pandemic
Investment in strong health systems is key to pandemic-proofing the world.

Thirty-seven countries have received grants worth $338 million from the Pandemic Fund to boost their resilience to pandemics in the first round of the fund’s disbursements.

Three disbursements involve multi-country grants: to 12 Caribbean countries to strengthen their early warning surveillance, build laboratory systems and workforce development; to seven Latin American countries to engage communities and territories​ in pandemic response, and to five Central Asian countries to bolster their One Health response.

Single-country recipients include Burkino Faso, Ethiopia, Kazakhstan​, West Bank and Gaza, Yemen and Zambia.

The fund, which was launched at the G20 meeting in November 2022 to help low- and middle-income countries prepare for future pandemics, received 179 applications from 133 countries. 

“We are very pleased that the Pandemic Fund has been able to move forward so quickly to allocate funding to projects that represent a good balance across geographical regions, country income groups, and participating Implementing Entities,” said Pandemic Fund Board co-Chairs, Dr Chatib Basri, former Indonesian finance minister, and Dr Sabin Nsanzimana, Rwanda’s health minister.

Independent evaluation

“All proposals were independently reviewed and evaluated by the Technical Advisory Panel (TAP)and we are confident that the portfolio of projects selected by the board for funding will increase pandemic prevention, preparedness, and response (PPR) capacity and respond to the inequalities that COVID-19 further revealed to the world.”

The WHO’s head of health emergencies, Dr Mike Ryan, currently chairs the TAP, while the fund is hosted by the World Bank.

“In keeping with the Pandemic Fund’s mission to catalyse funding and promote coordination, the $338 million of grants awarded will mobilize over $2 billion in additional resources, adding $6 for each $1 coming from the Fund,” according to a media release from the Fund.

 Priya Basu, executive head of fund’s secretariat, said that the response to the first call was “eight times oversubscribed”. 

“This first round of funding was a learning exercise and we are committed to drawing lessons that will be reflected in how we do business in the future. We are excited to see the results and impact of our funding,” added Basu.

The fund’s second call for proposals is expected towards the end of 2023.

It has raised $2 billion in seed capital from 25 sovereign and philanthropic contributors but needs an estimated $10-billion a year for the next five years to pandemic-proof the world.

Image Credits: Tehran Heart Centre .

United Nations Headquarters, New York

The final reading of the Political Declaration for the United Nations High-Level Meeting on Pandemic Prevention, Preparedness and Response (PPPR) is scheduled for Tuesday in New York – and while the revised text has a few more practical clauses than the bland zero-draft, it remains more aspirational than actionable.

The draft Political Declaration, which has been shared with Health Policy Watch, puts “equitable, people-centered and community-based” primary health care at the centre of countries’ pandemic mitigation.

There are five sections to the “call to action”: equity, global governance, leadership and accountability, health, and financing and investment.

In terms of equity, the declaration commits to strengthening “research and development capacity in developing countries” funded by “greater official development assistance”, surge financing and other “innovative financing”.

Strongest language for medical supply

The strongest language in the declaration calls on member states to “ensure the supply and distribution of sustainable, fair, equitable, effective, efficient, quality, safe, affordable and essential medicines, including generics, vaccines, diagnostics and other health technologies and innovation”.

Some of the “how” to achieve this involves the transfer of technology and know-how “within the framework of relevant multilateral agreements”; voluntary licensing – although confined to cases where public funding has been invested in research and development;  and strengthening “local and regional capacities for the manufacturing, regulation and procurement”.

Emergency trade measures designed to tackle pandemics should be “targeted, proportionate, transparent, temporary”. In addition, they should not “create barriers to trade or disrupt global and regional supply chains”. 

India’s decision to refuse to allow locally manufactured generic COVID-19 vaccines to leave its borders at the height of the pandemic – effectively stopping the only vaccine supply COVID-19 vaccine access platform COVAX had lined up for developing countries – would be antithetical to these clauses.

Manufacturing capacities should be “diversified” across regions and ‘facilitate the movement of medical and public health goods, especially during pandemics and other health emergencies among and within countries”.

The declaration also stresses the need to address the current global pandemics of HIV, tuberculosis and malaria, as well as tackling antimicrobial resistance – a potential pandemic source.  

One contentious clause 

The declaration will be adopted at the High-Level Meeting on 20 September which is aimed at “political mobilisation” for PPPR, but the draft is being finalised in two days of informal consultations on Monday and Tuesday. After Tuesday, the declaration goes into “silence procedure” – that is no more discussion – under the HLM. 

By Monday, the one clause that was still contentious called for “the importance of refraining from promulgating and applying any unilateral economic, financial or trade measures not in accordance with international law and the Charter of the United Nations that impede the full achievement of universal health coverage, particularly in developing countries”.

China, Russia, Pakistan, Cuba and others support this clause but the US, European Union and others want it removed.

The HLM will be “aligned and informed” by the ongoing World Health Organization (WHO) negotiations on the pandemic accord and the changes to the International Health Regulations (IHR), according to the declaration.

Another pandemic HLM will be convened in 2026 “to undertake a comprehensive review of the implementation of the present declaration” – a far cry from the establishment of an international oversight body proposed by the Independent Panel.

Meanwhile, Monday saw the conclusion of the joint plenary meeting of the WHO Intergovernmental Negotiating Body (INB) negotiating a pandemic accord, and the Working Group on the International Health Regulations (WGIHR), which is amending the globally binding regulations relating to public health emergencies.

The WGIHR continues meeting for the remainder of the week, as the two negotiation processes accelerate ahead of the looking summer vacation in the northern hemisphere.

Image Credits: UN Photo/Manuel Elias.

Dr Mike Ryan, WHO head of health emergencies.

The worst outcome of the two World Health Organization (WHO) pandemic negotiations currently underway would be the adoption of contradictory definitions and processes, warned Dr Mike Ryan, the head of health emergencies at the World Health Organization (WHO) on Friday.

“At the very minimum, the two instruments will need to be very aligned on the definitions they use,” stressed Ryan at a joint meeting of the Intergovernmental Negotiating Body (INB) negotiating a pandemic accord, and the Working Group on the International Health Regulations (WGIHR), which is amending the globally binding regulations relating to public health emergencies.

Twisted road from emergency to pandemic

The primary determination of the IHR is whether a  public health emergency of international concern (PHEIC) exists that requires the collective response of the member states, Ryan explained at Friday’s meeting.

“The binary nature of the PHEIC is sometimes difficult to deal with because, at one level you either have a PHEIC or you don’t, [but] the events don’t sit that easily,” said Ryan. 

Ryan suggested that member states could introduce a third category to indicate an “intermediate stage” that would enable WHO to say: “We’re very worried, but it’s not yet a PHEIC”. 

Surprisingly, the International Health Regulations (IHR) do not include a definition of a pandemic, whereas the INB has a draft definition in its compilation draft of a pandemic accord.

The textbook definition of a pandemic is “a public health emergency that represents a fully global threat that we expect to affect everyone in the population”, according to Ryan.

But declaring a pandemic is tricky as it usually had to be made before all countries have been affected and often when there isn’t yet enough data to determine the trajectory of a disease outbreak.

“So the question is, are you defining a pandemic that will occur are you defining a pandemic that has occurred? And when you still have a fighting chance of containing a disease, does a pandemic definition assist or not assist in that process?” he asked.

“You could argue that polio was a pandemic although it was never declared as a pandemic. You could also argue that Mpox was a pandemic because it affected people all over the world, but it affected a particular population segment all over the world. So you can get yourself into a lot of twisted discussions,” he warned.

“Do the member states want to introduce the concept of ‘pandemic’ formally into the process, or do you want to have that characterization built in as part of the declaration of PHEIC? They’re not exactly the same thing.”

 

Already, the process of getting as far as identifying a potential health risk is detailed and complicated.

“There is a very complex intelligence workflow, and this is going on 24 hours a day, 365 days a year, and being carried out by all of our regional and country offices with yourselves,” Ryan told member states.

“Around 60,000 different pieces of information are scanned a month, and at least 1000 signals of relevance are detected,” he added. Around 35 new health threats were considered for a formal rapid risk assessment by the Secretariat each month, with around five requiring assessment.

Country responses

The representative from Brunei.

In response to the challenges Ryan posed, the US suggested: “a tiered alert system under the IHR 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”. 

The US said that it viewed the “current PHEIC or binary approach as insufficient to trigger international coordinated action at earlier stages of outbreaks”. This was needed to “mobilise resources, facilitate early assistance and allow countries and regions to ramp up response measures in a more tailored and timely way”.

“Our proposal under the IHR also includes the pandemic emergency declaration within this tiered alert system to maintain consistency with the well-established framework to evaluate risks and to galvanise a coordinated global response to declared emergencies,” added the US representative.

“This IHR pandemic emergency declaration would be linked to the pandemic accord because of its ability to trigger activation of emergency response provisions within the accord.”

Brunei proposed “a simple definition of a pandemic as a PHEIC resulting from an emerging infectious disease with potential to overwhelm health systems”, and said its declaration should lie within the provisions of the IHR.

“While the IHR has its emphasis on the early spread of disease, it doesn’t say very much about what happens when the global spread is already well established. It is in this gap that we see a pandemic accord can be of most value by providing for a multilateral system for ensuring global health security in the event of sustained and prolonged disease spread,” added Brunei. 

The Brunei representative made a rather neat distinction between the two instruments, characterising 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”, and the pandemic accord, which “could serve as an instrument that outlines the obligation of member states to each other”. 

Australia also supported strengthening the process to declare a PHEIC and new IHR provisions “to introduce criteria for declaration of a pandemic or pandemic emergency”.

“The criteria must be unambiguous and meaningfully differentiate between a pandemic and a PHEIC, and the definition of a pandemic should avoid restrictive criteria that might delay effective public health responses,” it stressed.

The joint WGIHR and INB meeting continues on Monday.

INB informal meetings to continue

Meanwhile, the public report back at the end of the sixth INB meeting on Friday yielded very little information other than that there will be more informal meetings to assist with its negotiations on the controversial Chapter Two on equity. 

The informal meetings will continue on research and development (Article 9), on access and benefit sharing (Article 12) and supply chain logistics (Article 13).

Three new informal meeting processes have been added to the already overloaded agenda. Informal meetings on the “co-development and transfer of technology and know-how” (Article 11) will be co-facilitated by Colombia, the Philippines and Saudi Arabia.

India, Tanzania, and the United Kingdom will co-facilitate informal talks on pandemic prevention and public health surveillance (Article 4) and “Strengthening pandemic prevention and preparedness through a One Health approach” (Article 5).

Pandemic accord
A COVAX vaccine delivery to Africa in April 2021

With the fate and nature of the pandemic accord currently being negotiated by World Health Organization (WHO) member states still uncertain, global health experts are calling for “realistic” backup plans to protect the world against the next pandemic.

“We need an ambitious but implementable pandemic accord – that is the Holy Grail,” Javier Guzman, Director of Global Health at the Center for Development (CDG) told a CDG panel on Thursday convened to discuss the lessons of the pandemic, particularly in relation to the global COVID-19 vaccine access platform, COVAX.

“Now, will it materialize? Will it be enforceable? Would it be ambitious enough? Will it be ratified? I’m not very optimistic, based on what I’ve seen,” said Guzman. “So if that doesn’t happen – or if that happens, but it’s not enforceable, or it’s not what we all need as the globe – then we need to move to the second best option, which is realistic options.”

Guzman said that two such options include building regional vaccine manufacturing capacity and ensuring vulnerable countries have quick access to financing. He cited the regional level, particularly in Africa, as the place to seek solutions to the problems of equitable access to vaccines, which were predominantly felt at a regional rather than global level.

Regional manufacturing efforts are underway

Around 30 investment initiatives across 14 African countries for vaccine manufacturing on the continent have been announced since COVID-19. / Image: PAVM, Gavi, AVMI, Africa CDC, Lion’s Head Research, WHO.

Support for African manufacturing is already progressing. Next month, Gavi, the global vaccine alliance, the African Union (AU) and the African Centre for Disease Control and Prevention (Africa CDC) are convening a regional vaccine manufacturing forum to bolster the least-resourced continent.

The aim of the forum is for African leaders, African manufacturers and Gavi to “strategize around sustainable manufacturing”, said Gavi’s Aurélia Nguyen. Gavi and the AU have already signed a memorandum of understanding in this regard.

“Investing in our routine systems is the backbone of investment in pandemic preparedness and response if we’re able to make more systemic changes,” added Nguyen, COVAX’s former CEO and Gavi’s Chief Program Strategy Officer.

Akhona Tshangela, programme coordinator for the Partnerships for African Vaccine Manufacturing (PAVM) at the Africa CDC, said that the continent “is working towards building a vaccine manufacturing capacity that promotes tech transfer and strengthens the regional framework”.

The PAVM has been formed to address the limited production of vaccines, diagnostics and therapeutics on the continent, said Tshangela, adding that the AU’s memorandum of understanding with Gavi will “help support our manufacturers on the continent to gain entry into the markets”.

“In addition to vaccine manufacturing, we’re also focusing on ensuring that we develop regional regulatory harmonisation frameworks so that whatever products come out of the African continent are seen as good quality and safe for use not just globally,” Tshangela added.

While there is a lot of appetite and political will for diversified vaccine manufacturing, and the benefits for the resilience of the global vaccine supply chain are clear, the costs must also be placed squarely on the negotiating table, said Guzman. 

“Clearly, we need to understand that there is a trade-off,” he said. “If you want to have diversified vaccine manufacturing, you sacrifice some economies of scale, you sacrifice price, affordability.”

Access to financing

L-R: (top)Janeen Madan Keller (moderator), Matt Cooper, Javier Guzman,(bottom) Aurelia Nguyen, Akhona Tshangela, Saul Walker.

Nguyen highlighted five key lessons from COVAX for future pandemics: having financing from day zero; clear communication with stakeholders, particularly about risk; equitable access, particularly for the most vulnerable; legal and regulatory challenges to access, and trade-related barriers in a pandemic setting. 

Whether the world has learnt Nguyen’s first lesson of the COVID-19 pandemic – that financing must be available from day zero – remains uncertain.

Financing for pandemic preparedness

A pandemic fund to bolster global investment in prevention, preparedness and response ahead of the next pandemic was launched at a G20 meeting last year, but the fund has mobilized far less than the estimated minimum of $10 billion a year needed to equip countries to combat future pandemics.

“How we can maximise the investments by the pandemic fund to support pandemic preparedness? And now what is the conversation about surge financing?” asked Guzman. 

“We’ve got new heads of the World Bank and the Inter-American Development Bank – but how can we, either regionally or globally, agree on a framework to provide swift access to funds in response to a pandemic? That could be relaxed rules on country borrowing or it could be automatic access for pre-qualified countries,” he said. 

Saul Walker, Director of Public Partnerships at the Coalition for Epidemic Preparedness Innovations (CEPI), also spoke about the need for quick access to finances in the face of a pandemic.

Although CEPI made some “initial investments” in mRNA vaccine research and development (R&D) in February 2020, it was simply unable to compete with the vast R&D funding coming in from high-income countries and other funders in later rounds. 

If CEPI had been able to compete with this funding, it might have enabled more equitable access to the mRNA vaccines that were later developed.

Matt Cooper, an independent consultant for Itad who took part in an independent evaluation of COVAX completed in May, argued that the global pandemic preparedness and response strategy must find a way to “facilitate, incentivize, perhaps even compel, vaccine manufacturers to engage in tech transfer agreements such that vaccine suppliers can be scaled up as rapidly as possible”.

“Countries are serving their own populations first and companies are pursuing their commercial interests,” warned Cooper. “Let’s be under no illusion that those behaviours will be replicated in the future.”

Ducks in a row

On 24 February 2021, a plane carrying the first shipment of COVID-19 vaccines distributed by the COVAX Facility landed at Kotoka International Airport in Accra.

Responding to COVID-19 was like “flying a plane while we were building the plane, and then trying to work out where to land it,” said Walker.

CEPI was only three years old when the pandemic started and had to work out a multitude of things on the fly. This was also true for the many organisations, countries and structures working together as the pandemic unfolded. 

Stakeholders in the pandemic response had to hash out  “roles and responsibilities, handoffs, how information flows up and down a value chain, how much delegation boards are given to be able to move fast, what the risk tolerances of different organisations are,” said Walker.

“And actually as you move along, roles and responsibilities change,” he said.

For Nguyen: “At the end of the day, it really is the strength of the health system that determines the strength of the pandemic response.”

And for Guzman, the current period of preparation must not be wasted as the next pandemic looms: “It’s about timing. It’s about having everything ready to go.”

Image Credits: WHO, UNICEF/Kokoroko.

Raquel da Silva, who lives in Manaus in Brazil’s Amazonas State, had malaria five times in five consecutive months.

Brazil is the first country in the world to introduce tafenoquine, the first new single-dose treatment for P. vivax malaria developed in 70 years, in its public health system.

Raquel da Silva has lived in Manaus in Brazil’s Amazonas State since her childhood. Today she shares her home on the banks of the Rio Negro with her husband Camilo, their three children, her mother-in-law and her grandmother-in-law. 

On the weekends, she works in a restaurant. As a mother of three, Raquel needs her energy to keep up with her children, but living in one of the most malaria-affected areas in the country, she has lost track of how many times she has contracted malaria. 

“My family and I had malaria five times for five consecutive months last year,” Da Silva told Medicines for Malaria Venture (MMV) when she first met them in 2020.

“When I got malaria, my baby was six months old, so I didn’t manage to take the full treatment regimen for seven days. I took just enough so my symptoms would improve, so it always relapsed. My husband works so he had to leave the house and I didn’t have energy to do anything. It was hard.”

Malaria disproportionately impacts the poorest and most vulnerable in society, perpetuating a cycle of poverty. P. falciparum, which is more deadly and prevalent in Africa, has long received the most attention in the malaria world, but P. vivax, known for its frequent relapses, also requires focus if more malaria-endemic countries are to join the 41 nations that have already been declared malaria-free.

Approval of tafenoquine for national rollout

On 5 June, Brazil took an important step in that direction, becoming the first country in the world to approve the new single dose P. vivax treatment, tafenoquine, for nationwide rollout in the public health system.

P. vivax malaria is the most geographically widespread of the two parasites and is the predominant species in most countries in Asia-Pacific and Latin America as well as in other areas on the cusp of malaria elimination.

Transmission is driven by the parasite’s ability to cause relapses – patients suffer recurrent malaria episodes from just one infectious mosquito bite, and human-to-human transmission occurs when a mosquito feeds on the blood of an infected person and transmits the parasite to family members, friends, and neighbours. 

To stop the relapses, both the blood- and liver-stages of the P. vivax infection must be treated, providing what is known as ‘radical cure’.

Until now, this involved blood-stage treatment with chloroquine for three days and liver-stage treatment with primaquine for seven or 14 days. But there are huge issues with treatment adherence. Most patients will not complete the full 7-14 day treatment course, and so risk suffering relapses which in turn fuel further P. vivax malaria transmission.

Turbocharging Brazil’s efforts to eliminate malaria

In Brazil, where over 80% of reported malaria cases in 2021 were caused by P. vivax, the Ministry of Health (MoH) and the country’s malaria research community have been searching for better tools to tackle P. vivax malaria for a long time. 

Between 2014 and 2016, researchers in Manaus and Porto Velho played a pivotal role in the clinical development programme for tafenoquine, the single-dose treatment developed by GSK and MMV.

The same researchers also conducted critical clinical and operational studies on a new point of care test, developed by SD Biosensor and PATH  that could identify a hereditary condition, glucose-6-phosphate-dehydrogenase (G6PD) deficiency, which can cause haemolytic anaemia in those who take either primaquine or tafenoquine. In Brazil around 5% of the population is presumed to be G6PD deficient.

The new G6PD test opened up new opportunities to rapidly diagnose the condition and adapt treatment accordingly. Tracking the development of the diagnostic and treatment in tandem, Brazil’s Ministry of Health recognised their potential to supercharge the country’s malaria elimination efforts.

By the time tafenoquine had been approved as a treatment and registered in Brazil in 2019, plans were already underway to study the drug’s real-world application in Manaus and Porto Velho. The MoH wanted to know whether it would be feasible for health workers, at different levels of the vast network of malaria services within the public system, to perform the quantitative point-of-care G6PD test and provide tafenoquine or primaquine based on the test results.

First real-world study launched with impressive results

Fast forward, past COVID-related delays, to September 2021 when the first real-world study, TRuST, was launched, sponsored by the MoH and MMV. The MoH in coordination with the Municipal and State level health authorities rolled out tafenoquine and G6PD testing in 43 health facilities throughout Manaus and Porto Velho. 

They trained 370 healthcare professionals, and more than 6,000 patients consented to have their data anonymized and collected for analysis by the TRuST study team.

The results were impressive. The level of compliance with the new treatment protocol was above 99%, consistent across all healthcare facilities, showing that routine testing for G6PD activity before providing appropriate radical cure was feasible throughout the Brazilian health system. 

Following the end of patient recruitment into the study in August 2022, a comprehensive dossier was submitted to CONITEC, the country’s health technology assessment body, in December of that year. The dossier included the first and second interim analyses of TRuST; a qualitative research study looking at patient and health worker perceptions; a cost-effectiveness analysis; and a budget impact analysis. 

On reviewing this, CONITEC recommended that the new tools be incorporated into the public health system. On 5 June, the government of Brazil issued a decree on adoption, making it the first malaria-endemic country to introduce single-dose tafenoquine and quantitative point-of-care G6PD testing throughout the health system.

As one of the patients treated with the new shorter treatment during the study, Raquel is optimistic about the new possibilities that the drug provides. She says that, although she also takes preventive measures such as using bed nets, the drug provides a sense of security in case she or her family members do fall ill again.

Regional impact

What does this mean beyond Brazil? Countries in the region are already seeking to learn from Brazil’s experience. A similar tafenoquine and G6PD testing feasibility study, funded by Unitaid, is about to start in Peru with support from MMV and the University of Peru Cayetano Heredia (UPCH). 

The team there received training from the TRuST team in December 2022, enabling them to move more quickly, based on the Brazilian experience. The Ministry of Public Health in Thailand is conducting a similar study with support from MMV, examining routine use of tafenoquine and point-of-care G6PD testing in hospitals and malaria clinics. 

Recruitment in that study is set to conclude in August, providing real-world evidence from a different context. Unitaid is supporting two additional real-world feasibility studies on the use of tafenoquine and G6PD testing in Vietnam and Ethiopia, with support from the international global health non-profit PATH and local research partners. Together this emerging evidence may inform WHO guidelines and support national malaria programmes as they seek to optimise tools for the control and elimination of P. vivax.

Marcus Lacerda was one of the Principal Investigators on both the Tafenoquine Rollout STudy (TRuST) and the Tafenoquine Phase III studies.

Elodie Jambert is senior director at Medicines for Malaria Venture (MMV), the product development partnership that co-developed tafenoquine with GSK and co-sponsored TRuST with the Brazilian Ministry of Health.

Image Credits: Nathalie Brasil, Instagram: @_nathaliebl.

Firearms were the leading causes of death amongst children and teenagers aged 1-17 in the US in 2020 and 2021, according to a new study published by KFF, a US-based policy think tank.

The number of children dying in firearm-related incidents in the US has doubled since 2013, and now ranks higher than other causes of death like injury and illnesses. Death by firearms includes suicide attacks, assaults, and attacks for undetermined reasons.  

Firearm-related deaths accounted for 20% of deaths of children under the age of 18 in the US in 2021. This amounts to a total of 4,733 deaths, with 2,571 of them children aged 12 and under. 

The mortality rate due to firearms in teens is particularly high at 25.2 deaths per 100,000. The mortality rate of children alone due to gun-related incidents in 2021 was 3.7 deaths per 100,000, over double the number recorded in 2013, at 1.8 deaths per 100,000 – and that was the lowest in recent times,  The second leading cause of deaths in this age group is motor vehicle accidents. 

Provisional data from 2022 saw gun deaths remaining the top cause of death in this age group, tracking a steep increase in gun violence assaults across the country. 

This mortality rate is around 10 times the average seen in other similarly large and wealthy countries in the world. Canada occupies second place in child and teen mortality rates due to firearms. Other than Canada, no other peer country has “firearms” in the top-five causes of children’s deaths. 

Regulation aligns with mortality

A hotly debated topic in the US, gun violence is an extremely political issue in which both sides – those protective of their right to bear arms, and those demanding stricter laws around the purchase and possession of firearms – hold considerable influence in electoral outcomes. 

Analyzing the correlation between laws around the purchase and possession of firearms, the study pointed out that the mortality rate attributed to firearms was markedly lower in states with strict gun laws, compared with the rates reported in states with liberal laws around the purchase and possession of firearms. 

Louisiana, Mississippi, and Alabama reported the top three highest firearm mortality rates in children and teens, while New York reported the lowest firearm mortality rate in the country. However, even the rate recorded in New York is thrice that of Canada. 

According to the Gun Violence Archive, a US-based non-profit working to publish accurate public information on gun violence incidents across the country, there have been 420 mass shootings, including mass murders, in the US during the first half of 2023. Over 1,000 children and teens aged 1-17 have been killed in these attacks. 

Image Credits: Max Kleinen/ Unsplash.

China’s climate progress is  rated as ‘highly insufficient’

After three days of climate talks with Chinese officials, US Climate Envoy John Kerry acknowledged political differences were obstructing cooperation between his country and China, the world’s biggest climate polluters.

Kerry concluded his Chinese visit by appealing for the climate crisis to be addressed as a stand-alone issue separate from politics if progress is to be made.

Climate talks between the two countries were suspended almost a year ago by China, angered by the visit last August of US House of Representatives Speaker Nancy Pelosi to Taiwan.

According to the US State Department, Kerry’s visit was aimed at “increasing implementation and ambition and promoting a successful COP28”.

The 28th United Nations Framework Convention on Climate Change Conference of Parties (COP28), the world’s climate change negotiating forum, is meeting in the United Arab Republic from 30 November to 12 December.

Despite its global commitments, China has made very little progress in cutting its greenhouse gas emissions, and is ranked “highly insufficient”, the second worst rating, by the Global Climate Tracker.

However, Chinese leader Xi Jinping told an environmental meeting on Thursday that his country was “accelerating greening and low-carbonization” but that it would achieve the climate goals at its own pace, according to the China People’s Daily.

Kerry’s visits took place amid scorching heat waves in Europe, Asia and US. China’s northwestern Xinjiang region recorded its highest temperature ever of 52.2C on Sunday.

A technician assists health workers with a drone at Matawale Health Centre in Zomba. Malawi has started using drones to distribute polio vaccines.

On a partly cloudy morning last week, staff and onlookers watched with excitement and curiosity as a drone carrying polio vaccine doses was launched from the Matawale Health Centre in Zomba in eastern Malawi.

The drone was being sent to Chisi Island, one of the hard-to-reach parts of this district that is often left out of health initiatives due to its difficult geographical terrain.

But after wild poliovirus was detected in a young girl in Malawi’s capital, Lilongwe, in March 2022 and three further cases of vaccine-derived poliovirus were detected last year, the country started a supplementary campaign against polio.

Currently, 17 suspected cases of polio are awaiting diagnosis after specimens were sent to a laboratory in South Africa and health authorities are racing to vaccinate some 8.8 million children from birth to the age of 15 years with its immunisation drive.

The use of drones to deliver vaccines to Chisi Island and other hard-to-reach areas has seen an increase in immunisation coverage. It also offers hope to parts of the country where health infrastructure and roads have been damaged due to the recent Tropical Cyclone Freddy.

From bad roads and boats to mere minutes

Ordinarily, staff from the Zomba District Health Office (DHO) would drive 50 kilometres to Kachulu Beach with medical supplies including vaccines. At the beach, the supplies would be transported by a motor boat for 30 minutes before finally reaching the Island. Fuel for the boat alone costs K120,000 (about $126) f.

“This was costly and time-consuming for our office. Transporting commodities has been a matter of a few minutes using the drone,” says Zomba DHO spokesperson, Arnold Mndalira.

Before the fifth mass polio vaccination campaign, which ran from 12-15 July, the Zomba district office used a drone for the first time to transport COVID-19 vaccines, blood samples and specimen results, Mndalira explains

“The drone has a 3.5kg carrying capacity. Plus the advantage with this is that it can go several times within a short time,” Mndalira told Health Policy Watch.

The drones are supplied and managed by Swoop AERO, a global medical drone logistics networking company. 

The Malawi government and UNICEF launched an air corridor to test the potential humanitarian use of drones (also known as unmanned aerial vehicles) in 2017. 

This corridor is the first in Africa and one of the first globally with a focus on humanitarian and development use, according to UNICEF. 

Swoop AERO now delivers essential medical commodities to 60 remote facilities across six districts in Malawi.

Anne Nderitu, Operations Manager for Swoop AERO.

“It’s so satisfying to deliver life-saving commodities such as vaccines using drones. It feels good to be part of making a difference in people’s lives,” says Anne Nderitu, Operations Manager for Swoop AERO. 

Health facility workers have been trained to receive the drone for the mass polio vaccination campaign and other medical commodities. By 14 July – day three of the campaign – the drones had already delivered 8,500 polio vaccine doses to hard-to-reach areas in Zomba, Chikwawa and Mangochi districts. The drone can carry 2,000 doses in one trip.

“We are targeting to reach 24 districts with this technology in the coming months. It’s imperative to extend these services to a wider Malawian public health space,” Nderitu says.

However, she notes that unpredictable weather is one of the drawbacks in drone operations.

But Africa’s poor transportation and logistics derail the distribution of medicines and vaccines, particularly medicines with short shelf lives.

“Drone technology is providing the logistical and delivery solutions that can potentially enable African countries to distribute essential supplies to disadvantaged communities, remove access restrictions and facilitate the quicker delivery of life saving medications and vaccines,”  according to the African Union Development Agency, NEPAD.

Tamanda Chikuni says her child has sometimes missed vaccinations because of stockouts.

Tamanda Chikuni, a parent living near the Magomero Health Centre, praised the use of drones to deliver vaccines and medical supplies.

“My child has missed routine immunisations before due to vaccine stockouts at Magomero Health Centre. The facility could not immediately restock due to transportation challenges. The drone has simplified the process,” said Chikuni.

Benson Wyson, a Health Surveillance Assistant at Magomero Health Centre, says the drone technology has simplified his job: “Vaccines arrive on time. We no longer have to wait longer to restock. This has even made the mass polio vaccination more successful than the previous ones.”

Two days after the mass vaccination launch, the facility had already reached 7,000 of the 16,000 targeted children with the polio vaccines.

The facility is 34 km from Zomba District Health Office but it would take the whole day to receive vaccines and medical supplies due to logistical arrangements and transportation time With the drone, the process now takes 13 minutes.

Simon Kondowe, UNICEF Malawi’s Polio Cold Chain and Vaccine Management Consultant, says drone-driven vaccine delivery has assisted in boosting immunisation coverage for the polio campaign.

“UNICEF is committed to ensuring that immunisations are up to standard using innovative systems like drone technology. Some facilities in the country have become inaccessible following Tropical Cyclone Freddy but we are reaching them with medical suppliers using the drone,” he told Health Policy Watch. 

Helping to achieve universal health coverage

In many remote, developing regions of the world, drones are one of the most effective solutions to achieving universal health coverage, where mobility is a key stumbling block to meeting healthcare targets.

Professor Adamson Muula, head of Community and Environmental Health at Kamuzu University of Health Sciences (KuHes), says that Malawi and its development partners have taken a bold decision use drones.

“But while we can discuss the obvious benefits such technology has afforded it, we must also embrace rigorous assessment, especially by independent agencies and consultants as to the cost-effectiveness of such initiatives,” cautioned Muula, noting that the price to buy and maintain drones needed to be considered.

“Since the drones were introduced because of gaps in health services delivery, have these gaps been completely addressed? Or has the situation been that some problems have been addressed and others have been left unattended?” he asked.

Muula also observed many of Malawi’s usual health service delivery problems were addressed by technological innovations funded by development partners, which “makes the health sector extremely fragile”.

Image Credits: Josephine Chinele, UNICEF Malawi.

Dr Tedros Adhanom Ghebreyesus speaking at the media briefing in Geneva on Wednesday.

With the sixth meeting of the Intergovernmental Negotiating Body (INB) meeting to develop a  pandemic accord currently underway in Geneva, the World Health Organization (WHO) chief minced no words when he slammed “groups with vested interests” for trying to sabotage the negotiations.

“Twenty years ago, the tobacco industry tried to undermine negotiations on the WHO Framework Convention on Tobacco Control. The same thing is happening now,” Dr Tedros Adhanom Ghebreyesus told a media briefing at the WHO headquarters in Geneva on Wednesday.  

“Groups with vested interests are claiming falsely that the accord is a power grab by WHO, and that it will stymie innovation and research. Both claims are completely false,” said Tedros.

The sixth INB meeting, which ends on Friday, when it will meet with the Working Group on the amendments to the International Health Regulations (WGIHR). The WGIHR, which is looking into how to tighten compulsory international regulations that govern public health outbreaks and pandemics, holds its fourth meeting from 24 to 28 July. 

Both groups are expected to present final drafts of their negotiations at the World Health Assembly in 2024. 

Doubling down on his displeasure with the unnamed “vested groups”, Tedros said that those who spread “lies” about the pandemic instrument are “endangering the health and safety of future generations”. 

“This accord aims to address the lack of solidarity and equity that hampered the global response to COVID-19. It’s a historic opportunity for the world to learn the painful lessons COVID-19 told us and make the world safer for generations to come.”

On Monday, as the INB negotiations resumed, co-chair Roland Driece, urged member states to complete discussions on the contentious Chapter Two of the compilation draft before a first draft could be formulated for text-based negotiations. 

“I would rather have a first draft that has substance, which we all feel is strong enough to have real line-to-line discussions on, than having something in between which is not good enough yet,” said Driece.

Tedros’ words come in light of the continued efforts to dispel mis- and disinformation about the pandemic instrument on social media. Twitter in particular has been awash with conspiracy theories about COVID-19 and the subsequent pandemic accord negotiations.

Earlier this year, Twitter CEO Elon Musk tweeted that “Countries must not cede authority to the WHO”. His tweet was in response to a speech by the Australian Senator Malcolm Roberts criticising the global health agency. 

Tedros responded that the countries would not be ceding sovereignty to the WHO as the pandemic accord will not change the sovereign status of any country. 

Tedros said on Wednesday that the pandemic accord is like a business contract signed by two companies, likening countries to companies. 

“If two companies sign a business contract and use lawyers to help them develop it, that doesn’t give the lawyers control over the contract, nor make them a party to it. It’s the same here,” he said. 

“The pandemic accord is an agreement between countries and the WHO is helping them to develop that agreement. But WHO will not be a party to the agreement…This is an agreement between countries and countries alone.”

Image Credits: WHO.

For the second time this year, a new drug showed that the cognitive decline caused by Alzheimer’s disease – the leading cause of dementia worldwide that affects an estimated 55 million people – can be slowed down.

Clinical trial results for donanemab, presented to the Alzheimer’s Association International Conference on Monday, showed the antibody medicine developed by Eli Lilly slowed the cognitive decline of Alzheimer’s patients by 35%. The drug was even more effective in the earliest stages of the disease, reducing cognitive decline in patients by around 60%.

Lecanemab, a similar drug made by Eisai and Biogen, received full marketing approval from the US Food and Drug Administration (FDA) earlier this month, based on clinical trial data that showed the drug slowed cognitive decline in participants by 27%. 

The back-to-back success of trials for antibody treatments targeted at Alzheimer’s are the culmination of decades of research long viewed as a dead-end. A decade ago, leading drugmakers such as GSK, AstraZeneca and Pfizer shelved efforts to develop drugs to treat the disease, citing the high price tag and slim chances of success. 

“We have waited a long time for Alzheimer’s treatments, so it’s really encouraging to see tangible progress continuing to gather pace in the field,” said Giles Hardingham, who leads the UK Dementia Research Institute. “It is terrific to see these results published.” 

The FDA approval of Lecanemab in June was the first time a drug proven to slow the effects of Alzheimer’s was made available to patients, marking a watershed moment in the fight against the disease. Eli Lilly said in a press release it expects the FDA to take regulatory action on donanemab by the end of this year. 

While the clinical effects of recent breakthrough drugs remain modest, experts said their efficacy proves that the once unstoppable disease could one day be managed and treated. 

“This is truly a turning point in the fight against Alzheimer’s,” said Dr Richard Oakley, an associate director of research and innovation at the Alzheimer’s Society. “Science is proving that it is possible to slow down the disease.”

Clinical results highlight the complexity of Alzheimer disease

Both new drugs are based on a theory of Alzheimer’s called the ‘amyloid cascade hypothesis’, which holds that the abnormal buildup of a small proteins in the brains of people with Alzheimer’s is a primary cause of the disease. 

The proteins, known as amyloid peptides, clump together to form plaques that can damage neurons and kill cells. Lecanemab and donanemab work by clearing these toxic proteins from the brains of patients.

Brain scans of patients participating in the clinical trials showed both drugs were extremely effective at eliminating the amyloid proteins they are designed to target. Donanemab was so effective that a significant number of patients were switched to a placebo after the drug cleared enough amyloid plaques. 

The trials show that removing amyloid from the brain is capable of changing the course of Alzheimer’s. But a series of editorials published in the Journal of the American Medical Association (JAMA) alongside the results for Eli Lilly’s drug said the data showed amyloids are just one part of the complex picture of Alzheimer’s. 

“Donanemab was very effective at eliminating its target,” Jennifer Manly, from Columbia University Irving Medical Center, and Kacie Deters, from the University of California, Los Angeles, wrote in one JAMA editorial. “The clinical effect was comparatively weak.”

In another editorial, a team of experts from the University of California, the University of Wisconsin and Upstate Medical University echoed similar concerns about the drug’s limitations, observing that the “results serve to highlight the complexity of Alzheimer disease itself.” 

“The exceptional ability of drugs such as donanemab and lecanemab to remove amyloid, paired with their rather subtle effect on the rate of decline in cognitive and functional measures, suggests that amyloid is likely not the only factor that contributes to Alzheimer’s disease progression,” they said. 

Both drugs also involve risks. Brain swelling was observed in up to a third of patients in the donanemab trial, mostly without incident. Brain bleeding occurred in a small minority of patients, and three participants, including one from the placebo group. died of “treatment-related” complications.

Then there is the price-tag: One year of Lecanemab costs $26,500 in the United States. The competition introduced by Eli Lilly’s new drug is expected to reduce the price, but cutting-edge treatments don’t become inexpensive overnight. 

“The modest benefits would likely not be questioned by patients, clinicians, or payers if amyloid antibodies were low risk, inexpensive, and simple to administer,” another JAMA editorial observed. “They are none of these.”

A ‘new era’ in the dementia fight

Eli Lilly said it expects the FDA to take regulatory action by the end of 2023.

Science still has much to learn about Alzheimer’s, but the pace of research is picking up. More trials for Alzheimer’s drugs are ongoing now than ever before, according to research from the University of Nevada.

And there is a lot of ground to catch-up: Nearly 5 million papers about cancer have been published on the public medical research database PubMed – 19 times more than on dementia. Experts hope recent breakthroughs will stimulate funding and allow the field to build towards more effective medicines.

“This is just a start,” said Howard Fillit, chief scientist of the Alzheimer’s Drug Discovery Foundation. “We must continue advancing the drug pipeline to develop the next class of drugs centered around the biology of aging to ultimately stop Alzheimer’s in its tracks.

The new treatments for Alzheimer’s disease are not a cure, but they can still be life-changing. Slowing the onset of common symptoms like memory loss, concentration lapses, and difficulties communicating can allow people with Alzheimer’s to live active, independent lives for longer.

David Colley, an 80-year-old patient who took part in the clinical trial of the drug donanemab, told the BBC that he is “one of the luckiest people you’ll ever meet.”

His son, who observed Colley’s cognitive decline in the years leading up to the trial, said the treatment stabilized his father’s condition, allowing him to continue to participate in the family’s life.

“Thanks to decades of research, the outlook for dementia and its impacts on people and society is finally changing,” said Dr. Susan Kohlhaas, research director at Alzheimer’s Research UK. “We’re entering a new era where Alzheimer’s disease could become treatable.”