I have been struggling with an eating disorder for the past few years. I am afraid to eat and afraid I will gain weight. The fear is unjustified as I was never overweight. I have weighed the same since I was 12 years old, and I am currently nearing my 25th birthday. Yet, when I see my reflection, I see somebody who is much larger than reality.
I told my therapist that I thought I was fat. She said it was 'body dysmorphia'.
She explained this as a mental health condition where a person is apprehensive about their appearance and suggested I visit a nutritionist. She also told me that this condition was associated with other anxiety disorders and eating disorders. I did not understand what she was saying as I was in denial; I had a problem, to begin with. I wanted a solution without having to address my issues.
Upon visiting my nutritionist, he conducted an in-body scan and told me my body weight was dangerously low.
I disagreed with him.
I felt he was speaking about a different person than the person I saw in the mirror. I felt like the elephant in the room- both literally and figuratively. He then made the simple but revolutionary suggestion to keep a food diary to track what I was eating.
This was a clever way for my nutritionist and me to be on the same page. By recording all my meals, drinks, and snacks, I was able to see what I was eating versus what I was supposed to be eating. Keeping a meal diary was a powerful and non-invasive way for my nutritionist to walk in my shoes for a specific time and understand my eating (and thinking) habits.
No other methodology would have allowed my nutritionist to capture so much contextual and behavioural information on my eating patterns other than a daily detailed food diary.
However, by using a paper and pen, I often forgot (or intentionally did not enter my food entries) as I felt guilty reading what I had eaten or that I had eaten at all.
I also did not have the visual flexibility to express myself through using photos, videos, voice recordings, and screen recordings. The usage of multiple media sources would have allowed my nutritionist to observe my behaviour in real-time and gain a holistic view of my physical and emotional needs.
I confessed to my therapist my deliberate dishonesty in completing the physical food diary and why I had been reluctant to participate in the exercise. My therapist then suggested to my nutritionist and me to transition to a mobile diary study.
Whilst I used a physical diary (paper and pen), a mobile diary study app would have helped my nutritionist and me reach a common ground (and to be on the same page) sooner rather than later.
As a millennial, I wanted to feel like journaling was as easy as Tweeting or posting a picture on Instagram. But at the same time, I wanted to know that the information I provided in a digital diary would be as safe and private as it would have been as my handwritten diary locked in my bedroom cabinet.
Further, a digital food diary study platform with push notifications would have served as a constant reminder to log in my food entries as I constantly check my phone. It would have also made the task of writing a food diary less momentous by transforming my journaling into micro-journaling by allowing me to enter one bite at a time rather than the whole day's worth of meals at once.
Mainly, the digital food diary could help collect the evidence that I was not the elephant in the room, but rather that the elephant in the room was my denied eating disorder.
The elephant in the room
I live in Afghanistan. My first COVID-19 vaccine was in April 2021 and with the COVISHIELD vaccine. I was supposed to get my second dose a month later but it never arrived. That is because Afghanistan, like the majority of the world, has a severe vaccine shortage.
To make matters worse, our country has decided that the second dose will be with a different vaccine. I will say this again so you can please think about it one more time: people will get a first dose of one drug and a second dose of another.
Our people are confused and rightfully.
This makeshift vaccination protocol is a response to the shortage and not how these drugs were intended to be used. Although the WHO has stated that it is safe to receive the first dose of one vaccine and the second of another, there is evidence that patients with different doses have a higher correlation with side effects like fever, headache and joint pain (Source: Gavi).
The population in the developing world can see how authorities are improvising, leading to a lack of trust on decision makers and a fear for side effects to those who have received the makeshift vaccination protocol.
As the pandemic continues plaguing low-income countries, rich countries’ stockpiling has stressed the need for pharmaceutical industries to waive the IP rights.
The extreme shortage of vaccines has widened the disparity between income countries and low-income countries.
At this critical juncture, low income countries are hit hard with the outrageous third wave of the pandemic. Countries like Afghanistan, Pakistan, the Philippines, and many African countries are suffering.
How could we possibly end the pandemic when the virus is still circulating in the world? How come rich countries stockpile the vaccines when the majority of the population is in dire need of vaccines?
A solution to increase the speed of vaccine manufacturing is with the IP waiver.
A patent waiver, also called intellectual property (IP) waiver, occurs when the owner of a patent surrenders their rights so others can make use of their know-how without paying the patent owner royalties or licensing fees.
In October 2020, India and South Africa proposed at the World Trade Organisation that patent holders of COVID-19 vaccines should temporarily waive their rights until a widespread global vaccination would be in place. The motion for an IP waiver has been already supported by WHO and more than 100 countries. The central argument behind this motion is that every country should have the right to produce its own vaccine during the pandemic (source Nature).
In the early days of the pandemic, when the virus was spreading faster across the world, Big Pharma companies started to manufacture vaccines as a means fight back the virus. The manufactured vaccines helped countries to take control and save lives.
The first countries that had access to the vaccine were, not surprisingly, high-income countries.
The pandemic has widened the disparity between high-income countries and low-income countries due to vaccine outreach and production.
In light of the current circumstances, a temporary waiver on the IP rights to allow low-income countries to produce their own vaccine seems a pragmatic solution.
A narrower waiver during the pandemic will also shrink the gap that has echoed the notion of health inequality.
Developed nations and Big Pharma have made efforts to deliver vaccines to low-income countries. Unfortunately, such delivery is often correlated with delays and pseudo-colonial dependencies. A temporary waiver will help us get closer and closer to the end of the pandemic.
At this period, an immediate agreement between Big Pharma and LMICs is necessary if the world wants to mark the end of the pandemic.
One of the most remarkable precedents in history was the dispute involving big pharma and poor countries over the production of antiretroviral medications for AIDS, which cost around $10,000 per person annually until the development of generics, which reduced the price to $300 per person annually.
At that time, western pharmaceutical industries asserted that drugs manufactured in LMICs did not satisfy quality requirements, despite data repeatedly showing no basis for this assertion.
Today, we would not have achieved significant success in antiretroviral therapies in LMICs if it had not been for generic manufacturers, and we have seen that generics are safe and of high quality. Based on the past reflections, both sides should realize that there is no safer way of ending the pandemic, if no agreement happens.
COVID-19 is desease that has hit harder in lower-income communities.
A life lost in London is worth the same as a life lost in Nairobi. Yet, the urgency and response times are not the same.
The sheer profit from vaccine manufacturing is a big source of income for Big Pharma companies to drive their assets.
One must agree that rich countries’ actions and investments have saved lives, but in high-income countries with low-income countries, the population is still in a dire situation.
What is known so far is that human lives are at stake, and it must be stopped and valued above everything else.
If Big Pharma companies and LMICs agree over waiving IP rights, LMICs can create hubs for vaccine production in different regions.
Hub creation in low-income countries can help with future pandemics.
These hubs can be monitored with a quality assessment and surveillance system to ensure the desired quality required for the production of the vaccines. Moreover, hubs will expedite the delivery of the vaccines to countries hit hard with the pandemic in a short period.
The world has taught us an important lesson, that we must be prepared for any unexpected pandemic. Beforehand preparation will help to curb unnecessary losses, both health and financial losses.
One could think that an IP waiver would be unfair with Big Pharma because it would affect their profit.
This may sound true on the surface but in reality they themselves have earned fundings to develop these vaccines.
International and Governmental Organizations like CDC, EU, Gates Foundation have funded COVID-19 vaccines for development.
Big Pharma and the companies on the supply chain did not have the means to manufacture these vaccines by themselves. It was the concerted efforts from public funding that made it possible for the vaccines to develop in a never-seen-before way.
Big Pharma and the vaccine supply chain should acknowledge this controversy, and show support in granting IP waiver to low-income countries and not lobbying against it.
The dependency that LMICs have at this moment on Big Pharma and higher income countries is a sign that the world has not learned from the damage that colonialism can do.
The most burden of the diseases is in countries with low access to healthcare facilities, mainly the low-income countries.
The pandemic has also turned into a new dilemma for these countries. The data reported from these countries are not fully accurate due to the low testing capacity. Thus, the true extent of the pandemic is still not clear.
The chance is now for Big Pharma and higher income countries to exercise a new type of relationship with developing countries. A relationship that starts from the basis of capacity building and self-reliance and not pervasive dependencies that only increase inequalities and disparity.
High-income countries and Big Pharma companies’ dedication to sharing their knowledge and expertise would help these countries fully stand on their own and become more adept in controlling health crises.
The pandemic has lighted the need for knowledge and expertise in any corner of the world. When the virus spread hit all countries, the world was unanimous in finding a way to stop the pandemic. After some relief from the pandemic, it seems the world is divided, and the virus continues posing imminent threat to the health of the population.
All in all, what we observe now is a high time of disparity between high-income countries and low-income countries, and Big Pharma companies have a role in shrinking this gap.
The EU and CDC funded these COVID-19 vaccines. These public grants were needed so solutions could be developed at warp speed. Human lives were at stake.
At the same time, those policies contributed to a concentration of power among these few for-profit companies. Today, these companies realized their life-saving COVID-19 vaccines with public grants are lobbying against the IP waiver.
The global fight for COVID-19 is far from over and human lives are still at stake.
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Dear Digital Diary,
I realized that there is an unquestionable comfort in being misunderstood. For to be understood, one must peel off all the emotional layers and be exposed.
This requires both vulnerability and strength. I guess by using a physical diary (a paper and a pen), I never felt like what I was saying was analyzed or judged. But I also never thought I was understood.
Paper does not talk back.Using a daily digital diary has required emotional strength. It has required the need to trust and the need to provide information to be helped and understood.
Using a daily diary has needed less time and effort than a physical diary as I am prompted to interact through mobile notifications. I also no longer relay information from memory, but rather the medical or personal insights I enter are real-time behaviours and experiences.
The interaction is more organic. I also must confess this technology has allowed me to see patterns in my behaviour that I would have otherwise never noticed. I trust that the data I enter is safe as it is password protected. I also trust that I am safe because my doctor and nutritionist can view my records in real-time.
Also, with the data entered being more objective and diverse through pictures and voice recordings, my treatment plan has been better suited to my needs.
No more elephants in this room