INB co-chairs Roland Driece and Precious Matsoso.

The fractious pandemic agreement talks – supposed to end with an agreement on Thursday (28 March) – have limped into extra time, with World Health Organization (WHO) member states resolving to hold an additional intergovernmental negotiating body (INB) meeting from 29 April to 10 May.

The World Health Assembly (WHA), which begins on 27 May, is supposed to adopt the agreement, intended to be a global guide on how to prevent, prepare for, and respond to, pandemics.

But the best case scenario is for the WHA to adopt an “instrument of essentials”, a bare-bones text that will be fleshed out over the next 12 to 24 months in advance of the proposed Conference of Parties, according to people close to the talks.

At the briefing at the end of Thursday’s talks, which started almost four hours later than scheduled, INB co-chair Roland Driece said that “there is no champagne”.

“We had long intensive discussions, but we have not succeeded in concluding this meeting,” added Driece. 

Consensus text

Instead, the INB Bureau would get a revised text to member states by no later than 18 April.

However, this text would be different from the previous one as it would aim to draw out consensus points rather than provide a shopping list of issues.

“That text will be building on the current one but also be different in focus and in level of detail, like we discussed before, but still trying to operationalise equity as much as we can,” said Driece. “We will build on the consensus already identified. Consensus is an important word.”

Extract from the INB 9 reportback

The INB drafting group will focus on “agreeing text”, and member states were also urged to “provide the Bureau with any convergence text resulting from informal consultations, as soon as possible”.

Meanwhile, when the INB resumes, there will be space for “structured informal meetings or working groups, as needed, to progress the work”.

At the start of the two-week negotiations, a number of member states had complained that their proposals and agreements reached in sub-groups had not been reflected in the Bureau’s draft text.

The focus on consensus appeared to cheer delegates, including Switzerland which said there was “a clear way forward”. Switzerland had refused to accept the draft text at the start of the talks.

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus implored delegates to draw on the “spirit of Geneva” to conclude the talks.

“Let the spirit of Geneva – the spirit of cooperation, mutual respect, and shared responsibility – guide your deliberations as you work towards finalising the agreement by the set deadline in May this year,” said a visibly tired Tedros.

“Together let us reaffirm our commitment to global health security, to solidarity in times of crisis and to a future where no one is left behind by operationalising equity with international law,” added Tedros.

WHO Director General Dr Tedros, flanked by WHO head of health emergencies, Dr Mike Ryan, at INB 9.

Putting on a brave face?

Finding consensus points may be hard in the coming days as many countries appear to have lost patience with one another, and with the INB Bureau and WHO Secretariat members who have been steering the process.

Countries across the political spectrum accused one another of refusing to make compromises, and criticised the Bureau for failing to provide direction.

However, the geopolitical reality is that some of the 194 member states are at war, while others are long-term trade enemies. This was never going to be easy, despite the recent trauma of COVID-19.

In the past two weeks, so much text has been added to the 31-page draft that the meeting started with that it had swollen to a completely unwieldy 100-page draft by Tuesday 26 March with multiple opposing clauses contained in brackets.

For example, by last Saturday (23 March), 50 countries had submitted at least one bracketed suggestion for Article 11, which deals with technology transfer, according to Knowledge Ecology International (KEI), which had two observers at the meeting.

However, the now notorious Article 12, which deals with pathogen access and benefit-sharing (PABS), remains the biggest obstacle.

The European Union believes that there is a place for intellectual property rights in PABS. However, this has been rejected by the Group on Equity – an alliance of 34 countries  – and the Africa region.

But the Group on Equity, which includes countries with large generic medicine producers such as India, Brazil and Indonesia, has also been accused of trying to secure advantages for these companies but taking a hard line on technology transfer.

Meanwhile, Colombia blamed the lack of progress in the past two weeks on “changing modalities, which were sometimes unclear, but also because we’re facing a highly complex document”.

“We support the Bureau in producing a streamline text and one which can achieve consensus but it will have to have substantive provisions which will take us beyond the status quo. The agreement that we will reach must be clearly based on the principles of equity and solidarity that tragic experiences that we live through during the COVID 19 pandemic.

Additional reporting by Elaine Ruth Fletcher

Farmworker Sonali Kadam has been finding it difficult to work in the fields during the summers because of unbearable pain caused by kidney stones.

Whenever farmworker Sonali Kadam experiences pain in her lower abdomen, she fears losing consciousness and pops a painkiller. 

Her fearful response goes back a decade when she was diagnosed with nephrolithiasis, commonly known as kidney stones, which are hard deposits of salt and minerals formed in the kidneys. 

When Kadam, a farmworker, first experienced this pain, she ignored it and kept working in the sugarcane fields. Within an hour, her pain aggravated, and she collapsed. 

Kadam, a resident of Arjunwad village in India’s Maharashtra state, has multiple stones in the kidney, each around 8mm in size. Usually, stones smaller than 5mm pass on their own through urine, while bigger stones might need medical intervention and sometimes even surgery.

In her quest to get rid of these stones, Kadam has consulted over 10 different doctors and took hundreds of painkillers but nothing worked. 

“This has traumatized me so much that whenever it starts paining, I fear I will either faint or die,” she told Health Policy Watch.

Kadam, 34, says her condition worsens in summers when the temperature tops 40° Celsius. As a farmworker, her day in the fields begins at 9am. There she sows seeds, clears weeds and harvests crops until about 5.30pm each day. 

“During this time, I am exposed to a lot of heat, which has been worsening my kidney stones,” she shares

Kidney disease rises with temperature

What Kadam has experienced isn’t a one-off case. Higher temperatures cause dehydration, leading to a rising concentration of minerals like calcium in the urine, which is responsible for the growth of kidney stones. 

A study published in the Lancet in March 2024 analyzed 135,4675 Acute Kidney Injury (AKI) cases in England between 2017 and 2021 and found a 62.3% increased odds of AKI when temperatures reached 32°C compared with that at 17°C. The researchers also found that in July 2021, a week-long heatwave led to a 28.6% increase in AKI counts. 

A study by the Children’s Hospital of Philadelphia in 2014 analyzed over 60,000 US patients and found a rising probability of people being diagnosed with kidney stones as daily temperatures rose. Researchers found that, at 30° C, the relative risk of kidney stone presentation was 36-39% higher than at 10° C.

Research from Australia points out that even a 1°C rise in daily minimum temperature increased emergency department admissions for kidney stones. 

Meanwhile, a paper in Nature’s Scientific Reports in January 2022 projecting the impact of rising heat on kidney stones in South Carolina, predicts that by 2089, even in the case of aggressive reduction in greenhouse gas emissions, the prevalence of kidney stones will increase by between 2.2% and 3.9%, costing an additional $57 million to $99 million respectively..  

According to the Global Burden of Disease study, 116 million cases of acute urolithiasis, a condition in which kidney stones move into the ureters, urethra, and bladder from the renal pelvis, occurred in 2019. 

This led to 13,300 deaths and 604,000 global disability-adjusted life years. For every 100,000 people, 1,394 were diagnosed with acute kidney stones. While there are no global projections yet, a rising chorus of experts are warning that kidney stones will rise sharply with the soaring temperatures.

“Global warming from climate change predisposes to kidney stones and acute kidney injury,” says Dr Matthew Borg, one of the authors and a biostatistician and research epidemiologist at t the University of Adelaide in Australia

Climate change can disrupt water treatment processes due to increased pollutant loads in heavy rainfall, which can decrease the availability of clean drinking water. 

“This can increase the risk of diarrhoeal diseases such as leptospirosis and schistosomiasis that, if not adequately managed, can cause dehydration and AKI,” Borg explains. 

There is already a 12% average prevalence of kidney stones worldwide, with 15% being the norm in Northern India. 

Unable to afford surgery 

Last year was the warmest year on the planet, during which India witnessed some of its deadliest heat waves. 

A report by international climate scientists found that human-induced climate change made the April 2023 heatwaves 30 times more likely in India and Bangladesh.  

Moreover, a paper published in PLOS Climate in 2023 found that heat waves can impact over 90% of India. 

Doctors have advised Vandana Badame to have surgery to remove her kidney stones, but she can’t afford it.

Three years ago, farmworker Vandana Badame felt a cramping pain in her side and back while working in the chilli fields in Maharashtra’s Ganeshwadi village. 

“The pain was unbearable. I kept puking and thought I was going to die,” 40-year-old Badame remembers. 

The culprit was a 9mm kidney stone. The doctors suggested surgery but she simply can’t afford it.

 Since then, she has relied solely on drinking water, hoping that the stone will pass through urine. But the kidney stone has caused her tremendous pain, which increases when she works in scorching heat. 

During such times, her only solution is to immediately go to a nearby clinic, take pain management injections, and continue working in the field. 

“Even if it pains, I have to keep working. What else can I do?” asks Badame, who is her family’s sole earner. 

Every month, she relies on intravenous drips to continue working in the fields. She gets 220 Indian Rupees ($2.65) for eight hours in the field, while an intravenous drip costs her at least Rs600 ($7). 

Whenever she steps out in the field, she carries five litres of water and painkillers. As the temperature increases, so does her vulnerability to the pain caused by kidney stones. 

A 2013 paper published in the International Journal of Environmental Health Research found that “the number of hot days in a year is positively correlated with the number of urolith patients”.

 Researchers also found that drought and semi-arid conditions in India made groundwater more saline, which is associated with the formation of kidney stones. 

Moreover, a 2020 study that analyzed 1500 industrial workers from South India exposed to extreme heat had a 2.3 times higher chance of severe health outcomes, with one third of steelworkers reporting kidney stones.

Lack of health facilities 

When farmworker Basappa Kamble, 51, collapsed from kidney stone pain at 1am in 2022, it took over an hour for him to reach the hospital. 

“There are no sonography facilities in the nearby areas,” says community healthcare worker Shubhangi Kamble, who rushed him to a private hospital where a 17 mm kidney stone was detected.  

“He was hospitalized for a week,” says Kamble. Despite the surgery, he complains of recurring pain. 

In his village, Arjunwad, with less than 6000 people, a majority are farmers, farm workers, and outdoor workers exposed to tremendous heat. 

Kamble started surveying her community and found that the problem of kidney stones peaked during summers. 

Workplace guidelines

“Workplace guidelines, such as enforced work to rest ratios, reducing physically strenuous work during the hottest hours of the day, and adequate access to good ventilation and shade, should be reviewed to improve workers’ safety in hot temperatures,” suggests Borge.

Besides this, he suggests general precautions like preparing for increased presentations of kidney stones and AKI, including staffing, equipment, training, and dialysis facilities during hot seasons.

However, for its 833 million strong rural population, India just has 764 district and 1224 sub-district hospitals catering to kidney ailments. 

“Since these hospitals are overcrowded and far away from villages, the only solution for many is to take a painkiller. Its overdose has led to several side effects,” shares Kamble. 

Farmworkers are forced to rely on costly private hospitals during such pressing times and a single doctor’s visit costs at least $6. Kadam and Badame earn this money after toiling in the fields for 16 hours. 

“Many times, I avoid going to the doctor and buy medicines from the pharmacy directly,” shares Kadam. 

Frustrated with the unbearable pain, sometimes she even ties a rope around her waist, attaches it to a firm object or a hook in the wall, and pushes herself against it. 

“This comforts me for a while. Every day, I feel like there is no end to this pain, and it will only go after I die.”

Image Credits: Sanket Jain.

Young children in Harare scrounge for left-over food.

HARARE, Zimbabwe – The maize meal porridge that their mother had previously blended with peanut butter and sugar for them is now a thing of the past for scrawny 13-year-old Nesbit Chigariro and his three siblings.

The family barely has enough food for a single meal a day, as the El Nino-induced drought sweeping southern Africa has pushed them to the wobbly edge of survival.

Miranda Chigariro, Nesbit’s 33-year-old mother, told Health Policy Watch that her children had fallen sick all at once earlier this year and nurses at a local clinic told her that they all suffered from kwashiorkor, a severe form of malnutrition.

The Chigariro family lives in Caledonia, an informal settlement 17 km east of the Zimbabwean capital, Harare. Harare is  home to nearly two million people, many battling starvation as a result of the latest drought.

Regional crisis

Many parts of southern Africa are contending with intense food shortages following the drought that has devastated crops during the region’s peak agricultural season from October 2023 to March 2024. 

The UN’s Food and Agriculture Organization (FAO) predicts that 33 African countries, including Zimbabwe and Zambia, will require outside help to address food insecurity.

“Many parts of Southern Africa are abnormally dry, with drought in eastern Angola, western and central Zambia, northeastern Namibia, northern Botswana, much of Zimbabwe, central Mozambique, central and eastern South Africa, and Lesotho,” according to the latest report (22-28 March) from the Famine Early Warning System (FEWS)

The El Nino phenomenon is triggered by the warming of the Pacific Ocean off the coast of South America, resulting in much less rainfall across many African countries and excessive rainfall in other parts of the world.

The governments of neighbouring Malawi and Zambia have already declared states of emergency because of drought and the Zimbabwean government is also believed to be contemplating this.

The drought has also reduced people’s access to clean water, causing cholera outbreaks. By mid-March 2024, a total of 28,556 cholera cases had been reported and 589 deaths from 62 districts across the 10 provinces, according to the United Nation’s children’s agency, UNICEF.

Some measured portions of maize meal on a vendor’s makeshift table in Harare, Zimbabwe. Times are desperate and many people are forced to buy tiny food portions.

Insufficient aid

In January, the United States Agency for International Development (USAID) announced a contribution of $11.27 million to the World Food Program (WFP) in Zimbabwe aimed at food aid for approximately 230,000 of the most vulnerable people across the hardest-hit districts, including Mwenezi, Mangwe, Chivi and Buhera.

This was supplemented by a $1.36 million contribution to the WFP by the Japanese government in February.

But this is a drop in the ocean as around a quarter of the population – 4.1 million Zimbabweans – teeter on the brink of food insecurity.

Amongst these millions are Nesbit and his three siblings, aged 10, six, and one, each facing the gnawing ache of hunger every day.

Nesbit’s parents sell sweets and popcorn on the streets in central Harare. If the siblings are lucky, they may get plain and unsweetened maize meal porridge once in a while.

The children are emaciated with jutting-out bellies that show their malnourished state.

Worst off is Nesbit’s one- year-old sister, who was weaned early because her mother, Miranda, could no longer produce adequate breast milk to feed her owing to hunger.

Miranda blames the drought for the family’s predicament, explaining that she and her husband rarely had enough to feed their children, let alone themselves.

“Our field, from which we have often harvested some maize each year, has produced nothing for us this time around, while very few people are buying from us these days as we sell our wares in the city,” Miranda told Health Policy Watch.

Looking thin and frail, Miranda said the family had been bashed by hunger that had worsened in the past three months.

Her malnourished husband, 37-year-old Dickson Chigariro, said that they only eat once at dinner time when they return home to their children.

A result of perpetual starvation and stress, Dickson and Miranda both suffer from stomach ulcers.

Inflation fuels hunger

A destitute blind beggar and her child on a street of Harare waits for Good Samaritans to donate anything to her.

With the cost of food ever rising, Zimbabwe’s inflation rate stands out at over 1,000%, the highest in the world, according to Professor Steve Hanke, a US economist at Johns Hopkins University.

In 1992, another drought killed over a million cattle in this country and many malnourished people turned to donors to help them survive.

But even as many Zimbabweans both in urban and rural areas are suffering, the government has remained adamant that nobody will succumb to hunger.

“Cabinet wishes to assure the nation that there will be enough grain before the commencement of the next maize or traditional grains intake in April 2024,” Zimbabwe’s Information Minister, Jenfan Muswere, told reporters last month after a Cabinet meeting. 

Not long after Muswere made the claims about food self-sufficiency, Zimbabwe received a donation of 25,000 tonnes of wheat and 23,000 tonnes of fertiliser from Russia.

Zimbabwe’s Agriculture Minister, Anxious Masuka, has also been on record in the media claiming that the southern African nation holds 190,000 metric tonnes of maize in its grain silos.

Yet with many Zimbabweans like the Chigariro family enduring hunger, government officials have played hide-and-seek games with the media, evading questions about the mounting hunger-related ailments.

“Thanks for your questions. However, the Ministry of Public Service and Social Welfare is most appropriate,”Donald Mujiri, a spokesman in the Ministry of Health, said in an emailed response to Health Policy Watch.

‘Nobody talks about it’

Malory Chagwiza, a trained nurse who volunteers as a community health worker because he cannot find work, said that the drought had also meant people were short of drinking water, which was causing dehydration.”

“Food insecurity is leading to malnutrition, which has negatively impacted the majority of people’s immune systems, rendering them susceptible to diseases. Some are already dying from the underlying effects of hunger, with nobody talking about it,” claimed Chagwiza.

Heatwaves and lack of water are also causing food-borne diseases as a result of food vendors operating under unhygienic conditions, he added.

Zimbabwe has also seen a surge in cholera cases, usually caused by people’s lack of access to clean water.

While the Zimbabwean authorities are indecisive about whether to declare the drought a state of disaster, there is grim evidence of this disaster in the country’s starving population.

“We can only endure, resting in the comfort that there are many like us here, some of whom are even worse,” said Miranda, from her disintegrating shack.

As Health Policy Watch, left she held a small bottle filled only with water to her one-year-old’s mouth. 

Image Credits: Jeffrey Moyo.

Women over the age of 60 and women with disabilities, face a higher risk of abuse yet their experiences are largely hidden in most data, according to two new publications released today by the World Health Organization (WHO).

Where there is data, these groups face high prevalence, with one systematic review finding greater risks of intimate partner violence for women with disabilities and another finding higher rates of sexual violence. 

“Older women and women with disabilities are under-represented in much of the available research on violence against women, which undermines the ability of programmes to meet their particular needs,” said Dr Lynnmarie Sardinha, Technical Officer at WHO and the UN Special Programme on Human Reproduction (HRP) for Violence against Women Data and Measurement.

Sardinha is one of the authors of two new WHO briefs on measuring violence against older women and against women with disabilities. These briefs are the first in a series on neglected forms of violence by the UN Women-WHO Joint Programme on Violence against Women Data. 

“Understanding how diverse women and girls are differently affected, and if and how they are accessing services, is critical to ending violence in all its forms,” said Sardinha.

According to the WHO, one in three women worldwide experience physical and/or sexual violence in their lifetime, whether from their intimate partners or from others. The prevalence of violence ranges from 20% in the WHO’s Western Pacific region, to 22% in Europe, and as high as 31- 33% in the Africa, Eastern Mediterranean and South-East Asia regions.

Additional risks

But older women and women with disabilities also face specific risks and additional forms of abuse, sometimes at the hands of caregivers or health care professionals. These include coercive and controlling behaviours such as withholding of medicines, assistive devices or other aspects of care, and financial abuse.

In older age, intimate partner violence tends to change from physical to psychological abuse, including threats of abandonment, although more research is needed to understand how power dynamics shift in older age.

Older women and women with disabilities can be extremely isolated when violence occurs, making it more difficult for them to escape and report the abuse. Stigma and discrimination can further reduce access to services or information, or result in their accounts of violence being dismissed by responders.

“Gender-based violence is rooted in unequal power and control over women,” said Dr Avni Amin, Head of the Rights and Equality across the Life Course Unit at WHO and HRP. 

“For older women and women with disabilities, their dependency and isolation are further exploited by perpetrators, increasing their risk of abuse. Services must be responsive to their needs and identify appropriate contacts through the health and care systems, so that all women experiencing violence can access empathetic, survivor-centered care.”

Noting that older women are currently represented in only about 10% of data on violence against women, the WHO recommends extending the age limit for survey participation and incorporating questions relating to different types of violence, encompassing a broad spectrum of disabilities.

They also advocate for user-friendly formats such as Braille or EasyRead to enhance the accessibility and participation of some disabled women.

Image Credits: UN Women.

Bats captured from the Kitaka mine in Uganda were discovered to be the source of a Marburg virus outbreak in July 2007.

As World Health Organization (WHO) member states bang heads in Geneva over a pandemic agreement to keep the world safe, a group of scientists has challenged global decision-makers to pay far more attention to humans’ relationship with animals.

“Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations,” write the 24 scientists from a range of different global institutions in an article in Nature Communications published on Tuesday (26 March).

Using bats as their case study, they show how environmental changes exacerbate zoonotic spillover – and identify the “ecological interventions that can disrupt these spillover mechanisms”.

Primary prevention of zoonotic spillover

Their ecological countermeasures focus on bats because a number of major epidemics and pandemics” – SARS-CoV-2, Ebola, SARS-CoV-1, MERS-CoV, and Nipah virus –  have an evolutionary origin in bats.

Certain bat species also host four of the nine diseases identified by the WHO as having the potential to generate epidemics that pose a great risk to public health.

So what does an ecological approach look like when applied to bats? The authors propose three measures to prevent zoonotic spillover from bats to humans.

The first involves protecting where bats eat, which involves numerous interventions including preserving and restoring vegetation diversity and structural complexity in bat foraging habitats.

In subtropical Australia, for example, Pteropus species bats (which carry the deadly Hendra virus) feed on nectar in winter-flowering forests. But in some areas, over 90% of these forests have been destroyed.

“Replanting winter habitats would be a sustainable, scalable, and effective strategy to reduce the risk of spillover of not just Hendra virus, but other viruses carried by Pteropus species bats,” they argue.

Preventing zoonotic spillover involves protecting bats where they eat and roost and protecting people wo interact with them.

The second measure involves protecting where bats roost.

“Roosts are locations where bats sleep, shelter, mate, socialise, and raise their young. With few exceptions, bats cannot construct shelters and must roost in pre-existing natural (eg, caves, rock crevices, tree cavities, and tree foliage) or human-made (eg, buildings, bridges, mines) structures,” the authors state.

The third measure involves protecting people and their livestock who come into contact with bats. This can be done by reducing livestock’s interactions with bats and bat excreta and providing personal protective equipment for peoplein contact with bats or their excreta.

In Malaysia, for example, “a regulation requiring fruit trees to be planted at a distance from pig sties may explain the lack of subsequent Nipah virus spillovers”, the authors note.

Integrating ecological and biomedical approaches

“Recognising that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy,” they argue.

Pandemics almost always start with a microbe infecting a wild animal in a natural environment, but when a wild animal then infects a human, this is often triggered by “human-caused land-use change”. The more land use changes, the greater the risk of zoonotic spillover.

“Designing land management and conservation strategies to explicitly limit spillover is central to meeting the challenge of pandemic prevention at a global scale,” they argue.

“In our view, the most effective strategy to reduce the probability of another pandemic is to preserve intact ecosystems and bolster their resilience through restoration and the creation of buffer zones.

“Our primary emphasis should be on maintaining and enhancing the integrity and resilience of still-intact landscapes to prevent new interfaces that could enable the emergence of Disease X.”

Pandemic agreement and One Health

Article 5 of the draft pandemic agreement is devoted to One Health, which it defines as “an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) is closely linked and interdependent”.

According to the draft agreement, parties will commit to a One Health approach for pandemic prevention, preparedness and response that is “coherent, comprehensive, integrated, coordinated and collaborative among relevant actors and sectors”.

Proposed measures include engaging communities to prevent, detect and respond to zoonotic outbreaks; workforce training; updating international standards and guidelines, and developing multilateral mechanisms to help developing countries to adopt a One Health approach.

Image Credits: Chris Black/WHO.

A convention of the Polish Left party, one of leading advocates for legalizing abortion.

Poland’s right-wing Law and Justice (PiS) party, which championed the country’s restrictive abortion laws, was voted out of power last October, but the path to improving access to abortion is not fast or straight forward.

“First of all, we need accessible abortions and we need, which is extremely important, the decriminalisation of abortion support,” activist Agata Adamczuk told Health Policy Watch. She is from Dziewuchy Dziewuchom (Gals Help Gals) Foundation, a Polish feminist NGO providing information on safe abortions. 

Yet, Parliamentary Speaker Szymon Hołownia says it’s not a good time to introduce abortion reform, the Polish Press Agency reports. According to Hołownia, parliamentarians may vote against any abortion reforms if they are placed on the agenda before the local government elections on 7 April, fearing reactions of more conservative voters.

“If we proceed after the [local] elections, the chances will be much greater. Talks and declarations about supporting the draft bills in the first reading will start,” said Hołownia, adding that discussion on a draft abortion reform Bill was set down for 11 April.

Coalition politics

Hołownia is leader of Polska 2050, a new Christian Democrat party,  and one of the three parties that make up the ruling coalition. The group is ambiguous in their stance towards reproductive rights, whereas the other two parties in ruling coalition, the New Left and Prime Minister Donald Tusk’s Civic Platform, have made abortion on demand up to the 12th week of pregnancy one of their priorities.

“It’s a good first step, in the right direction, but it’s not enough,” Adamczuk highlighted.

Even if there is a law granting abortion on demand until the 12th week of pregnancy, in practice it likely won’t be respected “because we’ve already faced such situations”, she adds.

Last year, demonstrations were held in 60 cities in protest against the unnecessary deaths of women because hospitals were reluctant to abort pregnancies that endangered their lives, even though performing them would have been legal, Newsweek Poland reported.

However, the Civic Platform and the New Left remain optimistic that abortion rights are a necessary and realistic goal for the current term of the parliament.

“We have the right to and we want the draft bill on abortion to be finally proceeded in the Sejm,” said Anna Maria Żukowska, a leader of the New Left, during the party’s summit.

Yet a new Bill to make abortion access less restrictive is likely to face opposition of some parties in the Catholic country, including the possibility that President Andrzej Duda, who is aligned to PiS, may veto it. He has been quoted as saying that advocating abortion access is “demanding the right to kill”.

Abortion mostly forbidden – but still happening

Poland’s abortion laws are the second most restrictive in Europe, with only Malta reaching a lower score on legality and accessibility, according to the Abortion Policies Atlas.

A comparison of abortion-related policies in Europe. Poland with considerably more restrictive laws than most countries.

Performing the procedure is now legal only in cases of rape and where there is serious risk to the mother’s health. Even then, doctors are permitted conscientious objection to performing abortions, which further limits access to abortion.

In 2020, the politicised Constitutional Tribunal ruled that it was against the Polish Constitution to allow abortion if there was a serious deformation of the foetus.

As a result of this ruling, the number of legal abortions decreased tenfold, amounting to only about a hundred cases per year since 2020, according to Statista.

Yet the total annual number of abortions is estimated to be between 80,000 and 93,000. Numerous NGOs help provide information and organisational support for ordering abortion pills online or assisting women to schedule a surgical abortion abroad.

Lack of education 

Women’s protests following the Constitutional Tribunal’s ruling are credited with helping to unseat the PiS party in the last parliamentary elections. The ruling coalition has made abortion on demand until the 12th week of pregnancy one of their top priorities.

Women’s Strike protests in Warsaw, 2020, against the constitutional tribunal sentence dramatically limiting access to abortions.

Even if the relaxation of abortion laws happens, it will do little to improve reproductive rights in Poland, according to Adamczuk. 

“Politicians should acknowledge the fact that simply changing the law will not automatically mean changing the situation for abortion accessibility. We need a more holistic revolution there,” she said.

“What we need is to do work at the ground level, to fight abortion stigma,” she stresses, pointing out that Polish medical circles are reluctant to provide abortion. 

The recent Polish Gynaecologists Association guidelines, for instance, say all other options should be tried before performing the procedure on a patient whose mental health is likely to suffer if they give birth.

Another crucial element is medical education: right now, no classes on abortion care are included in the gynaecologists’ curricula, Adamczuk says. 

Some sources highlight the causal link between the lack of education and the lack of accessibility. 

“If doctors receive the message that abortion is not a normal medical procedure during their studies, they will be more likely to carry on that opinion,” the activist added. “Performing abortions is almost exclusively our burden, of us activists, and most probably that won’t change in the nearest future.”

Decriminalising help

“We simply cannot be penalised for doing the job of the state,” Adamczuk highlighted, pointing out that decriminalising abortion help is one of the most urgent changes that need to happen. 

Last year, Polish abortion activist Justyna Wydrzyńska was found guilty of facilitating abortion and sentenced to eight months of community service. 

Although she declared that the court’s decision won’t stop her from continuing her work, such cases may have had a chilling effect on abortion access.

However, Wydrzyńska’s trial might have inspired another draft Bill currently waiting to be proceeded on decriminalising abortion support. 

The New Left has also proposed other Bills to advance women’s rights, including a change to the definition of rape and more favourable rules for maternity leave.

“We’re glad that abortion is the talk of the town right now, that there’s discussion about it,” says Adamczuk. “But just discussing is far too little.”

Image Credits: Lewica, Abortion Policies Atlas, Greenpeace Polska.

UN Security Council approves a first-ever resolution calling for a cease-fire in Gaza

WHO Director General Dr Tedros Adhanom Ghebreyesus on Monday welcomed a UN Security Council resolution calling for a ceasefire and the assurance of humanitarian aid in Gaza, and the immediate release of all hostages. 

The resolution, which passed with a vote of 14 in favor and the United States abstaining, was the first resolution to pass the body since the 7 October attack by Hamas-led gunmen on Israeli communities that left 1,200 Israelis dead, and triggered Israel’s massive invasion of Gaza in a war that so far has resulted in the deaths of over 32,000 Palestinians, according to Gaza’s Hamas-run health ministry.  

Fighting continues in Shifa and raging around two more Gaza hospitals

Gaza’s Al Shifa hospital during a WHO visit on Friday 1 March – was only just getting back into service after months of siege, officials say.

The director-general’s comments came as fierce fighting continued to rage in and around three strategically placed Gazan hospitals – Al Shifa in the north, and Nasser and Al Amal Hospitals in Khan Younis. 

Israel claims to have killed over 170 Hamas militants in battles at Shifa over the past week, including Hamas chief of internal security, Faiq Mabhouh, along with detaining around 800 people on the hospital grounds. 

Hamas and Islamic Jihad gunmen continued to barricade themselves inside parts of the facility Monday night, Israel said.  The claims were denied by Hamas, which said that over a dozen patients had died during the operation, the most prolonged in a health facility since the war began.   

Patients and health workers who managed to leave the compound described harrowing scenes, with a shortage of food and water, and bodies piling up on the hospital grounds. 

Dr. Tayseer al-Tanna, 54, a vascular surgeon, told the New York Times that Israeli forces had gathered doctors and patients together in parts of the hospital, while they swept the grounds outside.

“The Israeli military didn’t treat us violently,” Dr. Al-Tanna was quoted as saying. “But we had almost no food and water.”   

He declined to comment on whether Palestinian fighters had fortified themselves in parts of the medical complex.

On Monday evening, Israel’s military spokesman claimed that Hamas and Islamic Jihad forces were still positioned inside the hospital’s emergency room, the maternity ward and a burn ward, were firing at Israeli forces, and throwing mortar shells from their positions.  

Following its first incursion into the hospital in November, Israel exposed video footage of Israeli hostages being brought into Shifa on 7 October. It also displayed caches of arms, ammunition and a tunnel dug underneath the compound. But experts later disputed the army’s claims that the hospital had been a major Hamas command and control centre.  On Monday, 17 March, Israel said that it had moved back into the hospital during an overnight operation, after it discovered leading Hamas military operatives regrouping there.

The hospital was only just getting back into service after weeks of siege in northern Gaza, in which medical supply deliveries were largely blocked, said Rick Peeperkorn speaking at a WHO press conference last Thursday.

“Shifa hospital was bouncing back and providing minimal services,” he said. But then a planned WHO mission to the hospital last week was cancelled by Israel. 

“It was cancelled due to the ongoing insecurity in the region. And this is, again, I think we’ve raised so often, what is needed is an effective and a transparent, workable deconfliction mechanism,” Peeperkorn said. 

The northern Gaza area is desperately in need of emergency malnutrition measures to stave off looming famine, he assserted. Hospitals also need to play a key role in this, he said, acting as “nutrition stabilisation centres” while northern Gaza, the area most at risk, is flooded “with ready-to-use therapeutic foods,” followed by a return to local food production as soon as possible.

Al Amal and Nasser Hospitals also now under siege 

Meanwhile, two other hospitals in the southern Gaza city of Khan Younis, Al Amal and Al Nasser, also came under siege by Israeli troops over the weekend, as fierce fighting raged in surrounding neighbourhoods.   

In separate statements, both Hamas officials in Gaza and the Palestinian Authority in the West Bank claimed that Israel had launched assaults on the hospitals, resulting in a number of casualties. Israel denied its forces had entered the hospitals, but said they had been cordoned off during fighting in the area.  

“@WHO and @ochaopt are extremely worried about the safety of the patients, companions, and the few health workers remaining at the hospital. We urgently need safe access to ensure patients can be provided with life-saving care,” stated an X post by WHO’s Office for the Occupied Palestinian Territories. 

“Our team was not given clearance to proceed to the hospital for assessment and facilitating patient transfer this evening but was able to assist nine health workers who walked from Al-Amal to south #Gaza with water and first aid.

“International law is clear: patients, health workers, and civilians must be protected. We urge parties to the conflict to respect their obligations.”

Image Credits: UN News , WHO.

Deep breath: A woman is screened for TB in Valenzuela.

A woman walks to an open tent and stands before a “camera” on a tripod, with a green curtain serving as her backdrop. 

“One, two, three…hold still…deep breath,” instructs the man in a black vest, speaking in Filipino, then presses the shutter.

Within five minutes, the photo is ready. But this is no ordinary snapshot from a photo booth. It is an image of the woman’s lungs taken by a portable X-ray machine.

A radiologist examines the image, and it is clear. The woman doesn’t have tuberculosis and is able to leave the tent feeling relieved. 

With the help of artificial intelligence, this portable X-ray can screen for possible cases of tuberculosis (TB) – even without a radiologist being present.

But while an X-ray is a valuable screening tool, it does not provide confirmatory results. This is where the rapid molecular test machine, Truenat, steps in.

Diagnosis of TB takes just an hour with the Truenat machine, which can run 10 to 12 specimens in eight hours, testing two specimens simultaneously. Compact and portable, it eliminates the need for patients to travel to hospitals or diagnostic centers – and it too can run on batteries.

The instant TB screening was a hit in Valenzuela.

The portable X-ray machine offering free TB screening was a blockbuster hit, particularly amongst the elderly residents of Valenzuela, a city north of Manila, the capital of Philippines. 

The Philippines has the fourth highest TB burden in the world and contributes 7% of global cases, behind India (27%), Indonesia (10%), and China (7.1%), according to the World Health Organization’s (WHO) Global Tuberculosis Report 2021.  

But for the archipelagic country with 7,640 islands, citizens’ access to healthcare and diagnostic  tools has been one of the greatest barriers to addressing tuberculosis. 

The portage X-ray machine are able to determine who should be tested for TB.

The portable X-ray machine, which is compact enough to fit in a regular-sized backpack and runs of batteries that each have the capacity to capture at least 100 images, has the potential to change that – along with the portable rapid tests. 

“In metro Manila, our streets can be very narrow. Where a regular car cannot [enter], But these (X-ray and Truenat machines) can be brought in a suit[case] so we can reach the unreachable,” said Dr Lalaine Mortera, of the United States Agency for International Development (USAID)  Tuberculosis Innovations and Health Systems Strengthening programme.

USAID and Stop TB Partnership have donated eight portable X-ray machines to the country. The other seven machines have been strategically distributed to geographically isolated regions and areas with high TB prevalence, including Bataan, Cebu, Laguna, Tarlac, Pampanga and South Cotabato.

An elderly woman gets screened for TB for the first time in her life.

Mortera told Health Policy Watch that during their visit to Minglanilla, an area near the city of Cebu, a 93-year-old woman had her chest X-rayed for the first time in her life. 

The X-ray machine can screen out those whose lungs are healthy, identifying those who should be tested for TB. Because of these new technologies, Valenzuela was able to achieve a 135% increase in case notification rate for tuberculosis.

Once diagnosed with TB, the city government provides free medication to the patients.

Aside from portable X-rays and Truenat machines, the health department also has mobile clinics. Like an ice cream truck, these mobile clinics go around the country providing basic health diagnosis. 

The Truenat TB test can get results in an hour, and the testing machine is portable and runs on batteries.

Tackling TB in the workplace

Valenzuela, with a population of around 675,000 residents, is home to numerous factories employing thousands of workers. As an industrial city, it became the first in the Philippines to adopt the Workplaces #WorkTBFree initiative run by the labor and health departments.

The initiative offers online resources to assist human resources and occupational safety officers to implement tuberculosis programs in workplaces.

“We hope that these learning tools will help the business sector in Valenzuela City find and treat workers with TB, toward our goal of maintaining healthy workplaces,” USAID Director of Health Michelle Lang-Alli said.

Dr Marthony Basco, Valenzuela’s health officer, said that company nurses also serve as their partners.  

“We just provide them with meds. The patient can take the medicine within their workplaces. We ask for the assistance of their nurses so this doesn’t compromise the continuity of the work,” Basco said.

To sustain TB treatment, the city government also allocates around $17,700 annually, augmenting aid from the national government and external agencies.

“It is not enough that we rely on what the region[al office] or Department of Health give us but also to augment because we do not want any diagnosed patients that are not treated timely,” said Dr Ma Cecilia  Aquino, National TB Medical Coordinator for Valenzuela City.

Recognizing the financial burden on individuals reliant on daily income, the city government also provides financial assistance to workers diagnosed with tuberculosis to ensure treatment continuity.

Moreover, the city has implemented an ordinance aimed at eradicating workplace discrimination which protects workers diagnosed with TB from unjust termination.

Fighting stigma

The stigma and discrimination surrounding tuberculosis present significant challenges in both diagnosis and treatment. The Philippines addresses this issue creatively, presenting TB screening as a routine check-up.

With the slogan “Para healthy lungs, pa-check ka lungs” (For healthy lungs, just check your lungs), the initiative aims to encourage individuals to prioritize their lung health without stigma.

“If you talk about TB screening, people will not come even if it’s free,” Mortera said. “You have to package it like a general check-up. Because the stigma is very high.”

The health department also launched a catchy informative jingle on how to take care of your lungs. 

TB prevalence in the Western Pacific

Despite concerted efforts, the fight against tuberculosis (TB) in the Philippines, as well as in countries around the world, remains an uphill battle. 

According to Health Secretary Teodoro Herbosa, the country recorded 612,534 new TB cases in 2023. This alarming figure represents a significant increase, with 549 cases per 100,000 population compared to 2022’s 439 cases per 100,000 people.

In 2022, the Western Pacific region had an estimated 1.9 million TB cases and 104,000 fatalities. This morbidity figure surpasses the pre-COVID-19 toll recorded in 2019, which stood at 92,000 deaths.

The WHO estimates that around 280 people lose their lives to TB and close to 5,000 people fall ill with this preventable and curable disease every day. 

In response, the 2023 UN General Assembly High-Level Meeting on TB outlined ambitious targets, aiming to accelerate the end of TB by 2027. These goals emphasize comprehensive care, rapid diagnosis, and closing funding gaps.

Image Credits: James Cruz.

mpox virus
Both Clade I and II strains of mpox are circulating in outbreak stricken DRC

WHO officials said that they are trying to expedite delivery of mpox vaccines to outbreak-stricken DR Congo through talks with the world’s only two mpox vaccine manufacturers, as well as appeals for vaccine donations and negotiations with DRC officials.

But speaking at a press briefing on Thursday, WHO’s Dr Mike Ryan, Executive Director of Health Emergencies, and technical lead Maria Van Kerkhove were unable to provide concrete details as to when significant quantities of vaccines could be rolled out – and how many, in light of the global shortage of supplies.  

Despite two years of millions of doses of global mpox vaccine rollout, there has been no mass administration of the vaccines so far in DRC or other west African countries. This is despite the fact that the region, and DRC in particular, is now the epicenter of the largest and deadliest mpox outbreak to date. 

The problems are multiple – ranging from global supply lines to local regulatory hurdles, stigma around mpox and vaccine hesitancy. 

Mpox lesions

At the global level, the production line of Bavarian Nordic, the Belgium-based manufacturer of one the world’s two available mpox vaccines, MVA-BN, halted its production for months in 2022 due to building renovations.  

Then in August, 2023, it received a $120 million contract from the US Biomedical Advanced Research and Development Authority (BARDA) to manufacture new mpox vaccine product in bulk.  But that has only partly restored the depleted US stockpile – believed to be the world’s largest.  

At the same time, stigma around the disease, which can be sexually transmitted, as well as around vaccines more generally has also held back progress in the DRC – one of the most vaccine-hesitant countries in Africa. 

An attempt to donate doses of mpox vaccine was stalled for more than a year, Bavarian Nordic Chief Executive Paul Chaplin said in a statement to Reuters, in December 2023. National regulatory approval of vaccines and medicines has thus inched forward at snail’s pace. 

Taking gloves off to join in partnership

Dr Mike Ryan mpox press conference
Dr Mike Ryan, WHO Executive Director of Health Emergencies at a recent press conference

“We know that production capacity of the manufacturers is closely held proprietary information sometimes, but we have an idea of production,” Ryan said, adding. “I think Bavarian Nordic has been very open to discussing how they could scale up production. 

“And I do know that GAVI and others are willing to engage around how the existing vaccines beyond donations could also be procured.  

“So we are taking the gloves off to join hands in partnership – not to beat anyone around on the head,” Ryan said. 

The MVA-BN vaccine as well as a second vaccine, LC16 KMB, produced by the Japanese firm KM Biologics, both present technical challenges in terms of their administration as well, Ryan pointed out. The MVA-BN requires two jabs – a challenge in settings like DRC wracked by conflict and insecurity.  

The LC16 vaccine, on the other hand, requires intradermal administration – a relatively simple skin jab, but still a procedure requiring training for the health workers unfamiliar with the technique.  

In addition, Ryan added, neither vaccine has yet been formally approved for use in children – and amongst the 250 deaths seen so far in DRC this year, most victims have been children under the age of 15. 

Targeting vaccines due to limited supplies 

“Given limited supply, limited availability of vaccines need to really be able to use those vaccines in a targeted way to reach those who are most at risk,” Van Kerkhove said. 

“We’re currently looking at a number of different ways the vaccines could enter into the country, led by our country office, the Ministry of Health and their partners. We’re looking at bilateral donations, at the use of vaccines as part of a response strategy – at a number of different options apply, but we’re also looking at supply,” she stressed, adding:  “We’re looking at how many doses could be available. And then of course the strategies in which those vaccines can be used in outbreak situations.”

Still trying to understand the epidemiology ’

While the barriers remain, virus transmission continues to expand within communities and geographies. 

“In 2024 alone there have been more than 3000 suspected cases and about 250 deaths with a crude case fatality ratio around 7.8%,” said Van Kerkhove, of the outbreak, the largest ever seen by the DRC to date.  

The high fatality rate is due to the fact that most cases seen so far in the DRC have been of the Clade I mpox virus, which very deadly. 

In contrast, it was the much milder Clade II virus that triggered WHO’s declaration of a global health emergency in 2022 – which it began circulating widely outside of Africa, primarily among men who have sex with men. The emergency  was declared to be over in 2023, after the successful rollout of millions of vaccines among at-risk groups in high and middle income countries.  

As well as being more deadly, the patterns of transmission of the Clade I virus in DRC and West Africa, also appear to be much more varied – although sexual transmission is a factor, it is not the only one.

DRC and global health officials are thus struggling to “better understand the epidemiology,” of the outbreak, which is happening amongs a wide variety of communities and populations – from children to sex workers.  

“There are clearly different outbreaks that are happening, some are happening among sex workers, some are zoonotic transmission and some family clusters,” Van Kerkhove said. 

“We’re working with our country office in DRC, our regional office and many different partners to look at the types of interventions that can prevent infections, but also stop transmission,” Van Kerkhove said. “And one of those interventions is vaccines.”  

“We had a big partnership meeting yesterday. A lot of people are now actively engaged. But let’s be real here.  We do have to look at the different types of scenarios and be realistic about how much vaccine is available, how quickly the vaccines can be used, and how they can optimally be used in different parts of DRC and beyond. To have the biggest impact in stopping human-to-human transmission.”

Image Credits: National Foundation for Infectious Diseases , Tessa Davis/Twitter , WHO.

What actions and strategies are required for countries and communities to have more agency in their health?

This is the topic of the latest episode of the Global Health Matters “Dialogues” podcast series, in which host Dr. Garry Aslanyan tries to “blow up some of the echo chambers that exist in global health.”

In this episode, he talks with Olusoji Adeyi, a seasoned Nigerian global health practitioner who has held many prominent leadership positions, about overhauling the existing power dynamics in global health.

Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi
Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi

“Aid is still used as a lever to exert power over nations at times,” Aslanyan said.

Adeyi proposed six essential changes to turn the situation around.

No. 1—Have clarity of purpose.

No. 2—Consider the needs, realities, and interests of recipient countries as the starting point for any deliberation.

No. 3—Emphasise learning.

“All too often, it’s almost as if principal actors in global health resist learning because such learning might threaten the status quo,” said Adeyi. “When it threatens the status quo, it threatens the current imbalance. And so it’s shut down or suffocated.”

No. 4—Overhaul the legacy foreign aid paradigm, including ending aid for basic health services and commodities and goods.

“This is not a call for an abrupt cessation today,” Adeyi stressed, “but it ought to be done, say by the year 2030, that’s a six to seven-year period so that there’s a finite date in sight and there is a transition out of it, with exceptions only for say countries at war, because then we’re talking about humanitarian purposes or countries that have suffered sudden and devastating natural disasters. Those would be sensible exceptions there.”

No. 5—End the current practice of technical assistance so that the aid given via technical assistance is no longer tied to the source of financing for that technical assistance.

No. 6—Developing/improving/supporting mission-critical institutions in low- and lower-middle-income countries.

Systemic Flaws in Vaccine Distribution

Adeyi highlighted the vaccine distribution process during the COVID-19 pandemic as a prime illustration of systemic flaws. He told Aslanyan that during the pandemic’s peak, “a few individuals convened at Davos and hastily drafted what would essentially become global policy for distributing COVID-19 vaccines and related technologies to low- and middle-income nations.”

Those initial sketches materialized into ACT-A for accelerated access to COVID technologies and COVAX, managed by Gavi. Consequently, during the pandemic’s peak, high-income nations stockpiled vaccines, leaving African countries in a predicament where even those countries that wanted to buy vaccines had to rely on donations rather than purchase vaccines themselves.

“If you go to buy a car, a computer, or a pair of shoes, you are empowered as the buyer,” Adeyi explained. “But if you are waiting for somebody to donate a car, a pair of shoes, or a computer to you, you are disempowered, and you are at the mercy of the donor. And, of course, COVID did not live up to the hype.

“If you had accountable leadership, they would acknowledge that failure and find ways to do better,” he continued. “But the leadership of Gavi did the exact opposite by claiming they had established a blueprint for how to get vaccines to poor people in an emergency, which was just the exact opposite of what had happened.”

Adeyi said that this illustrates how significant power imbalances result in policies, decisions, and practices that counter the interests of those intended to benefit.

Previous “Dialogues” episode: A Conversation with Daisy Hernández.

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: Screenshot, Global Health Matters Podcast.