The presence of Hungary’s President, Katalin Novak (second from right) as a speaker at the Women Deliver conference, shocked many SRHR advocates.

The Women Deliver conference is one of the world’s largest gatherings on gender equity and sexual and reproductive health and rights (SRHR). This year, amidst a global backlash against the rights of women and people of diverse genders, the meeting was held for the first time in Africa in Rwanda from 17-20 July.  More than 6,300 women’s rights activists, feminists, and policymakers from 170 countries attended.

There were significant outcomes. Most notable was Canada’s commitment of more than $200 million in funding for new projects to support sexual health and reproductive areas, including family planning, comprehensive sexuality education, advocacy for SRHR, safe abortion and post-abortion care, and sexual and gender-based violence. There was also a timely boost for resourcing feminist movements and growing collective political influence from the local to multilateral spaces. 

Closing the gender nutrition gap

A monumental campaign, Closing the Gender Nutrition Gap: an Action Agenda for Women and Girls, was launched by over 40 organizations to close the gender nutrition gap. Women and girls worldwide are twice as likely to suffer from malnutrition as men and boys. 

This campaign is an excellent opportunity for feminist movements to highlight the stark – and growing – inequalities in nutrition. Cultural norms, social roles, economic disparities, and discriminatory practices create and sustain this overlooked crisis. 

‘Closing the Gender Nutrition Gap’ identifies four action areas.

The United Nations Population Fund (UNFPA) announced the Kigali Call to Action: United for Women and Girls’ Bodily Autonomy to accelerate investments and actions, with women-led organizations and the feminist movement at the center. UNFPA called for coordinated and collective action to achieve bodily autonomy, reproductive rights and gender equality for women and girls everywhere.

Increased attacks

The meeting came a year after the US Supreme Court struck down Roe v Wade, a key abortion rights law, which is still sending vibrations and bringing a lot of uncertainty about women’s reproductive rights beyond the US.  

In Africa, for the last few years, conservative leaders have been restricting space and policy around women’s bodily autonomy, donors have restricted funding, and there’s fear among civil society organizations advocating for reproductive justice, including abortion. 

There are intensified, well-organized attacks on the human rights of women and the LGBTQI+ community, especially in Africa. Women and LGBTQI+ people are becoming increasingly unprotected in many African countries as they are subjected to waves of well-funded efforts by anti-rights actors that endanger lives.

Family Watch International head Sharon Slater, a leading international opponent of sexual and reproductive health rights, on a visit to Uganda shortly before that country adopted its Anti-Homosexuality Act.

Well-organized anti-gender movements have been working to undermine women and LGBTQI+ communities rights for decades. This growing conservative, anti-gender narrative includes key influential policymakers, fundamentalist religious bodies, and even some “progressive” governments funding anti-LGBTQI+ backlash through bilateral relationships with religious civil society organizations, such as the Inter-Religious Council of Uganda. 

These groups have popularized support for discriminatory and retrogressive legislation in developing countries, such as the 2023 Anti-Homosexuality Act in Uganda, which made ‘aggravated homosexuality’ punishable by death. As a result, many Ugandans who identify as members of the LGBTQ+ community are now living in fear for their lives.

With the support of conservative civil society organizations that have access to major decision-making bodies, negotiations and forums, anti-rights entities from Africa and across the globe are co-opting human rights language and weakening or removing references to sexual and reproductive rights. 

Beyond financial backing, anti-rights and anti-gender actors have trained and helped representatives take over influential positions in governments, courts, and other institutions in many places to institutionalize anti-rights norms and practices in offices of influence.

Contradictions at Women Deliver

Many feminist activists had hoped this year’s meeting to be a crucial rallying point, but that high hope was very quickly shot down by the presence of key advocates against the very rights this conference is intended to promote. Specifically, the participation of Hungary’s rightwing president, Katalin Novak, who addressed the opening ceremony, shocked many feminists and advocates. 

As former Family Minister in the populist government of Viktor Orban, Novak has been a party to anti-LGBTQ laws and the tightening of abortion regulations in her country. Novak has also told women not to expect the same pay as men, while her government has outlawed adoption by unmarried couples and excluded LGBTQ couples from adopting children. Hungary has also refused to ratify the Istanbul Convention, designed to protect women from violence. 

Thousands protest against anti-LGBTQ laws in Budapest, Hungary, in 2021.

Much more to my discomfort was the number of people that applauded her speech in Kigali; whether it was about being in the presence of a  president or sharing the values communicated, they cared little for the symbolism that their applause meant for women and LGBTQI rights in Africa.

Her speech was dismissive of teenage pregnancies in many global south countries, which is an insult to a region grappling with rates as high as 25%, twice the global average at 92 births per 1000 women.  Her presence, and the opportunity given to her to speak, were not representative of the supposedly progressive audience gathered in support of all women in all their diversity and all their choices.

Novak also perpetuated harmful gender norms around women and their supposed reproductive responsibility to “choose motherhood”, while her appreciation for African women’s high birthing rates was concerning, especially with burdens associated with this, from high maternal deaths, high teenage pregnancy rates, high unmet need for contraceptives and gender-based violence in the form of forced unions, child marriages and restrictions on women’s bodily autonomy.

Reproductive autonomy includes the right to determine the number of children to have and the spacing of children, and that right can be to determine whether to have no children. The negative gender social norms we face in Africa and restrictive policies do not make this possible for many women.

Her remarks were racially degrading about African women’s “reproductive responsibility”. Several feminists, human rights activists and advocates have called out Women Deliver for giving an audience to Novak in a space that is supposed to be safe. 

Safe spaces and agency must be protected

We need to stay in control of our voice and demand accountability from entities that claim to be feminist at any point that they challenge the realization and enjoyment of our rights. Women Deliver, one of the largest gatherings on gender equality, should remain a place to challenge corrosive gender norms that sustain inequality and challenge restrictive, discriminatory, and oppressive norms.

Normalization is an instrument of power and plays a role in classification and hierarchization. In this case, platforms such as Women Deliver, normalizing anti-rights groups’ access to spaces of women and gender-diverse people to spread harmful rhetoric undermines their safety and their full humanity. Countering these anti-feminist, anti-democratic trends is everyone’s responsibility. 

Platforms such as Women Deliver should be safe spaces for women to dialogue and call to account, in all their diversity. There should be accountability for surrendering these spaces to anti-rights groups and advancing politics that endanger the progress and safety of gender-diverse people and women’s rights.

Yvonne Mpambara is a Ugandan feminist lawyer and Reproductive Justice Advocate. This article was first published by African Feminism.

Image Credits: Lydia Gall/ Human Rights Watch.

RSV
GSK has sued Pfizer for patent violations over its RSV vaccine

Merely months after securing US Food and Drug Administration (FDA) approval for its Respiratory Syncytial Virus (RSV) vaccine, British pharma giant GSK has taken Pfizer to court for patent violations. 

GSK filed the lawsuit in a US federal court in Delaware on Wednesday alleging that Pfizer’s RSV vaccine, Abrysvo, violates four patents surrounding the antigen that GSK uses in its own RSV vaccine, Arexvy, Reuters reported. 

The US FDA approved both vaccines in late May, to be administered to adults aged over 60 years. RSV is common during winter seasons and kills over 100,000 children aged under five every year. While its symptoms are considered non-threatening to adults, over 14,000 adults aged above 65 in the US die due to RSV every year. The virus is estimated to affect around 64 million people every year globally, with an annual death toll of 160,000. 

In response to the lawsuit, Pfizer asserted confidence in its intellectual property position and added that it will strongly defend its case. 

The market for RSV vaccine is estimated to reach $10 billion by 2030, according to analysts. Other contenders in this market are Sanofi and its partner AstraZeneca, that are working on a prophylactic monoclonal antibody for infants, and Bavarian Nordic, and Moderna that are currently in Phase 3 clinical trials for their vaccines. 

The race to make an RSV vaccine possible started several decades ago, in the late 1960s. Between 1966 and 1968, a promising clinical trial for an RSV vaccine had to be shut down after two young children that participated in the trial died and many more children ended up being hospitalized. 

It wasn’t until years later that scientists discovered that the virus that caused RSV shifted shapes, similar to SARS-CoV-2. Finally, in 2013, scientists from the National Institutes of Health (NIH) discovered a way to freeze the shape-shifting protein in one of its forms, thus making it possible to develop an antigen. 

Common during winter seasons, RSV garnered attention during the COVID-19 pandemic when it filled hospitals across the US with ailing children and older adults in 2021 and 2022. 

Image Credits: NIAID.

A dengue prevention worker sprays mosquito repellent in Bangkok, Thailand.

The number of dengue cases in the Americas has surpassed three million this year, as climate change makes people more vulnerable to the disease and the world more hospitable to the mosquitoes that carry it. 

Rising temperatures and shifting rainfall patterns are providing a boon to the Aedis aegypti mosquito, the main carrier of dengue. Warmer year-round temperatures are allowing the mosquitoes to thrive for longer periods of the year, and extending their mating season, allowing them to reproduce in greater numbers. 

Climate change is also extending the geographical range where the mosquito can survive, as warmer winters and milder autumns lead to fewer cold-weather deaths, meaning that more mosquitoes survive to adulthood.

“The mosquito in particular is a vector that has continually spread across the world,” Dr Raman Velayudhan, an expert at the WHO’s neglected tropical disease unit, told reporters on Wednesday. “It is a silent expansion … and right now a population of nearly 4 billion are at risk of this disease.”

The effects of global warming on the spread of Aedis mosquitoes are most visible in Brazil, which has already reported 2.4 million cases this year as mosquitoes invade its southern states, which are now hot enough to support them.

The incidence of dengue in Peru, Argentina and Bolivia has also risen sharply as a result of climate conditions. Peru has already recorded a caseload over four times higher than the average of the last five years – the country’s worst-ever outbreak of the disease. The outbreak in Argentina is also one of the largest in the country’s history. 

The World Health Organization (WHO) warned in July that the world is on track for over four million dengue cases in 2023, and that climate change is playing a significant role in its spread. The record for global dengue cases was set in 2019 when 5.3 million cases were reported. Global case numbers have risen eightfold since 2000, with 4.2 million reported in 2022.

Global dengue case numbers are vast underestimations, Velayudhan said, citing the 80% asymptomatic case rate and pandemic-disrupted reporting systems.

“We need to convey this message that dengue is a silent disease,” said Velayudhan. “We need to treat it as an endemic disease with epidemic potential.” 

Dengue can cause a range of symptoms, from mild fever to severe illness. There is no specific treatment for dengue, but early diagnosis and supportive care can help to reduce the risk of death. It is fatal in less than 1% of cases. 

A window into the future of dengue

mosquito
Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. Climate change is enabling their spread.

Computational epidemiologists at the University of Michigan have projected that Brazil’s epidemic potential for dengue could increase by 10-20% by 2040, as temperatures rise and rainy seasons get longer. This could lead to longer dengue seasons in Brazil, and could also be mirrored in other countries around the world.

The ongoing El Niño event, which is characterized by higher temperatures and extreme weather patterns, may provide a window into the future of dengue. Its effects on rainfall in the Americas and during monsoon season in Asia will likely play a large role in how close the world gets to the 5.3 million case record set in 2019.

In Bangladesh, monsoon rains have already led to a deadly dengue outbreak. Health experts in the country, including the Bangladesh Medical Association, have urged the government to declare a “public health emergency.” Some have compared the outbreak to the country’s 2019 dengue epidemic, which was so severe that many in Bangladesh refer to it as the “year of dengue.”

In July, meanwhile, changing climate patterns led the European Center for Disease Control to sound the alarm over the rising risk of mosquito-borne diseases across the continent, from which Europe has historically been protected.

“If this continues, we can expect to see more cases and possibly deaths from diseases such as dengue, chikungunya and West Nile fever,” Andrea Ammon, director of ECDC said at a press conference last month.

And the risks are not limited to dengue: Research shows the spread of over half of infectious diseases — including arboviruses like Zika, chikungunya and dengue — are aggravated by climate change.

Disease-carrying ticks, bacteria, algae and fungi and mosquitoes are all on the move. As the world warms, the diseases they carry will follow them as they expand their geographical reach to adapt to climate change.

Image Credits: Patrick de Noirmont/Sanofi Pasteur, Sanofi Pasteur/Flickr.

Bureau of Global Heath Security and Diplomacy
US Secretary of State Antony Blinken, Health Secretary Xavier Beccera, USAID head Samantha Power and new Bureau head John Nkengasong

The US has consolidated its efforts to address global health threats into a single structure, the Bureau of Global Heath Security and Diplomacy, which was launched on Monday.

Renowned Cameroonian health expert Dr John Nkengasong, appointed last year to lead the US President’s Emergency Plan for AIDS Relief (PEPFAR), leads the new structure and will report directly to US Secretary of State Antony Blinken. He also remains head of PEPFAR.

PEPFAR, the hugely successful HIV programme estimated to have saved 25 million lives over 20 years, will be incorporated into the new bureau alongside all other US efforts to address future pandemics and other health emergencies.

“We’re setting up a new bureau to focus fully on the need to drive both internal and international coordination and accelerate the State Department’s ongoing efforts to strengthen global health security so that the world can respond with immediacy and intention when the next health crisis emerges,” Blinken told the launch.

Blinked outlined three main functions for the Bureau, the first being to lead US diplomacy in  “strengthening the global health security architecture so that the world is better prepared to prevent, detect, control and respond to infectious diseases”. 

“That includes by working with partners to modernise existing organisations like the World Health Organization (WHO) so that they’re more fit for purpose and by shaping new structures like the Pandemic Fund,” said Blinken.

The second function is to “leverage US foreign assistance to strengthen public health systems, including laboratories and supply chains for vital medical counter-measures” to enable countries to be better prepared to address health threats.

The third is “to elevate health security as a core US foreign policy priority” through both international diplomatic engagement and health security policymaking across the US government.

Dr John Nkengasong leads the new structure.

Nkengasong said that some of the Bureau’s immediate priorities are to “strengthen the global health security architecture to ensure greater capacity, coordination and accountability”, including through the Pandemic Fund, amending the International Health Regulations and successfully negotiating a pandemic accord.

He also flagged the danger posed by antimicrobial resistance (AMR), which is projected to kill about 10 million people a year from 2050 if nothing is done to address it.

Describing PEPFAR as the US government’s most successful global health programme, Nkengasong said that the lessons learned from PEPFAR – particularly the importance of an “all of government response” – would be applied to the new Bureau. 

“We recognise that the frequency of the health threats has increased because of the greater connectivity, globalisation, climate change, population growth, food insecurity, and many others,” added Nkengasong, who headed the Africa Centre for Disease Control during the pandemic.

Samantha Power, Administrator of the US Agency for International Development, told the launch that the odds of living through another pandemic of similar severity as COVID-19 in our lifetimes was almost 40%.

“To give a sense of the need here, the WHO and the World Bank estimate that the annual funding gap in pandemic preparedness is $10 billion annually. This new bureau is going to play an absolutely vital role in coordinating with our partners to summon the global cooperation and the resource investments needed to keep us all safe,” said Power.

Rightwing threat to PEPFAR

Meanwhile, PEPFAR is facing a right-wing backlash based on misinformation, as reported recently by Health Policy Watch.

PEPFAR’s five-year budget is due for reauthorisation by the US Congress by 30 September, but there has been unprecedented right-wing mobilisation against it over the past few months by both US and African groups.

The US right-wing groups claimed in a recent letter sent to Senate and Congress leaders that PEPFAR grantees  “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. Signatories include the Center for Family and Human Rights (C-FAM), Heritage Foundation and the Dr James Dobson Family Institute.

A similar letter was sent on 6 June to the same US Senate and Congress leaders by some African politicians and religious leaders claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”.

US Representative Chris Smith, who co-sponsored PEPFAR’s refinancing in 2018, has also joined its critics by recently claiming that the programme is being used to “promote abortion on demand”.

Illegal for PEPFAR to fund abortion

However, it is illegal for PEPFAR to fund or support abortion, and abortion is illegal in most of the  African countries where it operates.

“PEPFAR has never, will not ever, use that platform in supporting abortion,” said Nkengasong, as reported by Devex.

One of the PEPFAR grantees that have been singled out is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which targets teenage girls in 16 African countries.

Girls and young women are up to five times more likely to contract HIV than boys and men their age, and DREAMS offered HIV prevention services to 2.9 million adolescent girls and young women in 2022.

“These people are all playing with fire, and they’re playing with people’s lives, and there can only be one reason: political motivation to kill PEPFAR,” Mark Dybul, former US global AIDS coordinator, told Devex.

Moderna
Moderna mRNA vaccine is found to be the safest for older adults. 

Older adults vaccinated with Moderna’s COVID-19 vaccine were 15% less likely to be infected with COVID-19 than those vaccinated with Pfizer-BioNTech’s, according to a peer-reviewed study, published in JAMA Network on Wednesday.

The study was based on observational data from 6.3 million adults, almost 60% women and 86.5% White, with an average age of 76 years old and were inoculated with either of the two mRNA vaccines against COVID-19. 

The results showed Moderna’s COVID-19 vaccine was also marginally safer with fewer post-vaccine adverse events like pulmonary embolism and thromboembolic events reported among the said group.

“The results of this study can help public health experts weigh which mRNA vaccine might be preferred for older adults and older subgroups, such as those with increased frailty,” Dr Daniel Harris, epidemiologist and the lead author of the study said. 

His team, at the Center for Gerontology and Healthcare Research at the Brown University School of Public Health, observed two groups of older adults, one with Pfizer-BioNTech’s mRNA vaccine and the other with Moderna’s mRNA vaccine for 28 days after receiving their first doses of the vaccines. 

Overall, only 1% of all the adults who participated in the study reported adverse events. Of these, those who received Moderna’s vaccine were associated with a 4% lower risk of pulmonary embolism (sudden blockage in blood vessels) and a 2% lower risk of thromboembolic events (several conditions related to blood clotting). 

Harris stressed that the risk of adverse events from contracting COVID-19 were substantially higher than the risk of adverse events from being vaccinated by either of the two mRNA vaccines.

“But in an ideal world where we can have a choice between which vaccine product is used, we wanted to see whether one vaccine was associated with better performance for older adults and those with increased frailty,” said Harris.

Long COVID clinical trials begin recruitment

Meanwhile, the US National Institute of Health (NIH), on Tuesday, launched the second phase of clinical trials to evaluate at least four potential treatments for long COVID. As part of the RECOVER Initiative, a range of  treatments will be evaluated through these trials including drugs, biologics, and medical devices.   

“The trials are designed to evaluate multiple treatments simultaneously to identify more swiftly those that are effective,” said the NIH in a press release. 

Created to study the long-term effects of long COVID, the RECOVER Initiative is currently conducting research on how COVID-19 affects the different tissues and organs in the human body, using data from over 24,000 participants, 60 million electronic health records, and over 40 pathobiological studies. 

The information gained from these studies has been used to design the second phase in which the safety and efficacy of long COVID treatments will be studied in groups of 300-400 people. 

“Hundreds of RECOVER investigators and research participants are working hard to uncover the biologic causes of long COVID. The condition affects nearly all body systems and presents with more than 200 symptoms,” Dr Walter J. Koroshetz, director of the NIH’s National Institute of Neurological Disorders and Stroke, and co-lead of the RECOVER Initiative, added. 

“Recognizing that more than one solution is likely needed, we’ve taken the lessons learned from RECOVER participants to design rigorous clinical trial platforms that will identify treatments for persons with different symptom clusters to improve their function and well-being.”

Image Credits: Gavi .

African cancer patients receiving chemotherapy

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

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

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

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

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

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

Access to high-impact treatments

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

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

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

Cervical Cancer

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

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

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

Breast Cancer

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

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

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

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

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

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

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

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

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

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

Prostate Cancer

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

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

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

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

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

Kaposi sarcoma

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

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

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

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

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

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

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

Lung Cancer

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

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

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

Improving access is a ‘moral need’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vaccine hoarding is unlikely to stop 

A protest against COVID-19 vaccine inequity.

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

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

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

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

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

‘Complementarity, coherence and continuum’

Ashley Bloomfield, WGIHR co-chair

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

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

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

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

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

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

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

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

Tiered threat alerts for IHR?

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

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

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

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

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

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

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

Incentives for countries to share information 

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

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

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

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

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

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

Equity in operation, not just in talk 

INB co-chair Precious Matsoso

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

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

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

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

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

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

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

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

Failure of international systems 

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

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

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

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

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

Other pandemic responses also pushing ahead

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

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

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

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

Image Credits: Aishwarya Tendolkar, CGTN.

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

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

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

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

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

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

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

Smoking prevalence has declined most sharply in women.

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

‘Insidious’ tactics 

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

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

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

MPOWER prevented 300 million new smokers 

Kelly Henning, head of health programmes at Bloomberg Philanthropies

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

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

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

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

Lack of strong taxation policies

Only 41 countries have smoking taxation policies.

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

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

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

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

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

Tobacco lobby is buying up pharma firms  

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

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

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

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

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

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

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

Slight movement away from tobacco cultivation in Africa 

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

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

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

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

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

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

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

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

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

Equitable distribution of health products in global health emergencies 

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

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

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

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

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

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

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

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

Equitable drug distribution and finance in proposals  for IHR revisions 

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

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

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

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

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

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

Process for determining a global health emergency

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

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

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

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

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

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

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

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

Image Credits: PMO Barbados.

One Life, One Liver campaign launched on World Hepatitis Day

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

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

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

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

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

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

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

Vaccination, testing and treatment: the key to saving lives

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

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

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

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

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

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

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