African cancer patients receiving chemotherapy

Africa has one of the highest cancer death rates in the world, yet this could be markedly improved by better access to treatments already widely available in high-income countries for the continent’s biggest killers – breast, cervical, lung and prostate cancers and Kaposi sarcoma.

This is according to a recent study by the Botswana-Rutgers Partnership for Health, which researched which cancer treatments that are effective in other regions could have an impact in sub-Saharan Africa (SSA) – but are not available or hard to get.

Cancer is in the top three causes of premature death in the vast majority of countries in SSA. Without significant intervention, annual deaths are projected to nearly double between 2020 and 2030, reaching about one million by 2030.

In high-income countries “the rapid evolution of precision oncology therapies is increasingly transforming the length and quality of life for cancer patients”. But in SSA “basic levels of cancer care, treatment and palliation are limited”, the study notes.

As a result, Africa’s cancer patients have “poor survival outcomes across most malignancies”. In 2020, Africa’s cancer incidence made up 5.7% of global cases, but its cancer mortality was 7.2% of global deaths.

There is a 30% survival rate for children with cancer in low-income countries in comparison to over 90% for children in high-income countries, WHO Director-General Dr Tedros Adhanom Ghebreyesus noted recently.

Access to high-impact treatments

“Cancer is threatening sub-Saharan African populations to a degree that demands a large-scale response,” said Richard Marlink, the director of Rutgers Global Health Institute and a study author. 

“This guidance provides a framework for how to improve access to the life-saving and life-altering medications that are proven to work. The high-impact treatments available elsewhere are needed in this region of our world.”

While there is a dearth of accurate data about cancer in the region, the study used cancer registries and other studies to get a sketch of the cancer burden.

Cervical Cancer

Cervical cancer is the leading cause of cancer-related death in women in SSA. For patients with advanced cervical cancer, the standard of care is chemotherapy in conjunction with radiation therapy. 

But a study of 29 oncology treatment centres in 12 SSA countries found an inconsistent supply of cisplatin, a preferred chemotherapy drug as well as limited access to radiation therapy.

In addition, access to radiotherapy is limited access due to a lack of trained personnel and equipment and equipment maintenance.

Breast Cancer

Elisabeth Nyiramana (left) is a breast cancer survivor from Rwanda.

Data from cancer registries show that breast cancer incidence is rising in nine countries in SSA. For example, in Harare (Zimbabwe) there has been a 4.9% average annual increase in the incidence of breast cancer and a 4.5% increase in Kampala (Uganda).

Mortality rates in southern Africa are “among the world’s highest due to late-stage presentation and lack of screening programs”, according to the study.

In a population-based registry study of 834 patients in 11 countries in SSA, only one-third received chemotherapy.

Breast cancer patients are also not routinely tested to determine their specific hormonal profiles, which means that “treatment may not include precision targeting, which is available in high-income countries where profiling capabilities are more accessible”.

“Treatment for breast cancer greatly differs based on hormonal status and human epidermal growth factor (HER2) expression status,” the study notes.

HER2-positive breast cancer is one that tests positive for the protein HER2, which promotes the growth of cancer cells. Treatments that specifically target HER2 are very effective.

Hormonal therapy with the drug tamoxifen is recommended for HER2 tumours. Tamoxifen is inexpensive or even free in some countries, so it may be prescribed even if the patient’s hormonal profiling has not taken place. This could harm the patient and provide no therapeutic advantage.

But even when hormonal profiling is available, the medications that have proven to be most effective “may be cost-prohibitive to obtain” – such as trastuzumab, which targets HER2. 

“Another barrier is that immunotherapy, using drugs such as atezolizumab and pembrolizumab, requires specialized monitoring and management protocols that usually aren’t available in this region,” the study notes.

Prostate Cancer

A leading cause of cancer death among men is prostate cancer, particularly in southern Africa where there are approximately 66 cases per 100,000 (more than double the rate recorded in West and East Africa).

Prostate cancer is also increasing. For example, in Kampala, Uganda, an average annual percentage increase of 5.2% was found between 1991–2010.

Treatment with surgical castration to remove the testicles is widespread in sub-Saharan Africa, yet “newer generation oral hormone therapy may have an expanded role in the region”.

Abiraterone with prednisone therapy is an oral hormone therapy that can improve outcomes. This is included on the World Health Organization’s Essential Medicines List, and is “expected to be available through multiple generic options and that reduced pricing is in the foreseeable future”. 

Molecular profiling, which isn’t readily accessible in the region, could also assist to identify patients with metastatic castration-resistant prostate cancer and develop treatments appropriate for them. Androgen deprivation therapy can provide symptom relief and improve survival.

Kaposi sarcoma

While Kaposi sarcoma (KS) is relatively rare worldwide, it is more common in people with weakened immune systems and has increased 20-fold in SSA since the 1980s alongside the HIV/AIDS epidemic.

Antiretroviral treatment has reduced the incidence of AIDS-associated KS, but there is still “ongoing significant morbidity and mortality from KS in the region”, according to the study.

This cancer, caused by infection with human herpesvirus-8, manifests in patches of abnormal tissue growing in the body, especially under the skin, in the lining of the mouth, nose and throat; and in lymph nodes. 

Since most cases of KS are associated with HIV, the study notes that “it is imperative for all patients living with HIV to receive antiretroviral therapy”. 

The medicine, Paclitaxel, can be used to treat advanced KS and is “much more affordable and readily available in SSA” than other medicines.

The World Health Organization’s (WHO) updated Essential Medicines List (EML) released last week includes a new KS treatment, liposomal doxorubicin.

The study also notes the lack of interest in studying new therapies for KS, despite the significant burden of disease in the region. The first large clinical trial in more than a decade that compared chemotherapy drugs used to treat Kaposi sarcoma in SSA took place in 2020. 

Lung Cancer

Greater access to tobacco products in Africa is expected to increase lung cancer.

In high-income countries, molecular targeted therapies for lung cancer have achieved substantial survival benefits – but the equipment and trained personnel to do this are lacking in SSA.

Increased affordability and marketing of tobacco products in sub-Saharan Africa is expected to increase lung cancer. The researchers emphasised the need for more advanced pathology capabilities in the region to improve precision diagnostics and therapeutics. 

Improving access is a ‘moral need’

“We recognize that costs and cost-effectiveness concerns are important factors in realistically increasing availability of a broad range of oncology drug therapies in SSA,” the study notes.

“The moral need, however, to advance therapeutics and reduce the significantly high case-fatality rates from cancer in SSA remains an urgent global imperative.”

“High drug costs are a major challenge to bridging the stark inequities in access to cancer treatments,”  said lead author Kirthana Sharma.

“To optimize cancer treatment in this region, diagnostic and laboratory infrastructure also needs to be strengthened, and the oncology workforce needs to be further trained and developed.”

The Botswana-Rutgers Partnership for Health is a collaboration between Botswana’s Ministry of Health, the University of Botswana and Rutgers Global Health Institute. Botswana’s cancer mortality rate exceeds 63%, and the partnership is engaged in efforts to strengthen the country’s health systems and provide comprehensive, patient-centred oncology care.

Image Credits: Roche, Cecille Joan Avila / Partners In Health, Flickr: Marco Verch Professional Photographer and Speaker.

Members of Physicians for Human Rights in the US call for vaccine equity during COVID-19.

While July saw a crush of global pandemic-related meetings – some joint and some clashing – to accommodate tight schedules and northern summer holidays, achieving a pandemic-proof world is still a long way off. 

The two pandemic negotiations underway at the World Health Organization (WHO) have held individual and joint meetings over the past few weeks, with talks dominated by equity, early warnings for pandemics and financing.

The Working Group on amendments to the IHR (WGIHR) is strengthening the International Health Regulations (IHR), the only legally binding global rules governing health emergencies. 

Meanwhile, the Intergovernmental Negotiating Body (INB) is developing a pandemic accord to address other gaps that emerged during COVID-19 – particularly how to ensure equitable access to vaccines and medicines.

The United Nations General Assembly holds a High-Level Meeting on Pandemic Prevention, Preparedness and Response (PPPR) on 20 September to ensure political leadership for future pandemics, and the draft political declaration for this has also been finalised in the past two weeks.

However, the declaration is more aspirational than action-oriented – although there is an outside chance that it might be tightened up during the HLM.

In combination, these three processes are supposed to lay out a continuum of multilateral and country-based action to prepare for, identify and ward off future pathogens that threaten humanity. 

However, while there is unanimous agreement that equity must be at the heart of any future pandemic response, there is still substantial disagreement about how this can be achieved. 

Vaccine hoarding is unlikely to stop 

A protest against COVID-19 vaccine inequity.

Gaps and weaknesses in the global response to pandemics have been well documented, particularly in a damning report from the Independent Panel on Pandemic Preparedness and Response (the Panel).

“An amended IHR that fails to address the gaps expressed by COVID-19 will not make the world safer. Likewise, a pandemic accord that fails to ensure equitable access to pandemic-related products, fails,” WHO Director-General Dr Tedros Adhanom Ghebreyesus warned the recent two-day joint meeting of the WGIHR and the INB.

The most glaring failure was the inability of many low and middle-income countries, particularly in Africa, to get early access to COVID vaccines as wealthy countries bought excessive doses when they were scarce.

While the three negotiation processes are unlikely to entirely prevent wealthy countries from buying hoards of scarce vaccines at a premium from pharmaceutical companies in future pandemics, they can reduce inequity by developing fair and rational global processes to govern the allocation and distribution of pandemic goods. The INB Bureau has proposed, for example, that 20% of vaccines produced in future pandemics are allocated to the WHO for distribution.

An important part of the negotiations is making explicit the roles and responsibilities of countries and international bodies, particularly identifying global structures that decide who gets access to medicine – rather than leaving this to politicians from wealthy nations who are beholden to their electorates.

‘Complementarity, coherence and continuum’

Ashley Bloomfield, WGIHR co-chair

“Complementarity, coherence and continuum” is how New Zealand’s Dr Ashley Bloomfield, co-chair of the WGIHR characterised the themes emerging out of the two-day meeting between his group and the INB.

At the meeting, the Brunei delegate described the IHR as “emphasising the obligations of member states to the WHO, particularly in terms of reporting, surveillance and domestic implementation of standing recommendations of the Director General”.

Meanwhile, a pandemic accord should define the “multilateral system for ensuring global health security in the event of sustained and prolonged disease spread”, outlining “the obligation of member states to each other,” added the Brunei delegate.

Currently, the highest level of danger in the IHR is a “public health emergency of international concern” (PHEIC), but there is now wide support for the addition of a “pandemic” category, said Bloomfield. The two Bureaus co-ordinating the respective negotiations would work on a proposal for discussion, he added.

The WHO Secretariat has also recommended that this definition “be accompanied by a mechanism to determine a pandemic [and] the actions that such a declaration would trigger” as well as how to de-escalate these actions once the threat is over. 

Dr Mike Ryan, the WHO’s head of health emergencies, also suggested that the negotiators include an “intermediate stage” that would enable the WHO to say: “We’re very worried, but it’s not yet a PHEIC”. 

The Independent Panel was scathing in its assessment of the current IHR health emergency process, describing the “step-by-step confidentiality and verification requirements and threshold criteria” needed before the WHO Director-General (DG) can declare a PHEIC as constraining rather than facilitating rapid action. 

Under the amended IHR, the DG may need to be empowered to publish information about outbreaks with pandemic potential without the approval of implicated member states.

Tiered threat alerts for IHR?

The WHO team investigating the origins of the COVID-19 pandemic at the Wuhan International Airport. Chinese authorities frustrated their ability to access sites of early infection.

Amid the many proposed amendments to the IHR, US wants a tiered alert system “to better define stages of public health threats, enable better reporting incentives and to prevent local or regional outbreaks from becoming large-scale global health emergencies, including pandemic emergencies”. 

It wants the IHR to include a “pandemic emergency declaration within this tiered alert system”. This would be linked to the pandemic accord “because of its ability to trigger activation of emergency response provisions within the accord”.

While the US proposal has widespread support it also faces opposition, including from Russia and China, who believe it could undermine their national sovereignty.

China’s refusal to grant WHO experts access to Wuhan, ground zero for COVID-19, after the pandemic had been declared also raises the question of whether the IHR should empower WHO-appointed experts to visit the sites of outbreaks.

Meanwhile, the African region and Bangladesh have proposed an amendment to Article 12 of the IHR dealing with equity, which would see the WHO DG making an “immediate assessment of availability and affordability of required health products” after the declaration of a PHEIC.

According to this proposal, the DG would also develop “an allocation mechanism or plan, based on public health need, to avoid any potential shortages and ensure that populations at risk have access to health products and technologies”.

Incentives for countries to share information 

The IHR do not set down member states’ obligations following the declaration of a PHEIC. In changing the system of alert to orient it towards speedy action, the incentive structures need to be addressed. 

At present, public health actors only see the downside of drawing attention to an outbreak in their country that has the potential to spread – which under COVID-19 triggered travel bans and other punitive actions. 

The Panel proposed that “incentives must be created to reward early response action and recognise that precautionary and containment efforts are invaluable protection which benefits all humanity”.

In addition, countries themselves need to jack up their capacity to identify and prepare for health emergencies.

One-third of member states do not have enabling legislation and financing for health emergency prevention, detection, and response capabilities, according to the reports countries are required to submit to the WHO in terms of the IHR.

When the WGIHR meets again in October, it will focus on equity provisions (Article 13 A) and financing mechanisms to achieve equity (Article 44), according to Bloomfield.

Equity in operation, not just in talk 

INB co-chair Precious Matsoso

Given the triumph of nationalist self-interest during COVID, it is hardly surprising that the pandemic accord negotiations have focused on equity, in particular equal access to vaccines, as well as research and development (R&D), pathogen access and benefit-sharing, and global supply chains. 

However, the usually jovial INB co-chair Precious Matsoso recently expressed some frustration with member countries’ repetition of equity being a cornerstone of the accord “without saying how it shall be operationalised”.

The European Union is also concerned that talks have focused too much on pandemic response to the detriment of preparedness and prevention.

INB negotiations have splintered into a number of informal meetings on contested issues in the draft agreement – largely related to the draft’s Chapter Two on equity – for member states to gain a better understanding of each other’s views.

As the accord will be legally binding, this makes reaching agreement on controversial issues harder. Sticking points include intellectual property rights for pandemic-mitigating products, and whether member states should be “incentivised” for sharing information about pandemic-causing pathogens.

The access and benefit-sharing approach originates from the Convention on Biological Diversity, which states that countries have sovereign rights over their genetic resources and should be consulted before these resources are used in research and development (R&D). Some countries, primarily in Africa, want to have a share in profits derived from products that are developed from the genomic sequencing of pathogens that they share.

The pharmaceutical industry is dead set against genomic sequencing sharing being linked to rewards, warning that this will slow down the development of future vaccines.

“We do not have to choose between equitable access and innovation,” Tedros told the joint WGIHR/ INB meeting. “We do not have to choose between protecting public health and making a fair profit. We can strike a balance.”

Failure of international systems 

The Independent Panel’s list of essential functions for effective pandemic preparedness and response.

The Panel believes that system-level change is needed to overcome the failure of the international system to prevent, contain, and mitigate the impact of COVID-19.

It had pinned its hopes on the establishment of an independent Global Health Threats Council to elevate pandemic risk to the same level as war, terrorism and economic threats.

But the UN draft Political Declaration on Pandemic Preparedness and Response entrusts the WHO with managing pandemics. The UN’s only oversight is another HLM in 2026 to assess the declaration’s progress.

This puts even more pressure on the WHO negotiations to ensure that the processes and structures they decide on are fit for the challenge.

Other pandemic responses also pushing ahead

Outside of the pandemic negotiations, a number of key initiatives are underway to pandemic-proof the world. Post-pandemic, there is widespread political support for each WHO region to have the ability to manufacture its own vaccines. To assist with this, the global vaccine alliance, Gavi, and the African Union (AU) are spearheading building regional vaccine manufacturing, and in August, they are convening a regional vaccine manufacturing forum.

The aim of the forum is for African leaders, manufacturers and Gavi to “strategize around sustainable manufacturing”, according to Gavi’s Aurélia Nguyen. 

Meanwhile, the Pandemic Fund has awarded its first tranche of $338 million in grants to help 37 countries to build their pandemic resilience. The Pandemic Fund was initiated by the G20 and is housed at World Bank. The World Bank estimates that the world needs $10 billion a year for the next five years to address the gaps in countries’ pandemic responses.

As Tedros told the joint meeting of the two WHO negotiations: “All of these elements are essential but insufficient on their own. It’s only the combined strengths of all of them together that will truly keep the world safer.”

Image Credits: Aishwarya Tendolkar, CGTN.

No smoking policies in public indoor places, like restaurants, have had widespread uptake worldwide. 

Some 5.6 billion people – 71% of the world’s population – are now covered by at least one tobacco protection policy adopted by their national governments, according to a new World Health Organization (WHO) report published today.  

That is five times more people than were protected in 2007, when the comprehensive set of anti-smoking policies, known as MPOWER, was first recommended by WHO. 

Among those policies, some 40% of people worldwide live in countries that have declared all indoor public places to be smoke-free, according to the new WHO report on the global tobacco epidemic.

Proportion of the world’s population covered by at least one fully-implemented MPOWER policy.

Tobacco smoke is estimated to kill some eight million people worldwide, including 1.3 million non-smokers exposed to dangerous second-hand smoke. 

Trends in tobacco use have seen a decline in absolute numbers from 1.367 billion in 2000 to 1.298 billion in 2020, according to a 2021 WHO report on trends in tobacco use.  Since 2007, when the MPOWER package was first recommended by WHO, that prevalence has declined by about 10% for both sexes, with a particularly sharp decline in female smokers. 

Smoking prevalence has declined most sharply in women.

“These aren’t just numbers,” said WHO’s Rudiger Krech at an embargoed press briefing last week. “This policy package has literally changed our lives. It means that families can go out to restaurants without worrying about their children breathing secondhand smoke. Our kids aren’t bombarded with tobacco and e-cigarette ads next to their schools. It means that people that once helped to quit smoking can get the support that they need.” 

‘Insidious’ tactics 

Dr Rudiger Krech, WHO director for health promotion, at a WHO press briefing on tobacco policies.

Yet the tobacco industry continues to use a range of “insidious” tactics to exert influence on policymakers, Krech, director of health promotion, warned. 

As a result, 2.4 billion in 44 countries remain unprotected by even one MPOWER measure. And as one indicator of the state of play, “53 countries still do not have complete smoking bans in health facilities.” 

MPOWER prevented 300 million new smokers 

Kelly Henning, head of health programmes at Bloomberg Philanthropies

“As you’ve heard, we estimate that more than 70% of the world’s population is now protected with at least one MPOWER tobacco control policy as compared to 15% in 2007,” said Dr Kelly Henning, head of Bloomberg’s public health program, speaking at the press briefing from New York City. “This fivefold increase in protected citizens has prevented an estimated 300 million people from becoming smokers. 

She added, however, that, “despite the progress that we’ve made since 2007, tobacco is still the leading cause of preventable death in the world and the fight is not over.”

Only 41 countries, out of 195 WHO member states and observers, have what WHO describes as “complete policies” in tobacco taxation, regarded as one of the most powerful tools available to governments. 

The most recent WHO data on smoking prevalence also doesn’t fully take into account smokeless tobacco use, which by all counts is growing – although surveys of e-smoking trends in many countries lag behind.   

Lack of strong taxation policies

Only 41 countries have smoking taxation policies.

Strikingly, coverage for tobacco taxation has grown very slowly over the last 15 years, the new WHO data shows.  Only 41 countries worldwide have put in place higher taxes for cigarettes – even though such taxes can be a lucrative form of revenue, and useful in supporting government smoking cessation and other related health services.

Since 2007, only 5% more of the world’s population is covered by tax policies that levy stiff taxes on cigarettes today.

Even fewer countries have programmes supporting mass media ads warning of the dangers of smoking and smoking cessation programmes. 

While the proportion of people globally able to access smoking cessation measures has increased significantly over the past 15 years, protection against smoking advertisements in the mass media has in fact declined.   

Conversely, the measures with the highest amount of country uptake include pack warnings (103 countries) and smoke-free environments for the public (74 countries).  

Tobacco lobby is buying up pharma firms  

An estimated 1.3 million children work in tobacco fields around the world – exposed to harmful toxics in the course of their labours.

Among the tobacco industry’s suite of tactics, there have been new endeavours to purchase pharma companies “to gain status in health policy circles,” Krech said. 

“The tobacco industry recently is making attempts to actually buy medical enterprises to be at the table when it comes to actually looking at the fight against cancers, or other [issues] in the global health sphere, [where we have ] established communications with the industry,” Krech cautioned.

“They tried to, for instance, buy a vaccine company during the recent COVID crisis to actually produce or get into the discussion of producing COVID vaccines which we found very interesting.”

“There are whitewashing tactics where they tried to be part ‘of the solution’,” said Krech. “During the COVID crisis, they offered respirators and gave out masks to people for free.”

Additionally, he said that while a number of tobacco companies have publicly stated that they intend to move out of smoking products altogether “the inverse is true”.

“They just want to hook our children on e-cigarettes and vaping to make them nicotine dependent – and then, of course, they will switch to cigarettes afterwards.”

Slight movement away from tobacco cultivation in Africa 

On the plus side, Krech said that there appears to be a slight movement out of tobacco farming in Africa following a 20% increase in tobacco cultivation on the continent over the last 15 years. 

“We now see that, as the world faces a food crisis, we need food not tobacco. So, therefore, yes, indeed, we see a slight decrease in dependency on tobacco growing. 

“There is actually a move to alternative crops because they see that, you know, growing tobacco is [also] extremely poisonous for farmers and for their kids.”

Image Credits: WHO, WHO , WHO, Unfairtobacco.org.

IHR Working Group Concludes its fourth meeting on revisions in the International Health Regulations in Geneva Friday.

The thorny and unresolved issues of how to incorporate health equity measures and supportive finance for low and middle income countries into revisions of the WHO International Health Regulations (IHR), are set to be two key items on the agenda of an IHR negotiating body when talks resume again in early October. 

This was one of the key messages at the close of the fourth meeting of the WHO Working Group on Amendments to the International Health Regulations, which concluded today after a week of discussions. 

Although most negotiations took place behind closed doors, the meeting report that was discussed briefly in a public session on Friday provided a snippet of the talks so far and the envisioned way forward.  

The IHR are binding rules governing countries’ behaviour during global public health emergencies.  Revisions to the rules are being negotiated in parallel with a new WHO pandemic accord. 

Equitable distribution of health products in global health emergencies 

IHR Working Group Co-Chair Ashley Bloomfield of New Zealand presents the draft meeting report of this week’s session on amendments to the IHRs.

In the wake of the COVID-19 pandemic, more equitable distribution of health products has  been a key pillar of conversation in the pandemic accord negotiations. 

However, LMICs have stressed that they face the same kind of barriers accessing diagnostics, treatments and vaccines in any kind of health emergency – and those barriers would have to be addressed in IHR revisions. 

Recent examples include Ebola and Mpox, when essential diagnostics, vaccines, and treatments were slow to reach groups in lower-income countries than in their higher income counterparts – even though the lower income countries were on the front lines of fighting both viruses. 

So even if new mechanisms for ensuring access to health products and finance for LMICs wind up being incorporated into a final pandemic accord, similar provisions would have to be incorporated in parallel, into the IHR, some countries have argued.    

“I think we agree that two areas we really want to discuss again in October are articles 13 A and 44, financing mechanisms,” said the IHR co-chair, Ashley Bloomfield of New Zealand, during Friday’s final discussion. Bloomfield is a co-chair of the Working Group for the amendments to the IHR, along with Abdullah Asiri of Saudi Arabia.

Talks on the two points will also be held jointly with the Intergovernmental Negotiating Body that is debating the details of a pandemic accord, the IHR working group members agreed.

“Discussion jointly with the INB … we see that as a very important way to help progress,” Bloomfield added.  

Equitable drug distribution and finance in proposals  for IHR revisions 

The WHO co-sponsored COVAX vaccine facility supported free and discounted purchases of COVID vaccines during the pandemic, but a similar mechanism doesn’t exist for other public health emergencies that the world has seen recently, such as Ebola or Mpox. Portrayed here is a delivery to Barbados in April 2021.

A 2022 compilation of proposed IHR amendments etches out some of the proposals submitted by countries regarding both measures – although there is wide disagreement between member states on how to handle the two issues. 

In the draft compilation, some of the proposals for a new Article 13 A, covering “Access to Health Products, Technologies and Know-How for Public Health Response”, call for the establishment of an “allocation plan/mechanism”… for health products, in the event of the declaration of a public health emergency “to avoid any potential shortages of health products and technologies”.   Some of the proposals also would remove many IP restrictions on needed health products, and mandate WHO to commission their production from manufacturers.   

A proposed new Article 44 A, meanwhile, on Financial mechanisms for equity in health emergency preparedness and response, calls for the establishment of  “a mechanism … for providing the financial resources on a grant or concessional basis to developing countries.” 

At the same time, there has been considerable concern among members of both the INB and the IHR Working Group about ensuring that the new pandemic accord and the IHR revisions complement each other, rather than overlapping or, worse yet, creating conflicting sets of rules and obligations.

This is particularly important since a pandemic is inevitably going to evolve out of a global public health emergency, as declared under the IHR.  So new finance and equity mechanisms would need to be consistent under both agreements. 

Process for determining a global health emergency

Amendments to the International Health Regulations discussion by the IHR Working Group. Friday’s Working Group group also noted that Article 13 A, addresssing equitable distribution of drugs in an emergency, would be discussed again when talks resume on 2 October.

Among the key topics addressed during this week’s session, the Working Group report noted, were, proposed revisions to: 

  • Responsible authorities – Article 4
  • Notification, verification and provision of information (Articles 5; 6-11, and Annex 2); 
  • Determination of a public health emergency of international concern (Article 1) 
  • Emergency committee (Articles 48, 29)
  • Temporary and standing recommendations (Articles 15, 16, 17, 18)  

More prompt notification of emerging threats, as well as stricter requirements for verification and provision of information, have been the other issues at the heart of the debate over the IHR reforms. 

Proposed amendments, submitted by the United States last year, set out a tightly-paced timeline with as little as 48 hours for countries to notify WHO of an emerging threat, and then a similar window of time in which they could choose to either accept WHO support for an investigation, or in the absence of that, a WHO notice to other countries of the emerging threat. 

But some countries, led by China and Russia, have baulked at the US proposals, seeing them as an infringement on their sovereignty. Developing countries have meanwhile sought measures that link prompt notification to the sharing of “benefits” from any treatments developed as a result of their sharing of pathogen information. 

Another key question discussed this week was the WHO determination of a global public health emergency of international concern (PHEIC). Member states are considering whether such a declaration should continue to be a “binary” yes/no declaration – or if a “yellow light” of warning should be inserted into the system to cover emergencies at a regional level or with other kinds of of potential, short of a full-blown global crisis.

There were no updated draft texts released, however, on the points covered by the IHR Working Group this week.  And such texts are likely to be a long time in coming. Even with regards to the draft meeting report, displayed on a screen during the closing session, several member state delegations stressed that it was an informal summary of the week’s actions, and not a formally agreed-upon text.  See the draft meeting report here. 

Image Credits: PMO Barbados.

One Life, One Liver campaign launched on World Hepatitis Day

Viral hepatitis could become a more lethal killer than malaria, tuberculosis and HIV combined by 2040, if current trends in undetected infection and treatment continue, warned the World Health Organisation (WHO) on Friday, World Hepatitis Day. 

In observance of the day, WHO launched a call, under the title “One life, one liver”, to scale up testing and treatment for hepatitis, a group of five diseases which infect the liver, causing deadly liver damage and cancer.  Of those diseases, hepatitis B and C are the two viruses in this group which cause the most disease and death.

Over 400,000 people die of hepatitis C annually, while of the two billion people infected with hepatitis B, over 800,000 die every year.

For some time, it has seemed that the world was on track to reduce or even eliminate hepatitis, with increasing numbers of people receiving curative treatment for hepatitis C. A global target for reducing hepatitis B infections was reached by 2020, making it the only health-related Sustainable Development Goals on track, with a real possibility of elimination by 2030.

But testing remains inadequate, with only 21% of people infected with hepatitis C diagnosed – and of those, just 13% have been treated, WHO pointed out. The picture for Hepatitis B is even worse, with only 10% of people living with chronic hepatitis B having a diagnosis, and just 2% getting treatment.

And the increase in the numbers of people receiving treatment to cure hepatitis C is slowing, while many African countries do not have access to the vaccine for hepatitis B that is administered at birth, a key intervention. “SARS-CoV-2 pandemic’s detrimental impact on the health system slowed or even suspended HCV [hepatitis C virus] elimination programs” in many countries, noted a recently published paper, adding that “HCV testing and treatment fell, which increased morbidity and mortality.

“Millions of people are living with undiagnosed and untreated hepatitis worldwide, even though we have better tools than ever to prevent, diagnose and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO remains committed to supporting countries to expand the use of those tools, including increasingly cost-effective curative medication, to save lives and end hepatitis.”

Vaccination, testing and treatment: the key to saving lives

New WHO guidance for countries to tackle hepatitis effectively, include a core set of recommendations to: 

  • ensure access to treatment for all pregnant women living with hepatitis B;
  • provide hepatitis B vaccines for their babies at birth;
  • diagnose 90% of people living with hepatitis B and/or hepatitis C;
  • provide treatment to 80% of all people diagnosed with hepatitis. 

Optimal blood transfusion, safe injections and harm reduction are additional measures countries can take in the fight against hepatitis.

The time is ripe for a renewed effort to reach the goal of reducing and/or eliminating hepatitis, as treatment prices have dropped significantly, WHO aded.

When the game-changing curative fourse for heptatis C was first introduced in high-income countries, its cost was over $90,000.  Today it is just $60 for the 12-week course in low-income countries. Treatment for those living with hepatitis B costs under $30 a year.

In addition, west and central African countries, where mother-to-child transmission of hepatitis B remains high, will benefit from Gavi’s Vaccine Investment Strategy 2018, which was recently restarted, and includes those interventions.

In a separate statement, the Africa Centre for Disease Control and Prevention said: “The World Hepatitis Day on 28th July gives us an opportunity to join all stakeholders such as the World Health Organization and the World Hepatitis Alliance to raise awareness on the public health importance of this silent killer and to call on member states to invest more in the fight against Hepatitis B and C in Africa to reach viral hepatitis elimination by 2030.”

Temperature around the Mediterranean Sea on 24 July.

July 2023 may have experienced temperatures last seen in prehistoric times, as climate scientists confirm that once rare heatwaves are now routine events. 

Record heatwaves have been seen this year from the US to India, and according to the latest analysis, this July may be the hottest ever recorded.  

Dr Karsten Haustein, a climate scientist at Leipzig University, says that July’s average global temperature is projected to be 1.3-1.7°C above the average July temperature experienced before humans began warming the planet by burning fossil fuels. This is hotter by 0.2°C than the previous record, set in July 2019.

“Not only will it be the warmest July, but the warmest month ever in terms of absolute global mean temperature. We may have to go back thousands, if not tens of thousands of years, to find similarly warm conditions on our planet,” Haustein said. 

European Union’s Earth Observation Programme, Copernicus, and UN’s World Meteorological Organization have also confirmed that the “first three weeks of July have been the warmest three-week period on record and the month is on track to be the hottest July, and the hottest month on record.”

Scientists attribute the record temperatures to the continued burning of coal, oil, gas and other human activities since the beginning of the industrial era. They are also clear that this is not the new norm: temperatures will continue to rise and extreme weather events will worsen until the world drastically cuts fossil fuel use and reaches net-zero emissions. 

Climate change makes heatwaves routine

Earlier this week an international team of scientists with the World Weather Attribution (WWA) released their analysis of the impact of climate change on this year’s multiple heatwaves spanning the Americas, Europe and Asia. 

Heatwaves hit parts of the US and Mexico, southern Europe and China this July. Both Death Valley in the US and northwest China saw temperatures exceed 50°C. In Europe, too, temperature records were broken in Spain. The analysis was clear: climate change is to blame for once rare heatwaves becoming routine occurrences now. And more is to come.  

The heatwave in China would have been about a one in 250-year event before accelerated heating, while maximum heat like that recorded in July 2023 would have been virtually impossible in the US-Mexico region, as well as in southern Europe, before human-made global heating set in, the WWA analysis found. 

“On the one hand, we really need to stop burning fossil fuels to stop these records from continuing to be broken. But we also need to adapt. We need to adapt because even when we stop burning fossil fuels tomorrow, we will not go back, it will not get cooler,” said Dr Friederike Otto, senior lecturer in Climate Science at Imperial College London.

“We have to live with these and make it possible for people to live with these extreme conditions in summer because they are not rare. And the later we stop burning fossil fuels, the more frequent they become.”

Heat impacts on health set to worsen

Heatwaves are known to be silent killers; in Europe alone, an estimated 62,862 heat-related deaths occurred in 2022, according to a study published in Nature this July.

“Since the inception of the Lancet Countdown eight years ago, we have consistently seen an increase in the health impacts of climate change through our heat-related indicators: heat-related deaths among the elderly are rising; productivity is decreasing globally because of the heat, affecting people’s livelihoods and wellbeing,” said Dr Marina Romanello, who is the executive director of the Lancet Countdown on Climate Change and Health.

This year, news reports in central India linked dozens of deaths to the heatwave but the toll is yet to be confirmed by the government. With most countries lacking high-quality death records, it is easy for deaths linked to heatwaves to be underreported or dismissed.

“These heatwaves and wildfires are another reminder of the urgent need to reduce greenhouse gas emissions and protect the planet on which all life depends,” World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus said of the ongoing extreme weather events in Europe. He called for immediate climate action. 

All eyes on COP28 negotiations

Later this year, world leaders will meet in Dubai at the annual climate conference, or Conference of the Parties (COP), now in its 28th year. This year’s COP has already come under intense criticism, as the negotiations will be chaired by Sultan al-Jaber, CEO of the Abu Dhabi National Oil Company. 

At a time when fossil fuels need to be phased out, and renewables ramped up at a record pace, the selection of an oil baron to head critical climate talks has evoked dismay among advocacy groups and climate activists. 

Stakeholders remain hopeful that the large-scale acceptance of renewable energy will receive financial support from governments and banks.  

“We are already seeing this exponential build-up of renewable energy happen. 2022 was a banner year for renewables and energy efficiency and we need to see that expanding and going even faster,” said Catherine Abreu, Executive Director of the advocacy group, Destination Zero. 

Image Credits: Copernicus, European Union, Karsten Haustein.

Health workers in Cape Town, South Africa, getting vaccinated against COVID-19 in March 2021. Vaccines only became available for health workers at the end of this study.

A single healthcare worker infected with COVID-19 cost the Kenyan economy over $33,000 – around 18 times the country’s per capita GDP.

This is according to a new report on the economic cost of COVID-19 infections among healthcare workers in Eswatini, Colombia, Kenya and South Africa (the provinces of KwaZulu-Natal and Western Cape) during the first year of the pandemic, which has been compiled by the World Bank and Resolve to Save Lives.

The estimated cost per health worker infection ranged from $10,105 in Colombia to $35,659 in Eswatini, with $34,226 in South Africa’s KwaZulu-Natal province and $33,781 in its Western Cape province.

These figures are based on three calculations: the direct cost of healthcare worker’s infection in terms of their healthcare costs and loss of productivity; the costs of infections transmitted by sick healthcare workers; and the disruptions to essential health services.  

The economic burden was highest in areas with the fewest health workers. In South Africa’s Western Cape, the total cost of health worker infections was equivalent to 8.38% of the total health budget. 

In Kenya, where maternal and child death rates were high before the pandemic, health care worker illness disrupted essential services for these vulnerable populations and caused a substantial increase in deaths. This was the biggest “expense” in that country’s calculations.

“Immunisation, chronic disease management, emergency services, and surgery were also severely disrupted, leading to increased non-Covid deaths,” according to the report.

No vaccines for African health workers

At a press conference on Wednesday to launch the report, Dr Keith Cloete, head of health in the Western Cape, South Africa, reminded the audience of the impact of vaccine inequity on health workers.

“Everybody knew that the most important thing was to vaccinate healthcare workers. Our delay in having access to vaccines meant that, in your study period from 1 March 2020 until 28 February 2021, we had vaccines for two weeks,” said Cloete. 

The first South African health worker was vaccinated on 17 February 2021; health workers only got access to vaccines via a clinical trial of Johnson and Johnson vaccines rather than as part of a vaccine rollout for the general population.

In the absence of vaccines, the Western Cape had to try to assuage health workers’ fear by ensuring that they had personal protective equipment (PPE), and by improving its occupational health and safety and employee wellbeing policies, added Cloete.

The province also invested in good data to enable it to predict COVID-19 waves and plan accordingly.

“At the height of the waves is when you have the most healthcare workers in quarantine and in isolation, so you’re going to have the lowest number of available staff. So that’s one of the first predictive models we did, and we then intentionally employed people on contract to cover these waves,” explained Cloete.

The COVID-19 incidence among HCWs was higher than in the general population in all study sites – almost 10 times higher in Kenya and seven to eight times higher in the two provinces of South Africa 

“The economic burden due to SARS-CoV-2 infection among HCWs makes a compelling investment case for pandemic preparedness, particularly the protection of HCWs, and resilient health systems going forward,” argues the report.

Juan Pablo Uribe, the World Bank’s Global Director for Health Nutrition and Population, warned that there was a projected shortage of 10 million health workers by the end of the decade and that health workers from low-income countries were moving to high-income countries, exacerbating shortages in poorer countries.

“Many of our health workers are still very much unsatisfied or frustrated in their workplaces. And more important, they’re facing incredible risks of infection, of disability and injuries and in many places, even of violence,” said Uribe.

Resolve CEO Dr Tom Frieden said that health workers needed to be protected during pandemics by policies, protective equipment, and data systems and information “to hold us all accountable for protecting people who protect and care for us so that they can be safer and healthier, and societies can be safer and healthier”. 

Image Credits: Western Cape government.

As the effects of climate change hit home for people and communities around the world, lawsuits are becoming a central tool in the fight for climate justice.

The number of climate cases taken to court has more than doubled in the last five years, as people and communities turn to the legal system to hold governments and corporations accountable for their inaction on climate change, according to a new Global Climate Litigation Report, published Thursday by the UN Environment Programme (UNEP) and the Sabin Center for Climate Change Law at Columbia University.

The latest data shows that over 2,300 climate-related legal cases have been filed since UNEP began tracking climate litigation in 2017.

“The challenge with climate litigation is that it needs to target each country individually,” said Maria Antonia Tigre, a senior fellow in climate litigation at Columbia’s Sabin Center, at a joint press briefing Tuesday, just ahead of the report’s release. “Lots of cases have to be filed to actually move the needle.”

The new UNEP report collates and analyzes data on some 2180 cases filed to end 2022, with Sabin Center’s online data base recording nearly 200 more cases filed since the start of 2023.

Current trajectory has temperature rising 2.7°C -2.8°C by 2100

That means that lawsuits are now becoming a central tool in the fight for climate justice as the world catapults above the 1.5°C global heating threshold set out by the 2015 Paris Agreement. The current climate emissions trajectory leaves the planet set to exceed pre-industrial temperatures by 2.7°C by 2100, according to a 2021 UN analysis of climate emissions and mitigation commitments.

The weak pledges made ahead of the 2022 COP27 meeting led to even more gloomy projections of a 2.8°C temperature rise by the end of the century.

As governments and corporations fail to adjust course on greenhouse gas emissions that may alter the global climate for generations, people are resorting to litigation to try to claw back control of their future.

“There is a distressingly growing gap between the level of greenhouse gas reductions the world needs to achieve in order to meet its temperature targets, and the actions that governments are actually taking to lower emissions,” said Michael Gerrard, the founder and director of the Sabin Center. “This inevitably will lead more people to resort to the courts.”

The United States continues to dominate global climate change case numbers.

The largest number of climate cases have been filed in the United States, which accounts for around 70% of the global total. Courts in Australia, the United Kingdom, European Union and the United Kingdom round out the top five climate litigators.

Even so, nearly 20% of cases have been filed in developing countries, the report said. For the first time, two developing countries – Mexico and Brazil – are in the top ten countries facing climate litigation.

The report comes a day ahead of the one-year anniversary of the United Nations General Assembly vote to recognize access to a clean, healthy and sustainable environment as a universal human right – a decision viewed as historic for explicitly linking human rights to climate change.

Inger Andersen, Executive Director of UNEP, declared that the resolution sent a message that “nobody can take nature, clean air and water, or a stable climate away from us – at least, not without a fight”.

A year of heatwaves, drought, floods and record temperatures has repeatedly challenged the ambitions set out in the non-binding resolution, pushing people, environments and ecosystems around the world to their limits.

As the current El Niño event develops over the coming months, global-mean air temperature are already expected to rise above pre-industrial levels by more than 1.5°C for extended periods. Average temperatures across the earth’s terrestial areas, which are typically warmer than the seas, have also risen above the threshold already.

“The climate crisis is getting worse, not better,” said Patricia Kameri-Mbote, who leads UNEP’s legal division. “People are increasingly turning to the courts for answers.”

A new field of climate law

The disruptive activities of climate activists around the world are increasingly being met with criminal charges – even as lawsuits over official climate inaction proliferate.

Lawsuits arguing that the right to a healthy and sustainable environment is inherent to existing national constitutional law and international human rights law is the most common category of litigation, the report said.

Plaintiffs also sued governments for not abiding by emissions targets set out in international agreements like the Paris Accords. They have challenged the construction of new fossil fuel extraction facilities in the courts, and attacked greenwashing in corporate marketing.

The growing number of cases and legal strategies for climate litigation is increasingly defining a new field of law, UN experts said.

“These cases are being seen across the world,” said Andy Raine, head of environmental law at UNEP. “[Precedents] have influence and impact that don’t always just stay within national borders.”

Youth climate activists have been a driving force in climate litigation, filing 34 cases on behalf of children, teens, and young adults.

Legal ‘backlash’ cases proliferate

The report also warned, however, of a growing number of legal “backlash” cases against climate activists and affected communities as corporations try to protect their fossil fuel assets. Criminal and civil cases that target the disruptive actions of climate activists are also increasing, Tigre said.

The legal costs associated with major climate litigation, however, also represent a high bar of entry that prevents many of the world’s most vulnerable from using it as an avenue for climate justice, the report said.

“Many cases are still not brought to the forefront as financial challenges, intimidation, lack of know-how and other barriers remain in place,” the report said. “These barriers are especially harmful for vulnerable groups including Indigenous Peoples, women and those from a lower socioeconomic status, the majority of whom are women.”

International courts yet to weigh in

The International Court of Justice’s advisory opinion on the responsibilities of states to respond to climate change to protect present and future generations is pending.

Climate cases are also working their way through international courts – although the process is slow and painstaking. In March, the UN General Assembly requested an advisory opinion from the International Court of Justice on the obligations of states to respond to climate change. The resolution also invited the court to give an opinion on these obligations with respect to future generations.

“The advantage of the ICJ advisory opinion is that we would hopefully have the highest court in the world clarifying what the legal obligations of states are,” said Tigre. “A big challenge often facing individuals in these systemic cases against governments will be surpassed … domestic courts will likely follow that interpretation.”

“Obviously, you won’t solve any problem in and of itself, because it’s an advisory opinion, but it would help for future litigation and hopefully also lead to certain changes from governments without the need for further litigation, as well,” Tigre added.

Criminal charges have also been sought in international courts. In 2021, a communication was filed with the International Criminal Court (ICC) requesting that former Brazilian President Jair Bolsonaro be investigated for crimes against humanity for his role in deforestation activities in the Amazon rainforest.

The communication argued that Bolsonaro actively promoted and facilitated attacks on the Amazon and the people who depend on it, which constitutes “a clear and extant threat to humanity itself”. If the ICC pursues the case, it would be the first time that environmental and climate harm formed the basis for charges of crimes against humanity.

Image Credits: Markus Spiske/ Unsplash, CC.

High cost has prevented some cancer drugs from being included in the World Health Organization’s (WHO) updated Essential Medicines List (EML) and Essential Medicines for List Children (EMLc) released on Wednesday.

These include “patented, highly-priced” treatments for lung and breast cancer.

“With the cancer medicines, we are facing now an issue where we have a very high burden of disease and very expensive, highly-priced medicines,” said Dr Benedikt Huttner, secretary of the expert committee that advises the WHO on the EML.

“For some of the medicines [cost] was one of the factors leading the expert committee not to recommend them currently,” Huttner told a WHO global press conference.

Among the new recommended EML cancer drugs are a treatment for Kaposi sarcoma and a medicine to stimulate the production of white blood cells to reduce the toxic effect of some cancer medicines on bone marrow, as well as the extension of some children’s cancer treatments to cover three additional cancers.  WHO’s essential medicines lists are widely used by countries in medicines procurement choices and decisions about what drugs to include in government subsidized medicines plans. 

Access to medicines a killer for cancer patients

Access to medicines remains a killer for cancer patients, and the 30% survival rate for children with cancer in low-income countries, in comparison to more than 90% for children in high-income countries, reflects this, said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“Every year, an estimated 350,000 children are diagnosed with cancer in low and middle-income countries (LMICs). Many of them cannot access the treatment they need,” noted Dr Tedros.

“Only 25% of low-income countries covered childhood cancer medicines in their health benefit packages. This subjects children and families to significant suffering and financial hardship or puts them at risk of receiving substandard and falsified medicines.”

James R Downing, CEO of St Jude Children’s Research Hospital

EML Pricing group still not formed

Despite several WHO mentions of the high cost of drugs excluded from the list, an EML sub-group on pricing, which was recommended by experts in 2021, still hasn’t been been launched.

At Wednesday’s press conference, Huttner reaffirmed it was going to be set up soon – even though it hasn’t begun its work yet.

“There is actually going to be also an advisory group advising WHO on how to deal with the issue of highly-priced medicines,” he stated.  The new working group is supposed to develop more systematic strategies for monitoring medicines prices and for assessing and making high-priced, but essential drugs more affordable, as part of WHO and EML processes.   

‘Where you live in the world’ is a major determinant for children’s cancer survival

A major determinant of survival for children with cancer is “where you live in the world”, James R Downing, CEO of New York City’s St Jude Children’s Research Hospital, told the press conference.

“In developed countries, we have made incredible progress against paediatric cancer with cure rates approaching 90% for many of the more common paediatric cancers. Yet the rest of the world has been left behind,” he added.

In 2021, St Jude Hospital announced that it would contribute $200 million over six years to improve access to cancer drugs for kids via the Global Platform for Access to Childhood Cancer Medicines, an initiative that it is running with the WHO.

The initiative aims to provide an uninterrupted supply of free, quality-assured cancer medicines to low- and middle-income countries – focusing first on six of the most common cancers that cause over half of childhood cancers. The aim is to raise survival rates to at least 60% in these countries by 2030.

Interruptions in medicines access a key factor undermining children’s survival

This followed earlier work between St Jude and the WHO via the Global Initiative for Childhood Cancer, which identified lack of access to medicine and interruptions in supply as key factors undermining the survival of children with cancer.

“Some 40-60% of children being treated for cancer will have disruptions in their access to chemotherapy, and that decreases their chance of cure,” said Downing. 

“In other countries, the quality of the drugs is not up to standards, and so they’re getting inferior drugs that are leading to inferior treatment.”

The platform is being piloted in six countries initially, with UNICEF as a collaborating partner.

“The idea is that we will set up a secretariat at the WHO that will manage this, and that we will have a procurement agency that will produce those drugs with generic drug producers,” Downing explained.

“We will know the market size because of the analytics that we have developed and then we will be able to ship those drugs into those countries. And we know their capacity to use those drugs effectively to treat children with cancer because they’re part of the St Jude Global Alliance and we have spent energy and time training them and putting forward to them the exact protocols they should be using to treat those children.”

Another challenge is the lack of diagnostic tools to diagnose cancer in LMICs, and St Jude is also working on a platform to develop and distribute cheaper diagnostics.

Children undergoing chemotherapy

Multiple sclerosis drugs included on EML for first time

In other new EML additions, medicines for the treatment of multiple sclerosis (MS) have been included on the essential medicines list for the first time ever, along with new treatments for cardiovascular conditions and infectious diseases.

Three medicines that can slow MS – cladribine, glatiramer acetate and rituximab – have been added. Multiple sclerosis is a chronic, debilitating disease of the nervous system affecting approximately 2.8 million people worldwide. 

Fixed-dose combinations of multiple medicines (commonly called ‘polypills’) for the prevention of diseases of the heart and blood vessels, have also been added to the EML for the first time.

“The list is an important tool for achieving universal health coverage, providing guidance to governments, health facilities and procurers on which medicines are the best value in terms of benefits for individuals and communities. The EML includes medicines only on the basis of solid evidence for safety and efficacy. Approved indications within national jurisdictions or the availability of on-label alternatives is not a decision criterion,” said Huttner. 

Other medicines for infectious diseases that have been listed in the new EML include:

  • ceftolozane + tazobactam, effective against multi-drug resistant bacteria, including difficult-to-treat infections caused by carbapenem-resistant Pseudomonas aeruginosa; the drug is a ‘reserve’ group antibiotic, under WHO’s three-tiered  “AWaRe” system for judicious antibiotic use, meaning it should only be used when other treatments have failed.
  • pretomanid to treat multidrug-resistant or rifampicin-resistant tuberculosis;
  • ravidasvir (to be used in combination with sofosbuvir) for the treatment of chronic hepatitis C virus infection in adults;
  • monoclonal antibodies for Ebola.

Altogether, the recommended changes bring the number of medicines on the WHO essential medicines list, which is updated every two years, to 502 drugs for adults and to 361 for the essential medicines list for children. 

But the WHO warned that “rising prices and supply chain disruptions mean that all countries now face increasing problems in ensuring consistent and equitable access to many quality-assured essential medicines”.

Image Credits: National Cancer Institute, National Cancer Institute, USA.

WHO's New Leadership TeamThe cases of drug-resistant gonorrhoea, a sexually transmitted disease, are on the rise in many parts of the world, the World Health Organization (WHO) has warned. 

The agency added that it considers Neisseria gonorrhoea a “priority microorganism” to be monitored for antimicrobial resistance. 

The new WHO guidance on sexually transmitted infections (STIs) requires countries to work towards improving access to better testing and diagnostic services. 

“Early testing and diagnosis are key in stopping the spread of STIs,” Dr Teodora Wi, the lead for sexually transmitted infections of the WHO’s Global HIV, Hepatitis and STIs programmes, said. “When left untreated, certain STIs can lead to long-term irreversible outcomes and some can be potentially fatal.”

Countries like Australia, Austria, Canada, Denmark, France, Ireland, the United Kingdom, and several countries in Asia including China, Japan, Singapore and Vietnam, have reported cases of Neisseria gonorrhoea, a pathogen that is highly resistant to the antibiotic medication ceftriaxone.

“The enhanced gonorrhoea AMR surveillance (EGASP) suggests high rates of resistance in gonorrhoea to current treatment options such as ceftriaxone, cefixime and azithromycin in Cambodia, for instance,” the WHO said in a press release. 

Eighty two million new cases of N.gonorrhoea are being reported around the world every year in people between the ages of 15 and 49. 

“In addition, antimicrobial resistance (AMR) in N. gonorrhoea is particularly problematic. With resistance to both cephalosporins, including third-generation extended-spectrum cephalosporins, and fluoroquinolones, N. gonorrhoea is a multidrug-resistant pathogen,” the WHO indicated, adding that the resistance observed in the pathogen outpaces the new antibiotics being developed for it. 

“WHO considers N. gonorrhoea to be a priority microorganism for AMR monitoring in the Global Antimicrobial Surveillance System and for drug development in the context of AMR.” 

The new guidance is also expected to help make STI testing more accessible and affordable to the masses, which will lead to better data collection, the WHO added. 

Image Credits: Flickr – Guilhem Vellut, Guilhem Vellut.