Part of the Global Health Matters “Dialogues” series.

“We make choices about who we take care of, and we make choices about who we neglect,” says author Daisy Hernández about health systems around the world.

A guest on a recent episode of the Global Health Matters podcast‘s “Dialogues” program, Hernández shared her personal experience with Chagas disease and the journey she undertook to understand it while writing her book “The Kissing Bug: A true story of a family, an insect and a nation’s neglect of a deadly disease.”

Hernández is an essayist, memoirist, journalist, and a professor of creative writing at Northwestern University in the United States. Her work focuses on the intersections of race, ethnicity, immigration, class and sexuality. Chagas is a disease caused by the parasite Trypanosoma cruzi, which is transmitted to animals and people by insect vectors and is found only in the Americas.

Hernández’s Auntie Theodora was diagnosed with Chagas in the United States when Hernández was very young.

“I grew up in the shadow of Chagas disease, and I say in the shadow because it’s been so neglected that we thought it was a very rare disease,” Hernández said. “We had no idea about the millions of people who have this disease around the world, mostly from Latin America.”

In her book and the discussion with host Dr. Garry Aslanyan, Hernández describes how, in the U.S., as recently as 10 years ago, it was almost impossible to know where to get tested for the disease, let alone treated. She also walks through some of her interviews with doctors,
biologists, infectious disease specialists and entomologists, and shares stories of other families.

Hernández’s research took her across the United States and Columbia.

“You describe how pathogens don’t care about bank accounts, national boundaries, tax returns, yet not all health care systems are equipped to deal with a disease such as Chagas,” Aslanyan points out. Then he asks: “How do you see this playing out across different places and maybe even Colombia? How did that play out.”

Hernández describes how, in Columbia, they have a much greater awareness than in the United States about Chagas disease. However, still, there was a divide between the rural areas and cities.

“I met this doctor, a young, young doctor right out of medical school, born and raised in the city, in the capital, and he was doing his one-year commitment of going out into rural areas to provide care,” Hernández recalls. “Chagas disease was entirely new for him, and he made such an impression on me because he was so eager to learn everything. He created his textbook on Chagas disease that he showed me. He had several patients infected and was resourceful, a really incredible person.

“But it really also reminded me of what I was seeing in the U.S., which was the individual doctors ending up with their patients and realizing like, okay, I didn’t learn this in medical school 20 years ago, in some cases, 30 years ago or longer, I need to learn about it now and taking the initiative to learn about the disease, to educate their colleagues as well, in some cases to go out into the community to do testing as well.”

Today, she compares what her family went through then and what she learned in the book to what America saw around COVID-19.

In the U.S., at least in the early days, testing sites sprung up in very wealthy neighborhoods when they were desperately needed in poor areas where people had to go to work and couldn’t work from home, for example.

It took Hernández seven years to complete the book, and she said she saw much more awareness of Chagas in the last seven to 10 years in the United States.

“I keep saying still a long way to go, but again, it’s also really determined by where you live,” she said. “There’s been a lot of activism in L.A. County, and so I think if you’re in L.A. County, everyone knows, oh, there’s a particular cardiologist devoted to this. The same thing is in Florida; we have an infectious disease specialist working on Chagas disease. So people within the community they know, and then the upside, of course, is Google. People get online, and you can also track down folks that way.

“It’s been really incredible to see awareness amongst healthcare professionals,” Hernández concluded.

To listen to more episodes of Global Health Matters, click here.

Dialogues is a new series from the Global Health Matters podcast that includes interviews with some of the world’s sharpest global health minds and brightest thinkers. The goal of each Dialogue is to go beyond the echo chambers that exist in global health and to have in-depth conversations with guests who have explored global health issues from their multi-disciplinary perspectives.

Image Credits: Global Health Matters podcast.

Left-right: Nadya Wells, Bram Wagner, Maria Ortino, Suerie Moon

In the wake of the COVID pandemic, global health is finally getting on the radar of asset managers of large equity and investment funds – as an option for promoting social responsibility objectives among investor clientele. 

At a Geneva Graduate Institute session Wednesday on Investors and Civil Society Working Together, two path-finding institutions – one a for-profit equity fund and the other a foundation – described the new territory that they are charting in collaborations and partnerships that funnel private sector assets into companies and strategies supporting health.  

“Innovative finance as a topic in Global Health Geneva, and more broadly, is a kind of holy grail at the moment because so many international organizations and Product Development Partnerships are suffering from a withdrawal of funding from governments, which are under budget pressures. So the creation of instruments to bring money into global health,” can make a big difference, said Nadya Wells, a senior research advisor at the Global Health Center, which sponsored the discussion.  

“We know in the retail investment space, meaning all of us as individuals, there is a huge desire to contribute to improving outcomes, but we don’t really have the way as an individual to find a way in. So maybe if we can come together, we can have these avenues and instruments created,” said Wells. 

Investing in healthier sustainable food production 

Kenya
Selena Ruto, community health volunteer visits a farm in Narok County, Kenya to discuss a calves vaccination schedule. Livestock can reduce use of antimicrobials that need to be conserved for human health.

With yawning needs for more equitable and sustainable public health investments, from nutrition to medicines, civil society and private sector actors have taken a page from the playbook of the climate and sustainability movement, to find creative new ways of working together.

The aim is to promote investments that can still make money – while prioritizing longer term social benefits over short-term profits, said Maria Ortino of Legal and General Investment Management (LGIM), one of the world’s largest asset management firms and part of a larger conglomerate managing over $1 trillion in assets. 

Ortino heads LGIM’s health team in its department of Environmental, Social and Governance (ESG) stewardship. The team is charting a course towards more responsible investment in two areas that they have identified as “systemic” risks to global health – antimicrobial resistance and nutrition. 

Maria Ortino, LGIM

“What do I mean by systemic risks, it’s risks that cause a breakdown or impairment of the financial system and negatively impacts the real economy,” she said. 

The aim is both to promote healthier nutrition as well as reducing risks of antimicrobial resistance (AMR) from overuse of antibiotics and other antimicrobial agents – particularly in livestock.  

“AMR in 2019 caused 1.27 million deaths on a global level,” she noted, referring to a Lancet study, published in 2022.  A WHO study published in early 2023, estimated that some 4.9 million deaths annually are somehow associated with AMR.  “The cost of not taking action on AMR, according to the World Bank, is an impact that’s equivalent to that of the 2008 financial crisis – so a decrease of global GDP of 3.8%.”

As for nutrition, “we look at the interconnected challenges of obesity, undernutrition and micronutrient deficiencies. Their costs in surveys have been estimated to equal $US 3.5 trillion   on an annual basis. Looking just at OECD countries, the [attributable] health cost expenditures to those individual countries. is around 8%. And that is why we look at these two risks.”

Long term investment horizon 

The long-term horizon is particularly appealing to large institutional investors such as pension funds, which have a long-term outlook anyway, and can mobilize millions to more socially responsible strategies, Ortino stressed. 

“Our clients have a long term time horizon, for example, pension funds. The fast return on investment, they’re not interested. You can say we are accepting that in the short term, it [a new policy] might likely, or will likely, have a long-term cost to the investments that we are making.  But we are looking at long-term results.”  

So when such clients signal their interest in supporting public health objectives as part of a socially responsible investment portfolio, the health team swings into action. 

And insofar as LGIM is invested in almost every publicly listed company in the world, “we see it as a concern for us when certain behaviors are not or not in consistent with what we would be expecting,” she added. 

“The reason for that is the financial implication, in the long term, for the investment.” 

Using shareholder and bondholder levers with McDonald’s

Trends in the sales of antimicrobial agents for animal use. Regions like China and South Asia that are experience the greatest growth in sales are also leading hotspots of drug resistance.

The most obvious way to wield influence is voting of large blocks of shares or bonds at investment meetings on shareholder resolutions calling for corporate policy reforms. But the vote at the annual shareholder meeting is usually the outcome of a much longer process, she explained.  

“We engage in dialogue with the companies in which we are investors. We speak publicly on our concerns that are related to these two areas, we seek policy changes at a national or international level,” she said. 

As one example, the LGIM has used its investment clout with the fast-food multinational McDonald’s to support shareholder resolutions seeking disclosures on its AMR stewardship in its meat production and supply chain.

Examining a petri dish for evidence of drug resistant microbes

It’s estimated that some 70% of global antimicrobial use is in animals – not humans – where the misuse and overuse of such agents contributes to AMR, undermining their effectiveness in human healthcare.  Cleaning up practices in flagship companies like McDonald’s, the largest US beef purchaser and one of the largest in the world, can therefore provide an example to others. 

“We have supported all of those resolutions and been public that we do support them – to make it clear to the companies in which we are invested that we’re looking ,” Ortino said. “We have also engaged in a one-on-one dialogue with McDonald’s raising concerns over AMR and wanting to see change.

“And last year, we co-filed a shareholder resolution that will seek McDonald’s to require the entire supply chain to apply the WHO guidelines on the use of medically important antimicrobials in food-producing animals.

“So in a sense, we are using the WHO guidelines to put pressure on the companies in which we are invested,” said Ortino, who in May 2023, published a blog on the LGIM company website: “McDonald’s can do more to tackle the growing threat of AMR.” 

Leveraging investor clout for healthier foods 

Affordable healthy food options are key to combating nutritin-related noncommunicable diseases that pose a drain on health systems and economies.

With regards to healthier nutrition goals, LGIM has collaborated with the Access to Nutrition Initiative and the Share Actions Healthy Markets Initiative to hold conversations with big food – including the world’s 20 largest food and beverage corporations – in which its shareholders are all invested as well. 

“What we are seeking from these conversations is disclosures on nutrition in their product portfolio.  How they evaluate the full product portfolio and how that product portfolio looks when it comes to healthy foods. 

“There are different types of [healthy food] models that have been government approved, and we encourage strongly encourage the companies to all use these models and disclose them so that we as investors, and the public. can actually see how their entire product portfolio looks like when it comes to health, health, healthiness or lack thereof. 

“We also look at the marketing policies that they have when it comes to marketing to children at various level and as well as the kind of targets that they are setting internally to increase the level of healthiness of the foods that they are marketing.”

Persuasion and voting leverage are two key levers that social responsible investors can use to promote change when they are managing “index funds” that is funds that their clients wish to hold onto, no matter what, for the long term.  

Selling stock holdings – or threatening to do so – is another lever that equity managers can leverage when they are managing “active funds” – that is funds that can be bought or sold if corporate managers fail to respond to other forms of pressure.

Ultimately, both forms of pressure can be useful in different settings, she noted. 

In the case of index funds, “it also means that we maintain our seat at the table with the company and so we can continue to put pressure on the company to make those changes rather than selling it and another investor just picks up those shares,” Ortino said. 

I would say all these levers have their use. But when we are an eternal shareholder, we say, ok, we will sit at the table and continue banging on it.  We see that as a great advantage rather than saying that we will sell and somebody else will buy them.”

Need more global health engagement officials in asset firms

“Global asset managers are increasingly focused on the ‘S’ in ESG, that is social responsibility goals as part of their environment, social and governance engagements,” noted Wells. But not so many of them have engagement professionals with a specific focus on global health. 

“But not so many have engagement professionals with a specific focus on global health challenges. This is something we have been calling for, including in research from 2018 which we did in collaboration with WHO, and which was published in The BMJ.

“We would like to see more people like Maria with this specific mandate. But coalition building is also a way to grow the impact.  Thus our call for building a community of practice around this topic and crowdsourcing a toolkit for stakeholders to use in further coalition-building.

Adds Ortino, “from an AMR perspective, I think we are where climate change was 10 years ago.  We are a few investors that are looking at, or focusing efforts or research on this, which is better than zero.  And I’m hoping that we will have the same trajectory as climate change. You can’t speak to any asset manager big or small, that doesn’t have at least one person who is dedicated to climate change. 

“I would hope that we will see that in 3-5 years when it comes to AMR.” 

Coalition-building amongst investors – and monitoring corporate performance

Bram Wagner, describes the objectives of the Access to Medicines Foundation

The Access to Medicines Foundation offers another model for engagement with the private sector – but from the civil society side of the room. 

“If we can compare a pharma company to a large tech company, we can see that tech companies generally love to go on about how their products are also enhancing people’s lives, said Bram Wagner, investment engagement officer with Foundation.  Based in The Netherlands, it is funded by the United Kingdom and Dutch governments, the Bill and Melinda Gates Foundation, other charities and AXA Investment managers .

“And as society and as investors we demand that tech firms take their corporate responsibility in terms of climate change in terms of their supply chains, and also how they treat their employees. But the affordability and accessibility of their products is not necessarily a demand that we make.

“For pharma companies, selling a product that can literally give you the ability to live comes with different ethical considerations than selling a phone or a laptop. 

“And fortunately, many pharma companies and also many investors are already recognizing this. 

“But access to medicine is a complex and multifaceted issue. And there are many stakeholders involved…In order to get these companies to move, it is essential to get all stakeholders on board including investors.  It has to be a collective effort. 

Access to Medicines Index

The Access to Medicines Index

The Access to Medicines Index which systematically ranks performance of the 20 leading pharma companies worldwide, was one of the first tools created by the Foundation to leverage action, nearly 20 years ago. 

“It involves ranking companies in line with their efforts to do more for access and for people living in LMICs. We assess the performance of companies, but also benchmark them against each other and against the industry averages,” Wagner said..

“And importantly for investors it also contains report cards, which are report cards that have real company-specific analysis but also concrete opportunities for companies to improve their efforts.”

But we are much more than just a research organization that publishes reports. We have the expertise and also the convening power to bring different stakeholders together.

We identify specific opportunities for companies to improve. We are building consensus for making changes…. We then track their progress and we also make sure to highlight best practices so other companies can learn from them. And by engaging them directly with the companies. We’re also improving buy-in at the CEO and board level of these companies to solve access issues. 

Empowering investor coalitions

Companies that are signatories to the Access to Medicines Foundation and collaborate in its work.

One key element of the Foundation’s formula involves collaborations with the internal access teams of pharma companies – to empower those teams to promote access strategies that are naturally well-tailored to the firm in question. 

“We’re also influencing companies indirectly by engaging with other stakeholders such as global health organizations, governments and investors.”

In terms of investors, the Foundation’s signatory base has grown to 138 large investment houses, which together manage some $US 22 trillion of assets.

“And this is in the form of a coalition of investors that has a clear objective to move pharma companies towards the achievement of the United Nations Sustainable Development Goal 3, which is to ensure healthy lives for all people. 

“We empower investors to do that by supporting them in their preparations for engagements and also their voting practices.”

“So when we are empowering internal access teams at pharma companies to drive change, a discussion that is then subsequently taking place in a boardroom can really tip things the other way if shareholders have a voice – they find the issue is important and they want it to be managed effectively. 

He underlines that in order for an investor to successfully engage with a company on access issues, “they do need to understand the issue at hand and they do need to understand the company’s specific situation. They can’t just simply declare that things need to change.”

As a result, the Foundation’s interventions, however disruptive, may also be appreciated by pharma management which might otherwise “get frustrated when shareholders are engaging them on issues that they don’t quite understand or they are not accounting for the company’s specific circumstances,” Wagner said. 

“So the investor engagement team takes our technical knowledge from our independent research, and we present it to investors in a way that is useful and relevant for them. We do this for example, in investor briefings, which are sessions that we organize for our signatories, where we do a real deep dive into the performance of a company and opportunities that we have identified for them. 

Benefits for investors as well 

And this has benefits for the investors as well – facilitating cooperation that is particularly important in the case of access to medicines, where systemic change is required to have real meaning. 

Finally, the foundation’s investor briefings, consultations as well as the company report cards complement investors’ own internal resources and expertise. 

“We enable investors to pool their resources together, and ‘take turns’ as to who is physically engaging with what company,” said Wagner.. 

“Imagine you are an investor and you’re holding 100, maybe 1000 companies. How are you going to prioritize? And how are you going to choose which company to which companies to engage? And how do you familiarize yourself with the issue at hand? Our coalition does exactly that by focusing on the most dominant and influential companies when it comes to access to medicines and in LMICs.” 

Image Credits: International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society, Van Boeckel et al, ETH Zurich, Ortino/LGIM, Scott Warman/ Unsplash, Getty Images .

Dr. Zsuzsanna Jakab, Deputy Director-General of the World Health Organization, during the Annual high-level discussion on human rights mainstreaming. 43rd session of the Human Rights Council , Palais des Nations, Geneva, Switzerland, February 24, 2020.
WHO Deputy Director-General Zsuzsanna Jakab announced new measures to curb sexual misconduct in the agency’s Western Pacific office. The region is set to elect its next regional director next week.

In the wake of an abuse scandal that led to the removal of its regional director, WHO’s Western Pacific Regional Office on Friday announced a series of new measures to combat abusive behaviour and sexual exploitation among the region’s over 600 staff. 

Last March, in an unprecedented move, some countries in the 37-member region voted to sack Regional Director, Dr Takeshi Kasai, for the Western Pacific after several complaints from staff of abusive and racist behaviour. 

Speaking at the press briefing, Dr Zsuzsanna Jakab, who replaced him as acting regional director, said the organisation has prepared a country-specific agenda for the next regional director who will be elected on Tuesday, 17th October 2023. 

“We are focusing on the code of conduct and code of ethics which are global documents and need to be introduced and addressed in every part of the organisation,” said Jakab. “The WHO has a large number of zero-tolerance policies on abusive behaviour, sexual harassment, fraud and financial mismanagement just to mention a few.”

“We have systems and mechanisms in place on how staff members can report if they find or face any incident,” she added. 

The 37 member states set to vote by secret ballot for the new RD, countries span the Pacific region from China to Japan, New Zealand and Pacific island states, representing a combined population of 1.9 billion.  

In her comments at the briefing, Jakab addressed sexual harassment, toxic work culture and the behavioural and cultural changes that WHO is working to introduce. 

Dr Takeshi Kasai (left), began his term as WHO Regional Director for the Western Pacific in February 2019. He was removed in March 2022 following a prolonged investigation of allegations of abusive conduct towards his staff.

While Kasai did not face allegations of sexual misconduct, the WHO has also been shaken by a series of such harassment cases including at headquarters and in its Africa region. 

A total of nine WHO staff in headquarters have been fired over the past year for harassment including Temo Wqanivalu, accused of misconduct at last year’s World Health Summit in Berlin, and most recently, Maurizio Barbeschi, former head of WHO’s Health Security unit.  

In January, three WHO headquarters officials were cleared of allegations of a managerial cover-up of sexual exploitation cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo (DRC). 

Legal cases against about a dozen WHO responders in the field are still being pursued by Congolese women in local courts, with WHO support. And WHO has invested millions in awareness-raising and prevention. 

But in July, a UN rapporteur criticized WHO for being far too slow in providing financial, psychological and legal assistance to victims of some 80 UN and WHO staff in the DRC. 

“This is a global issue. And actually, this was started by Dr Tedros after the events in one of the African countries. There is a very strong global policy in place and strong global leadership,” Jakab said, referring to the DRC scandal. 

Deadline of mid-November 

On a visit to the Congolese city of Goma in November 2022, Gaya Gamhewage, WHO’s lead official in prevention and response to sexual misconduct, committed to supporting survivors of sexual assault of the Ebola outbreak.

The WHO has set a deadline of mid-November to roll out a country-by-country action plan against sexual misconduct in WPRO’s 15 country offices. 

“I would like to assure you that this is a piece of work which is of high priority led by the Director General and regional directors. In our region particularly we reached out to all the country offices,” said Jakab. 

“Following some global and regional guidance, we worked with them to develop a country-by-country action plan which we are finalising now. We have received a number of action plans from the WRs [director of WHO country offices] and we’re hoping to do this by mid-November which is our global deadline.”

WHO also is strengthening mechanisms and building awareness about abuse prevention amongst staff members to help them address any complaints they may have. They can report to the WHO headquarters but also to the regional office.

In response to a question from Health Policy Watch, Jakab said, “We’ve invested quite a lot into strengthening our abilities and capacities at the regional office and country offices particularly on sexual misconduct and sexual exploitation.”

‘Open House’

The acting Regional Director said she has personally taken steps to hear complaints and identified incidents that “still exist” since her appointment in March.

“I have an open house and any staff member from the office can come to see me if they have any problems with disrespectful or abusive issues in the office. It was very helpful to identify the incidents that still exist. The number is going down and that was good for me to see. Whenever we saw an incident like this we took action immediately,” she said. 

Jakab is set to remain in office until 1 February, while the new RD transitions into the role. 

In that capacity, she said she has already prepared a medium and long-term follow-up action plan for the new RD , who is to be elected next week. 

There are five candidates running for election. They include Dr Song Li, proposed by China, Dr Susan Mercado, proposed by the Philippines, Dr Jimmie Rodgers, proposed by Solomon Islands, Dr Saia Ma’u Piukala, proposed by Tonga and Dr Tran Thi Giang Huong, proposed by Viet Nam. 

Geopolitics at Heart of Elections for New Director of WHO Western Pacific Region  

 

Following the election, the winner will then be appointed by the WHO executive board in January – usually a formality – for a five-year term. 

Kasai was elected in 2019 and became the first-ever Regional Director of the WHO to be fired in the history of the 75-year-old organisation.

The election is held in the Regional Committee headquarters in Manilla, attended by health ministers of the member-states. 

The next Regional Director’s name will be announced on Tuesday after the vote. Each of the five candidates will have an hour-long interview, a presentation followed by questions and then voting. Each has already been asked about their approach to the controversies that have hit the WHO hard. 

No compensation for complainants against fired WHO regional boss

In a move to stimulate more awareness about the need for reforms,  WHO has invited a number of staff members to report on their experiences to the Regional Committee. 

Although the investigation against Kasai is “finished on our side,” Jakab responded to a Health Policy Watch question saying there is no compensation for the complainants.

“The compensation is to make sure that this will never happen again,” said Jakab. “But we do not have any policy in the WHO which provides compensation for any of these behavioural issues.”

As the harassment issues form a backdrop to the elections, it is just one of the many challenges facing a region which includes vast development divides and geopolitical rivalries between countries such as China, the Republic of Korea, Japan and Australia. While China remains one of the world’s largest carbon emitters, Pacific Island States face an existential crisis with climate change-triggered rising sea levels – another fault line the new regional director must navigate.

Image Credits: Flickr, WHO, WHO.

Moderator Lerato Mbele ,UN Climate and Finance Envoy Mark Carney, Moroccan Finance Minister Nadia Fettah Alaoui, World Bank president Ajay Banga and IMF Managing Director Kristalina Georgiva address a panel on climate solutions.

How to get more money to address the climate crisis and poverty has been the focus of the annual meetings of the World Bank and the International Monetary Fund (IMF), taking place in Marrakesh in Morocco this week.

Staggering under enormous debt burdens that increased exponentially during the pandemic, African countries appealed for a 10-year moratorium on interest payments and better debt relief measures at the continent’s recent climate summit in Nairobi.

“Africa is now paying more in debt service than the estimated $50 billion a year the Global Center on Adaptation says it needs to invest in climate resilience. These investments are not nice-to-haves — they are vital for building roads, bridges and dams that can withstand torrential rains and floods,” wrote the African Union’s Moussa Faki Mahamat, Kenya’s President William Ruto, and Africa Development Bank’s Akinwumi Adesina in a New York Times article on the eve of the Marrakesh meetings.

“But instead of receiving funds to address the climate crisis, Africa is borrowing at a cost up to eight times higher than the rich world to rebuild after climate catastrophes. This is why Africa urgently needs a pause in debt repayments so that it can prepare for a world of ever greater climate extremes,” they added.

Ajay Banga, appointed World Bank president in June, has acknowledged the need for cultural change at the Bank – a process that started before he assumed office – and used various public forums this week to elucidate his vision for this.

‘Intertwined challenges’ of climate, pandemics and food insecurity

A key concept is addressing “intertwined challenges”. 

“The effort to segregate challenges into poverty, separately from pandemics,  separately from food insecurity, separately from climate change, doesn’t work in practice,” Banga told a media briefing on Tuesday.

“We are seeking approval from our governors to redefine the vision of the bank to be that of eradicating poverty, but on a livable planet. And what we mean by a liveable planet is exactly the challenges of pandemics and climate change and food insecurity and fragility.”

World Bank President Ajay Banda

“Climate change tends to mean different things, depending on where you’re coming from,” Banga told a public forum.

The narrow definition addresses how to avoid “carbon-intensive growth, as in the emissions from energy generation, transportation and construction materials”, he added.

But the Global South’s definition is “loss of biodiversity, forestry cover going, less rainfall, challenges with the soil degradation”, exacerbated by weather crises such as hurricanes – which “takes away double digits of your GDP” if you’re a  Caribbean island.

“Africa is a continent where 600 million people don’t have access to electricity so if you don’t get them the basics, it’s no point discussing the alternatives,” said Banga.

“There is the issue beyond energy – of heavy transportation, construction materials, methane emissions. And finally, even if you get all that right in the world over the next 25-30 years, if you don’t get carbon capture right, we’re still dead in 2050.”

How to tackle climate?

The World Bank is putting 50% of its climate money into mitigation, which Banga defined as “the avoidance of future heavy emissions-growth patterns”, and 50% into adaptation, covering the concerns of the Global South.

IMF Managing Director Kristalina Georgiva said that mitigation was somewhat more straight forward than adaptation: “What we could see is technologies being brought in cost terms to a level that they are commercially viable. Take, for example, solar. When we look around, how today, solar energy is becoming massively available.

“Adaptation is more complicated because it is so multifaceted. You need the infrastructure to be climate resilient. You need agriculture to be climate resilient. You need to address so many aspects of it at the same time.”

However, Georgiva said that it was possible to do this, as Bangladesh, which “used to lose thousands and thousands of people in floods”, had done.

“They have built schools to be also places for retreat for people, for animals. They built a system that alerts people. Go there, save yourself and your livelihood. They switched from chicken to ducks because ducks can swim.”

IMF Managing Director Kristalina Georgiva

Where will the money come from?

The Bank put around $40 billion into climate last year, but the need is far greater. So where will more money come from?

Banga believes there are three key sources. The first one is subsidies. 

“The world spends $1.25 trillion on subsidising fuel, agriculture and fisheries,” said Banga, adding that while some of these were “critical for the social contract between the government and its citizens”, the number is too high. 

“Europe used to spend close to $60 billion a year on fertiliser subsidies. They’ve now spending the same money with their farmers, but to incentivise them to use less fertiliser. That to me is a clever way of taking a subsidy which was environmentally challenging and converting it to a subsidy that is environmentally useful. And so I just believe that this topic of subsidies needs discussion. It gets lost very easily because of the politics involved.”

The second is voluntary carbon markets, which allow companies, governments, and other groups to address greenhouse gas emissions by buying and selling carbon emission credits.

“The World Bank is a few months away from being able to convert real forestry change into credits on a voluntary carbon market,” said Banga, who described this measure as “the ultimate way of getting money to move in the right direction”.

If the Bank issued certification for carbon credits, this would eliminate “greenwashing” and unlock “green credit”.

The third pillar is private sector involvement, particularly in larger middle-income countries that need to curb their greenhouse gas emissions.

“There are enough private sector investors with projects who would like to be able to invest in those countries,” he added, but the political and foreign exchange risks need to be managed.

Political risk relates to when governments change and this brings about policy changes.

“Foreign exchange risk is more difficult to fix than political risk – we actually have ways including getting the right regulatory policy laid out by my smart ministers and regulators in advance. Ask me about forex risk after a year because right now, I have no clue how to solve that!” said Banga.

Protestors calling for debt cancellation outside the Marrakesh meetings.

What about special drawing rights?

What African leaders really want is for the IMF to channel $100 billion a year in special drawing rights (SDR) to climate and development efforts. SDRs are an international reserve asset issued by the IMF to help supplement a country’s reserves. They are not a loan so don’t add to debt and can be exchanged for hard currency or donated amongst IMF member countries.  

Mia Mottley, the Prime Minister of Barbados, called for an annual $500 billion allocation of SDRs to finance a transition to climate mitigation and climate adaptation policies at the Conference of the Parties on Climate Change (COP26) in November 2021.

A few months earlier, in August that year, the IMF had allocated a historic $650 billion worth of SDR to its 190 member countries to help address the impact of the pandemic. 

High-income countries can channel some of their SDR allocations to low- and middle-income countries, but at present, this reallocation “incorporates conventional IMF lending mechanisms involving new debt and conditionality”, according to the Center for Economic and Policy Research (CEPR). 

In addition, some high-income countries “face domestic legal or legislative hurdles that may prevent them from engaging in bilateral SDR transfers”, adds the CEPR, arguing that “the most accessible, costless, and rapid way to get desperately needed aid to developing countries is through a new allocation of SDRs”.

Thursday marked a Global Day of Action for debt, climate and economic justice observed by various civil society organisations engaged with the topic, some of which demonstrated outside the World Bank-IMF meetings.

Shortly before the start of the meetings, an alliance of civil society groups wrote an open letter to the World Bank and IMF urging them to triple multilateral development bank (MDB) finance in order to achieve global climate goals including “a phase-out of all support to fossil fuel projects by 2024”. 

They also urged the delivery of  $100 billion in SDR, guidelines on pandemic investments to leverage the Resilience and Sustainability Trust (RST), and called on Ministers at Marrakesh to “recognise loss and damage as a critical part of the climate finance architecture and the need for additional sources of financing, including international taxes or levies”. 

While Banga has proved to be approachable and open to dialogue during this week, it remains to be seen whether any of these demands will be met by the close of the meetings on Sunday.

Burned out ruins of Kibbutz Beeri near the Gaza Strip in southern Israel following the incursion by Hamas militants into the village on Saturday.

The World Health Organization has called for the end of hostilities between Hamas and Israel, and the opening of a humanitarian corridor from Egypt to Gaza Strip for vital medical supplies – along with the release of over 100 Israeli and foreign hostages seized when thousands of Hamas militants first crossed the border on Saturday, killing an estimated 1200 Israelis, foreign workers and students.

The dead included infants and children, older people and women shot or bludgeoned to death, or burned alive in their homes and even in their beds. The rampage occurred after the militants broke through an Israeli border fence early in the morning and moved systematically through about a dozen kibbutzim (collective villages) and small towns scattered only a few miles from the Gazan enclave – on a morning when Israeli families had gathered to celebrate the Jewish holiday of Simchat Torah.

The grisly operation has been roundly denounced by US President Joe Biden, the European Union and other world leaders as a massacre.

The Hamas militants, who surprised Israel’s powerful military, also took about 130 as hostages. The captives included young mothers with infants and young children, seen in Hamas social media posts cowering in the back of vehicles as they were hauled back to the Gazan enclave. The hostages, which also include foreign nationals from the US, Canada, Thailand, Nepal, and other nations, are to be used as apparent bargaining chips for the release of Palestinian prisoners in Israeli jails.

Since the Hamas operation on Saturday, Israel has responded with massive bombing of the Hamas-controlled Gaza Strip – as well as cutting off access to vital water, electricity and fuel supplies.  About 900 residents of Gaza have so far died in the Israeli bombings, which have ruined many neighborhoods, many of them only recently rebuilt from a devastating clash with Israel in 2014. Tayyip Erdoğan, president of Türkiye, has denounced the Israeli attacks on Gaza as a “massacre”, as well.

Ruins of a Gaza apartment building bombed by Israel in reprisals for Saturday’s attacks.

However with Hamas continuing massive missile strikes on southern and central Israel, there is almost no chance that Israel would lift its blockade soon, or that either side would respond to the appeals for calm.

On Wednesday, there were also fresh worries of a widening war front, with the Iranian-backed Hezbollah, a Hamas ally, launching guided missiles into Israel for the third day this week.  However, a report Wednesday evening of a drone incursion from the north, which sent millions of Israelis in northern Israel into shelters, was later determined to be a false alarm.

WHO has offered assistance 

Bodies gathered for burial in one of the Israeli kibbutzim entered by Hamas militants on Saturday.

“WHO has offered assistance to health officials in both Israel and the occupied Palestinian territory,” said the WHO statement, stressing that Gaza’s hospitals and health care facilities face paralysis even as thousands of injured are seeking treatment.

Late Wednesday afternoon Gaza’s central power plant ceased to function due to lack of fuel.

“In the Gaza Strip, hospitals are running on backup generators with fuel likely to run out in the coming days. They have exhausted the supplies WHO pre-positioned before the escalation. The life-saving health response is now dependent on getting new supplies and fuel to health care facilities as fast as possible,” WHO said.

“WHO is urgently working to procure medical supplies locally to meet demand, and preparing supplies from its Global Medical Logistics Hub in Dubai, UAE.

Negotiations on hostages and humanitarian relief

There are widespread reports of negotiations involving Egypt, Qatar, the United States and Israel in an effort to contain the conflict, and open up a channel for hostage exchanges and humanitarian aid.

“On 9 October, WHO Director-General Dr Tedros Adhanom Ghebreyesus met with the Egyptian President Abdel Fattah El-Sisi, who agreed to a WHO request to facilitate the delivery of health and other humanitarian supplies from WHO to Gaza via the Rafah crossing. Such humanitarian corridors must be protected,” asserted WHO in its statement.

“WHO is urgently working to procure medical supplies locally to meet demand, and preparing supplies from its Global Medical Logistics Hub in Dubai, UAE.

Within Israel, however, there is widespread support for the fuel and power blockade amongst the widening circle of Israelis caught up in the hostilities.

“If you see who has backup fuel and generators in their homes, it is the Hamas militants,” said one media channel, saying that humanitarian aid would merely be syphoned off by Hamas to prolong the hostilities.

The WHO statement also made reference to the hostages held in Gaza, which Hamas has said number 130 – calling for their safe release.

“WHO is also gravely concerned about the health and well-being of hostages, including elderly civilians, seized from Israel by Hamas in attacks on 7 October. The hostages’ health and medical needs must be addressed immediately, and we call for their safe release,” said WHO.

Hamas has controlled the Gaza Strip since 2007, when it expelled the PLO’s Fatah, breaking up a unity government formed after Hamas won elections.  Israel withdrew its forces and dismantled its settlements in the tiny enclave in 2005. But since the takeover by Hamas, Israel has maintained a blockade on the tiny enclave, which is only 365 square kilometres, and with more than two million residents, one of the most densely populated places on earth.

Image Credits: @Israel, WHO , M. Schwartz @YWN.

The health impacts of the devastation caused by the floods in Pakistan in June 2022 are still unfolding.

The devastating floods that submerged one-third of Pakistan in 2022 have severely disrupted the country’s vaccination programme, leaving millions of children at risk of preventable diseases.

The floods severely damaged health infrastructure, causing overall immunization coverage in the country to drop to 64% in 2022, from a national average of 74% in 2020, according to a new national survey conducted by the World Bank and Aga Khan University seen by Health Policy Watch. 

The survey found that Baluchistan, Pakistan’s largest and least populated province of over 12 million people, has the lowest immunization coverage rate for fully immunized children (FIC), at 37.9%. 

Khyber Pakhtunkhwa (KP) province follows with 60.5%, Sindh with 68%, and Punjab, the only province to achieve the national immunization target, with 88.5%. 

Pakistan’s vaccination rate was already one of the lowest in the world before the floods hit, with around 431,000 children not fully vaccinated in 2022, according to the World Health Organization

Immunization rates by district, according to the 2022 World Bank and Agha Khan University survey. 

The floods devastated immunization infrastructure across Pakistan and displaced 33 million people, including 16.5 million children, according to UNICEF.

Iftikhar Nizami, a senior advisor at Help Foundation, an NGO working in flood-hit regions, told Health Policy Watch the devastated areas of Baluchistan, Sindh, and Punjab were already poverty-stricken before the floods caused immense damage.

“Health infrastructure was scarce in these areas, and the floods washed away what little there was,” Nizami said. “Even a year later, water is still standing in many areas, and people are displaced. Reaching them to provide basic immunization services is a very difficult task.”

Health ministries at the federal and provincial levels told Health Policy Watch that the floods have made it more difficult for Pakistan to reach the targets set out by its Expanded Program of Immunization (EPI) – Pakistan’s national immunization strategy –  but they are hopeful that they can narrow the gap once health infrastructure is rebuilt. 

“Flood-hit areas face major structural problems, and the residents’ bad days are not over yet,” Nizami said.

Immunization facilities in flood-hit Sindh are still struggling

Trees cocooned in spiders webs after flooding in Sindh, Pakistan.

Health authorities in Sindh, the province hardest hit by the 2022 floods in which 4.4 million acres of agricultural land and 799 lives were lost, are still struggling to cope with the aftermath. 

“Immunization facilities in flood-hit districts are still inundated,” said Dr Muhammad Naeem, Director of Communicable Disease Control at the Health Department of Sinhd. “We are trying to reach out to people with mobile teams.” 

Naeem said there are currently 30,000 children in the province who have not received any vaccines, and that challenges with the availability of vaccinators and their transportation remain in flood-hit districts.

The primary healthcare infrastructure destroyed in the flood is being rehabilitated under a World Bank project, and the province is also working with public-private partners to reach displaced people, Naeem said. 

“If there were no floods in 2022, we would have achieved the target of 80% FIC in the province,” said Naeem.

Pakistan’s immunization indicators fall short of goals

Percentage of fully immunized children by province. Only Punjab was able to meet its immunization
target.

Despite significant efforts by the Pakistani government and its partners, the country’s immunization indicators have yet to reach the expected benchmarks, according to the WHO. The key goals of polio and measles eradication, and measles control, have not been achieved.

A survey conducted by the World Bank and Agha Khan University after the floods found that Baluchistan has the highest rate of zero-dose children at 39%, followed by Khyber Pakhtunkhwa at 10.1%, Sindh at 7%, and Punjab at 0.9%. 

The measles rate per million population in these provinces is 17.72%, 28.22%, 12.71%, and 5.68% respectively.

The Director General (DG) of the Ministry of National Health Services Coordination and Regulations (NHSR&C), Dr Baseer Khan Achakzai, told Health Policy Watch that immunization coverage in the southern parts of Punjab, Sindh, and Baluchistan provinces was already low because of human resource shortages and areas being hard to reach.

“The 2022 floods completely wiped out more than 1,600 static sites used for immunization, which brought coverage down to 64%,” said Achakzai.

Achakzai added that when the homes of millions were flooded, the immunization records of the displaced were often lost. Authorities and international partners spent eight months reaching the scattered population for immunization.

Pakistan’s national strategy aims to achieve universal immunization coverage

Timeline of vaccine introductions to Pakistan’s national health system, according to Aga Khan University.

Immunizing children with vaccines may avert up to 17% of childhood mortality in Pakistan, according to the WHO

Pakistan’s newly drafted National Immunization Policy 2022 of its Expanded Program of Immunization (EPI) envisions “to achieve the universal immunization coverage leaving no one behind to die from a vaccine-preventable disease”. 

The goal of the EPI is to reduce infant, child, and mother mortality and morbidity linked with vaccine-preventable diseases, as per EPI’s schedule, and to limit other infectious diseases (epidemics and pandemics) through emergency vaccination drives. The policy aligns with international commitments and national directions, including SDG 3 and the National Health Vision (2016-2025). 

Dr Mukhtar Ahmed Awan, director of EPI Punjab province, told Health Policy Watch that the immunization coverage in the province’s southern parts had been hit hard by the floods, but that the region has still performed well compared with the rest of the provinces.

“Punjab’s coverage is above 88%, which is the highest, and this is because of multiple interventions adopted by the program to immunize 3.39 million children aged 0 to 23 months annually,” Awan said.

Awan said the provincial program has focused on vaccinating mothers and children in labor rooms of government hospitals, rolling out mass vaccination campaigns, hiring staff for vacant positions, and using technology to get real-time data during immunization.

Awan added that each vaccinator visits each outreach site eight times in 18 months, resulting in the vaccination of approximately 1.8 million children a month.

“We are confident that we can achieve 95% coverage in the next five years,” said Awan.

Rebuilding 1,700 vaccination sites destroyed in floods

Pakistani Prime Minister Shehbaz Sharif described the devastation of the 2022 floods as  “greater than that caused by the 2010 floods in Pakistan, which the UN then described as the worst natural disaster it had ever responded to.”

The National Immunization Policy 2022 draft envisions achieving more than 90% coverage with the third dose of Pentavalent vaccine among children under 1 year of age at the national level and at least 80% coverage in every district through routine immunization by 2025 and sustaining it.

Achakzai, the Director General of the Ministry of National Health Services Coordination and Regulations (NHSR&C), said the government is working on three strategies to close the immunization gap created by the 2022 floods.

First, the government is rebuilding around 1,700 static vaccination sites that were washed away in the floods with the help of international partners. Second, it is recruiting more than 3,000 vaccinators to bridge the human resource gap. Third, it is installing solar panels in health facilities where electricity provision has been discontinued, as vaccines need to be kept at a certain temperature.

“With these measures, the government is trying to improve the current immunization coverage status by 10 to 15 per cent in the provinces of Baluchistan, Khyber Pakhtunkhwa, and Sindh by February and March next year,” said Achakzai.

Image Credits: UK DFID, OXFAM, UNDP.

Norway’s Ambassador for Global Health, Dr John-Arne Røttingen, is the incoming CEO of Wellcome.

Norway’s Ambassador for Global Health, Dr John-Arne Røttingen, has been appointed CEO of the charitable foundation Wellcome, one of the world’s largest funders of science aimed at solving urgent health issues, the body announced on Wednesday.

Røttingen, who will assume the position in January 2024, has had a versatile and varied career. He started out as a medical scientist, and then trained as a medical doctor before moving into the fields of infectious disease epidemiology and global health.

He received his MD and PhD from the University of Oslo, an MSc from Oxford University and an MPA from Harvard University. 

He has already had a long association with Wellcome. He was the founding CEO of the Coalition for Epidemic Preparedness Innovation (CEPI), which Wellcome helped to launch in 2017.

He was also CEO of the Research Council of Norway, where he worked with Wellcome and European funders to accelerate open access to research publishing. His current position is in Norway’s Ministry of Foreign Affairs.

Røttingen has also led the steering groups for the Ebola vaccine trial in Guinea and the COVID-19 WHO Solidarity Trial, as well as the Lancet Series on access and sustainable effectiveness of antimicrobials. He has worked in academia and co-authored more than 150 peer-reviewed publications.

He is currently on the boards of Gavi, the vaccine alliance, PATH, the Global Antibiotic Research and Development Partnership (GARDP) and the Medicines Patent Pool (MPP). 

“Wellcome believes in the power of science to build a healthier future for everyone, and that science delivers the greatest change through collaborative action across society,” said Wellcome board chairperson Julia Gillard.

“John-Arne’s career and experience exemplify these beliefs. He has built a reputation as one of the world’s most effective and respected figures at the interface between science and advocacy at the highest global levels.”

Røttingen said that he had long admired Wellcome’s  “inspiring work to bring the potential of science and discovery to society to build a healthier future”. 

“Philanthropy has a critical role to play in catalysing and complementing public and private research spend to improve health globally. I know well from my own experience the power of the support Wellcome gives science and scientists, backing basic research and ensuring transformative research achieves impact in the world,” he added.

Wellcome has committed to spending £16 billion on science until 2032, supporting discovery research into life, health and wellbeing, and focusing on three key health challenges: mental health, infectious disease and climate and health.

Wellcome is self-funded through returns from its investment portfolio, which has grown significantly in recent years to £38bn. 

Incoming EMRO director Dr Hanan Balkhy being congratulated by current regional director Dr Ahmed Al-Mandhari

Dr  Hanan Balkhy has been elected as the World Health Organization’s (WHO) Regional Director for the Eastern Mediterranean Region (EMRO), becoming the first woman ever to have been chosen for the challenging position in the world’s most conflict-ridden region.

A Saudi national, Balkhy will assume the position on 1 February 2024 for a period of five years, serving a population of 745 million people. 

This was after the region’s 22 member states chose Balkhy on Tuesday at their 70th session. Her nomination will be presented to the WHO Executive Board in January for formal ratification. 

Balkhy has an expertise of more than a decade in public health, children’s health, and infectious diseases. 

She has been Assistant Director-General for Antimicrobial Resistance at the WHO headquarters in Geneva since 2019. Prior to this, Balkhy was the first Executive Director for Infection Prevention and Control at the Saudi Arabian Ministry of National Guard. 

Socio-economic gaps

The EMRO region stretches out across Morrocco to the Gulf and West Asia to Pakistan, the new regional director has to explore and identify strategies to improve the region’s healthcare capabilities by addressing the glaring socio-economic gaps

The region comprises some of the world’s richest countries – Qatar, the United Arab Emirates (UAE), Saudi Arabia, Bahrain, Kuwait and Oman – and the poorest – Afghanistan, Yemen, Sudan and Somalia.  Iran, Iraq, Afghanistan and Pakistan are all part of the region

There are massive discrepancies between the countries in terms of health indicators. For example, the life expectancy in Qatar is 80 years but in Somalia, it is only 55.4 years. 

In terms of maternal mortality, 620 Afghan women die for every 100,000 live births, in comparison with 70 Kuwaiti women  per 100,000 births.

While Israel opted to be part of the WHO European region, Balkhy will have to address the health fallout of the intense conflict between Israel and the Occupied Palestine Territory, which is also part of her region.

A mother and her newborn baby at the Maternal & Child Health Training Institute in Dhaka, Bangladesh.

Excessive bleeding is the main cause of women dying in childbirth, yet the global guidelines to tackle postpartum haemorrhage (PPH) are inadequate and outdated.

To rectify this, the World Health Organization (WHO) and its partners have developed the world’s first PPH roadmap, and aim to have new global guidelines by the first quarter of 2025.

“Severe bleeding in childbirth is one of the most common causes of maternal mortality, yet it is highly preventable and treatable,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “This new roadmap charts a path forward to a world in which more women have a safe birth and a healthy future with their families.”

The roadmap focuses on four strategic areas – research, norms and standards, implementation and advocacy.

Around 70,000 women die every year as a result of this excessive bleeding, with over 85% of these deaths in sub-Saharan Africa and South Asia. 

Risk factors include anaemia, placental abnormalities, and other complications in pregnancy such as infections and pre-eclampsia. 

Yet the current guidelines are largely silent on how to prevent PPH. Anaemia, or severe iron deficiency, affects 37% of pregnant women around the world – and in some places in South Asia, is as high as 80%. This could be rectified by giving vulnerable pregnant women high-quality prenatal vitamins that include iron.

Lack of trained health workers and medicines

Many countries lack the medicines and trained health workers to stem the excessive bleeding.

Research conducted in four African countries by Dr Hadiza Galadanci, a Nigerian obstetrician, found that many healthcare workers struggled to recognise how much blood loss is too much – and over half the women who experienced PPH were never diagnosed.

“If bleeding starts, it needs to be detected and treated extremely quickly,” according to the WHO. “Too often, however, health facilities lack necessary healthcare workers or resources, including lifesaving commodities such as oxytocin, tranexamic acid or blood for transfusions.”

To address the frequent stock-outs of PPH medicines, the WHO and global partners involved in pooled procurement – such as the Global Financing Facility (GFF), Reproductive Health Supplies Coalition and UNFPA – will conduct a scoping exercise by the end of the year to work out how to “nudge procurement of PPH commodities towards higher quality products and to increase international financing for these commodities”. 

Extending the scope of midwives

One of the measures that the WHO is working on to address the lack of trained health workers is for the scope of practice of midwives to be extended. The International Federation of Gynecology and Obstetrics (FIGO), International Confederation of Midwives (ICM), and ministries of health and national professional societies are assisting with this.

The ICM recently published a scope of practice and competencies for midwives that includes providing intravenous medication, for example.

“Addressing postpartum haemorrhage needs a multi-pronged approach focusing on both prevention and response – preventing risk factors and providing immediate access to treatments when needed – alongside broader efforts to strengthen women’s rights,” said Dr Pascale Allotey, WHO Director for Sexual and Reproductive Health. 

“Every woman, no matter where she lives, should have access to timely, high-quality maternity care, with trained health workers, essential equipment and shelves stocked with appropriate and effective commodities – this is crucial for treating postpartum bleeding and reducing maternal deaths.”

The Bill and Melinda Gates Foundation (BMGF) recently released a report advocating for a simple package of care to be adopted by countries to stem PPH.

Five treatments are conventionally used to stop the bleeding – uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, and genital tract examination. 

“But those interventions were being delivered sequentially – and far too slowly,” according to the report, which advocates for them all to be applied at the same time.

Image Credits: UN Photo/Kibae Park/Flickr.

Lab technicians at South African at vaccine manufacturer Afrigen.

The Bill and Melinda Gates Foundation (BMGF) announced on Monday that it would invest $40 million to advance the development of mRNA innovation and production in low- and middle-income countries (LMICs) to help them produce low-cost and high-quality vaccines at large scale.

In an address to the more than 1,400 scientists, policymakers, and donors attending the foundation’s Grand Challenges annual meeting in Senegal, BMGF co-chair Bill Gates, called for the world to spend at least $3 billion more every year on global health research and development (R&D) to close the critical gaps in funding for neglected diseases.

“New health technologies have the potential to save millions of lives, but R&D funding is going in the wrong direction,” Gates told delegates. “Donors need to step up their commitments to ensure health innovations reach other who need them more quickly, so more lives can be saved”. 

Although overall health R&D funding is growing, only about 2% is directed at diseases that affect the world’s poorest population. 

The Gates Foundation acknowledges the potentially critical role of mRNA technology in developing vaccines against infectious diseases commonly found in the global south, including tuberculosis and  malaria. 

The new grant of $40 million is to improve the access of African research institutes with vaccine manufacturing experiences to access to Quantoom Biosciences’ affordable mRNA research and manufacturing platform. 

Quantoom Biosciences will get $20 million to facilitate access to the next-generation mRNA health tools, while the Institut Pasteur de Dakar in Senegal and South Africa’s Biovac, will each receive $5 million to improve their capacity to develop vaccines to fight local diseases. A further $10 million will be allocated to other LMIC vaccine developers that have yet to be identified. 

“Putting innovative mRNA technology in the hands of researchers and manufacturers in Africa and around the world will help ensure more people benefit from next-generation vaccines,” said Dr Muhammad Ali Pate, Nigeria’s Minister of health and social welfare and a global expert on vaccines. 

“This collaboration is an encouraging step that will increase access to critical health technologies and help African countries develop vaccines that meet the needs of their people.”

The cost of producing a vaccine with Quantoom’s platform could drop to nearly half the cost of vaccines produced with traditional mRNA methods. 

“Innovation can be transformative, but only if it reaches the people who need it most,” said Morena Makhoana, CEO of Biovac

“This collaboration will help close critical gaps in access to promising mRNA vaccines against diseases that disproportionately affect the world’s poorest. It will also assist us in our mission to establish end-to-end vaccine manufacturing capability at scale in Africa for global supply”.

During the COVID-19 pandemic, Africa was sidelined in the rush for vaccines. In reaction, the African Union adopted a New Public Health Order in September 2022 which sets a bold target of meeting up to 60% of the continent’s vaccine demand through regional manufacturing by 2040. At present, the continent only produces 1% of vaccines used in Africa.

Image Credits: Rodger Bosch/ MPP & WHO.