting of *any* novel human influenza subtypes as potential PHEICs, no matter how serious. Since 2020, there has been a global H5N8 outbreak among bird populations – wild birds and poultry. Cases have been reported in Saudi Arabia, Russia, Kazakhstan, Netherlands, Germany, Denmark, UK, France, Sweden, India, Japan, Norway, South Korea.

e.g. Estonia's 17 Feb OIE report
Feb 20, 2021 • 9 tweets • 3 min read
Russian has reported seven human cases of avian influenza to @WHO

No confirmation of subtype yet.

No evidence yet of human to human transmission: all cases reported are workers in a poultry plant.

reuters.com/article/us-hea… There have been a few highly pathogenic avian influenza infections (HPAI) across Europe recently in wild birds (@OIEAnimalHealth – WAHIS appears to be down this morning?)
Jan 29, 2021 • 7 tweets • 3 min read
*Public health actions to control new SARS-CoV-2 variants*

Our paper just published in @CellCellPress w wonderful co-authors @NathanGrubaugh @firefoxx66 @JosephFauver & @mugecevik

We describe actions govts should urgently take to protect health.

🧵1/7

cell.com/cell/fulltext/… New SARS-CoV-2 variants of concern will continue to emerge: exacerbating already crippling outbreaks & potentially reducing efficacy of some vaccines, cause increased rates of reinfections and prolonging the pandemic.

2/7
Jan 29, 2021 • 6 tweets • 4 min read
Today, @ThinkGlobalHlth is celebrating its one year anniversary. @RebeccaKatz5 & I were fortunate enough to be invited to write a piece for this new @CFR_org blog, led by @TomBollyky.

Some reflections from that piece on why global governance matters.
thinkglobalhealth.org/article/why-gl… From the outset, it was obvious that global governance was about to be seriously tested. Unfortunately, over this pandemic we've seen that play out to be the case – not only globally but also national governance.
Dec 22, 2020 • 6 tweets • 2 min read
I disagree with folks dismissing the implications of the UK variant of concern.

While individual behaviors to avoid transmission may not change, the impact at the population level is serious: hospitals are already at capacity.

Quick thread
/1 Any factor that ramps up transmission (biological or behavioral) amplifies cases, and as a result, severe cases and deaths. When hospitals hit capacity, cases that could have been treated successfully will be triaged along increasingly stringent crisis standards of care.
/2
Dec 21, 2020 • 8 tweets • 2 min read
Public Health England has just released their updated report on the UK #SARSCoV2 variant

"Investigation of novel SARS-CoV-2 variant: Variant of Concern 202012/01"

I'll do a quick summary thread below & link to report: A cluster was identified & used to assess increasing incidence of the Variant of Concern (designated as such 18 Dec) in Kent, UK:
- 4% (255/6130) of Kent cases had available genomes
- in Kent: 117 genomically similar cases identified (10-19 Nov)
- in UK: 962 genomes of VoC(8 Dec)
Dec 20, 2020 • 7 tweets • 2 min read
A lot of good discussion today about what we know and don't know about the new #SARSCoV2 variant in the UK.

But what does this mean (if anything) for government responses & public health law control measures, even if greater transmissibility is confirmed?

Quick notes (1/7) Firstly, the virus is already sufficiently transmissible to be a concern. As others have noted, already important critical public health measures (avoiding crowds, social distancing, mask wearing, hand washing) will address variants that emerge:
(2/7)
Dec 10, 2020 • 5 tweets • 2 min read
Vaccine news that may not be covered outside of Australia:

The University of Queensland/CSL #covid19 vaccine trial has reportedly been abandoned for really interesting reasons, with one less potential vaccine for global COVAX Facility pool.

Quick thread:
smh.com.au/politics/feder… The UQ/CSL vaccine (V451) uses a molecular clamp vaccine platform with the COVID-19 spike protein: the clamp "locks" the spike protein to be more stable for purification & manufacture. It contains a small component derived from HIV that cannot infect people & poses no health risk
Dec 9, 2020 • 6 tweets • 2 min read
With the vaccine Executive Order now up, President Trump has ordered that "Americans" have priority to "US Govt COVDI19 Vaccines".

I want to push back on some arguments dismissing the risk of this as there are very concerning impacts.

whitehouse.gov/presidential-a… United States Government COVID-19 Vaccines are defined in the EO as "COVID-19 vaccines developed in the United States or procured by the United States Government"

This does not limit the scope of the EO to those purchased under APAs, but includes vaccines developed here.
Dec 1, 2020 • 10 tweets • 5 min read
This is a huge drop of China #COVID19 documents from @npwcnn. Unfortunately, this leak confirms points I & other China, health, law folks have said since Jan.

I'm going to summarize some of the key findings in 🧵below

Here's full report:
edition.cnn.com/2020/11/30/asi… Finding 1: Hubei (Wuhan's province) had 20 times increase in "influenza cases" in Dec. High number of "unknown cause" is flag: flu relatively easy to confirm if tested. Also not clear how many confirmed influenza, & if so, if/what samples or GSD was shared w @WHO GISRS.
🧵2/10
Nov 29, 2020 • 7 tweets • 3 min read
Lovely piece from @guardian on our recent publication in Proc @royalsociety B "What would it take to describe the global diversity of parasites?"

It may not be apparent but this is also a story of rectifying colonial "exploration narratives".

🧵1/6

theguardian.com/environment/20… To follow the article, here's a great explainer thread about our piece by @wormmaps about the science of estimating how many uncounted parasites there may be (including the Brothers Grimm & uncountable things):

🧵2/6

https ://twitter.com/wormmaps/status/1329070889372176384?s=20
Nov 15, 2020 • 13 tweets • 4 min read
Failures in US leadership mean Americans face tough decisions with Festive Season. In Jan, China faced similar choices but w more uncertainty).

A short thread comparing & drawing lessons between:
– January China 🧧Lunar New Year🧧
– November United States 🦃Thanksgiving🦃

1/13 Starting with some case count comparisons between Lunar New Year in China & now in the US:

– 254.3 cases per day: China (Jan 25)
– 135,714.3 cases per day: US (Nov 12)

2/13