Tunisian hospitals overwhelmed as COVID-19 surges across Africa

Kumaran Ira

Hospitals in Tunisia and across much of Africa are overwhelmed as the Delta variant fuels a July upsurge of COVID-19 to levels in Africa unprecedented since the beginning of the pandemic.

Tunisia, with 575,002 cases and 18,968 deaths registered, has the highest rate of confirmed cases and deaths of any continental African country. It has seen 48,116 cases and 1,587 deaths of COVID-19 per 1 million inhabitants. However, the Delta variant has driven caseloads and the strain on inadequate health care systems to unprecedented heights in countries across the Maghreb, all of West Africa and indeed the entire African continent.

A slum overlooking Lagos downtown in Nigeria, Tuesday May 12, 2020. (AP Photo/Sunday Alamba)

While nearly half of Tunisia’s confirmed cases and deaths have occurred just since May 2021, cases surged to 5,494 in Morocco on July 24, approaching the worst days of November 2020; to 1,505 on July 26 in Algeria, the highest ever; and 1,722 on July 18 in Senegal, also a new record.

Yesterday, Senegal’s national Director of Public Health Institutions, Ousmane Dia, told AFP: “We are overwhelmed and close to saturation, with 99 percent of hospital beds occupied in Dakar,” the capital. “It is hard to keep up if we receive 600 to 700 new patients each day,” he added, noting that health personnel are “extremely tired and burned out.” Dia said that the situation was only somewhat better outside of the capital, with 45 percent of hospital beds already occupied. Only 640,000 of Senegal’s 17 million people are vaccinated against COVID-19.

Tunisian hospitals have seen conditions like those in Dakar for a number of weeks. On July 8, Health Ministry spokesman Nissaf Ben Alaya bluntly declared: “The current heath situation is disastrous. … The rate of new cases has enormously increased. The health system, unfortunately, has collapsed.” Alaya pointed to an acute shortage of beds and especially of medical oxygen to treat the severely ill, adding: “If we do not unite our efforts, the health catastrophe will only worsen.”

Since these statements, Tunisia took emergency measures and received international assistance that has slowed the pace of recorded infections, although—in line with policy in the imperialist countries of North America and Europe—it still opposes a strict lockdown to allow non-essential workers to shelter at home.

The day after Alaya spoke, Tunis announced a night-time curfew in six of the worst-hit regions of Tunisia. It also received hundreds of thousands of doses of COVID-19 vaccines from China, France, Italy and Portugal; shipments of medical equipment from Germany; and shipments of medical oxygen from Algeria. Over the last week, the number of infections fell 47 percent from the previous week, to 24,641.

Nonetheless, the situation in Tunisia remains extremely grave, and deaths continue to mount among the large numbers of people now on emergency life support. Over 90 percent of hospital beds remain occupied in large areas of the country, not only in the capital, Tunis, but especially in poorer areas with weaker health systems.

Kairouan, a city of 600,000 in central Tunisia, has seen dozens of deaths, including of children, with test positivity rates in the city exploding upwards to between 45 and 50 percent as the contagion exploded out of control. At Kairouan’s Ibn Jazzar hospital, the influx of new patients was so fast that COVID-positive patients were mixed with other patients.

Imen Fteiti, a nurse at Ibn Jazzar hospital, told AFP there were so many patients that “some died without us realizing that it had happened.” The ward had only 3 nurses for 35 COVID patients. She added: “There is a lack of oxygen equipment and we have reached a point where we do not know whom to help first. … We start early in the morning and we never know when we will end.”

She pointed to the horrific psychological stress of seeing so many of her patients die. AFP reported that she is “still haunted by a young woman who begged her to give emergency care to her father, because she had just lost her mother to COVID-19. ‘Unfortunately he died, too,’” Fteiti said.

Staff at Mongi-Slim hospital in the Tunis suburbs spoke to Le Monde to share similar stories of tragedy and unbearable work stress during the pandemic. “What is terrifying, is that we cannot see the end of the tunnel. New patients arrive every day, and each time we must make difficult choices to determine who will have access to emergency life support,” an anesthesiologist who wanted to remain anonymous declared. “The average age on life support is between 40 and 50, mainly due to the Delta variant. As soon as one bed becomes free, a new patient arrives.”

She said that she was particularly distressed by the ten young pregnant women who were admitted to her hospital with COVID-19. “We were only able to save one of them,” she said.

She added that she was angry at the Tunisian government’s attacks on health workers’ pay and conditions: “Recently, we were told we would have to give up our vacations, whereas in France, health care staff received bonus pay for their work during the crisis. It is impossible to understand this.”

These reports underscore the politically-criminal failure of the wealthiest capitalist powers to coordinate in a timely manner the sending of critical medical equipment and vaccines to the world’s poorest continent. Reports have emerged that over 4 million people have died during the pandemic in India, unreported in official health figures. It is clear that urgent action is necessary to avert truly horrific losses among Africa’s 1.2 billion population.

Amid the new wave of the pandemic driven by the Delta variant, barely 1 percent of Africa’s population has been vaccinated. While Africa has registered 6.6 million cases and 166,000 deaths, Red Cross regional director for Africa Mohammed Mukhier warned that this was a drastic under-reporting of cases and deaths, which has made it harder to organize international cooperation to treat the virus in Africa.

He said, “Since the outset of the pandemic, not enough attention has been paid to the evolution of this virus on the African continent. Lower levels of transmission data have created the perception that this region has not been so affected by the pandemic. The upward trend in the number of infections that we are now seeing is partially as a result of insufficient funding to address several gaps in the response. These include weak surveillance mechanisms; weak testing capacity; insufficient protective gear and medical equipment, including hospital beds, oxygen and ambulance services.”

Red Cross official Rui Alberto Oliveira stressed the obstacles to effective treatment of COVID-19 posed by ongoing civil wars and also mass AIDS infections across sub-Saharan Africa. With AIDS badly weakening millions of people’s immune system, this creates a large population that is vulnerable not only to having very serious cases of COVID-19, but also to creating new, potentially more dangerous variants of the coronavirus.

Oliveira said, “Responding to COVID-19 in countries facing multiple crises, such as DR Congo, Sahel, Lake Chad, Mozambique, Ethiopia, Sudan or Somalia is extremely challenging, meaning the disease may continue to circulate unchecked. We cannot wait for the situation to deteriorate further before taking action. We must ensure that enough resources are made available, now, to halt the progress of the imminent and potentially catastrophic third wave of COVID-19 in Africa.”

Drone war whistleblower Daniel Hale sentenced to 45 months in prison

Kevin Reed

Daniel Hale, the whistleblower and former military intelligence analyst who leaked details of the US drone warfare program to the Intercept in 2014, was sentenced to 45 months in federal prison on Tuesday for violating the Espionage Act. In a backhanded acknowledgement of the significance of Hale’s revelations, US District Judge Liam O’Grady said that the 33-year-old’s disclosure of documents went beyond his “courageous and principled” opposition to the military’s deadly use of drones.

Judge O’Grady went on to say, “You are not being prosecuted for speaking out about the drone program killing innocent people. You could have been a whistleblower … without taking any of these documents.” Among the documents that Hale obtained and turned over to journalist Jeremy Scahill was proof that a targeted assassination program was being run out of the White House by then-President Barack Obama, behind the backs of the American people.

Daniel Hale

Hale’s exposures also contained an analysis of the drone warfare program that showed—far from Obama’s claim of the surgical precision of the unmanned aerial vehicle attacks—nearly 90 percent of the people killed in the missile strikes were not the intended targets. Hale also revealed the criteria which the Obama White House used for placing an individual on the terrorism watch list and then authorizing them to be assassinated by military personnel from remote-controlled operations thousands of miles away.

In a brief statement before Judge O’Grady handed down the sentence, Hale said he copied the classified documents because he believed it “was necessary to dispel the lie that drone warfare keeps us safe, that our lives are worth more than theirs.” The courageous whistleblower then went on, “I am here because I stole something that was never mine to take—precious human life. I couldn’t keep living in a world in which people pretend that things weren’t happening that were. Please, your honor, forgive me for taking papers instead of human lives.”

Although O’Grady’s nearly four-year sentence was far less than the maximum of eleven years that was demanded by federal prosecutors, that Hale is serving any time at all is a travesty of justice and part of an ongoing assault on democratic rights and the rights of whistleblowers who expose the crimes of US imperialism.

The vendetta against Daniel Hale has been ongoing for past the past seven years. Under Obama, federal authorities searched Hale’s home in 2014 before the publication of the documents by the Intercept. He was then indicted by a grand jury on four counts of violating the US Espionage Act of 1917 and one count of theft of government property, and arrested in 2019 during the Trump administration. Hale was accused of printing 36 documents from his computer including 23 that were unrelated to his work for an intelligence contractor of the National Geospatial-Intelligence Agency and giving 17 of these to Scahill, 11 of which were marked either “secret” or “top secret.”

Although he originally pled not guilty to all charges, Hale changed his plea to guilty on one of the Espionage Act charges on March 31, 2021 in order to avoid a likely sentence of decades in prison. He admitted in court that he was the author of a chapter titled “Why I Leaked the Watchlist Documents” included in Scahill’s 2017 book The Assasination Complex. After his guilty plea, Hale was initially released pending sentencing but was rearrested on May 5 and imprisoned on the orders of Judge O’Grady on the grounds that he had violated the terms of his pretrial release.

During pretrial motion to dismiss the charges, Hale’s attorneys argued that the Espionage Act violates the First Amendment because the public’s right to know about the war crimes of the US government stands above any commitment to preserve classified documents in the interests of national security as a service member or contractor for the Department of Defense. The prosecution sought to exclude Hale’s public interest defense—a legal tactic that has been used in many of the Espionage Act case that were brought under Obama and continued by the Trump administration—and this request was granted by Judge O’Grady.

Fully aware that he faced years if not a decade in prison, Hale never wavered in explaining his motivation along with the emotional toll that his experience in the Air Force had on him. As he explained in the 11-page hand-written letter to Judge O’Grady on July 18, Hale said he suffered from PTSD and depression and that his exposure to combat in the Air Force “irreversibly transformed my identity as an American” and that he was compelled to “violate the Espionage Act.”

In his statement to the court prior to sentencing on Tuesday morning, Hale said, “With drone warfare, sometimes nine out of 10 people killed are innocent. You have to kill part of your conscience to do your job.”

Following the sentencing, Hale’s support team posted a series of tweets that said, “#DanielHale has already spent years under investigation and has been dragged through a lengthy court process. Despite the fact that the government failed to even prove his disclosure caused harm, he is now subject to harsh sentencing intended for outright spies.

“But everyone agrees that #DanielHale is not a spy. He is a deeply honorable man who is being punished simply for acting on his conscience and telling the truth.”

The ongoing use of the Espionage Act—by both Democrats and Republicans in the White House—against whistleblowers and journalists who provide irrefutable proof of the crimes of American imperialism is a prominent expression of the decay of democracy and drift toward authoritarianism in the US. Since 2010 there have been ten prosecutions of individuals under the Espionage Act for either leaking classified information to the media—such as Chelsea Manning and Edward Snowden—or “seeking” classified information as in the case of WikiLeaks founder and publisher Julian Assange.

With the sentencing of Hale, the Biden administration now joins that of Obama and Trump with the distinction of jailing someone with the honesty, courage and determination to stand up to the most powerful military apparatus in world history.

La Trobe University in Australia announces hundreds more job cuts

Eric Ludlow

On July 14, La Trobe University in Melbourne announced the slashing of 230 jobs as part of a “Change Proposal.” This is part of a destructive new wave of job losses throughout Australia’s public universities, on top of up to 90,000, including casuals, during 2020.

In addition to the slashing of casual staff, La Trobe’s management will have cut 15 percent of the university’s permanent workforce since the beginning of the pandemic. That is among the highest rate of job losses of any university in Australia.

La Trobe Institute for Molecular Science building at La Trobe University in 2015 [Source: Wikimedia Commons]

As well as the academics and all staff members, this has serious consequences for the students, both under-graduate and post-graduate. They face course cuts, larger class sizes and the loss of experienced educators and thesis supervisors.

The management said the proposal would be subject to a three-week “consultation” period before being finalised. This is a bid to dampen, divert and dissipate the outrage and opposition of staff and students.

As at a number of other universities, the management declared that new roles would be offered in a brutal “Hunger Games”-style spill and fill operation, with staff forced to vie for remaining positions. Altogether, the change proposal would result “in the order of a loss of 200 FTE [full-time equivalent] positions.”

The proposal features major restructuring, including the “centralisation” of student services, and “[c]onsolidation of some disciplines and departments within Schools” to align with “strategic objectives.” The School of Molecular Sciences is to be liquidated into other schools, with the management dishonestly claiming this would “have no impact on teaching and learning.”

In the past year, La Trobe has already scrapped its drama department and either demolished or reduced around a dozen “financially unviable” disciplines in the arts and education.

Universities across the country have utilised the crisis brought on by the COVID-19 pandemic to accelerate years of pro-business restructuring at the expense of jobs, wages and conditions. A decade of chronic under-funding under the pro-market framework imposed by the last federal Labor government’s “education revolution” made the universities dependent on international student fee revenue, which has dropped sharply.

This offensive has been possible because of the full cooperation of the National Tertiary Education Union (NTEU), which covers academic staff, and the Community and Public Sector Union (CPSU), which covers professional and administrative staff.

La Trobe University’s NTEU branch last year adopted a version of the NTEU’s fraudulently named “ Jobs Protection Framework ” (JPF). The JPF was proposed in May 2020 to allow university managements nationally to cut wages by up to 15 percent while still eliminating “at least 12,000 jobs.”

After an upsurge of rank-and-file opposition to the JPF, most universities abandoned the deal to pursue similar pacts with individual NTEU branches. At La Trobe, the NTEU proceeded with a version of the JPF, claiming it would “protect jobs.” Yet the university still announced around 400 redundancies under the framework last July and August.

Taking advantage of the NTEU’s complicity, the management claimed in its July 14 announcement that the JPF “saved 225 jobs and reduced the magnitude of changes we need to make in 2021 … but didn’t provide permanent savings.”

In response, NTEU appealed for another such deal. La Trobe NTEU branch president Alysia Rex said in a media release she was “disappointed” that Vice Chancellor John Dewar had “made this announcement without exhausting all other options.” She urged Dewar to “work with the union to find alternatives to involuntary redundancies.”

This appeal is along the same lines as NTEU operations elsewhere to help universities achieve their cuts by pressuring staff into “voluntary” redundancies. The union recently boasted of a “resounding success” at the University of Queensland, where it helped the management to axe five jobs by that means—more than the two posts originally targeted for elimination.

The union’s La Trobe statement outlines supposed “alternatives,” including “job shares” and a “pathway to retirement contracts.” These proposals are echoed in an online petition initiated by the NTEU. While the petition has received well over 1,000 signatures, indicating widespread anger among staff and students, it is another bid to funnel opposition into such outcomes.

One comment on the petition by a former student said: “Since I graduated, I have seen LTU [La Trobe University] decimated. Neither of the depts where I did majors exist anymore. They are not the only depts now gone. LTU used to be ‘cutting edge.’ Nowadays, it’s just ‘cutting.’”

Taylor, a first-year agriculture student at La Trobe, told the WSWS the change proposal was an “attack on the right of youth and students to quality education.”

Taylor

“There have been cuts across the country,” Taylor said. “This, of course, began before COVID-19 broke out, but the crisis caused by the virus was an excuse to further escalate cuts.”

“Typically, those teachers and lecturers who care the most for their students, putting the most effort into getting the most out of them, are the ones that are lost… There’s already been numerous job cuts at La Trobe. I think it’s clear that the quality of our learning is dropping.”

Taylor commented on the role of the unions, which “pose as defenders of university workers, yet they outright oppose any broader mobilisation against the cuts. I think it’s a reflection of the unions themselves who have tried to keep the university executives happy.”

A student-led campaign in defence of much-respected Mathematics lecturer Dr Frank Valckenborgh at Macquarie University in Sydney has won broad support, but the cuts at that university are continuing, as they are around the country. Similar petitions and campaigns have started at Melbourne’s Monash University and the University of Western Australia.

Student unions and associations, however, are also seeking to disorient these campaigns. At La Trobe University, the management-backed La Trobe University Student Association (LTSA) released a statement supporting the change proposal. It claimed the job cuts showed a focus “on LTU strengths and distinctiveness in teaching and research” and were “designed to simplify business processes and operations while making a positive difference to students, communities and partners.”

Claiming to represent the real voice of students is the La Trobe University Student Union (LTSU), which had much of its university funding diverted to the LTSA at the end of 2020. However, the LTSU has close ties to the Labor Party, which laid the foundation for the assault on tertiary education and defends the corporate profit system that is driving the restructuring.

London floods highlight failure to address climate change and its consequences

Thomas Scripps

Large areas of London were hit by flash floods this weekend. Although less severe than the recent devastating flooding in Europe and China, they caused serious disruption to health and transport systems and damage to homes.

Whipps Cross Hospital in the east of the city declared a major incident after it suffered a power outage due to the heavy rainfall. Ceiling panels in the maternity ward collapsed. Around 100 patients had to be evacuated, all scheduled operations cancelled, ambulances diverted and patients seeking urgent treatment asked to “attend alternative hospitals where possible.”

Several miles to the south, Newham Hospital was also forced to ask patients seeking urgent care to use other Accident and Emergency departments.

A street in east London during recent floods (credit: WSWS Media)

Nine London Underground and Overground stations were closed, with a video of Pudding Mill Lane station almost completely underwater going viral, as were many major roads.

The London Fire Brigade reported more than a thousand flooding-related calls, rescuing people from cars trapped in floodwater and helping with flooded basements and collapsed ceilings. Many homes have been severely damaged by the floodwater and overflowing sewage. Some households have been evacuated to emergency accommodation after power failures.

Flood warnings are in place for multiple areas of England, Wales and Scotland until Thursday.

The immediate cause of the weekend’s floods was the torrential rain which fell on the capital on Sunday. The average total rainfall for London in July is 45mm, but the St James’s Park station recorded 41.6mm of rain on Sunday alone, the station’s second-wettest July day since records began in 1912.

This is the second time in the last two weeks that a month’s rain has fallen in a day in London. On July 12, nearly three inches of rain fell in an hour and a half in parts of the capital. On that occasion, the resulting flooding saw 120 residents in Kensington and Chelsea evacuated from their homes, another 1,000-plus calls to the London Fire Brigade and several underground stations closed. Euston Station, one of the capital’s main rail hubs, was shut down after lines out of London were completely submerged.

Such extreme weather events are happening more frequently due to climate change. A warmer atmosphere holds more moisture, amplifying heavy rains that impact most on urban areas with large hard surface areas. Professor Hayley Fowler, from the UK Climate Resilience Programme, told the BBC, “These heavy short-duration bursts from thunderstorms which cause flash flooding are becoming more common”. Her research suggests that flash floods “will increase five-fold by the 2080s” if climate change continues on its current trajectory.

Dr Jess Neumann, a hydrologist at the University of Reading, told the Guardian, “Flooding from intense summer rainfall is going happen more frequently. No city, town or village is immune to flooding and we all need to take hard action right now if we are to prevent impacts from getting worse in the future.”

Similar warnings have been issued for years without any serious action being taken. Just last month, the government’s climate change committee warned that the country was not ready for the impacts of climate change, saying “adaptation action has failed to keep pace with the worsening reality of climate risk.”

In February, Labour MP Meg Hillier, the chair of parliament’s public accounts committee, warned, “The government is simply not doing enough to protect the UK’s current housing stock from floods or stepping in to prevent new homes being built on flood plains”. The Environment Agency agreed: “We need long-term investment to both build and maintain flood defences if we are to continue to protect and prepare the country from the increased risks that the climate emergency is bringing, with impacts already hitting worst case scenario levels.”

Major storms and floods in 2007, 2012, 2014, 2015- 16 and 2019- 2020, forcing tens of thousands of evacuations and causing billions of pounds worth of damage, have proven this point. An investigation by the research arm of Greenpeace, Unearthed, found that over 3,400 of England’s “high consequence” flood defences were rated as being in poor or very poor condition in 2019-20 by the Environment Agency.

Liz Stephens, associate professor of climate resilience at Reading University, commented after the weekend’s floods, “The surface water flood hazard maps for the UK have not been improved since 2013. These urgently need updating. The current accuracy of surface water flood maps reflects an investment choice and not what is possible with the state-of-the-art science.”

Large areas of the capital are at serious risk. According to the Greater London Authority, 17 percent of London is at medium or high risk of flooding and more than 1 million residents live on a floodplain.

The dangers are exacerbated by outdated infrastructure. Stephens told CNN, “The risk is always greater in the urban environment because we've got concreted surfaces, but we’re also relying on an old drainage infrastructure in London, we’re talking about Victorian drains.”

London’s underground network has long been identified as critically exposed. In 2016, the Guardian and the Independent reported on an unpublished Transport for London (TfL) flood risk report which identified 85 of its sites as being at “high risk” of flooding. Fifty-seven of those were London Underground stations, including some of the capital’s busiest—King’s Cross, London Bridge and Waterloo.

The report states, “London has been fortunate to escape the worst of recent storm events in the UK, but it is only a matter of time before heavy rainfall seriously affects London and the underground network.” It explained that the “increased laying of asphalt over earth surfaces” and climate change leading to “more intense” storms would be the biggest contributing factors.

London Underground requested £3 million over three years “to analyse the riskiest sites in greater detail and to begin to install protective measures”, but the service’s head drainage engineer told the Guardian that the money would not “scratch the surface” of the problem.

TfL’s “Annual Report and Statement of Accounts for the Year Ended 31 March 2021” identifies climate risk as a “growing threat” and notes that “funding constraints” mean it is “likely to remain a challenge over the medium term.”

Successive governments refuse to adequately respond to the dangers posed by flooding because the money for such an initiative would have to be taken from big business and the super-rich. It would require laws managing urban development which would cut across the untrammelled profiteering of private property developers. Since 2013, one in 10 homes in England have been built on land with a high flood risk. Twenty-two Hyde Parks worth of gardens have been paved over in London to make way for parking or patios, reducing natural drainage.

Nowhere is the destructive logic of inequality and the capitalist market clearer than in North Kensington, hit hard by the floods two weeks ago. The area is filled with “iceberg houses”—homes owned by multimillionaires and billionaires who have extended their basements to multiple times the size of the house, accommodating swimming pools, cinemas, gyms and garages. Nearly 3,800 basement planning applications have been submitted to Kensington council in the last 10 years.

These gargantuan developments are likely to have contributed to the flooding. Mary Dhonau, a former CEO of the National Flood Forum, explained to the Daily Mail, “There has got to be somewhere for the water to go. When there is rain it falls onto the ground and percolates in areas of the ground. Super-basements are being built where the water would naturally percolate. There are other factors like climate change, but the more we take away permeable surfaces the more places will flood.

“North Kensington is a prime example of land that would have soaked up water, which is now being used for super basements.”

Whether the issue is the implementation of immediate extreme weather defences or the deeper problem of climate change, the primary obstacle confronting humanity is not natural or scientific, but social. The dangers can only be resolved through the expropriation of the vast fortunes and industrial empires controlled by the super-rich oligarchy and the democratic use of these resources to meet social needs.

Expanding the buffet of choices for preventing HIV

Shobha Shukla

Great strides have been made in HIV prevention, treatment and care, since the first case of the viral infection was reported 40 years ago. Thanks to the untiring efforts of the HIV community, activists, and medical fraternity, 74% (27.5 million) of the 37.7 million people living with HIV are able to access the lifesaving antiretroviral therapy today. But the governments’ promise of ending AIDS by 2030 (Sustainable Development Goals) is still far from our sight.

Deliberations at the recently concluded 11th International IAS Conference on HIV Science (#IAS2021) show important progress in HIV prevention, treatment, and cure efforts despite major disruption to HIV programmes and research during the COVID-19 pandemic.

Keeping in mind that there were 1.7 million new HIV infections in 2020 (which is 3 times higher than the UNAIDS 2020 targets), HIV prevention must remain a key focus. While speaking with the journalists around IAS 2021, Professor Linda Gail Bekker, who is the Director of Desmund Tutu HIV Centre at the University of Cape Town, South Africa, and former President of the International AIDS Society (IAS), said that humanity comes in many shapes and forms, and so should HIV prevention options.

This article, the first in the series of a trilogy by CNS head and IAS HIV Science 2021 Media Fellowship Awardee Shobha Shukla, showcases an array of prevention options that are either already at our disposal or are in various stages of development.

Pre-Exposure Prophylaxis (PrEP): Once daily oral pill

It has been 10 years now since it was proved that adherence to antiretroviral based oral PrEP provides robust protection against HIV in all populations and for all routes of infection. We have PrEP-1, the daily oral HIV prevention pill Truvada whose two active ingredients are tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), both of which are nucleotide reverse transcriptase inhibitors.

But, in some users daily oral PrEP can be a barrier to adherence and can lead to pauses or discontinuation. This has led to the next discovery of taking the pill on-demand at the time of exposure and not daily. So we have PrEP 1.5, TDF/FTC as oral HIV prevention on-demand. The dosing for PrEP on Demand is 2-1-1, that is, two tablets taken 2-24 hours before engaging in sex, one tablet taken 24 hours after the first two, and another tablet 24 hours after that. But it can be used only by cisgender and other men who have sex with men.

While nearly 1 million people have accessed the PrEP prevention option globally, the oral daily or on-demand PrEP is not feasible for everyone. Many people may find it difficult to remember to take the pill daily or at the right time. If one stops on and off there is risk of poor coverage of exposure, as substantiated from a study by Global Evaluation of Microbicide Sensitivity, which found high rates of HIV drug resistance in some individuals who were diagnosed with HIV while participating in HIV PrEP rollout programmes in Eswatini, Kenya, South Africa, and Zimbabwe. Levels of drugs in their blood suggested that they were taking PrEP at least 4 times a week, which was not enough to prevent HIV infection, but enough for the resistant virus to emerge (as drugs used in PrEP are also used for HIV treatments). Moral of the story is to take PrEP every day as prescribed, to stay free of HIV.

So for those who cannot adhere to a daily regimen, the solution lies in having long-acting agents in different formulations – like the once-a-month pill or a long-acting injection or the vaginal ring.

Dapivirine Ring: Once a month vaginal ring

This monthly vaginal ring, developed by the International Partnership for Microbicides, is the first woman-controlled, topical long-acting HIV prevention method to reduce the risk of acquiring HIV through vaginal sex. It is a silicon ring that contains antiretroviral drug, dapivirine (a non-nucleoside reverse transcriptase inhibitor), and when worn inside the vagina, it releases the drug slowly for a period of 28 days, after which it should be replaced by a new ring. The dapivirine ring offers a discreet and long-acting alternative to daily oral PrEP.

Interim results from the REACH study show encouraging levels of adherence to dapivirine ring and oral PrEP among adolescent girls and young women in Africa. High adherence was observed in 50% of the ring users as against 22% of oral PrEP users. Moreover, 88% of the participants liked using the ring.

The European Medicines Agency and the World Health Organization have already approved the ring for use as an additional prevention choice for women in high HIV burden settings.

Zeda Rosenberg, CEO of International Partnership for Microbicides, said that Zimbabwe has already given the go-ahead for its use and many other African nations are expected to follow suit in the near future. Rosenberg also informed that studies are underway for its use in pregnant and breastfeeding women and for those who are 15-18 years old.

A 90-day dapivirine ring has successfully completed Phase-1 clinical study in which it was found to be well tolerated and delivered target levels of drug throughout the three months of use, showing the potential to provide long-acting and sustained HIV protection. Next phase studies are to begin this year and Rosenberg is hopeful that results would be available by 2023.

Long-acting Cabotegravir: Once every 8 weeks injection

It belongs to a new class of HIV drugs called integrase inhibitors and is delivered once every 8 weeks via intramuscular injection. Long-acting Cabotegravir has been found to be safe and well tolerated. Two studies (HPTN 084 and HPTN 083) done in sub-saharan Africa have found it to be statistically superior to daily oral PrEP in preventing HIV infection among cisgender women, cisgender men and transgender women who have sex with men.

This much awaited prevention method is now into the implementation phase and is moving towards licensure.

Although long-acting dapivirine ring, and long-acting Cabotegravir, both do not offer contraceptive benefits. Women of reproductive age do need multipurpose prevention technology products to address two or more overlapping health risks, such as, unintended pregnancy and HIV. The dual prevention pill is an answer to their prayers.

Dual Prevention Pill: A daily oral pill for women for protection against HIV and pregnancy

Dual prevention pill, a co-formulated tablet containing oral PrEP (TDF/FTC) and a combined oral contraceptive, is currently being developed for daily use to prevent both HIV and pregnancy and is likely to be a new multipurpose prevention technology to go to market. Since both the ingredients of dual prevention pill are already approved for individual use, their combination pill just needs to undergo bio-equivalence study to determine if they are as safe and effective in combination. Regulatory timelines suggest that dual prevention pill could receive US FDA approval by 2024.

Several other multipurpose prevention technologies for HIV and pregnancy prevention are in various stages of development, but still many years away from market launch.

Islatravir: Once a month oral PrEP

Islatravir is the first nucleoside reverse transcriptase translocation inhibitor currently being evaluated across a variety of dosing regimens, for both – treatment as well as prevention of HIV infection. It has a novel mechanism of action, as it can persist in the body for a long period of time and is being developed as a monthly pill and also as a sub-dermal implant for prevention that could provide protection for one year.

Interim data from a Phase-2a study to evaluate the safety, tolerability, and pharmacokinetics show that it is safe and was generally well tolerated through 24 weeks. Monthly doses of Islatravir, 60 mg and 120 mg, also achieved the pre-specified efficacious pharmacokinetic threshold for PrEP.

Two Phase-3 clinical studies (IMPOWER 024 and IMPOWER 022) to evaluate its efficacy and safety in cisgender women, men, and transgender women who have sex with men, have already begun. But it could be another 2-3 years from now till we have it. Phase-2 studies for the once-a-year removable Islatravir implant are also underway.

Lenacapavir Long Acting: twice-yearly injectable for HIV prevention

Lenacapavir (the first HIV capsid inhibitor) as a once every 6 months injectable for HIV prevention is in the early stages of development. Two studies to evaluate its efficacy and safety are to take place – one in South Africa and Uganda (in adolescent girls and young women) and the other in USA, Brazil, Peru, and South Africa (in cisgender men, transgender women, transgender men and gender non-binary individuals). It is also being developed as long acting treatment and implant.

Broadly neutralising antibodies

Broadly neutralising antibodies provide a new approach to HIV-1 prevention and treatment. But they are still in very early stages of development.

HIV Vaccine

There is currently no vaccine available to prevent or treat HIV infection. However, scientists are working to develop one. Research efforts undertaken by USA’s National Institutes of Health include two late-stage, multinational vaccine clinical studies called Imbokodo and Mosaico.

Basket of choices to prevent HIV

We need a basket of HIV prevention options. It is about choices and preferences depending on where people are in their life cycle, local realities, and contexts. Moreover, prevention options should be accessible, affordable, simple to use, and easy to adhere, for everyone! It is only then that we may expect better coverage of all people and of all exposures, rightly said Bekker.

Ten facts JDE workers need to know about the company and Unite

Jean Shaoul

Unite the union is presenting workers at Jacobs Douwe Egberts (JDE) Banbury plant with an ultimatum on behalf of JDE: accept the rotten deal it has worked out with the company to slash wages, terms and conditions or face the sack in September.

The World Socialist Web Site is presenting information derived from the most recent financial reports and accounts of parent company JDE Peet’s and its British subsidiary so that workers can understand both the company and its financial situation.

1. JDE Peet’s and the pandemic

JDE’s Banbury plant is part of the giant Netherlands-based multinational JDE Peet’s, which says it is “the world's largest pure-play coffee and tea group by revenue.” The second largest coffee roaster after Nestle, it sold “approximately 130 billion cups of coffee and tea in the financial year ended 31 December 2019 in more than 100 developed and emerging countries.”

Its brands, which it describes as “our local jewels… iconic in their local market” include Jacobs, Senseo, Peet’s Coffee, Ti Ora, Kenco, Tassimo, Moccona, L'OR and Douwe Egberts, as well as several well-known tea brands, including Horniman's Tea.

JDE Peet’s factory in St. Petersburg in Russia (credit: screenshot, JD Peet’s Annual Report 2020)

JDE Peet’s profits were barely hit during the pandemic, despite lockdowns that led to the closure of offices, hotels, bars, restaurants and many of the company’s coffee stores, as sales of coffee for home consumption soared and workers put in the extra hours to keep the lines running while infections and deaths soared internationally.

As the company declared, “Despite the challenging conditions of the pandemic and lockdowns in 2020, throughout it all, JDE Peet’s made significant progress across many areas in our first year as a publicly traded company. In this context, our employees’ resilience and dedication kept our factories running, our supply chains effective and our customers and consumers served, despite the pandemic’s many challenges.”

2. Massive dividend payout for the shareholders

Announcing revenues of €6.7 billion and an operating profit of €933 million for 2020, the company stated in its report to shareholders, “The strength we experienced in our In-Home segment largely offset the reduction we saw in Away-from-Home consumption” and “Early on, we adapted our Away-from-Home business models, and as a result, we expect these activities to come out even stronger following the crisis.”

Its message for 2021 was that the future looked bright. “Shareholders are set to get a €89 million handout from its profits in 2020, equivalent to nearly €4,500 for each of the company’s 20,000 workers worldwide.”

The profit squeezed out of workers at the Banbury plant was even greater, with each of the 371 workers, including top management, delivering more than £7,600 of profit after tax and debt charges for the parent company in 2019, the last year available. This figure is probably a gross underestimate as JDE trades with its sister companies within JDE Peet’s on terms designed to minimize overall costs, including tax and financing charges, to the parent company.

When new CEO Fabien Simon (former CFO of JDE) was appointed last year, he received a “golden hello” of €10 million. He will reportedly receive a gross annual salary of €1 million and a monthly expense allowance of €3,300, plus “bonus opportunities” equal to 250 percent of his salary. Yet JDE workers have been told the company “cannot afford” to pay £750,000-£800,000 to avoid forcing them onto unsociable and unhealthy night shifts.

3. Who owns JDE Peet’s ?

JDE Peet’s was floated on the Amsterdam stock market in May last year after a merger between JAB Holding Company, JDE, and Peet’s (the San Francisco Bay Area-based coffee roaster and retailer) to form JDE Peet’s.

Two massive corporations own 77 percent of the shares. JAB Holding, a German private investment group headquartered in the tax haven Luxemburg—and with holdings in companies producing well-known brands such as Coty, Pret A Manger, Krispy Kreme and Petcare—is the company’s largest shareholder via its shares in Acorn Holdings. The latter is a holding company that controls JDE Peet’s along with the Keurig Dr Pepper Group, a major producer and distributor of hot and cold beverages.

Around 90 percent of JAB’s shares are owned by the billionaire Reimann family that supported Hitler and the Nazi party well before 1933 and profited from forced labour in their industrial chemicals company in southern Germany.

The second-largest shareholder of JDE Peet’s is Mondelez International. The Chicago-based multinational food, confectionary and beverage company owns well-known brands such as Oreo, Ritz, TUC, Peek Freans, Côte d'Or, Toblerone, Cadbury, Green & Black's, Trident, Dentyne and Chiclets. There is a Mondelez-owned factory in Sheffield—the largest sweets factory in Europe. Mondelez also owns the famous Cadbury factory in Bourneville. Unite has issued no appeal for support from the workers there, keeping the Banbury300 isolated.

Mondelez has been mired in controversy in recent years.

* NGO Mighty Earth reported in 2017 that much of the cocoa used in chocolate produced by Mondelez and other major chocolate companies was grown illegally in national parks and other protected areas in Ivory Coast and Ghana.

* Greenpeace International reported in 2018 that 22 palm oil suppliers to Mondelez International cleared over 70,000 hectares of rainforest from 2015 to 2017.

* In 2015, the US Commodity and Futures Commission alleged that Mondelez International and its former subsidiary was involved in wheat-futures price fixing.

* Earlier this year, eight former child slaves from Mali brought a class-action suit against Mondelez claiming the company, along with Nestle and other well-known chocolate manufacturers, knowingly engaging in forced labour.

4. The purpose of the flotation

JDE Peet’s floatation last year raised €2.25 billion in Europe’s biggest IPO since 2018, generating €1.55 billion for one of its parent companies, Mondelez International, that sold some of its shares.

Within days of the flotation, JDE Peet’s shares jumped 12 percent to give it a market value of €16.8 billion, allowing those who had bought shares to sell off and make a quick profit. The company is now worth around €15 billion.

Apart from enriching its former owners, €700 million would go on reducing its high debt and lay the basis for further acquisitions and capital investment, further increasing the company’s capital base from which the shareholders would expect a rate of return, typically 10-15 percent, courtesy of the workforce. It signals a significant ramping up of the rate of exploitation of JDE Peet’s workers in the form of jobs, speed-ups and the gouging of wages and pensions.

5. JDE Peet’s dividend policy

The company has stated that its dividend policy “intends to preserve the independence of the company” and this in turn “will mainly depend on its financial position,” including its operating results. This is code for saying that its share price, and hence its dividends, must remain high to avoid a takeover.

In fact, the company declares that it “intends to provide a stable and increasing dividend per share, while the pace will be determined by the company’s capital allocation priorities.” [emphasis added] Investment and borrowings would be adjusted to ensure this.

The interests of the owners come first and foremost.

6. The attack on workers

Last year’s flotation was hailed as good news for the firm’s shareholders and its lenders, but that can only be achieved by squeezing the workforce ever-harder—by increasing the working day and reducing overtime payments. At Banbury, management plans to introduce a four-shift pattern, forcing staff to work 12-hour shifts, nights, weekends etc., while cutting traditional Christmas and bank holiday pay rates, and bringing in unpaid breaks and limiting them to 30 minutes. These plans would cost workers thousands in lost pay, with some losing £7,000–£12,000 per year.

In relation to pensions, the company’s financial report and accounts highlighted its defined benefits (DB) pension plan as “the most significant DB plan in the UK,” being more expensive than defined contribution (DC) plans and targeting it for cost reduction. The planned termination of the defined benefit pension scheme and its replacement by the inferior DC scheme will cost workers far more and save JDE millions of pounds a year.

JDE Peet’s intends to wring every penny it can out of workers to pay its shareholders and keep the stock market happy.

7. JDE Peet’s relies on the unions

Key to corporate cost cutting is the company’s reliance and partnership with the unions. The company boasts, “In many locations, we have works councils in place. Approximately 33 percent of our people are covered by collective bargaining agreements.” They include employees in the UK. The Unite union is now trying to push through a filthy deal that imposes the dictates of JDE management and its shareholders.

8. JDE Peet’s depends on its workers

JDE Peet’s main manufacturing plants are in the United States, France, Russia, the Netherlands, Germany, the UK, Brazil, China and Malaysia. However, because of the specialised technology needed for roasting, processing, and packaging its products, the company has consolidated its production capacity into large manufacturing sites. This, together with the high utilisation of these plants, “does not permit the spare capacity necessary to serve as backup for each other in case of significant interruption.” It cannot easily switch production elsewhere, which would also incur additional transport costs to service its markets.

In the UK, JDE processes and packages instant or freeze-dried coffee into various formats. It also processes and packages Tassimo R & G aluminium capsules for single-serve coffee.

The upshot is that workers are in a powerful position and should not be brow beaten by the union into accepting the rotten deal with a highly profitable company that is raking in billions.

9. JDE Peet’s workers have allies around the world

Most important of all, JDE Peet’s has a presence in more than 140 countries with revenues of €3.2 billion. It operates in nearly 40 countries, employing about 20,000 workers. These workers have the same interests as you. They are all exploited by the same global corporation. They are your allies.

10. Unite sits on massive assets while forcing striking workers back to work on sellout contracts

Unite’s financial assets are enormous. The union’s latest financial accounts (for 2019) show the union has net assets of £439 million, including £108 million in cash, £67 million in investments and £209 million in property. In 2019, Unite’s income from members was £162 million, but it spent just £1.3 million on all “disputes” (broadly defined) across the UK.

Unite officials have more in common with HR executives than with the workers they supposedly represent. General Secretary Len McCluskey earned £99,338 in salary and benefits last year. But McCluskey and other Unite officials have access to additional perks, with the 2019 accounts citing: “Executive Committee (Head Office) expenses” £338,000, “conferences” £1.8 million, “committees/executive councils” £3.1 million, “branch and regional costs” £169,000, “payments to regions and branches” £15 million.

Len McCluskey, 2016 Labour Party Conference (credit: Wikimedia Commons)

Unite held 245 ballots for industrial action in 2019, but just 25 of these resulted in strikes or “action short of strikes”. Unite’s role was to suppress industrial action in a pandemic that was killing tens of thousands of workers and with thousands more facing “fire and rehire”, job destruction and the slashing of conditions. Unite has a strike fund of £40 million yet its officials have told JDE workers there is no way to fight the company’s threats. Unite is a strike-breaking organisation that collaborates with the companies and the Johnson government against workers’ most basic rights and interests.

Mass anti-Bolsonaro protests as Brazil faces 550,000 COVID deaths

Gabriel Lemos

Hundreds of thousands of people took to the streets of Brazil last Saturday in a new round of protests against fascistic President Jair Bolsonaro’s murderous handling of the COVID-19 pandemic. The protests took place in hundreds of cities in all 26 Brazilian states and also abroad. In the largest of the demonstrations, 70,000 people gathered on Paulista Avenue in São Paulo, according to organizers.

It was the fourth day of mass demonstrations against Bolsonaro since May 29, when street protests began to take place after a deadly second wave of the pandemic in March and April, and amid the Senate Parliamentary Commission of Inquiry (PCI) investigation of the federal government’s conduct in combating the pandemic. The PCI has already revealed evidence of both a deliberate policy of herd immunity, i.e., letting the virus spread and infect the largest number of people, and of corruption in the government’s purchase of vaccines.

The demonstrations have been called by the so-called “Bolsonaro Out National Campaign,” consisting of the Workers Party (PT) and other bourgeois parties such as the Socialist Party (PSB) and the Democratic Labor Party (PDT), along with the PT’s pseudo-left satellites, such as the Socialism and Freedom Party (PSOL) and all the Brazilian union federations—including the PT-controlled CUT, the Morenoite Conlutas, linked to the pseudo-left Unified Socialist Workers Party (PSTU), and Força Sindical, whose origins date back to the Brazilian military dictatorship.

Mass protest on Paulista Avenue in São Paulo, July 24. (Credit: Mídia Ninja)

In a statement released on June 21, the Brazilian union federations affirmed that the demonstrations are intended to “pressure the president of the Lower House, Arthur Lira,” who is responsible for deciding whether to open impeachment proceedings, “to put on the agenda one of the more than one hundred impeachment requests.”

This demand reveals much of the character of these organizations and where they are seeking to direct the opposition against Bolsonaro. In 2019, the first year of the Bolsonaro government, Brazil saw the largest demonstrations in years against the federal government’s cuts on education. Since then, the PT, the pseudo-left and the unions have all worked to divert this enormous popular dissatisfaction behind the capitalist state, from the presidential elections to empty appeals to Congress and the Supreme Court against Bolsonaro. And they have used the demonstrations to relieve the enormous social pressure from below and to get this potentially explosive movement under control.

Since 2019, the union federations have also begun to hold joint May Day rallies, in which they have brought the most right-wing figures in Brazilian politics onto their platforms. These are politicians responsible for carrying out broad attacks against the Brazilian working class over the years and who supported Bolsonaro’s election, even as they would later try to distance themselves from him. This mainly includes officials of the Brazilian Social Democracy Party (PSDB), who joined the last two May Day rallies that featured the hated former president Fernando Henrique Cardoso. This year, the governor of São Paulo, João Doria, was also expected to attend it, but the CUT, in view of the wide negative repercussions, ended up blocking his participation.

This rotten political alliance culminated in the launching of a “super-request” for Bolsonaro’s impeachment by the PT, the PSOL and the unions along with far-right parties and figures. Among Bolsonaro’s former supporters who signed the impeachment request delivered on June 30 were the reactionary federal deputies Alexandre Frota (PSDB) and Kim Kataguiri, of the liberal Free Brazil Movement (MBL), one of the leaders of the demonstrations for the impeachment of former PT president Dilma Rousseff in 2016 on trumped-up charges.

In the next round of mass demonstrations, which took place just a week after, on July 3, the presidents of the PT and PSOL, Gleisi Hoffmann and Juliano Medeiros, as well as the PSOL’s Morenoite factions Resistência and Socialist Left Movement (MES), openly advocated the participation of right-wing parties, in order to develop a “mass” struggle against Bolsonaro, according to them.

A new reactionary political alliance was formed for last Saturday’s demonstrations, dubbed the “Democratic Bloc.” It includes the Maoist Communist Party of Brazil (PCdoB), openly right-wing parties like PSDB and Cidadania, and the “political renewal” movements Renova and Acredito, funded by big business and whose members in Congress supported Bolsonaro’s 2019 pension reform. The rotten and pro-corporate union federations, including Força Sindical, are also part of this bloc, as are student organizations linked to the PCdoB, such as the National Union of Students (UNE). The PCdoB is the main advocate for the protests to take on a nationalist “green and yellow” (the colors of the Brazilian flag) character, banning “red,” identified with the left, in order to form a “broad front” against Bolsonaro.

"Democratic Bloc" waving Brazilian flags in São Paulo (Credit: WSWS Media)

This whole process is happening as the pandemic continues to rage in Brazil. The demand for controlling the spread of the virus by closing schools and businesses has been completely excluded by the political parties and the unions leading the demonstrations. These political forces are acting to give a criminal cover for the continuation of the ruling class’ herd immunity policy.

In São Paulo, this has been happening through regular meetings between the union federations, including the CUT, and Governor Doria. These meetings serve the sole purpose of giving the millionaire governor a “social façade”—by promoting meager policies such as a subsidy for the purchase of cooking gas, at the request of the unions—while he pushes for a full reopening of all economic activities and schools.

Although the numbers of COVID-19 infections and deaths have decreased over the past month as vaccinations have increased, as of Saturday Brazil still had an average of 1,168 daily deaths and 37,885 infections. Brazil has already recorded 549,500 COVID-19 deaths, trailing only the US. São Paulo state alone recorded 418 deaths and 12,086 new cases last Friday.

With community transmission of the Delta variant confirmed in seven states and without the implementation of lockdown measures, experts warn that Brazil may see a new rise in the coming weeks, as in the US and Europe.

In the face of mass protests, the uncontrolled pandemic and revelations emerging from the COVID PCI, Bolsonaro and his allies have increased their threats of an electoral coup, adopting the same methods employed by Donald Trump in the last US presidential elections. Bolsonaro continues to advance his false claim that Brazil’s electronic voting system can and will be rigged to favor the election of former PT president, Luiz Inácio Lula da Silva.

A July 22 report by the daily Estado de S. Paulo revealed that these coup threats have been backed by Bolsonaro’s defense minister, Gen. Walter Braga Netto. He was appointed to this position as part of Bolsonaro’s unprecedented sacking of the entire military command with the open purpose of aligning the armed forces behind his reactionary agenda. The Estado reported that, in early July, Braga Netto, accompanied by the armed forces commanders, asked an interlocutor to warn House Speaker Arthur Lira that there would be no elections next year if there were no “printed and auditable ballots.”

A bill mandating printed ballots is also scheduled for a vote in August by a congressional special commission. The author of this bill is the right-wing federal deputy Bia Kicis, one of Bolsonaro’s most loyal allies. She met last Friday with Beatrix Von Storch, a leader of the fascistic Alternative for Germany (AfD), accompanied by the president’s son Eduardo Bolsonaro, who was in Washington on January 6, taking lessons from the coup attempt.

The response of the PT, and Lula in particular, to this development was one of total complacency and political opportunism. Globo ’s columnist wrote last week that “the former president was silent on the Estado report that revealed ... the [Braga Netto] threat ... so as not to place himself at odds with the military.” She further stated that “Lula has not spared efforts to get closer to the military.”

Both the PT’s record and the more recent moves by the party and Lula expose the fraudulence of their supposed opposition to Bolsonaro, as well as to everything the fascistic president stands for, including the threat of dictatorship. This also applies to the pseudo-left organizations and the unions, whose reactionary claim that bringing the right wing to the protests would make them more massive was quickly exposed. In São Paulo, the so-called “Democratic Bloc” managed to gather only a few dozen union and party bureaucrats with Brazilian flags in front of their sound truck on Paulista Avenue.

As in previous protests, the working class was completely absent as an organized social force. This contrasts with the intense opposition that has developed within the Brazilian working class throughout the pandemic, with protests and strikes by teachers as well as industrial, app delivery, health care, oil and transportation workers in defense of their living conditions and their own lives against the uncontrolled spread of COVID-19. This movement has been deliberately isolated and sabotaged by the unions.