COVID Highlighted Problems in Accessing Medicine for Non-Communicable Diseases – But They Can be Fixed 12/07/2023 Bente Mikkelsen An NCD Clinic at Lisungwi Community Hospital in Neno District of Malawi The COVID-19 pandemic exacerbated patients’ difficulties in accessing medication for non-communicable diseases (NCDs), but there is a range of measures countries can take to mitigate this – and a pandemic accord could address some of the structural weaknesses. COVID-19 had a disproportionate and far-reaching impact on people living with NCDs. Not only were they more vulnerable to severe COVID-19, but their access to health services and medicines was also disrupted. Across countries, similar stories were seen among people living with cardiovascular disease, diabetes, mental health conditions and cancer. These shortcomings are documented in a new WHO report Access to NCD medicines: emergent issues during the COVID-19 pandemic and key structural factors, jointly developed by WHO’s Departments of NCDs and Essential Medicines and Health Products. The report describes how essential NCD medicines were in short supply or simply not available during the pandemic, resulting in compromised care. Interruptions in access were more severe in low-income countries with fewer resources, as well as in other countries disadvantaged by medicines markets, such as landlocked countries, dependent on air cargo and ports in other jurisdictions, and countries subject to international trade sanctions. For instance, 31% of low-income countries (LICs) reported medicine unavailability or stockouts in 2020, increasing to 41%, or 11 out of 27 countries surveyed, in 2021, according to two successive WHO Country Capacity Surveys. In comparison, only two out of 57 high income countries (4%) reported stockouts in 2021. Beta-blockers, insulin, statins and steroid inhalers were in particularly short supply in LICs in 2021. Globally, 15% of countries experienced shortages in 2020, rising to 21% in 2021. Patients in LICs have often struggled to get access to NCD medicines, which have not traditionally received nearly as much attention in global health and development fora as infectious disease treatments. But the COVID-19 pandemic is a vivid example of how long-standing access issues were exacerbated during the global crisis. It highlighted the complex, cross-sectoral pathway from the production of medicines to the patient – underscoring how routine drugs need attention in future pandemic preparedness and response – along with medicines specific to any future crisis. Pandemic import restrictions During the pandemic, there were difficulties sourcing active pharmaceutical ingredients and materials, delays caused by export restrictions, transport and freight disruptions, and staff shortages due to sickness, curfews and quarantines. By April 2020, just a month after WHO declared that COVID-19 was a pandemic, 20 countries had already introduced export restrictions on medicines, according to the World Trade Organization (WTO). Other obstacles to accessing NCD medicines included the lack of forecasting tools to accurately predict demand and limited financial resources and administrative capacity, including the absence of donor-sponsored NCD medicine programmes. Patients also struggled to pay for their medicines as a result of their loss of income from lockdowns – in stark contrast to donor-sponsored medicine programmes for diseases such as HIV, tuberculosis, and malaria, where patients can get free medicine. NCDs are responsible for over 70% of all deaths globally, most of which occur in low and middle-income countries. A lack of access to NCD medicines can have devastating consequences. It is critical to heed the lessons learned during the pandemic and adopt innovative national response and preparedness plans to care for people with NCDs. This involves ensuring supply chain continuity as well as supporting better integration of NCD diagnosis and treatment into the primary health care systems of developing countries – so as to help ensure treatment during future health emergencies. Mitigating future supply chain risks Equity curve of percentage of countries where medicines for diabetes were generally available across World Bank income categories, by drug. There are a large variety of measures available for governments to improve the resilience of supply chains for NCD medicines. Firstly, governments and key stakeholders need to assess risks and potential breakage points in terms of factors such as the availability of raw materials, diversity of suppliers, and opportunities to boost local production of critical inputs or finished products. The global supply chain is interdependent, and one key challenge identified in the pandemic was the limited data availability and information sharing across sectors. Going forward, more transparency and data-sharing among relevant actors is critical. To support countries in meeting these challenges, WHO is working on initiatives to improve supply chain resilience for NCD medicines, including a suite of tools that countries can use. This would include methods for NCD medicines demand aggregation at national, regional and global levels to enable better medicines forecasting and quantification. Engagements with private sector entities can help encourage commitments that could increase accessibility of NCD medicines, such as voluntary licensing arrangements enabling more diversified production. Harmonization of definitions and rules around “essential medicines” eligible for “priority lanes” in international shipping and customs control would also be important. Public and private distribution Conceptual model of the impact of the COVID-19 pandemic on access to NCD medicines. Secondly, investments in innovative and integrated medicine service delivery models should be promoted to improve access to NCD treatments, as demonstrated in the latest WHO guidance on integrating the prevention and control of NCDs, which addresses both structural and emergent barriers. The guidance suggests, for instance, that countries could introduce models of care that use a mix of private and public sector primary health care centres and dispensaries to distribute NCD medicines and related health products. Measures such as multi-month NCD medicine dispensing, which proved effective in resource-limited settings during the pandemic, could be considered not only for future health emergencies but also as to bolster more routine delivery. Thirdly, governments and donor agencies need to improve the governance and financing mechanisms available for NCD medicines, as the medicines supply chain is a critical element in strengthening the resilience of the overall health system. Here, too, new tools under development by WHO can support country assessments of health facility availability for NCD service delivery. As we continue negotiations on a new pandemic accord, as well as charting the road to the next high-level meeting on NCDs in 2025, WHO, partners, and the global health community need to make concerted efforts to develop and implement a longer-term strategy to strengthen access and delivery mechanisms for medicines, including NCD medicines, particularly during emergencies. Only in that way, we can ensure that people living with NCDs have access to the medicines and care needed to manage their conditions, for healthy, productive lives. Dr Bente Mikkelsen, is the World Health Organization’s Director of Noncommunicable Diseases Image Credits: KSchermbrucker/PiH, World Economic Forum. After Seven Years of Planning, World Rehabilitation Alliance is Finally Launched 11/07/2023 Kerry Cullinan Grammy-award-winning musician Ricky Kej (centre back) and band perform at the World Rehabilitation Alliance launch After seven years of planning, the World Rehabilitation Alliance (WRA) was launched in Geneva on Tuesday with a founding membership of 82 organisations. Welcoming the launch, actress Emilia Clarke, who played Daenerys Targaryen (Khaleesi) in Game of Thrones, said that it was an “absolute joy” that her organisation, SameYou, is a founding member of the alliance. “I’ve suffered two brain haemorrhages, so I know firsthand just how vital rehabilitation was to my recovery,” said Clarke in a video message. “It’s something that matters to millions and millions of people all over the world, and yet still so many people don’t get access to what they need.” Emilia Clarke Grammy Award-winning singer Ricky Kej performed a song specially composed for the alliance, which was launched at the end of a two-day global summit convened by the World Health Organization (WHO) to assist countries to integrate rehabilitation care into their health systems. Earlier, Ukraine’s Deputy Health Minister, Mariia Karchevych, told the summit that her country had suddenly found itself having to provide rehabilitation for “thousands of people” injured by rockets fired on them by Russia. “In the midst of the war, we had to create a rehabilitation strategy and fully integrate it into our healthcare network,” said Karchevych. “Our lives changed in the war, but our principle remains the same. Everyone matters,” she added, expressing gratitude to the international community for its support, which she described as a “manifestation of love”. WHO Director-General Dr Tedros Adhanom Ghebreyesus described rehabilitation as “a universal right”. “This new alliance is a powerful demonstration of the collaborative spirit of the rehabilitation community. By uniting our voices across sectors, we can raise the profile of rehabilitation and support its integration in the continuity of care across all countries,” Tedros told the launch in a recorded message. “The need for rehabilitation is far, far greater than most people assume,” Dr Jérôme Salomon, Assistant Director-General and head of Universal Health Coverage at WHO, told the summit. “More than 2.4 billion people, almost a third of the global population, have health conditions that could benefit from rehabilitation. WHO’s Alarcos Cieza addresses the launch in Geneva. The summit came shortly after a watershed first-ever resolution on boosting access to rehabilitation care was passed by the World Health Assembly with unanimous support from the 193 member states in May. The resolution notes that global rehabilitation needs are “largely unmet”. In many countries, less than half of people receive the care they require. Integrating rehabilitation into health systems The summit launched a Package of Interventions for Rehabilitation aimed at assisting countries to integrate rehabilitation into their national health services, including training health workers to address the need. “The purpose of this package of interventions is to support the planning, the budgeting and the integration that we’ve talked about,” said Dr Binta Sako, WHO’s lead on rehabilitation in the Africa region. “It provides a lot of information on the type of evidence-based interventions that are needed. What is required to make the services available in terms of material and also human resources.” The package focuses on 20 health conditions spread throughout seven areas of health, added Dr Alexandra Rauch from the WHO’s Rehabilitation Programme. “It really shows the comprehensiveness of rehabilitation. It’s not about only improving body functions. It’s about improving life areas of people, and also including carers and families in rehabilitation programmes,” said Rauch. Image Credits: Megha Kaveri. Decline Recorded in India’s Air Pollution – But Not When it Matters Most 11/07/2023 Chetan Bhattacharji A dense toxic smog in New Delhi blocks out the sun. (8 November, 2017). On the face of it, it’s good news. India’s infamous air pollution has shown a significant decline across almost all states, according to a new three-year government-backed report known as SAANS – the Satellite-Based Monitoring of Ambient PM2.5 At National Scale for Air Quality Management. But there appears to be little decline during the winter months when pollution levels are at their worst, one of the report’s authors told Health Policy Watch – and the government has yet to release the full report with all the data covering three years from 2019-2022. However, the summary report shows that PM 2.5 levels (fine particles) across rural and urban regions have plateaued over the last six years and are demonstrating a consistent decline. In addition, it is the first time rural air pollution is being systematically mapped. The report made headlines because it showed a particularly huge drop in the most polluted states (see Table 2). The authors elected to monitor PM 2.5, as this category of microscopic pollutant can penetrate deep into the lungs and even enter the circulatory system, affecting other organs and systems. In 2017, about 670,000 deaths were attributed to this pollutant alone; in 2019, 1.67 million deaths – or over 3 deaths a minute – were linked to air pollution. Delhi has consistently remained the most polluted state, with an average PM 2.5 level of almost 104 micrograms/cubic metre, 20 times the safe limit guideline by the World Health Organization (WHO), for the last six years. DELHI IS MOST POLLUTED STATE FOR SIX YEARS 2017 ranking* 2022 ranking* 1 DELHI 118.5 1 DELHI 95.3 2 UTTAR PRADESH 102.7 2 BIHAR 77.2 3 HARYANA 93.1 3 HARYANA 71.7 4 BIHAR 92.5 4 UTTAR PRADESH 63.9 *micrograms/cubic m Table 1: PM 2.5 in urban areas. The top 4 most polluted states have remained the same for the last six years. Uttar Pradesh (UP), the most populated state, saw a fall in PM 2.5 of close to 40% in 2022 over 2017. In Delhi and Haryana, the decline was about 20%. This data was released in a summary and the full report will be released once cleared by top pollution control officials. However, a closer look reveals the falls are more modest when PM 2.5 levels in 2022 are compared to the average of the previous five years, that is 2017 to 2021. In Bihar, the fall is just 0.3% compared to 17% reported over the year. In Delhi and Haryana, the fall is about 10% rather than 20%. However, the fall remains substantial in UP at about 26%. State PM 2.5 level* in 2022 % change over 2017 % change over 2017-21 average DELHI 95.3 -19.5% -9.7% UTTAR PRADESH 63.9 -37.8% -26.4% HARYANA 71.7 -23.0% -10.8% BIHAR 77.2 -16.6% -0.3% *(micrograms/cubic metre) Table 2: Changes in PM 2.5 levels in India’s four most polluted states. The more pressing question is whether pollution has fallen substantially during the peak pollution months of October to January when pollution has been thick enough to close schools and cancel flights, thick enough to be tasted. PM 2.5 levels have hit 250-300 micrograms and more, that is, 50-60 times the WHO’s safe limit. Humayun’s Tomb, Delhi. Thick pollution and poor visibility occur when the air quality index (AQI) is very high. One of the report’s authors, Professor Sagnik Dey of the Centre for Atmospheric Sciences at the Indian Institute of Technology Delhi, told Health Policy Watch that the October to January situation “has not changed much.” In fact, the annual decline is mostly because of the improvement in the summertime when there are better conditions for the dispersion of polluted air – stronger winds and a higher mixed layer height. A telling map of daily pollution over 20 years used in the report shows just how bad these months are in India. Change in Annual ambient PM2.5 exposure in India from 2000 to 2019 (left) and daily PM2.5 Climatology (2000-2019) (right) Better and more effective reporting But the data in the report is significant in other ways. It is perhaps the first time the government has supported such extensive satellite-based monitoring of air quality. The authors say the technology has improved and there is a high correlation between this data and that from the official network of ground sensors, which is more accurate but also expensive. Crucially, the new satellite-based data fills in a major gap in air quality monitoring in rural areas. There is negligible rural coverage by ground-based sensors. Interestingly, the satellite data shows that there is little difference in concentration levels between urban and rural areas and the declines are also similar. The sources of ambient pollution of course may differ – vehicular and industrial pollution are high in urban areas whereas household sources were found to be the largest contributor to ambient PM2.5 in rural India. Gas cylinder roll-out eases rural pollution However, Dey suggests that rural air quality most likely improved from better penetration of liquified petroleum gas (LPG) under the government’s Ujjwala scheme to provide free gas cylinders, particularly to the rural poor. High PM 2.5 in rural areas is significantly attributable to the wide use of solid fuel for cooking, heating and even lighting, according to the report’s press release. The report has also mapped air sheds, which offers an important understanding of how pollution spreads across a region regardless of political boundaries. This supports an argument for the central government to adopt a still more proactive and wider role to cut air pollution, as it may be easier for one centre to navigate across different airsheds rather than many states. But for effective action, that is to reduce or eliminate sources of pollution, satellite data will not be enough. A large network of ground-based sensors will not only be more accurate but reflect the nuances as well as the sources of pollution. The government has upped its target for cutting air pollution to 40% by 2026. At first glance, it may seem it’s on target. But the fine print of the SAANS report (‘breath’ in Hindi) does not suggest that. Image Credits: Wikipedia, Source http://www.saans.co.in/home.html. ‘A Lifelong Journey’: Two Billion People Need Rehabilitation Globally 10/07/2023 Stefan Anderson Rehabilitation is often neglected in health systems. WHO officials say that has to change. Six years, five months and six days after suffering a stroke that paralyzed her left side, Madeline Niebanck shared her story of recovery at World Health Organization (WHO) headquarters. Niebanck, 28, spoke to delegates on Monday gathered for a global summit to strengthen financing for and access to rehabilitation care in health systems. She called on governments to use the conference to make investments that can provide what she says people going through rehabilitation need most: “hope”. “The past six years have been filled with learning how to adapt and to live a new life,” said Niebanck. “Rehab is not easy. It is hard, and it’s a lifelong journey.” Twenty-two at the time of her stroke, Niebanck had just graduated from the University of Georgetown when an arteriovenous malformation – a tangle of abnormal blood vessels – ruptured in her brain, damaging her brainstem. She was rushed into emergency surgery, and doctors told her parents they were not sure she was going to make it. “The neurosurgeon saved my life that night, but what I realize now is that surviving the brain hemorrhage was not the finish line,” said Niebanck. “It was just the beginning of a very long rehabilitation journey.” Niebanck recovers in the hospital after a tangle of blood vessels burst in her brain, paralysing the left side of her body. The high-level WHO meeting is the first since a watershed resolution on boosting access to rehabilitation care passed in the World Health Assembly with unanimous support from WHO’s 193 member states in May. The resolution – the first to directly address rehabilitation in 75 years of the World Health Assembly – found that global rehabilitation needs are “largely unmet”. In many countries, less than half of people receive the care they require. The non-binding document commits to expand financing, integrate rehabilitation into national healthcare systems, minimize the prohibitive costs of assistive technologies like hearing aids, promote research and include rehabilitation in emergency preparedness and response plans. “The need for rehabilitation is far, far greater than most people assume,” said Dr Jérôme Salomon, Assistant Director-General and head of Universal Health Coverage at WHO. “More than 2.4 billion people, almost a third of the global population, have health conditions that could benefit from rehabilitation. Niebanck shares her story with delegates at WHO headquarters. “[Madeline’s] story reminds us the core of rehabilitation is winning the fight to restore health, functioning and dignity,” said Salomon. “It also underlines that winning this fight is as critical as the fight to survive.” The number of people requiring rehabilitation has climbed by nearly 70% since 1990, driven by an increase in musculoskeletal disorders like lower back pain, neurological disorders and sensory impairments. Leading causes of disability vary from country to country, from hearing loss in China to fractures in Russia, vision loss in India and lower back pain in the United States. “The challenge and the tragedy is when rehabilitation services are not available or are not provided,” said Alarcos Cieza, who leads WHO’s vision, hearing, disability, and rehabilitation unit. “In many countries where people don’t receive rehabilitation, people die.” WHO defines rehabilitation as a range of interventions and technologies designed to help people with disabilities regain their independence. These include assistive technologies such as hearing aids, glasses, wheelchairs and prosthetics, and physical, occupational, and psychological therapies. “Rehabilitation is about our everyday life, how we communicate, how we move around,” said Cieza. “It’s about sleeping, it’s about breathing, it’s about our relationships – it’s really about our lives.” Rehabilitation still out of reach for millions Four decades after the WHO recognized rehabilitation as an essential health service, millions of people still lack access to these life-altering interventions. Health systems across the world suffer from significant funding shortfalls, but gaps in access are especially large in low- and middle-income countries. WHO estimates 20 to 40% of health resources are wasted through inefficiencies and corruption. Rehabilitation is especially hard hit by this problem. “With the rising prevalence of noncommunicable diseases, ageing populations, and improved survival from injuries, the need for rehabilitation services is expected to increase significantly,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. “Low investment and awareness persist, driven by pervasive misconceptions that rehabilitation is too costly, or simply unfeasible to deliver in low-resource settings.” Hearing aids, glasses and other assistive technologies can be prohibitively expensive. Taken for granted in wealthy countries, these simple technologies are out of reach for millions globally. More than one-third of national health expenditure in low- and middle-income countries comes from out-of-pocket expenses, a major source of financial hardship for families. Assistive technologies such as glasses, hearing aids and wheelchairs are particularly expensive, and many low-and middle-income countries do not have any national service for these products. Many people cannot access, or choose to forgo, the assistive devices they need because they are too expensive. More than one billion people – one in eight globally – cannot see properly because they cannot afford glasses. The high costs of rehabilitation often prevent people from accessing the care they need, which can have serious impacts on their health and well-being. It can also lead to poverty, as families may have to sell assets or take on debt to pay for assistive devices. “For most people, rehabilitation services, including necessary assistive technologies, are often out-of-pocket expenses that they cannot afford – this is unacceptable,” said Salomon. “Anyone with rehabilitation needs must have access to quality services whenever and wherever they need them without facing financial hardship.” Rehabilitation is also badly affected by the ongoing global shortage of healthcare workers, which is projected to hit 10 million by 2030. The staffing crisis is most acute in low- and middle-income countries and the rural, hard-to-reach areas within them. Meanwhile, the COVID-19 pandemic accelerated the migration of trained health workers to high-income health systems in search of higher pay, worsening the shortage in the already struggling health systems of poorer countries. Progress is progress: WHO pushes ahead Map of countries supported by WHO in the area of rehabilitation. WHO has significantly increased its technical assistance to countries for rehabilitation services since the Global Rehabilitation 2030 agenda was adopted in 2017. In that time, WHO has provided technical assistance to 37 countries, up from zero when the agenda was adopted. Twenty-five low- and middle-income countries have so far implemented strategic plans on rehabilitation with WHO assistance. On the first day of the rehabilitation summit on Monday, WHO published two policy guides for governments seeking to improve rehabilitation care. The first guide, a package for rehabilitation interventions with contributions from over 700 experts from 90 countries, is to assist countries on the “planning, budgeting and implementing of rehabilitation in their health systems.” The second provides guidance on how to ensure that people with disabilities have access to rehabilitation services during disasters and other emergencies – the difficulties of which were brought into sharp focus by COVID-19, the war in Ukraine, and the Turko-Syrian earthquake. WHO is expected to launch further technical guidance in the areas of workforce, information systems, financing, and health service delivery over the course of the Global Rehabilitation 2030 conference, which ends on Tuesday. Image Credits: Marina Raspopova/ Unsplash, CC. Warning That UN High-Level Meeting on Pandemics May be ‘Squandered’ Opportunity 10/07/2023 Kerry Cullinan As United Nations (UN) member states meet in New York on Monday and Tuesday to discuss the political declaration to be adopted at the General Assembly’s High-Level Meeting (HLM) on Pandemics in September, there are growing concerns that the current draft is weak and proposes an over-reliance on the World Health Organization (WHO) to manage future pandemics. The current draft – pared down from 58 to 15 pages – has dispensed with a number of critical concerns, particularly about how future pandemics will be governed, located almost entirely with the WHO. The most vocal criticism of the draft comes from the co-chairs of the Independent Panel for Pandemic Preparedness and Response, which has proposed a high-level independent oversight group to govern global pandemic responses. “We are gravely concerned that the opportunity presented by the High-Level Meeting and the expected Political Declaration on Pandemic Prevention, Preparedness and Response is being squandered,” wrote Ellen Johnson Sirleaf and Helen Clark in an open letter released on Sunday. “The current draft of the political declaration… does not express the commitments required of heads of state and government to transform the international system of pandemic preparedness and response. Instead, it reads as a health resolution,” they add. The Independent Panel has published a road map to deal with future pandemics, that sets out recommendations on governance, equitable access to pandemic countermeasures, preparedness and surge finance, the need for clear rules and roles, and for a stronger WHO. “Only international, multilateral, and multi-sectoral collaboration can safeguard the world from the next pandemic threat,” according to the Independent Panel. Pointing out that the success of the WHO negotiations currently underway to develop a pandemic accord is not guaranteed, Sirleaf and Clark reiterate their view that “sustained highest-level political leadership on pandemic preparedness and response” is essential between and during health crises. “This is required to ensure protection to health, societies and economies, and to stop outbreaks from becoming pandemics,” they add. Describing the UN HLM as “a one-time and historic opportunity to commit to lasting and transformative change to pandemic preparedness and response”, they add that if member states “only tinker with the language” of the current draft, “the efforts to agree to the declaration will be wasted”. Meanwhile, Nina Schwalbe, a principal visiting fellow at the UN University’s International Institute for Global Health, also expressed disappointment with the draft. “Rather than a strong declaration that commits UN Member States at the highest level to fundamentally change how they address all aspects of pandemic prevention, preparedness, and response, it covers everything from hand hygiene to pollution,” commented Schwalbe on Twitter. https://twitter.com/nschwalbe/status/1677334373954203651 Image Credits: Wikimedia Commons. New WHO and UN-wide System to Aid Victims of Sexual Exploitation Needed, says Independent Investigator 07/07/2023 Stefan Anderson Families go to an Ebola treatment centre to visit a family member held in quarantine in Beni, North Kivu region, Democratic Republic of Congo. The World Health Organiztion (WHO) has been far too slow in providing financial, psychological and legal assistance to victims of sexual assault and exploitation committed by its staff in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola response, a veteran international investigator said at a WHO press conference on Friday. Hervé Gogo, presenting his assessment of the World Health Organization’s (WHO) performance since the scandal first came to light in 2020, said that the problems are endemic to the United Nations (UN) system as a whole and that solutions need a system-wide approach. “It took too much time,” Gogo said of the WHO support extended to over 100 victims in DRC who were raped, abused or lured into having sex in exchange for jobs or money by UN and WHO staffers. “Something needs to be done to streamline the process … particularly on the question of assistance to victims and survivors.” Gogo’s findings are part of his review of WHO’s compliance with recommendations made in 2021 by an independent enquiry commissioned after The New Humanitarian uncovered the sexual abuses committed by over 80 UN and WHO staff in the DRC. UN-wide provisions to victims are “not sufficient” A health worker checks a child potentially infected with Ebola being carried on the back of a caregiver at the Ebola Treatment Centre of Beni, North-Kivu province, Democratic Republic of Congo, during the 2018-2020 Ebola outbreak. The United Nations system lacks legal provisions for victims to receive compensation directly from the UN without first obtaining a favourable court ruling against one of its agencies. This process can take years, and even if the victim can identify the perpetrator – many cannot, as UN staffers often used fake credentials – proving the organisation is responsible for the actions of the abuser can be next to impossible. This system is “not sufficient” to support victims of sexual abuse, said Gogo. “Is it really possible to stick to this orthodoxy? Victims are faced with an impossible task,” he said. “We all really want victims to get compensated: The question is how. It all depends on member states to figure out how to create a mechanism of compensation without waiting for the court process to end.” Despite the delays in assistance reaching victims, Gogo said the UN health agency’s efforts since the crisis are “more than a good start” to the overhaul of its sexual abuse and exploitation policies. Search for justice continues in DRC WHO to Share Information with Congolese Court in Sexual Abuse Cases of 13 Women WHO has provided support to all 115 survivors of sexual assault in the DRC identified by the independent commission report regardless of whether the perpetrators were affiliated with WHO or other UN agencies, said Dr Gaya Gamhewege, the agency’s lead official in prevention and response to sexual misconduct. WHO is also providing legal support to victims who decided to pursue local court cases against their alleged abusers. The agency has also complied with requests for information from local authorities in DRC about 16 people linked to WHO who are facing legal action in the country. Gamhewege did not provide any further information on the status of the cases. “WHO will continue to support any and all survivors who need more support, even if they are affiliated to allegations by personnel from other agencies,” she said. WHO terminated seven consultants in after finding sufficient evidence of misconduct in the wake of the scandal, Gamehwage said in an interview with Health Policy Watch in April. The agency also posted 14 former staff and consultants identified as alleged perpetrators by the Independent Commission on the UN ClearCheck database, blacklisting them from being hired in the UN. ‘Not a single finding’ showing Tedros knew about abuse claims or cover-up WHO Member States re-elected Dr Tedros Adhanom Ghebreyesus to serve a second five-year term as Director-General of the WHO in May 2022. Gogo, who previously served as a senior judicial officer in the UN mission in DRC, was emphatic that no evidence implicating WHO Director-General Dr Tedros Adhanom Ghebreyesus or his inner circle in covering up the sexual assaults in the DRC has been uncovered. “There is not a single finding about any decision or any information that was shared DG,” Gogo told reporters. “There is nothing to hide.” No high-ranking WHO officials have been disciplined as a result of the sexual assaults in the DRC. Three senior managers at the agency who were accused of covering up the allegations were reinstated in January after being cleared of charges by the UN Office of Internal Oversight Services (OIOS), which investigated the cases at the request of WHO. WHO Direct-General Dr Tedros Adhanom Ghebreyesus told the WHO Executive Board they were reinstated because claims of managerial misconduct were “unsubstantiated”. But a copy of the confidential OIOS report seen later by Health Policy Watch made clear the managers were not found innocent in the cover-up: They were saved by a legal loophole. The report found that WHO policies at the time of the Ebola response in the DRC did not require manages to report sexual abuse allegations when the victim was not a direct “beneficiary” of WHO aid. Incidents involving women in the “broader community”, such as local residents or volunteers, were not covered by the reporting policies. This loophole has since been closed. “UN OIOS did not find that managerial misconduct was substantiated against anybody,” said Gamhewage. “That’s really all I have to say on that.” Mired in scandals, WHO says it is charting a new course On a visit to the Congolese city of Goma in November 2022, WHO’s Dr Gaya Gamhewage committed to supporting survivors of sexual assault of the Ebola outbreak. The UN health agency has been mired in a new wave of sexual misconduct scandals since British medical doctor Rosie James alleged a senior WHO official groped her at the World Health Summit in Berlin last October. WHO received an increased number of sexual misconduct allegations reported in the first half of 2023. Gamhewage told reporters that WHO received 48 allegations of sexual misconduct in the first six months of the year. Six of the allegations have been supported by evidence and are currently being processed. The uptick in reported cases is a “proxy indicator” that the agency’s accountability systems are improving, said Gamhewage. “We know that when there were no allegations it didn’t mean that there were no cases,” said Gamhewage. “It is just that people did not have the confidence and the trust to come forward.” WHO has become more aggressive in pursuing sexual assault allegations in an effort to rehabilitate its image after years of scandals. In April, Temo Waqanivalu was dismissed for allegedly harassing a James at the conference in Berlin. In early May, Peter Ben Embarek, a senior WHO scientist leading the agency’s investigation into the origins of the COVID-19 virus, was also dismissed for sexual misconduct. Embarek was the sventh WHO staff member to be dismissed for sexual misconduct in the previous six months. Since then, however, no new disciplinary actions against WHO personnel have been announced. “Culture is changing,” Gamhewage said in her concluding remarks. “But we have a long, long way to go.” Image Credits: Flickr: World Bank / Vincent Tremeau, UNICEF/Vincent Tremeau, WHO. Air Pollution Victims Could Sue For Damages Under Proposed New EU Rules 06/07/2023 Stefan Anderson The EU is updating its air pollution directive for the first time since 2008. The new laws are expected to take effect in late 2023 or early 2024. BRUSSELS – European Union citizens suffering from health effects caused by air pollution could soon be entitled to seek financial compensation from polluters under a proposed revision of the EU’s pollution regulations. The proposal is part of a broader overhaul of EU air pollution laws, expected to be completed in late 2023 or early 2024, said a senior European Commission official Thursday. The interests of European citizens are already protected by an array of legal umbrellas. Companies can be held liable for misleading consumers in their marketing; airlines are required to compensate customers for cancelled or delayed flights; and breaches of consumer privacy or competition laws frequently result in heavy fines. But no mechanism exists to protect people from breaches of air pollution limits or pollution from industrial sites like chemical factories, industrial farms or coal plants. And that has to change, said the European Commission’s Veronica Manfredi. “If we protect the economic interests of our citizens so well, maybe it is also time to have similar protections for their lungs,” said Manfredi, director of Zero Pollution and Green Cities at the European Commission. “Even just loss of time is recognized by the European Court of Justice (ECJ) as damage.” She was speaking at an event: Cleaner air: Time to capture the benefits, hosted by the European Policy Centre. Penalties, damages and access to justice Air pollution is responsible for over 300,000 premature deaths in Europe every year. The new air pollution rules navigating the EU’s lawmaking labyrinth are the first update to the bloc’s Ambient Air Quality Directive (AAQD) since 2008. The AAQD sets binding air quality standards for a range of air pollutants harmful to human health such as nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone which apply to all member states. The tighter rules proposed by the Commission aim to end the impunity by which polluters across the EU breach air pollution limits. Updated penalties would levy fines proportionate to the financial turnover of companies breaking air quality rules to offset any economic benefit drawn from the breaches. The Commission proposal is furthermore based on the EU’s “collective redress” model for consumer protection, which allows consumer and public organizations to seek collective settlements on behalf of consumers. The Representative Actions Directive, which was adopted in 2020 and came into full force across the bloc in June, empowers consumers to seek financial compensation for damages in areas such as data protection, financial services, and air travel. The update to the AAQD would allow individuals to do the same for health damages caused by air pollution. “We are envisioning something similar for people that are victims of pollution problems that lead them to health issues,” said Manfredi. “The new provisions entail a clear legal basis for the first time for people whose health has been damaged by air pollution to seek compensation.” Cost-benefit paradox The average annual population-weighted a PM2.5 concentration in European countries for 1990 (left) and 2019 (right). The European Environmental Agency estimates 96% of urban EU citizens are exposed to PM2.5 levels above WHO standards. Europe stands to gain hundreds of billions of euros from cleaner air. EU-wide benefits of meeting the air quality targets set by the Commission are estimated to be between €42 billion and €121 billion anually, according to a new report by the European Policy Center (EPC) published on Thursday. The costs of implementing the rules is less than €6 billion per year. “It is a paradox that we have a seven-to-one benefit ratio, but then there are still lots of resistance and concerns,” said Stefan Šipka, lead author of the EPC report. “And that is actually the lowest [estimated] ratio.” Premature deaths from air pollution have fallen by two-thirds from an estimated one million deaths in the 1990s to around 300,000 deaths in the EU region today. Implementing the stricter air quality limits set out by the Commission successfully could reduce that number yet again by over 75%, experts estimate. “It is still an absolutely unacceptable number,” said Manfredi. “It puts into tragic perspective even the number of appalling deaths we have experienced during the – after all – just two year COVID-19 pandemic.” The European Parliament’s Environment, Public Health and Food Safety (ENVI) Committee has approved the revision of the Ambient Air Quality Directive in June – a major step towards the finish line. But the directive needs to clear votes in the European Parliament and the EU Council, the body representing EU member states, before it is finalized. See the related Health Policy Watch story on a new TDR Global Health Matters podcast here: https://healthpolicy-watch.news/impossible-to-have-healthy-people-on-a-sick-planet-fighting-back-against-air-pollution/ Image Credits: Sébastien Bertrand, Daniel Moqvist. Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
After Seven Years of Planning, World Rehabilitation Alliance is Finally Launched 11/07/2023 Kerry Cullinan Grammy-award-winning musician Ricky Kej (centre back) and band perform at the World Rehabilitation Alliance launch After seven years of planning, the World Rehabilitation Alliance (WRA) was launched in Geneva on Tuesday with a founding membership of 82 organisations. Welcoming the launch, actress Emilia Clarke, who played Daenerys Targaryen (Khaleesi) in Game of Thrones, said that it was an “absolute joy” that her organisation, SameYou, is a founding member of the alliance. “I’ve suffered two brain haemorrhages, so I know firsthand just how vital rehabilitation was to my recovery,” said Clarke in a video message. “It’s something that matters to millions and millions of people all over the world, and yet still so many people don’t get access to what they need.” Emilia Clarke Grammy Award-winning singer Ricky Kej performed a song specially composed for the alliance, which was launched at the end of a two-day global summit convened by the World Health Organization (WHO) to assist countries to integrate rehabilitation care into their health systems. Earlier, Ukraine’s Deputy Health Minister, Mariia Karchevych, told the summit that her country had suddenly found itself having to provide rehabilitation for “thousands of people” injured by rockets fired on them by Russia. “In the midst of the war, we had to create a rehabilitation strategy and fully integrate it into our healthcare network,” said Karchevych. “Our lives changed in the war, but our principle remains the same. Everyone matters,” she added, expressing gratitude to the international community for its support, which she described as a “manifestation of love”. WHO Director-General Dr Tedros Adhanom Ghebreyesus described rehabilitation as “a universal right”. “This new alliance is a powerful demonstration of the collaborative spirit of the rehabilitation community. By uniting our voices across sectors, we can raise the profile of rehabilitation and support its integration in the continuity of care across all countries,” Tedros told the launch in a recorded message. “The need for rehabilitation is far, far greater than most people assume,” Dr Jérôme Salomon, Assistant Director-General and head of Universal Health Coverage at WHO, told the summit. “More than 2.4 billion people, almost a third of the global population, have health conditions that could benefit from rehabilitation. WHO’s Alarcos Cieza addresses the launch in Geneva. The summit came shortly after a watershed first-ever resolution on boosting access to rehabilitation care was passed by the World Health Assembly with unanimous support from the 193 member states in May. The resolution notes that global rehabilitation needs are “largely unmet”. In many countries, less than half of people receive the care they require. Integrating rehabilitation into health systems The summit launched a Package of Interventions for Rehabilitation aimed at assisting countries to integrate rehabilitation into their national health services, including training health workers to address the need. “The purpose of this package of interventions is to support the planning, the budgeting and the integration that we’ve talked about,” said Dr Binta Sako, WHO’s lead on rehabilitation in the Africa region. “It provides a lot of information on the type of evidence-based interventions that are needed. What is required to make the services available in terms of material and also human resources.” The package focuses on 20 health conditions spread throughout seven areas of health, added Dr Alexandra Rauch from the WHO’s Rehabilitation Programme. “It really shows the comprehensiveness of rehabilitation. It’s not about only improving body functions. It’s about improving life areas of people, and also including carers and families in rehabilitation programmes,” said Rauch. Image Credits: Megha Kaveri. Decline Recorded in India’s Air Pollution – But Not When it Matters Most 11/07/2023 Chetan Bhattacharji A dense toxic smog in New Delhi blocks out the sun. (8 November, 2017). On the face of it, it’s good news. India’s infamous air pollution has shown a significant decline across almost all states, according to a new three-year government-backed report known as SAANS – the Satellite-Based Monitoring of Ambient PM2.5 At National Scale for Air Quality Management. But there appears to be little decline during the winter months when pollution levels are at their worst, one of the report’s authors told Health Policy Watch – and the government has yet to release the full report with all the data covering three years from 2019-2022. However, the summary report shows that PM 2.5 levels (fine particles) across rural and urban regions have plateaued over the last six years and are demonstrating a consistent decline. In addition, it is the first time rural air pollution is being systematically mapped. The report made headlines because it showed a particularly huge drop in the most polluted states (see Table 2). The authors elected to monitor PM 2.5, as this category of microscopic pollutant can penetrate deep into the lungs and even enter the circulatory system, affecting other organs and systems. In 2017, about 670,000 deaths were attributed to this pollutant alone; in 2019, 1.67 million deaths – or over 3 deaths a minute – were linked to air pollution. Delhi has consistently remained the most polluted state, with an average PM 2.5 level of almost 104 micrograms/cubic metre, 20 times the safe limit guideline by the World Health Organization (WHO), for the last six years. DELHI IS MOST POLLUTED STATE FOR SIX YEARS 2017 ranking* 2022 ranking* 1 DELHI 118.5 1 DELHI 95.3 2 UTTAR PRADESH 102.7 2 BIHAR 77.2 3 HARYANA 93.1 3 HARYANA 71.7 4 BIHAR 92.5 4 UTTAR PRADESH 63.9 *micrograms/cubic m Table 1: PM 2.5 in urban areas. The top 4 most polluted states have remained the same for the last six years. Uttar Pradesh (UP), the most populated state, saw a fall in PM 2.5 of close to 40% in 2022 over 2017. In Delhi and Haryana, the decline was about 20%. This data was released in a summary and the full report will be released once cleared by top pollution control officials. However, a closer look reveals the falls are more modest when PM 2.5 levels in 2022 are compared to the average of the previous five years, that is 2017 to 2021. In Bihar, the fall is just 0.3% compared to 17% reported over the year. In Delhi and Haryana, the fall is about 10% rather than 20%. However, the fall remains substantial in UP at about 26%. State PM 2.5 level* in 2022 % change over 2017 % change over 2017-21 average DELHI 95.3 -19.5% -9.7% UTTAR PRADESH 63.9 -37.8% -26.4% HARYANA 71.7 -23.0% -10.8% BIHAR 77.2 -16.6% -0.3% *(micrograms/cubic metre) Table 2: Changes in PM 2.5 levels in India’s four most polluted states. The more pressing question is whether pollution has fallen substantially during the peak pollution months of October to January when pollution has been thick enough to close schools and cancel flights, thick enough to be tasted. PM 2.5 levels have hit 250-300 micrograms and more, that is, 50-60 times the WHO’s safe limit. Humayun’s Tomb, Delhi. Thick pollution and poor visibility occur when the air quality index (AQI) is very high. One of the report’s authors, Professor Sagnik Dey of the Centre for Atmospheric Sciences at the Indian Institute of Technology Delhi, told Health Policy Watch that the October to January situation “has not changed much.” In fact, the annual decline is mostly because of the improvement in the summertime when there are better conditions for the dispersion of polluted air – stronger winds and a higher mixed layer height. A telling map of daily pollution over 20 years used in the report shows just how bad these months are in India. Change in Annual ambient PM2.5 exposure in India from 2000 to 2019 (left) and daily PM2.5 Climatology (2000-2019) (right) Better and more effective reporting But the data in the report is significant in other ways. It is perhaps the first time the government has supported such extensive satellite-based monitoring of air quality. The authors say the technology has improved and there is a high correlation between this data and that from the official network of ground sensors, which is more accurate but also expensive. Crucially, the new satellite-based data fills in a major gap in air quality monitoring in rural areas. There is negligible rural coverage by ground-based sensors. Interestingly, the satellite data shows that there is little difference in concentration levels between urban and rural areas and the declines are also similar. The sources of ambient pollution of course may differ – vehicular and industrial pollution are high in urban areas whereas household sources were found to be the largest contributor to ambient PM2.5 in rural India. Gas cylinder roll-out eases rural pollution However, Dey suggests that rural air quality most likely improved from better penetration of liquified petroleum gas (LPG) under the government’s Ujjwala scheme to provide free gas cylinders, particularly to the rural poor. High PM 2.5 in rural areas is significantly attributable to the wide use of solid fuel for cooking, heating and even lighting, according to the report’s press release. The report has also mapped air sheds, which offers an important understanding of how pollution spreads across a region regardless of political boundaries. This supports an argument for the central government to adopt a still more proactive and wider role to cut air pollution, as it may be easier for one centre to navigate across different airsheds rather than many states. But for effective action, that is to reduce or eliminate sources of pollution, satellite data will not be enough. A large network of ground-based sensors will not only be more accurate but reflect the nuances as well as the sources of pollution. The government has upped its target for cutting air pollution to 40% by 2026. At first glance, it may seem it’s on target. But the fine print of the SAANS report (‘breath’ in Hindi) does not suggest that. Image Credits: Wikipedia, Source http://www.saans.co.in/home.html. ‘A Lifelong Journey’: Two Billion People Need Rehabilitation Globally 10/07/2023 Stefan Anderson Rehabilitation is often neglected in health systems. WHO officials say that has to change. Six years, five months and six days after suffering a stroke that paralyzed her left side, Madeline Niebanck shared her story of recovery at World Health Organization (WHO) headquarters. Niebanck, 28, spoke to delegates on Monday gathered for a global summit to strengthen financing for and access to rehabilitation care in health systems. She called on governments to use the conference to make investments that can provide what she says people going through rehabilitation need most: “hope”. “The past six years have been filled with learning how to adapt and to live a new life,” said Niebanck. “Rehab is not easy. It is hard, and it’s a lifelong journey.” Twenty-two at the time of her stroke, Niebanck had just graduated from the University of Georgetown when an arteriovenous malformation – a tangle of abnormal blood vessels – ruptured in her brain, damaging her brainstem. She was rushed into emergency surgery, and doctors told her parents they were not sure she was going to make it. “The neurosurgeon saved my life that night, but what I realize now is that surviving the brain hemorrhage was not the finish line,” said Niebanck. “It was just the beginning of a very long rehabilitation journey.” Niebanck recovers in the hospital after a tangle of blood vessels burst in her brain, paralysing the left side of her body. The high-level WHO meeting is the first since a watershed resolution on boosting access to rehabilitation care passed in the World Health Assembly with unanimous support from WHO’s 193 member states in May. The resolution – the first to directly address rehabilitation in 75 years of the World Health Assembly – found that global rehabilitation needs are “largely unmet”. In many countries, less than half of people receive the care they require. The non-binding document commits to expand financing, integrate rehabilitation into national healthcare systems, minimize the prohibitive costs of assistive technologies like hearing aids, promote research and include rehabilitation in emergency preparedness and response plans. “The need for rehabilitation is far, far greater than most people assume,” said Dr Jérôme Salomon, Assistant Director-General and head of Universal Health Coverage at WHO. “More than 2.4 billion people, almost a third of the global population, have health conditions that could benefit from rehabilitation. Niebanck shares her story with delegates at WHO headquarters. “[Madeline’s] story reminds us the core of rehabilitation is winning the fight to restore health, functioning and dignity,” said Salomon. “It also underlines that winning this fight is as critical as the fight to survive.” The number of people requiring rehabilitation has climbed by nearly 70% since 1990, driven by an increase in musculoskeletal disorders like lower back pain, neurological disorders and sensory impairments. Leading causes of disability vary from country to country, from hearing loss in China to fractures in Russia, vision loss in India and lower back pain in the United States. “The challenge and the tragedy is when rehabilitation services are not available or are not provided,” said Alarcos Cieza, who leads WHO’s vision, hearing, disability, and rehabilitation unit. “In many countries where people don’t receive rehabilitation, people die.” WHO defines rehabilitation as a range of interventions and technologies designed to help people with disabilities regain their independence. These include assistive technologies such as hearing aids, glasses, wheelchairs and prosthetics, and physical, occupational, and psychological therapies. “Rehabilitation is about our everyday life, how we communicate, how we move around,” said Cieza. “It’s about sleeping, it’s about breathing, it’s about our relationships – it’s really about our lives.” Rehabilitation still out of reach for millions Four decades after the WHO recognized rehabilitation as an essential health service, millions of people still lack access to these life-altering interventions. Health systems across the world suffer from significant funding shortfalls, but gaps in access are especially large in low- and middle-income countries. WHO estimates 20 to 40% of health resources are wasted through inefficiencies and corruption. Rehabilitation is especially hard hit by this problem. “With the rising prevalence of noncommunicable diseases, ageing populations, and improved survival from injuries, the need for rehabilitation services is expected to increase significantly,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. “Low investment and awareness persist, driven by pervasive misconceptions that rehabilitation is too costly, or simply unfeasible to deliver in low-resource settings.” Hearing aids, glasses and other assistive technologies can be prohibitively expensive. Taken for granted in wealthy countries, these simple technologies are out of reach for millions globally. More than one-third of national health expenditure in low- and middle-income countries comes from out-of-pocket expenses, a major source of financial hardship for families. Assistive technologies such as glasses, hearing aids and wheelchairs are particularly expensive, and many low-and middle-income countries do not have any national service for these products. Many people cannot access, or choose to forgo, the assistive devices they need because they are too expensive. More than one billion people – one in eight globally – cannot see properly because they cannot afford glasses. The high costs of rehabilitation often prevent people from accessing the care they need, which can have serious impacts on their health and well-being. It can also lead to poverty, as families may have to sell assets or take on debt to pay for assistive devices. “For most people, rehabilitation services, including necessary assistive technologies, are often out-of-pocket expenses that they cannot afford – this is unacceptable,” said Salomon. “Anyone with rehabilitation needs must have access to quality services whenever and wherever they need them without facing financial hardship.” Rehabilitation is also badly affected by the ongoing global shortage of healthcare workers, which is projected to hit 10 million by 2030. The staffing crisis is most acute in low- and middle-income countries and the rural, hard-to-reach areas within them. Meanwhile, the COVID-19 pandemic accelerated the migration of trained health workers to high-income health systems in search of higher pay, worsening the shortage in the already struggling health systems of poorer countries. Progress is progress: WHO pushes ahead Map of countries supported by WHO in the area of rehabilitation. WHO has significantly increased its technical assistance to countries for rehabilitation services since the Global Rehabilitation 2030 agenda was adopted in 2017. In that time, WHO has provided technical assistance to 37 countries, up from zero when the agenda was adopted. Twenty-five low- and middle-income countries have so far implemented strategic plans on rehabilitation with WHO assistance. On the first day of the rehabilitation summit on Monday, WHO published two policy guides for governments seeking to improve rehabilitation care. The first guide, a package for rehabilitation interventions with contributions from over 700 experts from 90 countries, is to assist countries on the “planning, budgeting and implementing of rehabilitation in their health systems.” The second provides guidance on how to ensure that people with disabilities have access to rehabilitation services during disasters and other emergencies – the difficulties of which were brought into sharp focus by COVID-19, the war in Ukraine, and the Turko-Syrian earthquake. WHO is expected to launch further technical guidance in the areas of workforce, information systems, financing, and health service delivery over the course of the Global Rehabilitation 2030 conference, which ends on Tuesday. Image Credits: Marina Raspopova/ Unsplash, CC. Warning That UN High-Level Meeting on Pandemics May be ‘Squandered’ Opportunity 10/07/2023 Kerry Cullinan As United Nations (UN) member states meet in New York on Monday and Tuesday to discuss the political declaration to be adopted at the General Assembly’s High-Level Meeting (HLM) on Pandemics in September, there are growing concerns that the current draft is weak and proposes an over-reliance on the World Health Organization (WHO) to manage future pandemics. The current draft – pared down from 58 to 15 pages – has dispensed with a number of critical concerns, particularly about how future pandemics will be governed, located almost entirely with the WHO. The most vocal criticism of the draft comes from the co-chairs of the Independent Panel for Pandemic Preparedness and Response, which has proposed a high-level independent oversight group to govern global pandemic responses. “We are gravely concerned that the opportunity presented by the High-Level Meeting and the expected Political Declaration on Pandemic Prevention, Preparedness and Response is being squandered,” wrote Ellen Johnson Sirleaf and Helen Clark in an open letter released on Sunday. “The current draft of the political declaration… does not express the commitments required of heads of state and government to transform the international system of pandemic preparedness and response. Instead, it reads as a health resolution,” they add. The Independent Panel has published a road map to deal with future pandemics, that sets out recommendations on governance, equitable access to pandemic countermeasures, preparedness and surge finance, the need for clear rules and roles, and for a stronger WHO. “Only international, multilateral, and multi-sectoral collaboration can safeguard the world from the next pandemic threat,” according to the Independent Panel. Pointing out that the success of the WHO negotiations currently underway to develop a pandemic accord is not guaranteed, Sirleaf and Clark reiterate their view that “sustained highest-level political leadership on pandemic preparedness and response” is essential between and during health crises. “This is required to ensure protection to health, societies and economies, and to stop outbreaks from becoming pandemics,” they add. Describing the UN HLM as “a one-time and historic opportunity to commit to lasting and transformative change to pandemic preparedness and response”, they add that if member states “only tinker with the language” of the current draft, “the efforts to agree to the declaration will be wasted”. Meanwhile, Nina Schwalbe, a principal visiting fellow at the UN University’s International Institute for Global Health, also expressed disappointment with the draft. “Rather than a strong declaration that commits UN Member States at the highest level to fundamentally change how they address all aspects of pandemic prevention, preparedness, and response, it covers everything from hand hygiene to pollution,” commented Schwalbe on Twitter. https://twitter.com/nschwalbe/status/1677334373954203651 Image Credits: Wikimedia Commons. New WHO and UN-wide System to Aid Victims of Sexual Exploitation Needed, says Independent Investigator 07/07/2023 Stefan Anderson Families go to an Ebola treatment centre to visit a family member held in quarantine in Beni, North Kivu region, Democratic Republic of Congo. The World Health Organiztion (WHO) has been far too slow in providing financial, psychological and legal assistance to victims of sexual assault and exploitation committed by its staff in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola response, a veteran international investigator said at a WHO press conference on Friday. Hervé Gogo, presenting his assessment of the World Health Organization’s (WHO) performance since the scandal first came to light in 2020, said that the problems are endemic to the United Nations (UN) system as a whole and that solutions need a system-wide approach. “It took too much time,” Gogo said of the WHO support extended to over 100 victims in DRC who were raped, abused or lured into having sex in exchange for jobs or money by UN and WHO staffers. “Something needs to be done to streamline the process … particularly on the question of assistance to victims and survivors.” Gogo’s findings are part of his review of WHO’s compliance with recommendations made in 2021 by an independent enquiry commissioned after The New Humanitarian uncovered the sexual abuses committed by over 80 UN and WHO staff in the DRC. UN-wide provisions to victims are “not sufficient” A health worker checks a child potentially infected with Ebola being carried on the back of a caregiver at the Ebola Treatment Centre of Beni, North-Kivu province, Democratic Republic of Congo, during the 2018-2020 Ebola outbreak. The United Nations system lacks legal provisions for victims to receive compensation directly from the UN without first obtaining a favourable court ruling against one of its agencies. This process can take years, and even if the victim can identify the perpetrator – many cannot, as UN staffers often used fake credentials – proving the organisation is responsible for the actions of the abuser can be next to impossible. This system is “not sufficient” to support victims of sexual abuse, said Gogo. “Is it really possible to stick to this orthodoxy? Victims are faced with an impossible task,” he said. “We all really want victims to get compensated: The question is how. It all depends on member states to figure out how to create a mechanism of compensation without waiting for the court process to end.” Despite the delays in assistance reaching victims, Gogo said the UN health agency’s efforts since the crisis are “more than a good start” to the overhaul of its sexual abuse and exploitation policies. Search for justice continues in DRC WHO to Share Information with Congolese Court in Sexual Abuse Cases of 13 Women WHO has provided support to all 115 survivors of sexual assault in the DRC identified by the independent commission report regardless of whether the perpetrators were affiliated with WHO or other UN agencies, said Dr Gaya Gamhewege, the agency’s lead official in prevention and response to sexual misconduct. WHO is also providing legal support to victims who decided to pursue local court cases against their alleged abusers. The agency has also complied with requests for information from local authorities in DRC about 16 people linked to WHO who are facing legal action in the country. Gamhewege did not provide any further information on the status of the cases. “WHO will continue to support any and all survivors who need more support, even if they are affiliated to allegations by personnel from other agencies,” she said. WHO terminated seven consultants in after finding sufficient evidence of misconduct in the wake of the scandal, Gamehwage said in an interview with Health Policy Watch in April. The agency also posted 14 former staff and consultants identified as alleged perpetrators by the Independent Commission on the UN ClearCheck database, blacklisting them from being hired in the UN. ‘Not a single finding’ showing Tedros knew about abuse claims or cover-up WHO Member States re-elected Dr Tedros Adhanom Ghebreyesus to serve a second five-year term as Director-General of the WHO in May 2022. Gogo, who previously served as a senior judicial officer in the UN mission in DRC, was emphatic that no evidence implicating WHO Director-General Dr Tedros Adhanom Ghebreyesus or his inner circle in covering up the sexual assaults in the DRC has been uncovered. “There is not a single finding about any decision or any information that was shared DG,” Gogo told reporters. “There is nothing to hide.” No high-ranking WHO officials have been disciplined as a result of the sexual assaults in the DRC. Three senior managers at the agency who were accused of covering up the allegations were reinstated in January after being cleared of charges by the UN Office of Internal Oversight Services (OIOS), which investigated the cases at the request of WHO. WHO Direct-General Dr Tedros Adhanom Ghebreyesus told the WHO Executive Board they were reinstated because claims of managerial misconduct were “unsubstantiated”. But a copy of the confidential OIOS report seen later by Health Policy Watch made clear the managers were not found innocent in the cover-up: They were saved by a legal loophole. The report found that WHO policies at the time of the Ebola response in the DRC did not require manages to report sexual abuse allegations when the victim was not a direct “beneficiary” of WHO aid. Incidents involving women in the “broader community”, such as local residents or volunteers, were not covered by the reporting policies. This loophole has since been closed. “UN OIOS did not find that managerial misconduct was substantiated against anybody,” said Gamhewage. “That’s really all I have to say on that.” Mired in scandals, WHO says it is charting a new course On a visit to the Congolese city of Goma in November 2022, WHO’s Dr Gaya Gamhewage committed to supporting survivors of sexual assault of the Ebola outbreak. The UN health agency has been mired in a new wave of sexual misconduct scandals since British medical doctor Rosie James alleged a senior WHO official groped her at the World Health Summit in Berlin last October. WHO received an increased number of sexual misconduct allegations reported in the first half of 2023. Gamhewage told reporters that WHO received 48 allegations of sexual misconduct in the first six months of the year. Six of the allegations have been supported by evidence and are currently being processed. The uptick in reported cases is a “proxy indicator” that the agency’s accountability systems are improving, said Gamhewage. “We know that when there were no allegations it didn’t mean that there were no cases,” said Gamhewage. “It is just that people did not have the confidence and the trust to come forward.” WHO has become more aggressive in pursuing sexual assault allegations in an effort to rehabilitate its image after years of scandals. In April, Temo Waqanivalu was dismissed for allegedly harassing a James at the conference in Berlin. In early May, Peter Ben Embarek, a senior WHO scientist leading the agency’s investigation into the origins of the COVID-19 virus, was also dismissed for sexual misconduct. Embarek was the sventh WHO staff member to be dismissed for sexual misconduct in the previous six months. Since then, however, no new disciplinary actions against WHO personnel have been announced. “Culture is changing,” Gamhewage said in her concluding remarks. “But we have a long, long way to go.” Image Credits: Flickr: World Bank / Vincent Tremeau, UNICEF/Vincent Tremeau, WHO. Air Pollution Victims Could Sue For Damages Under Proposed New EU Rules 06/07/2023 Stefan Anderson The EU is updating its air pollution directive for the first time since 2008. The new laws are expected to take effect in late 2023 or early 2024. BRUSSELS – European Union citizens suffering from health effects caused by air pollution could soon be entitled to seek financial compensation from polluters under a proposed revision of the EU’s pollution regulations. The proposal is part of a broader overhaul of EU air pollution laws, expected to be completed in late 2023 or early 2024, said a senior European Commission official Thursday. The interests of European citizens are already protected by an array of legal umbrellas. Companies can be held liable for misleading consumers in their marketing; airlines are required to compensate customers for cancelled or delayed flights; and breaches of consumer privacy or competition laws frequently result in heavy fines. But no mechanism exists to protect people from breaches of air pollution limits or pollution from industrial sites like chemical factories, industrial farms or coal plants. And that has to change, said the European Commission’s Veronica Manfredi. “If we protect the economic interests of our citizens so well, maybe it is also time to have similar protections for their lungs,” said Manfredi, director of Zero Pollution and Green Cities at the European Commission. “Even just loss of time is recognized by the European Court of Justice (ECJ) as damage.” She was speaking at an event: Cleaner air: Time to capture the benefits, hosted by the European Policy Centre. Penalties, damages and access to justice Air pollution is responsible for over 300,000 premature deaths in Europe every year. The new air pollution rules navigating the EU’s lawmaking labyrinth are the first update to the bloc’s Ambient Air Quality Directive (AAQD) since 2008. The AAQD sets binding air quality standards for a range of air pollutants harmful to human health such as nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone which apply to all member states. The tighter rules proposed by the Commission aim to end the impunity by which polluters across the EU breach air pollution limits. Updated penalties would levy fines proportionate to the financial turnover of companies breaking air quality rules to offset any economic benefit drawn from the breaches. The Commission proposal is furthermore based on the EU’s “collective redress” model for consumer protection, which allows consumer and public organizations to seek collective settlements on behalf of consumers. The Representative Actions Directive, which was adopted in 2020 and came into full force across the bloc in June, empowers consumers to seek financial compensation for damages in areas such as data protection, financial services, and air travel. The update to the AAQD would allow individuals to do the same for health damages caused by air pollution. “We are envisioning something similar for people that are victims of pollution problems that lead them to health issues,” said Manfredi. “The new provisions entail a clear legal basis for the first time for people whose health has been damaged by air pollution to seek compensation.” Cost-benefit paradox The average annual population-weighted a PM2.5 concentration in European countries for 1990 (left) and 2019 (right). The European Environmental Agency estimates 96% of urban EU citizens are exposed to PM2.5 levels above WHO standards. Europe stands to gain hundreds of billions of euros from cleaner air. EU-wide benefits of meeting the air quality targets set by the Commission are estimated to be between €42 billion and €121 billion anually, according to a new report by the European Policy Center (EPC) published on Thursday. The costs of implementing the rules is less than €6 billion per year. “It is a paradox that we have a seven-to-one benefit ratio, but then there are still lots of resistance and concerns,” said Stefan Šipka, lead author of the EPC report. “And that is actually the lowest [estimated] ratio.” Premature deaths from air pollution have fallen by two-thirds from an estimated one million deaths in the 1990s to around 300,000 deaths in the EU region today. Implementing the stricter air quality limits set out by the Commission successfully could reduce that number yet again by over 75%, experts estimate. “It is still an absolutely unacceptable number,” said Manfredi. “It puts into tragic perspective even the number of appalling deaths we have experienced during the – after all – just two year COVID-19 pandemic.” The European Parliament’s Environment, Public Health and Food Safety (ENVI) Committee has approved the revision of the Ambient Air Quality Directive in June – a major step towards the finish line. But the directive needs to clear votes in the European Parliament and the EU Council, the body representing EU member states, before it is finalized. See the related Health Policy Watch story on a new TDR Global Health Matters podcast here: https://healthpolicy-watch.news/impossible-to-have-healthy-people-on-a-sick-planet-fighting-back-against-air-pollution/ Image Credits: Sébastien Bertrand, Daniel Moqvist. Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Decline Recorded in India’s Air Pollution – But Not When it Matters Most 11/07/2023 Chetan Bhattacharji A dense toxic smog in New Delhi blocks out the sun. (8 November, 2017). On the face of it, it’s good news. India’s infamous air pollution has shown a significant decline across almost all states, according to a new three-year government-backed report known as SAANS – the Satellite-Based Monitoring of Ambient PM2.5 At National Scale for Air Quality Management. But there appears to be little decline during the winter months when pollution levels are at their worst, one of the report’s authors told Health Policy Watch – and the government has yet to release the full report with all the data covering three years from 2019-2022. However, the summary report shows that PM 2.5 levels (fine particles) across rural and urban regions have plateaued over the last six years and are demonstrating a consistent decline. In addition, it is the first time rural air pollution is being systematically mapped. The report made headlines because it showed a particularly huge drop in the most polluted states (see Table 2). The authors elected to monitor PM 2.5, as this category of microscopic pollutant can penetrate deep into the lungs and even enter the circulatory system, affecting other organs and systems. In 2017, about 670,000 deaths were attributed to this pollutant alone; in 2019, 1.67 million deaths – or over 3 deaths a minute – were linked to air pollution. Delhi has consistently remained the most polluted state, with an average PM 2.5 level of almost 104 micrograms/cubic metre, 20 times the safe limit guideline by the World Health Organization (WHO), for the last six years. DELHI IS MOST POLLUTED STATE FOR SIX YEARS 2017 ranking* 2022 ranking* 1 DELHI 118.5 1 DELHI 95.3 2 UTTAR PRADESH 102.7 2 BIHAR 77.2 3 HARYANA 93.1 3 HARYANA 71.7 4 BIHAR 92.5 4 UTTAR PRADESH 63.9 *micrograms/cubic m Table 1: PM 2.5 in urban areas. The top 4 most polluted states have remained the same for the last six years. Uttar Pradesh (UP), the most populated state, saw a fall in PM 2.5 of close to 40% in 2022 over 2017. In Delhi and Haryana, the decline was about 20%. This data was released in a summary and the full report will be released once cleared by top pollution control officials. However, a closer look reveals the falls are more modest when PM 2.5 levels in 2022 are compared to the average of the previous five years, that is 2017 to 2021. In Bihar, the fall is just 0.3% compared to 17% reported over the year. In Delhi and Haryana, the fall is about 10% rather than 20%. However, the fall remains substantial in UP at about 26%. State PM 2.5 level* in 2022 % change over 2017 % change over 2017-21 average DELHI 95.3 -19.5% -9.7% UTTAR PRADESH 63.9 -37.8% -26.4% HARYANA 71.7 -23.0% -10.8% BIHAR 77.2 -16.6% -0.3% *(micrograms/cubic metre) Table 2: Changes in PM 2.5 levels in India’s four most polluted states. The more pressing question is whether pollution has fallen substantially during the peak pollution months of October to January when pollution has been thick enough to close schools and cancel flights, thick enough to be tasted. PM 2.5 levels have hit 250-300 micrograms and more, that is, 50-60 times the WHO’s safe limit. Humayun’s Tomb, Delhi. Thick pollution and poor visibility occur when the air quality index (AQI) is very high. One of the report’s authors, Professor Sagnik Dey of the Centre for Atmospheric Sciences at the Indian Institute of Technology Delhi, told Health Policy Watch that the October to January situation “has not changed much.” In fact, the annual decline is mostly because of the improvement in the summertime when there are better conditions for the dispersion of polluted air – stronger winds and a higher mixed layer height. A telling map of daily pollution over 20 years used in the report shows just how bad these months are in India. Change in Annual ambient PM2.5 exposure in India from 2000 to 2019 (left) and daily PM2.5 Climatology (2000-2019) (right) Better and more effective reporting But the data in the report is significant in other ways. It is perhaps the first time the government has supported such extensive satellite-based monitoring of air quality. The authors say the technology has improved and there is a high correlation between this data and that from the official network of ground sensors, which is more accurate but also expensive. Crucially, the new satellite-based data fills in a major gap in air quality monitoring in rural areas. There is negligible rural coverage by ground-based sensors. Interestingly, the satellite data shows that there is little difference in concentration levels between urban and rural areas and the declines are also similar. The sources of ambient pollution of course may differ – vehicular and industrial pollution are high in urban areas whereas household sources were found to be the largest contributor to ambient PM2.5 in rural India. Gas cylinder roll-out eases rural pollution However, Dey suggests that rural air quality most likely improved from better penetration of liquified petroleum gas (LPG) under the government’s Ujjwala scheme to provide free gas cylinders, particularly to the rural poor. High PM 2.5 in rural areas is significantly attributable to the wide use of solid fuel for cooking, heating and even lighting, according to the report’s press release. The report has also mapped air sheds, which offers an important understanding of how pollution spreads across a region regardless of political boundaries. This supports an argument for the central government to adopt a still more proactive and wider role to cut air pollution, as it may be easier for one centre to navigate across different airsheds rather than many states. But for effective action, that is to reduce or eliminate sources of pollution, satellite data will not be enough. A large network of ground-based sensors will not only be more accurate but reflect the nuances as well as the sources of pollution. The government has upped its target for cutting air pollution to 40% by 2026. At first glance, it may seem it’s on target. But the fine print of the SAANS report (‘breath’ in Hindi) does not suggest that. Image Credits: Wikipedia, Source http://www.saans.co.in/home.html. ‘A Lifelong Journey’: Two Billion People Need Rehabilitation Globally 10/07/2023 Stefan Anderson Rehabilitation is often neglected in health systems. WHO officials say that has to change. Six years, five months and six days after suffering a stroke that paralyzed her left side, Madeline Niebanck shared her story of recovery at World Health Organization (WHO) headquarters. Niebanck, 28, spoke to delegates on Monday gathered for a global summit to strengthen financing for and access to rehabilitation care in health systems. She called on governments to use the conference to make investments that can provide what she says people going through rehabilitation need most: “hope”. “The past six years have been filled with learning how to adapt and to live a new life,” said Niebanck. “Rehab is not easy. It is hard, and it’s a lifelong journey.” Twenty-two at the time of her stroke, Niebanck had just graduated from the University of Georgetown when an arteriovenous malformation – a tangle of abnormal blood vessels – ruptured in her brain, damaging her brainstem. She was rushed into emergency surgery, and doctors told her parents they were not sure she was going to make it. “The neurosurgeon saved my life that night, but what I realize now is that surviving the brain hemorrhage was not the finish line,” said Niebanck. “It was just the beginning of a very long rehabilitation journey.” Niebanck recovers in the hospital after a tangle of blood vessels burst in her brain, paralysing the left side of her body. The high-level WHO meeting is the first since a watershed resolution on boosting access to rehabilitation care passed in the World Health Assembly with unanimous support from WHO’s 193 member states in May. The resolution – the first to directly address rehabilitation in 75 years of the World Health Assembly – found that global rehabilitation needs are “largely unmet”. In many countries, less than half of people receive the care they require. The non-binding document commits to expand financing, integrate rehabilitation into national healthcare systems, minimize the prohibitive costs of assistive technologies like hearing aids, promote research and include rehabilitation in emergency preparedness and response plans. “The need for rehabilitation is far, far greater than most people assume,” said Dr Jérôme Salomon, Assistant Director-General and head of Universal Health Coverage at WHO. “More than 2.4 billion people, almost a third of the global population, have health conditions that could benefit from rehabilitation. Niebanck shares her story with delegates at WHO headquarters. “[Madeline’s] story reminds us the core of rehabilitation is winning the fight to restore health, functioning and dignity,” said Salomon. “It also underlines that winning this fight is as critical as the fight to survive.” The number of people requiring rehabilitation has climbed by nearly 70% since 1990, driven by an increase in musculoskeletal disorders like lower back pain, neurological disorders and sensory impairments. Leading causes of disability vary from country to country, from hearing loss in China to fractures in Russia, vision loss in India and lower back pain in the United States. “The challenge and the tragedy is when rehabilitation services are not available or are not provided,” said Alarcos Cieza, who leads WHO’s vision, hearing, disability, and rehabilitation unit. “In many countries where people don’t receive rehabilitation, people die.” WHO defines rehabilitation as a range of interventions and technologies designed to help people with disabilities regain their independence. These include assistive technologies such as hearing aids, glasses, wheelchairs and prosthetics, and physical, occupational, and psychological therapies. “Rehabilitation is about our everyday life, how we communicate, how we move around,” said Cieza. “It’s about sleeping, it’s about breathing, it’s about our relationships – it’s really about our lives.” Rehabilitation still out of reach for millions Four decades after the WHO recognized rehabilitation as an essential health service, millions of people still lack access to these life-altering interventions. Health systems across the world suffer from significant funding shortfalls, but gaps in access are especially large in low- and middle-income countries. WHO estimates 20 to 40% of health resources are wasted through inefficiencies and corruption. Rehabilitation is especially hard hit by this problem. “With the rising prevalence of noncommunicable diseases, ageing populations, and improved survival from injuries, the need for rehabilitation services is expected to increase significantly,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. “Low investment and awareness persist, driven by pervasive misconceptions that rehabilitation is too costly, or simply unfeasible to deliver in low-resource settings.” Hearing aids, glasses and other assistive technologies can be prohibitively expensive. Taken for granted in wealthy countries, these simple technologies are out of reach for millions globally. More than one-third of national health expenditure in low- and middle-income countries comes from out-of-pocket expenses, a major source of financial hardship for families. Assistive technologies such as glasses, hearing aids and wheelchairs are particularly expensive, and many low-and middle-income countries do not have any national service for these products. Many people cannot access, or choose to forgo, the assistive devices they need because they are too expensive. More than one billion people – one in eight globally – cannot see properly because they cannot afford glasses. The high costs of rehabilitation often prevent people from accessing the care they need, which can have serious impacts on their health and well-being. It can also lead to poverty, as families may have to sell assets or take on debt to pay for assistive devices. “For most people, rehabilitation services, including necessary assistive technologies, are often out-of-pocket expenses that they cannot afford – this is unacceptable,” said Salomon. “Anyone with rehabilitation needs must have access to quality services whenever and wherever they need them without facing financial hardship.” Rehabilitation is also badly affected by the ongoing global shortage of healthcare workers, which is projected to hit 10 million by 2030. The staffing crisis is most acute in low- and middle-income countries and the rural, hard-to-reach areas within them. Meanwhile, the COVID-19 pandemic accelerated the migration of trained health workers to high-income health systems in search of higher pay, worsening the shortage in the already struggling health systems of poorer countries. Progress is progress: WHO pushes ahead Map of countries supported by WHO in the area of rehabilitation. WHO has significantly increased its technical assistance to countries for rehabilitation services since the Global Rehabilitation 2030 agenda was adopted in 2017. In that time, WHO has provided technical assistance to 37 countries, up from zero when the agenda was adopted. Twenty-five low- and middle-income countries have so far implemented strategic plans on rehabilitation with WHO assistance. On the first day of the rehabilitation summit on Monday, WHO published two policy guides for governments seeking to improve rehabilitation care. The first guide, a package for rehabilitation interventions with contributions from over 700 experts from 90 countries, is to assist countries on the “planning, budgeting and implementing of rehabilitation in their health systems.” The second provides guidance on how to ensure that people with disabilities have access to rehabilitation services during disasters and other emergencies – the difficulties of which were brought into sharp focus by COVID-19, the war in Ukraine, and the Turko-Syrian earthquake. WHO is expected to launch further technical guidance in the areas of workforce, information systems, financing, and health service delivery over the course of the Global Rehabilitation 2030 conference, which ends on Tuesday. Image Credits: Marina Raspopova/ Unsplash, CC. Warning That UN High-Level Meeting on Pandemics May be ‘Squandered’ Opportunity 10/07/2023 Kerry Cullinan As United Nations (UN) member states meet in New York on Monday and Tuesday to discuss the political declaration to be adopted at the General Assembly’s High-Level Meeting (HLM) on Pandemics in September, there are growing concerns that the current draft is weak and proposes an over-reliance on the World Health Organization (WHO) to manage future pandemics. The current draft – pared down from 58 to 15 pages – has dispensed with a number of critical concerns, particularly about how future pandemics will be governed, located almost entirely with the WHO. The most vocal criticism of the draft comes from the co-chairs of the Independent Panel for Pandemic Preparedness and Response, which has proposed a high-level independent oversight group to govern global pandemic responses. “We are gravely concerned that the opportunity presented by the High-Level Meeting and the expected Political Declaration on Pandemic Prevention, Preparedness and Response is being squandered,” wrote Ellen Johnson Sirleaf and Helen Clark in an open letter released on Sunday. “The current draft of the political declaration… does not express the commitments required of heads of state and government to transform the international system of pandemic preparedness and response. Instead, it reads as a health resolution,” they add. The Independent Panel has published a road map to deal with future pandemics, that sets out recommendations on governance, equitable access to pandemic countermeasures, preparedness and surge finance, the need for clear rules and roles, and for a stronger WHO. “Only international, multilateral, and multi-sectoral collaboration can safeguard the world from the next pandemic threat,” according to the Independent Panel. Pointing out that the success of the WHO negotiations currently underway to develop a pandemic accord is not guaranteed, Sirleaf and Clark reiterate their view that “sustained highest-level political leadership on pandemic preparedness and response” is essential between and during health crises. “This is required to ensure protection to health, societies and economies, and to stop outbreaks from becoming pandemics,” they add. Describing the UN HLM as “a one-time and historic opportunity to commit to lasting and transformative change to pandemic preparedness and response”, they add that if member states “only tinker with the language” of the current draft, “the efforts to agree to the declaration will be wasted”. Meanwhile, Nina Schwalbe, a principal visiting fellow at the UN University’s International Institute for Global Health, also expressed disappointment with the draft. “Rather than a strong declaration that commits UN Member States at the highest level to fundamentally change how they address all aspects of pandemic prevention, preparedness, and response, it covers everything from hand hygiene to pollution,” commented Schwalbe on Twitter. https://twitter.com/nschwalbe/status/1677334373954203651 Image Credits: Wikimedia Commons. New WHO and UN-wide System to Aid Victims of Sexual Exploitation Needed, says Independent Investigator 07/07/2023 Stefan Anderson Families go to an Ebola treatment centre to visit a family member held in quarantine in Beni, North Kivu region, Democratic Republic of Congo. The World Health Organiztion (WHO) has been far too slow in providing financial, psychological and legal assistance to victims of sexual assault and exploitation committed by its staff in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola response, a veteran international investigator said at a WHO press conference on Friday. Hervé Gogo, presenting his assessment of the World Health Organization’s (WHO) performance since the scandal first came to light in 2020, said that the problems are endemic to the United Nations (UN) system as a whole and that solutions need a system-wide approach. “It took too much time,” Gogo said of the WHO support extended to over 100 victims in DRC who were raped, abused or lured into having sex in exchange for jobs or money by UN and WHO staffers. “Something needs to be done to streamline the process … particularly on the question of assistance to victims and survivors.” Gogo’s findings are part of his review of WHO’s compliance with recommendations made in 2021 by an independent enquiry commissioned after The New Humanitarian uncovered the sexual abuses committed by over 80 UN and WHO staff in the DRC. UN-wide provisions to victims are “not sufficient” A health worker checks a child potentially infected with Ebola being carried on the back of a caregiver at the Ebola Treatment Centre of Beni, North-Kivu province, Democratic Republic of Congo, during the 2018-2020 Ebola outbreak. The United Nations system lacks legal provisions for victims to receive compensation directly from the UN without first obtaining a favourable court ruling against one of its agencies. This process can take years, and even if the victim can identify the perpetrator – many cannot, as UN staffers often used fake credentials – proving the organisation is responsible for the actions of the abuser can be next to impossible. This system is “not sufficient” to support victims of sexual abuse, said Gogo. “Is it really possible to stick to this orthodoxy? Victims are faced with an impossible task,” he said. “We all really want victims to get compensated: The question is how. It all depends on member states to figure out how to create a mechanism of compensation without waiting for the court process to end.” Despite the delays in assistance reaching victims, Gogo said the UN health agency’s efforts since the crisis are “more than a good start” to the overhaul of its sexual abuse and exploitation policies. Search for justice continues in DRC WHO to Share Information with Congolese Court in Sexual Abuse Cases of 13 Women WHO has provided support to all 115 survivors of sexual assault in the DRC identified by the independent commission report regardless of whether the perpetrators were affiliated with WHO or other UN agencies, said Dr Gaya Gamhewege, the agency’s lead official in prevention and response to sexual misconduct. WHO is also providing legal support to victims who decided to pursue local court cases against their alleged abusers. The agency has also complied with requests for information from local authorities in DRC about 16 people linked to WHO who are facing legal action in the country. Gamhewege did not provide any further information on the status of the cases. “WHO will continue to support any and all survivors who need more support, even if they are affiliated to allegations by personnel from other agencies,” she said. WHO terminated seven consultants in after finding sufficient evidence of misconduct in the wake of the scandal, Gamehwage said in an interview with Health Policy Watch in April. The agency also posted 14 former staff and consultants identified as alleged perpetrators by the Independent Commission on the UN ClearCheck database, blacklisting them from being hired in the UN. ‘Not a single finding’ showing Tedros knew about abuse claims or cover-up WHO Member States re-elected Dr Tedros Adhanom Ghebreyesus to serve a second five-year term as Director-General of the WHO in May 2022. Gogo, who previously served as a senior judicial officer in the UN mission in DRC, was emphatic that no evidence implicating WHO Director-General Dr Tedros Adhanom Ghebreyesus or his inner circle in covering up the sexual assaults in the DRC has been uncovered. “There is not a single finding about any decision or any information that was shared DG,” Gogo told reporters. “There is nothing to hide.” No high-ranking WHO officials have been disciplined as a result of the sexual assaults in the DRC. Three senior managers at the agency who were accused of covering up the allegations were reinstated in January after being cleared of charges by the UN Office of Internal Oversight Services (OIOS), which investigated the cases at the request of WHO. WHO Direct-General Dr Tedros Adhanom Ghebreyesus told the WHO Executive Board they were reinstated because claims of managerial misconduct were “unsubstantiated”. But a copy of the confidential OIOS report seen later by Health Policy Watch made clear the managers were not found innocent in the cover-up: They were saved by a legal loophole. The report found that WHO policies at the time of the Ebola response in the DRC did not require manages to report sexual abuse allegations when the victim was not a direct “beneficiary” of WHO aid. Incidents involving women in the “broader community”, such as local residents or volunteers, were not covered by the reporting policies. This loophole has since been closed. “UN OIOS did not find that managerial misconduct was substantiated against anybody,” said Gamhewage. “That’s really all I have to say on that.” Mired in scandals, WHO says it is charting a new course On a visit to the Congolese city of Goma in November 2022, WHO’s Dr Gaya Gamhewage committed to supporting survivors of sexual assault of the Ebola outbreak. The UN health agency has been mired in a new wave of sexual misconduct scandals since British medical doctor Rosie James alleged a senior WHO official groped her at the World Health Summit in Berlin last October. WHO received an increased number of sexual misconduct allegations reported in the first half of 2023. Gamhewage told reporters that WHO received 48 allegations of sexual misconduct in the first six months of the year. Six of the allegations have been supported by evidence and are currently being processed. The uptick in reported cases is a “proxy indicator” that the agency’s accountability systems are improving, said Gamhewage. “We know that when there were no allegations it didn’t mean that there were no cases,” said Gamhewage. “It is just that people did not have the confidence and the trust to come forward.” WHO has become more aggressive in pursuing sexual assault allegations in an effort to rehabilitate its image after years of scandals. In April, Temo Waqanivalu was dismissed for allegedly harassing a James at the conference in Berlin. In early May, Peter Ben Embarek, a senior WHO scientist leading the agency’s investigation into the origins of the COVID-19 virus, was also dismissed for sexual misconduct. Embarek was the sventh WHO staff member to be dismissed for sexual misconduct in the previous six months. Since then, however, no new disciplinary actions against WHO personnel have been announced. “Culture is changing,” Gamhewage said in her concluding remarks. “But we have a long, long way to go.” Image Credits: Flickr: World Bank / Vincent Tremeau, UNICEF/Vincent Tremeau, WHO. Air Pollution Victims Could Sue For Damages Under Proposed New EU Rules 06/07/2023 Stefan Anderson The EU is updating its air pollution directive for the first time since 2008. The new laws are expected to take effect in late 2023 or early 2024. BRUSSELS – European Union citizens suffering from health effects caused by air pollution could soon be entitled to seek financial compensation from polluters under a proposed revision of the EU’s pollution regulations. The proposal is part of a broader overhaul of EU air pollution laws, expected to be completed in late 2023 or early 2024, said a senior European Commission official Thursday. The interests of European citizens are already protected by an array of legal umbrellas. Companies can be held liable for misleading consumers in their marketing; airlines are required to compensate customers for cancelled or delayed flights; and breaches of consumer privacy or competition laws frequently result in heavy fines. But no mechanism exists to protect people from breaches of air pollution limits or pollution from industrial sites like chemical factories, industrial farms or coal plants. And that has to change, said the European Commission’s Veronica Manfredi. “If we protect the economic interests of our citizens so well, maybe it is also time to have similar protections for their lungs,” said Manfredi, director of Zero Pollution and Green Cities at the European Commission. “Even just loss of time is recognized by the European Court of Justice (ECJ) as damage.” She was speaking at an event: Cleaner air: Time to capture the benefits, hosted by the European Policy Centre. Penalties, damages and access to justice Air pollution is responsible for over 300,000 premature deaths in Europe every year. The new air pollution rules navigating the EU’s lawmaking labyrinth are the first update to the bloc’s Ambient Air Quality Directive (AAQD) since 2008. The AAQD sets binding air quality standards for a range of air pollutants harmful to human health such as nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone which apply to all member states. The tighter rules proposed by the Commission aim to end the impunity by which polluters across the EU breach air pollution limits. Updated penalties would levy fines proportionate to the financial turnover of companies breaking air quality rules to offset any economic benefit drawn from the breaches. The Commission proposal is furthermore based on the EU’s “collective redress” model for consumer protection, which allows consumer and public organizations to seek collective settlements on behalf of consumers. The Representative Actions Directive, which was adopted in 2020 and came into full force across the bloc in June, empowers consumers to seek financial compensation for damages in areas such as data protection, financial services, and air travel. The update to the AAQD would allow individuals to do the same for health damages caused by air pollution. “We are envisioning something similar for people that are victims of pollution problems that lead them to health issues,” said Manfredi. “The new provisions entail a clear legal basis for the first time for people whose health has been damaged by air pollution to seek compensation.” Cost-benefit paradox The average annual population-weighted a PM2.5 concentration in European countries for 1990 (left) and 2019 (right). The European Environmental Agency estimates 96% of urban EU citizens are exposed to PM2.5 levels above WHO standards. Europe stands to gain hundreds of billions of euros from cleaner air. EU-wide benefits of meeting the air quality targets set by the Commission are estimated to be between €42 billion and €121 billion anually, according to a new report by the European Policy Center (EPC) published on Thursday. The costs of implementing the rules is less than €6 billion per year. “It is a paradox that we have a seven-to-one benefit ratio, but then there are still lots of resistance and concerns,” said Stefan Šipka, lead author of the EPC report. “And that is actually the lowest [estimated] ratio.” Premature deaths from air pollution have fallen by two-thirds from an estimated one million deaths in the 1990s to around 300,000 deaths in the EU region today. Implementing the stricter air quality limits set out by the Commission successfully could reduce that number yet again by over 75%, experts estimate. “It is still an absolutely unacceptable number,” said Manfredi. “It puts into tragic perspective even the number of appalling deaths we have experienced during the – after all – just two year COVID-19 pandemic.” The European Parliament’s Environment, Public Health and Food Safety (ENVI) Committee has approved the revision of the Ambient Air Quality Directive in June – a major step towards the finish line. But the directive needs to clear votes in the European Parliament and the EU Council, the body representing EU member states, before it is finalized. See the related Health Policy Watch story on a new TDR Global Health Matters podcast here: https://healthpolicy-watch.news/impossible-to-have-healthy-people-on-a-sick-planet-fighting-back-against-air-pollution/ Image Credits: Sébastien Bertrand, Daniel Moqvist. Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
‘A Lifelong Journey’: Two Billion People Need Rehabilitation Globally 10/07/2023 Stefan Anderson Rehabilitation is often neglected in health systems. WHO officials say that has to change. Six years, five months and six days after suffering a stroke that paralyzed her left side, Madeline Niebanck shared her story of recovery at World Health Organization (WHO) headquarters. Niebanck, 28, spoke to delegates on Monday gathered for a global summit to strengthen financing for and access to rehabilitation care in health systems. She called on governments to use the conference to make investments that can provide what she says people going through rehabilitation need most: “hope”. “The past six years have been filled with learning how to adapt and to live a new life,” said Niebanck. “Rehab is not easy. It is hard, and it’s a lifelong journey.” Twenty-two at the time of her stroke, Niebanck had just graduated from the University of Georgetown when an arteriovenous malformation – a tangle of abnormal blood vessels – ruptured in her brain, damaging her brainstem. She was rushed into emergency surgery, and doctors told her parents they were not sure she was going to make it. “The neurosurgeon saved my life that night, but what I realize now is that surviving the brain hemorrhage was not the finish line,” said Niebanck. “It was just the beginning of a very long rehabilitation journey.” Niebanck recovers in the hospital after a tangle of blood vessels burst in her brain, paralysing the left side of her body. The high-level WHO meeting is the first since a watershed resolution on boosting access to rehabilitation care passed in the World Health Assembly with unanimous support from WHO’s 193 member states in May. The resolution – the first to directly address rehabilitation in 75 years of the World Health Assembly – found that global rehabilitation needs are “largely unmet”. In many countries, less than half of people receive the care they require. The non-binding document commits to expand financing, integrate rehabilitation into national healthcare systems, minimize the prohibitive costs of assistive technologies like hearing aids, promote research and include rehabilitation in emergency preparedness and response plans. “The need for rehabilitation is far, far greater than most people assume,” said Dr Jérôme Salomon, Assistant Director-General and head of Universal Health Coverage at WHO. “More than 2.4 billion people, almost a third of the global population, have health conditions that could benefit from rehabilitation. Niebanck shares her story with delegates at WHO headquarters. “[Madeline’s] story reminds us the core of rehabilitation is winning the fight to restore health, functioning and dignity,” said Salomon. “It also underlines that winning this fight is as critical as the fight to survive.” The number of people requiring rehabilitation has climbed by nearly 70% since 1990, driven by an increase in musculoskeletal disorders like lower back pain, neurological disorders and sensory impairments. Leading causes of disability vary from country to country, from hearing loss in China to fractures in Russia, vision loss in India and lower back pain in the United States. “The challenge and the tragedy is when rehabilitation services are not available or are not provided,” said Alarcos Cieza, who leads WHO’s vision, hearing, disability, and rehabilitation unit. “In many countries where people don’t receive rehabilitation, people die.” WHO defines rehabilitation as a range of interventions and technologies designed to help people with disabilities regain their independence. These include assistive technologies such as hearing aids, glasses, wheelchairs and prosthetics, and physical, occupational, and psychological therapies. “Rehabilitation is about our everyday life, how we communicate, how we move around,” said Cieza. “It’s about sleeping, it’s about breathing, it’s about our relationships – it’s really about our lives.” Rehabilitation still out of reach for millions Four decades after the WHO recognized rehabilitation as an essential health service, millions of people still lack access to these life-altering interventions. Health systems across the world suffer from significant funding shortfalls, but gaps in access are especially large in low- and middle-income countries. WHO estimates 20 to 40% of health resources are wasted through inefficiencies and corruption. Rehabilitation is especially hard hit by this problem. “With the rising prevalence of noncommunicable diseases, ageing populations, and improved survival from injuries, the need for rehabilitation services is expected to increase significantly,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. “Low investment and awareness persist, driven by pervasive misconceptions that rehabilitation is too costly, or simply unfeasible to deliver in low-resource settings.” Hearing aids, glasses and other assistive technologies can be prohibitively expensive. Taken for granted in wealthy countries, these simple technologies are out of reach for millions globally. More than one-third of national health expenditure in low- and middle-income countries comes from out-of-pocket expenses, a major source of financial hardship for families. Assistive technologies such as glasses, hearing aids and wheelchairs are particularly expensive, and many low-and middle-income countries do not have any national service for these products. Many people cannot access, or choose to forgo, the assistive devices they need because they are too expensive. More than one billion people – one in eight globally – cannot see properly because they cannot afford glasses. The high costs of rehabilitation often prevent people from accessing the care they need, which can have serious impacts on their health and well-being. It can also lead to poverty, as families may have to sell assets or take on debt to pay for assistive devices. “For most people, rehabilitation services, including necessary assistive technologies, are often out-of-pocket expenses that they cannot afford – this is unacceptable,” said Salomon. “Anyone with rehabilitation needs must have access to quality services whenever and wherever they need them without facing financial hardship.” Rehabilitation is also badly affected by the ongoing global shortage of healthcare workers, which is projected to hit 10 million by 2030. The staffing crisis is most acute in low- and middle-income countries and the rural, hard-to-reach areas within them. Meanwhile, the COVID-19 pandemic accelerated the migration of trained health workers to high-income health systems in search of higher pay, worsening the shortage in the already struggling health systems of poorer countries. Progress is progress: WHO pushes ahead Map of countries supported by WHO in the area of rehabilitation. WHO has significantly increased its technical assistance to countries for rehabilitation services since the Global Rehabilitation 2030 agenda was adopted in 2017. In that time, WHO has provided technical assistance to 37 countries, up from zero when the agenda was adopted. Twenty-five low- and middle-income countries have so far implemented strategic plans on rehabilitation with WHO assistance. On the first day of the rehabilitation summit on Monday, WHO published two policy guides for governments seeking to improve rehabilitation care. The first guide, a package for rehabilitation interventions with contributions from over 700 experts from 90 countries, is to assist countries on the “planning, budgeting and implementing of rehabilitation in their health systems.” The second provides guidance on how to ensure that people with disabilities have access to rehabilitation services during disasters and other emergencies – the difficulties of which were brought into sharp focus by COVID-19, the war in Ukraine, and the Turko-Syrian earthquake. WHO is expected to launch further technical guidance in the areas of workforce, information systems, financing, and health service delivery over the course of the Global Rehabilitation 2030 conference, which ends on Tuesday. Image Credits: Marina Raspopova/ Unsplash, CC. Warning That UN High-Level Meeting on Pandemics May be ‘Squandered’ Opportunity 10/07/2023 Kerry Cullinan As United Nations (UN) member states meet in New York on Monday and Tuesday to discuss the political declaration to be adopted at the General Assembly’s High-Level Meeting (HLM) on Pandemics in September, there are growing concerns that the current draft is weak and proposes an over-reliance on the World Health Organization (WHO) to manage future pandemics. The current draft – pared down from 58 to 15 pages – has dispensed with a number of critical concerns, particularly about how future pandemics will be governed, located almost entirely with the WHO. The most vocal criticism of the draft comes from the co-chairs of the Independent Panel for Pandemic Preparedness and Response, which has proposed a high-level independent oversight group to govern global pandemic responses. “We are gravely concerned that the opportunity presented by the High-Level Meeting and the expected Political Declaration on Pandemic Prevention, Preparedness and Response is being squandered,” wrote Ellen Johnson Sirleaf and Helen Clark in an open letter released on Sunday. “The current draft of the political declaration… does not express the commitments required of heads of state and government to transform the international system of pandemic preparedness and response. Instead, it reads as a health resolution,” they add. The Independent Panel has published a road map to deal with future pandemics, that sets out recommendations on governance, equitable access to pandemic countermeasures, preparedness and surge finance, the need for clear rules and roles, and for a stronger WHO. “Only international, multilateral, and multi-sectoral collaboration can safeguard the world from the next pandemic threat,” according to the Independent Panel. Pointing out that the success of the WHO negotiations currently underway to develop a pandemic accord is not guaranteed, Sirleaf and Clark reiterate their view that “sustained highest-level political leadership on pandemic preparedness and response” is essential between and during health crises. “This is required to ensure protection to health, societies and economies, and to stop outbreaks from becoming pandemics,” they add. Describing the UN HLM as “a one-time and historic opportunity to commit to lasting and transformative change to pandemic preparedness and response”, they add that if member states “only tinker with the language” of the current draft, “the efforts to agree to the declaration will be wasted”. Meanwhile, Nina Schwalbe, a principal visiting fellow at the UN University’s International Institute for Global Health, also expressed disappointment with the draft. “Rather than a strong declaration that commits UN Member States at the highest level to fundamentally change how they address all aspects of pandemic prevention, preparedness, and response, it covers everything from hand hygiene to pollution,” commented Schwalbe on Twitter. https://twitter.com/nschwalbe/status/1677334373954203651 Image Credits: Wikimedia Commons. New WHO and UN-wide System to Aid Victims of Sexual Exploitation Needed, says Independent Investigator 07/07/2023 Stefan Anderson Families go to an Ebola treatment centre to visit a family member held in quarantine in Beni, North Kivu region, Democratic Republic of Congo. The World Health Organiztion (WHO) has been far too slow in providing financial, psychological and legal assistance to victims of sexual assault and exploitation committed by its staff in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola response, a veteran international investigator said at a WHO press conference on Friday. Hervé Gogo, presenting his assessment of the World Health Organization’s (WHO) performance since the scandal first came to light in 2020, said that the problems are endemic to the United Nations (UN) system as a whole and that solutions need a system-wide approach. “It took too much time,” Gogo said of the WHO support extended to over 100 victims in DRC who were raped, abused or lured into having sex in exchange for jobs or money by UN and WHO staffers. “Something needs to be done to streamline the process … particularly on the question of assistance to victims and survivors.” Gogo’s findings are part of his review of WHO’s compliance with recommendations made in 2021 by an independent enquiry commissioned after The New Humanitarian uncovered the sexual abuses committed by over 80 UN and WHO staff in the DRC. UN-wide provisions to victims are “not sufficient” A health worker checks a child potentially infected with Ebola being carried on the back of a caregiver at the Ebola Treatment Centre of Beni, North-Kivu province, Democratic Republic of Congo, during the 2018-2020 Ebola outbreak. The United Nations system lacks legal provisions for victims to receive compensation directly from the UN without first obtaining a favourable court ruling against one of its agencies. This process can take years, and even if the victim can identify the perpetrator – many cannot, as UN staffers often used fake credentials – proving the organisation is responsible for the actions of the abuser can be next to impossible. This system is “not sufficient” to support victims of sexual abuse, said Gogo. “Is it really possible to stick to this orthodoxy? Victims are faced with an impossible task,” he said. “We all really want victims to get compensated: The question is how. It all depends on member states to figure out how to create a mechanism of compensation without waiting for the court process to end.” Despite the delays in assistance reaching victims, Gogo said the UN health agency’s efforts since the crisis are “more than a good start” to the overhaul of its sexual abuse and exploitation policies. Search for justice continues in DRC WHO to Share Information with Congolese Court in Sexual Abuse Cases of 13 Women WHO has provided support to all 115 survivors of sexual assault in the DRC identified by the independent commission report regardless of whether the perpetrators were affiliated with WHO or other UN agencies, said Dr Gaya Gamhewege, the agency’s lead official in prevention and response to sexual misconduct. WHO is also providing legal support to victims who decided to pursue local court cases against their alleged abusers. The agency has also complied with requests for information from local authorities in DRC about 16 people linked to WHO who are facing legal action in the country. Gamhewege did not provide any further information on the status of the cases. “WHO will continue to support any and all survivors who need more support, even if they are affiliated to allegations by personnel from other agencies,” she said. WHO terminated seven consultants in after finding sufficient evidence of misconduct in the wake of the scandal, Gamehwage said in an interview with Health Policy Watch in April. The agency also posted 14 former staff and consultants identified as alleged perpetrators by the Independent Commission on the UN ClearCheck database, blacklisting them from being hired in the UN. ‘Not a single finding’ showing Tedros knew about abuse claims or cover-up WHO Member States re-elected Dr Tedros Adhanom Ghebreyesus to serve a second five-year term as Director-General of the WHO in May 2022. Gogo, who previously served as a senior judicial officer in the UN mission in DRC, was emphatic that no evidence implicating WHO Director-General Dr Tedros Adhanom Ghebreyesus or his inner circle in covering up the sexual assaults in the DRC has been uncovered. “There is not a single finding about any decision or any information that was shared DG,” Gogo told reporters. “There is nothing to hide.” No high-ranking WHO officials have been disciplined as a result of the sexual assaults in the DRC. Three senior managers at the agency who were accused of covering up the allegations were reinstated in January after being cleared of charges by the UN Office of Internal Oversight Services (OIOS), which investigated the cases at the request of WHO. WHO Direct-General Dr Tedros Adhanom Ghebreyesus told the WHO Executive Board they were reinstated because claims of managerial misconduct were “unsubstantiated”. But a copy of the confidential OIOS report seen later by Health Policy Watch made clear the managers were not found innocent in the cover-up: They were saved by a legal loophole. The report found that WHO policies at the time of the Ebola response in the DRC did not require manages to report sexual abuse allegations when the victim was not a direct “beneficiary” of WHO aid. Incidents involving women in the “broader community”, such as local residents or volunteers, were not covered by the reporting policies. This loophole has since been closed. “UN OIOS did not find that managerial misconduct was substantiated against anybody,” said Gamhewage. “That’s really all I have to say on that.” Mired in scandals, WHO says it is charting a new course On a visit to the Congolese city of Goma in November 2022, WHO’s Dr Gaya Gamhewage committed to supporting survivors of sexual assault of the Ebola outbreak. The UN health agency has been mired in a new wave of sexual misconduct scandals since British medical doctor Rosie James alleged a senior WHO official groped her at the World Health Summit in Berlin last October. WHO received an increased number of sexual misconduct allegations reported in the first half of 2023. Gamhewage told reporters that WHO received 48 allegations of sexual misconduct in the first six months of the year. Six of the allegations have been supported by evidence and are currently being processed. The uptick in reported cases is a “proxy indicator” that the agency’s accountability systems are improving, said Gamhewage. “We know that when there were no allegations it didn’t mean that there were no cases,” said Gamhewage. “It is just that people did not have the confidence and the trust to come forward.” WHO has become more aggressive in pursuing sexual assault allegations in an effort to rehabilitate its image after years of scandals. In April, Temo Waqanivalu was dismissed for allegedly harassing a James at the conference in Berlin. In early May, Peter Ben Embarek, a senior WHO scientist leading the agency’s investigation into the origins of the COVID-19 virus, was also dismissed for sexual misconduct. Embarek was the sventh WHO staff member to be dismissed for sexual misconduct in the previous six months. Since then, however, no new disciplinary actions against WHO personnel have been announced. “Culture is changing,” Gamhewage said in her concluding remarks. “But we have a long, long way to go.” Image Credits: Flickr: World Bank / Vincent Tremeau, UNICEF/Vincent Tremeau, WHO. Air Pollution Victims Could Sue For Damages Under Proposed New EU Rules 06/07/2023 Stefan Anderson The EU is updating its air pollution directive for the first time since 2008. The new laws are expected to take effect in late 2023 or early 2024. BRUSSELS – European Union citizens suffering from health effects caused by air pollution could soon be entitled to seek financial compensation from polluters under a proposed revision of the EU’s pollution regulations. The proposal is part of a broader overhaul of EU air pollution laws, expected to be completed in late 2023 or early 2024, said a senior European Commission official Thursday. The interests of European citizens are already protected by an array of legal umbrellas. Companies can be held liable for misleading consumers in their marketing; airlines are required to compensate customers for cancelled or delayed flights; and breaches of consumer privacy or competition laws frequently result in heavy fines. But no mechanism exists to protect people from breaches of air pollution limits or pollution from industrial sites like chemical factories, industrial farms or coal plants. And that has to change, said the European Commission’s Veronica Manfredi. “If we protect the economic interests of our citizens so well, maybe it is also time to have similar protections for their lungs,” said Manfredi, director of Zero Pollution and Green Cities at the European Commission. “Even just loss of time is recognized by the European Court of Justice (ECJ) as damage.” She was speaking at an event: Cleaner air: Time to capture the benefits, hosted by the European Policy Centre. Penalties, damages and access to justice Air pollution is responsible for over 300,000 premature deaths in Europe every year. The new air pollution rules navigating the EU’s lawmaking labyrinth are the first update to the bloc’s Ambient Air Quality Directive (AAQD) since 2008. The AAQD sets binding air quality standards for a range of air pollutants harmful to human health such as nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone which apply to all member states. The tighter rules proposed by the Commission aim to end the impunity by which polluters across the EU breach air pollution limits. Updated penalties would levy fines proportionate to the financial turnover of companies breaking air quality rules to offset any economic benefit drawn from the breaches. The Commission proposal is furthermore based on the EU’s “collective redress” model for consumer protection, which allows consumer and public organizations to seek collective settlements on behalf of consumers. The Representative Actions Directive, which was adopted in 2020 and came into full force across the bloc in June, empowers consumers to seek financial compensation for damages in areas such as data protection, financial services, and air travel. The update to the AAQD would allow individuals to do the same for health damages caused by air pollution. “We are envisioning something similar for people that are victims of pollution problems that lead them to health issues,” said Manfredi. “The new provisions entail a clear legal basis for the first time for people whose health has been damaged by air pollution to seek compensation.” Cost-benefit paradox The average annual population-weighted a PM2.5 concentration in European countries for 1990 (left) and 2019 (right). The European Environmental Agency estimates 96% of urban EU citizens are exposed to PM2.5 levels above WHO standards. Europe stands to gain hundreds of billions of euros from cleaner air. EU-wide benefits of meeting the air quality targets set by the Commission are estimated to be between €42 billion and €121 billion anually, according to a new report by the European Policy Center (EPC) published on Thursday. The costs of implementing the rules is less than €6 billion per year. “It is a paradox that we have a seven-to-one benefit ratio, but then there are still lots of resistance and concerns,” said Stefan Šipka, lead author of the EPC report. “And that is actually the lowest [estimated] ratio.” Premature deaths from air pollution have fallen by two-thirds from an estimated one million deaths in the 1990s to around 300,000 deaths in the EU region today. Implementing the stricter air quality limits set out by the Commission successfully could reduce that number yet again by over 75%, experts estimate. “It is still an absolutely unacceptable number,” said Manfredi. “It puts into tragic perspective even the number of appalling deaths we have experienced during the – after all – just two year COVID-19 pandemic.” The European Parliament’s Environment, Public Health and Food Safety (ENVI) Committee has approved the revision of the Ambient Air Quality Directive in June – a major step towards the finish line. But the directive needs to clear votes in the European Parliament and the EU Council, the body representing EU member states, before it is finalized. See the related Health Policy Watch story on a new TDR Global Health Matters podcast here: https://healthpolicy-watch.news/impossible-to-have-healthy-people-on-a-sick-planet-fighting-back-against-air-pollution/ Image Credits: Sébastien Bertrand, Daniel Moqvist. Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Warning That UN High-Level Meeting on Pandemics May be ‘Squandered’ Opportunity 10/07/2023 Kerry Cullinan As United Nations (UN) member states meet in New York on Monday and Tuesday to discuss the political declaration to be adopted at the General Assembly’s High-Level Meeting (HLM) on Pandemics in September, there are growing concerns that the current draft is weak and proposes an over-reliance on the World Health Organization (WHO) to manage future pandemics. The current draft – pared down from 58 to 15 pages – has dispensed with a number of critical concerns, particularly about how future pandemics will be governed, located almost entirely with the WHO. The most vocal criticism of the draft comes from the co-chairs of the Independent Panel for Pandemic Preparedness and Response, which has proposed a high-level independent oversight group to govern global pandemic responses. “We are gravely concerned that the opportunity presented by the High-Level Meeting and the expected Political Declaration on Pandemic Prevention, Preparedness and Response is being squandered,” wrote Ellen Johnson Sirleaf and Helen Clark in an open letter released on Sunday. “The current draft of the political declaration… does not express the commitments required of heads of state and government to transform the international system of pandemic preparedness and response. Instead, it reads as a health resolution,” they add. The Independent Panel has published a road map to deal with future pandemics, that sets out recommendations on governance, equitable access to pandemic countermeasures, preparedness and surge finance, the need for clear rules and roles, and for a stronger WHO. “Only international, multilateral, and multi-sectoral collaboration can safeguard the world from the next pandemic threat,” according to the Independent Panel. Pointing out that the success of the WHO negotiations currently underway to develop a pandemic accord is not guaranteed, Sirleaf and Clark reiterate their view that “sustained highest-level political leadership on pandemic preparedness and response” is essential between and during health crises. “This is required to ensure protection to health, societies and economies, and to stop outbreaks from becoming pandemics,” they add. Describing the UN HLM as “a one-time and historic opportunity to commit to lasting and transformative change to pandemic preparedness and response”, they add that if member states “only tinker with the language” of the current draft, “the efforts to agree to the declaration will be wasted”. Meanwhile, Nina Schwalbe, a principal visiting fellow at the UN University’s International Institute for Global Health, also expressed disappointment with the draft. “Rather than a strong declaration that commits UN Member States at the highest level to fundamentally change how they address all aspects of pandemic prevention, preparedness, and response, it covers everything from hand hygiene to pollution,” commented Schwalbe on Twitter. https://twitter.com/nschwalbe/status/1677334373954203651 Image Credits: Wikimedia Commons. New WHO and UN-wide System to Aid Victims of Sexual Exploitation Needed, says Independent Investigator 07/07/2023 Stefan Anderson Families go to an Ebola treatment centre to visit a family member held in quarantine in Beni, North Kivu region, Democratic Republic of Congo. The World Health Organiztion (WHO) has been far too slow in providing financial, psychological and legal assistance to victims of sexual assault and exploitation committed by its staff in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola response, a veteran international investigator said at a WHO press conference on Friday. Hervé Gogo, presenting his assessment of the World Health Organization’s (WHO) performance since the scandal first came to light in 2020, said that the problems are endemic to the United Nations (UN) system as a whole and that solutions need a system-wide approach. “It took too much time,” Gogo said of the WHO support extended to over 100 victims in DRC who were raped, abused or lured into having sex in exchange for jobs or money by UN and WHO staffers. “Something needs to be done to streamline the process … particularly on the question of assistance to victims and survivors.” Gogo’s findings are part of his review of WHO’s compliance with recommendations made in 2021 by an independent enquiry commissioned after The New Humanitarian uncovered the sexual abuses committed by over 80 UN and WHO staff in the DRC. UN-wide provisions to victims are “not sufficient” A health worker checks a child potentially infected with Ebola being carried on the back of a caregiver at the Ebola Treatment Centre of Beni, North-Kivu province, Democratic Republic of Congo, during the 2018-2020 Ebola outbreak. The United Nations system lacks legal provisions for victims to receive compensation directly from the UN without first obtaining a favourable court ruling against one of its agencies. This process can take years, and even if the victim can identify the perpetrator – many cannot, as UN staffers often used fake credentials – proving the organisation is responsible for the actions of the abuser can be next to impossible. This system is “not sufficient” to support victims of sexual abuse, said Gogo. “Is it really possible to stick to this orthodoxy? Victims are faced with an impossible task,” he said. “We all really want victims to get compensated: The question is how. It all depends on member states to figure out how to create a mechanism of compensation without waiting for the court process to end.” Despite the delays in assistance reaching victims, Gogo said the UN health agency’s efforts since the crisis are “more than a good start” to the overhaul of its sexual abuse and exploitation policies. Search for justice continues in DRC WHO to Share Information with Congolese Court in Sexual Abuse Cases of 13 Women WHO has provided support to all 115 survivors of sexual assault in the DRC identified by the independent commission report regardless of whether the perpetrators were affiliated with WHO or other UN agencies, said Dr Gaya Gamhewege, the agency’s lead official in prevention and response to sexual misconduct. WHO is also providing legal support to victims who decided to pursue local court cases against their alleged abusers. The agency has also complied with requests for information from local authorities in DRC about 16 people linked to WHO who are facing legal action in the country. Gamhewege did not provide any further information on the status of the cases. “WHO will continue to support any and all survivors who need more support, even if they are affiliated to allegations by personnel from other agencies,” she said. WHO terminated seven consultants in after finding sufficient evidence of misconduct in the wake of the scandal, Gamehwage said in an interview with Health Policy Watch in April. The agency also posted 14 former staff and consultants identified as alleged perpetrators by the Independent Commission on the UN ClearCheck database, blacklisting them from being hired in the UN. ‘Not a single finding’ showing Tedros knew about abuse claims or cover-up WHO Member States re-elected Dr Tedros Adhanom Ghebreyesus to serve a second five-year term as Director-General of the WHO in May 2022. Gogo, who previously served as a senior judicial officer in the UN mission in DRC, was emphatic that no evidence implicating WHO Director-General Dr Tedros Adhanom Ghebreyesus or his inner circle in covering up the sexual assaults in the DRC has been uncovered. “There is not a single finding about any decision or any information that was shared DG,” Gogo told reporters. “There is nothing to hide.” No high-ranking WHO officials have been disciplined as a result of the sexual assaults in the DRC. Three senior managers at the agency who were accused of covering up the allegations were reinstated in January after being cleared of charges by the UN Office of Internal Oversight Services (OIOS), which investigated the cases at the request of WHO. WHO Direct-General Dr Tedros Adhanom Ghebreyesus told the WHO Executive Board they were reinstated because claims of managerial misconduct were “unsubstantiated”. But a copy of the confidential OIOS report seen later by Health Policy Watch made clear the managers were not found innocent in the cover-up: They were saved by a legal loophole. The report found that WHO policies at the time of the Ebola response in the DRC did not require manages to report sexual abuse allegations when the victim was not a direct “beneficiary” of WHO aid. Incidents involving women in the “broader community”, such as local residents or volunteers, were not covered by the reporting policies. This loophole has since been closed. “UN OIOS did not find that managerial misconduct was substantiated against anybody,” said Gamhewage. “That’s really all I have to say on that.” Mired in scandals, WHO says it is charting a new course On a visit to the Congolese city of Goma in November 2022, WHO’s Dr Gaya Gamhewage committed to supporting survivors of sexual assault of the Ebola outbreak. The UN health agency has been mired in a new wave of sexual misconduct scandals since British medical doctor Rosie James alleged a senior WHO official groped her at the World Health Summit in Berlin last October. WHO received an increased number of sexual misconduct allegations reported in the first half of 2023. Gamhewage told reporters that WHO received 48 allegations of sexual misconduct in the first six months of the year. Six of the allegations have been supported by evidence and are currently being processed. The uptick in reported cases is a “proxy indicator” that the agency’s accountability systems are improving, said Gamhewage. “We know that when there were no allegations it didn’t mean that there were no cases,” said Gamhewage. “It is just that people did not have the confidence and the trust to come forward.” WHO has become more aggressive in pursuing sexual assault allegations in an effort to rehabilitate its image after years of scandals. In April, Temo Waqanivalu was dismissed for allegedly harassing a James at the conference in Berlin. In early May, Peter Ben Embarek, a senior WHO scientist leading the agency’s investigation into the origins of the COVID-19 virus, was also dismissed for sexual misconduct. Embarek was the sventh WHO staff member to be dismissed for sexual misconduct in the previous six months. Since then, however, no new disciplinary actions against WHO personnel have been announced. “Culture is changing,” Gamhewage said in her concluding remarks. “But we have a long, long way to go.” Image Credits: Flickr: World Bank / Vincent Tremeau, UNICEF/Vincent Tremeau, WHO. Air Pollution Victims Could Sue For Damages Under Proposed New EU Rules 06/07/2023 Stefan Anderson The EU is updating its air pollution directive for the first time since 2008. The new laws are expected to take effect in late 2023 or early 2024. BRUSSELS – European Union citizens suffering from health effects caused by air pollution could soon be entitled to seek financial compensation from polluters under a proposed revision of the EU’s pollution regulations. The proposal is part of a broader overhaul of EU air pollution laws, expected to be completed in late 2023 or early 2024, said a senior European Commission official Thursday. The interests of European citizens are already protected by an array of legal umbrellas. Companies can be held liable for misleading consumers in their marketing; airlines are required to compensate customers for cancelled or delayed flights; and breaches of consumer privacy or competition laws frequently result in heavy fines. But no mechanism exists to protect people from breaches of air pollution limits or pollution from industrial sites like chemical factories, industrial farms or coal plants. And that has to change, said the European Commission’s Veronica Manfredi. “If we protect the economic interests of our citizens so well, maybe it is also time to have similar protections for their lungs,” said Manfredi, director of Zero Pollution and Green Cities at the European Commission. “Even just loss of time is recognized by the European Court of Justice (ECJ) as damage.” She was speaking at an event: Cleaner air: Time to capture the benefits, hosted by the European Policy Centre. Penalties, damages and access to justice Air pollution is responsible for over 300,000 premature deaths in Europe every year. The new air pollution rules navigating the EU’s lawmaking labyrinth are the first update to the bloc’s Ambient Air Quality Directive (AAQD) since 2008. The AAQD sets binding air quality standards for a range of air pollutants harmful to human health such as nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone which apply to all member states. The tighter rules proposed by the Commission aim to end the impunity by which polluters across the EU breach air pollution limits. Updated penalties would levy fines proportionate to the financial turnover of companies breaking air quality rules to offset any economic benefit drawn from the breaches. The Commission proposal is furthermore based on the EU’s “collective redress” model for consumer protection, which allows consumer and public organizations to seek collective settlements on behalf of consumers. The Representative Actions Directive, which was adopted in 2020 and came into full force across the bloc in June, empowers consumers to seek financial compensation for damages in areas such as data protection, financial services, and air travel. The update to the AAQD would allow individuals to do the same for health damages caused by air pollution. “We are envisioning something similar for people that are victims of pollution problems that lead them to health issues,” said Manfredi. “The new provisions entail a clear legal basis for the first time for people whose health has been damaged by air pollution to seek compensation.” Cost-benefit paradox The average annual population-weighted a PM2.5 concentration in European countries for 1990 (left) and 2019 (right). The European Environmental Agency estimates 96% of urban EU citizens are exposed to PM2.5 levels above WHO standards. Europe stands to gain hundreds of billions of euros from cleaner air. EU-wide benefits of meeting the air quality targets set by the Commission are estimated to be between €42 billion and €121 billion anually, according to a new report by the European Policy Center (EPC) published on Thursday. The costs of implementing the rules is less than €6 billion per year. “It is a paradox that we have a seven-to-one benefit ratio, but then there are still lots of resistance and concerns,” said Stefan Šipka, lead author of the EPC report. “And that is actually the lowest [estimated] ratio.” Premature deaths from air pollution have fallen by two-thirds from an estimated one million deaths in the 1990s to around 300,000 deaths in the EU region today. Implementing the stricter air quality limits set out by the Commission successfully could reduce that number yet again by over 75%, experts estimate. “It is still an absolutely unacceptable number,” said Manfredi. “It puts into tragic perspective even the number of appalling deaths we have experienced during the – after all – just two year COVID-19 pandemic.” The European Parliament’s Environment, Public Health and Food Safety (ENVI) Committee has approved the revision of the Ambient Air Quality Directive in June – a major step towards the finish line. But the directive needs to clear votes in the European Parliament and the EU Council, the body representing EU member states, before it is finalized. See the related Health Policy Watch story on a new TDR Global Health Matters podcast here: https://healthpolicy-watch.news/impossible-to-have-healthy-people-on-a-sick-planet-fighting-back-against-air-pollution/ Image Credits: Sébastien Bertrand, Daniel Moqvist. Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
New WHO and UN-wide System to Aid Victims of Sexual Exploitation Needed, says Independent Investigator 07/07/2023 Stefan Anderson Families go to an Ebola treatment centre to visit a family member held in quarantine in Beni, North Kivu region, Democratic Republic of Congo. The World Health Organiztion (WHO) has been far too slow in providing financial, psychological and legal assistance to victims of sexual assault and exploitation committed by its staff in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola response, a veteran international investigator said at a WHO press conference on Friday. Hervé Gogo, presenting his assessment of the World Health Organization’s (WHO) performance since the scandal first came to light in 2020, said that the problems are endemic to the United Nations (UN) system as a whole and that solutions need a system-wide approach. “It took too much time,” Gogo said of the WHO support extended to over 100 victims in DRC who were raped, abused or lured into having sex in exchange for jobs or money by UN and WHO staffers. “Something needs to be done to streamline the process … particularly on the question of assistance to victims and survivors.” Gogo’s findings are part of his review of WHO’s compliance with recommendations made in 2021 by an independent enquiry commissioned after The New Humanitarian uncovered the sexual abuses committed by over 80 UN and WHO staff in the DRC. UN-wide provisions to victims are “not sufficient” A health worker checks a child potentially infected with Ebola being carried on the back of a caregiver at the Ebola Treatment Centre of Beni, North-Kivu province, Democratic Republic of Congo, during the 2018-2020 Ebola outbreak. The United Nations system lacks legal provisions for victims to receive compensation directly from the UN without first obtaining a favourable court ruling against one of its agencies. This process can take years, and even if the victim can identify the perpetrator – many cannot, as UN staffers often used fake credentials – proving the organisation is responsible for the actions of the abuser can be next to impossible. This system is “not sufficient” to support victims of sexual abuse, said Gogo. “Is it really possible to stick to this orthodoxy? Victims are faced with an impossible task,” he said. “We all really want victims to get compensated: The question is how. It all depends on member states to figure out how to create a mechanism of compensation without waiting for the court process to end.” Despite the delays in assistance reaching victims, Gogo said the UN health agency’s efforts since the crisis are “more than a good start” to the overhaul of its sexual abuse and exploitation policies. Search for justice continues in DRC WHO to Share Information with Congolese Court in Sexual Abuse Cases of 13 Women WHO has provided support to all 115 survivors of sexual assault in the DRC identified by the independent commission report regardless of whether the perpetrators were affiliated with WHO or other UN agencies, said Dr Gaya Gamhewege, the agency’s lead official in prevention and response to sexual misconduct. WHO is also providing legal support to victims who decided to pursue local court cases against their alleged abusers. The agency has also complied with requests for information from local authorities in DRC about 16 people linked to WHO who are facing legal action in the country. Gamhewege did not provide any further information on the status of the cases. “WHO will continue to support any and all survivors who need more support, even if they are affiliated to allegations by personnel from other agencies,” she said. WHO terminated seven consultants in after finding sufficient evidence of misconduct in the wake of the scandal, Gamehwage said in an interview with Health Policy Watch in April. The agency also posted 14 former staff and consultants identified as alleged perpetrators by the Independent Commission on the UN ClearCheck database, blacklisting them from being hired in the UN. ‘Not a single finding’ showing Tedros knew about abuse claims or cover-up WHO Member States re-elected Dr Tedros Adhanom Ghebreyesus to serve a second five-year term as Director-General of the WHO in May 2022. Gogo, who previously served as a senior judicial officer in the UN mission in DRC, was emphatic that no evidence implicating WHO Director-General Dr Tedros Adhanom Ghebreyesus or his inner circle in covering up the sexual assaults in the DRC has been uncovered. “There is not a single finding about any decision or any information that was shared DG,” Gogo told reporters. “There is nothing to hide.” No high-ranking WHO officials have been disciplined as a result of the sexual assaults in the DRC. Three senior managers at the agency who were accused of covering up the allegations were reinstated in January after being cleared of charges by the UN Office of Internal Oversight Services (OIOS), which investigated the cases at the request of WHO. WHO Direct-General Dr Tedros Adhanom Ghebreyesus told the WHO Executive Board they were reinstated because claims of managerial misconduct were “unsubstantiated”. But a copy of the confidential OIOS report seen later by Health Policy Watch made clear the managers were not found innocent in the cover-up: They were saved by a legal loophole. The report found that WHO policies at the time of the Ebola response in the DRC did not require manages to report sexual abuse allegations when the victim was not a direct “beneficiary” of WHO aid. Incidents involving women in the “broader community”, such as local residents or volunteers, were not covered by the reporting policies. This loophole has since been closed. “UN OIOS did not find that managerial misconduct was substantiated against anybody,” said Gamhewage. “That’s really all I have to say on that.” Mired in scandals, WHO says it is charting a new course On a visit to the Congolese city of Goma in November 2022, WHO’s Dr Gaya Gamhewage committed to supporting survivors of sexual assault of the Ebola outbreak. The UN health agency has been mired in a new wave of sexual misconduct scandals since British medical doctor Rosie James alleged a senior WHO official groped her at the World Health Summit in Berlin last October. WHO received an increased number of sexual misconduct allegations reported in the first half of 2023. Gamhewage told reporters that WHO received 48 allegations of sexual misconduct in the first six months of the year. Six of the allegations have been supported by evidence and are currently being processed. The uptick in reported cases is a “proxy indicator” that the agency’s accountability systems are improving, said Gamhewage. “We know that when there were no allegations it didn’t mean that there were no cases,” said Gamhewage. “It is just that people did not have the confidence and the trust to come forward.” WHO has become more aggressive in pursuing sexual assault allegations in an effort to rehabilitate its image after years of scandals. In April, Temo Waqanivalu was dismissed for allegedly harassing a James at the conference in Berlin. In early May, Peter Ben Embarek, a senior WHO scientist leading the agency’s investigation into the origins of the COVID-19 virus, was also dismissed for sexual misconduct. Embarek was the sventh WHO staff member to be dismissed for sexual misconduct in the previous six months. Since then, however, no new disciplinary actions against WHO personnel have been announced. “Culture is changing,” Gamhewage said in her concluding remarks. “But we have a long, long way to go.” Image Credits: Flickr: World Bank / Vincent Tremeau, UNICEF/Vincent Tremeau, WHO. Air Pollution Victims Could Sue For Damages Under Proposed New EU Rules 06/07/2023 Stefan Anderson The EU is updating its air pollution directive for the first time since 2008. The new laws are expected to take effect in late 2023 or early 2024. BRUSSELS – European Union citizens suffering from health effects caused by air pollution could soon be entitled to seek financial compensation from polluters under a proposed revision of the EU’s pollution regulations. The proposal is part of a broader overhaul of EU air pollution laws, expected to be completed in late 2023 or early 2024, said a senior European Commission official Thursday. The interests of European citizens are already protected by an array of legal umbrellas. Companies can be held liable for misleading consumers in their marketing; airlines are required to compensate customers for cancelled or delayed flights; and breaches of consumer privacy or competition laws frequently result in heavy fines. But no mechanism exists to protect people from breaches of air pollution limits or pollution from industrial sites like chemical factories, industrial farms or coal plants. And that has to change, said the European Commission’s Veronica Manfredi. “If we protect the economic interests of our citizens so well, maybe it is also time to have similar protections for their lungs,” said Manfredi, director of Zero Pollution and Green Cities at the European Commission. “Even just loss of time is recognized by the European Court of Justice (ECJ) as damage.” She was speaking at an event: Cleaner air: Time to capture the benefits, hosted by the European Policy Centre. Penalties, damages and access to justice Air pollution is responsible for over 300,000 premature deaths in Europe every year. The new air pollution rules navigating the EU’s lawmaking labyrinth are the first update to the bloc’s Ambient Air Quality Directive (AAQD) since 2008. The AAQD sets binding air quality standards for a range of air pollutants harmful to human health such as nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone which apply to all member states. The tighter rules proposed by the Commission aim to end the impunity by which polluters across the EU breach air pollution limits. Updated penalties would levy fines proportionate to the financial turnover of companies breaking air quality rules to offset any economic benefit drawn from the breaches. The Commission proposal is furthermore based on the EU’s “collective redress” model for consumer protection, which allows consumer and public organizations to seek collective settlements on behalf of consumers. The Representative Actions Directive, which was adopted in 2020 and came into full force across the bloc in June, empowers consumers to seek financial compensation for damages in areas such as data protection, financial services, and air travel. The update to the AAQD would allow individuals to do the same for health damages caused by air pollution. “We are envisioning something similar for people that are victims of pollution problems that lead them to health issues,” said Manfredi. “The new provisions entail a clear legal basis for the first time for people whose health has been damaged by air pollution to seek compensation.” Cost-benefit paradox The average annual population-weighted a PM2.5 concentration in European countries for 1990 (left) and 2019 (right). The European Environmental Agency estimates 96% of urban EU citizens are exposed to PM2.5 levels above WHO standards. Europe stands to gain hundreds of billions of euros from cleaner air. EU-wide benefits of meeting the air quality targets set by the Commission are estimated to be between €42 billion and €121 billion anually, according to a new report by the European Policy Center (EPC) published on Thursday. The costs of implementing the rules is less than €6 billion per year. “It is a paradox that we have a seven-to-one benefit ratio, but then there are still lots of resistance and concerns,” said Stefan Šipka, lead author of the EPC report. “And that is actually the lowest [estimated] ratio.” Premature deaths from air pollution have fallen by two-thirds from an estimated one million deaths in the 1990s to around 300,000 deaths in the EU region today. Implementing the stricter air quality limits set out by the Commission successfully could reduce that number yet again by over 75%, experts estimate. “It is still an absolutely unacceptable number,” said Manfredi. “It puts into tragic perspective even the number of appalling deaths we have experienced during the – after all – just two year COVID-19 pandemic.” The European Parliament’s Environment, Public Health and Food Safety (ENVI) Committee has approved the revision of the Ambient Air Quality Directive in June – a major step towards the finish line. But the directive needs to clear votes in the European Parliament and the EU Council, the body representing EU member states, before it is finalized. See the related Health Policy Watch story on a new TDR Global Health Matters podcast here: https://healthpolicy-watch.news/impossible-to-have-healthy-people-on-a-sick-planet-fighting-back-against-air-pollution/ Image Credits: Sébastien Bertrand, Daniel Moqvist. Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Air Pollution Victims Could Sue For Damages Under Proposed New EU Rules 06/07/2023 Stefan Anderson The EU is updating its air pollution directive for the first time since 2008. The new laws are expected to take effect in late 2023 or early 2024. BRUSSELS – European Union citizens suffering from health effects caused by air pollution could soon be entitled to seek financial compensation from polluters under a proposed revision of the EU’s pollution regulations. The proposal is part of a broader overhaul of EU air pollution laws, expected to be completed in late 2023 or early 2024, said a senior European Commission official Thursday. The interests of European citizens are already protected by an array of legal umbrellas. Companies can be held liable for misleading consumers in their marketing; airlines are required to compensate customers for cancelled or delayed flights; and breaches of consumer privacy or competition laws frequently result in heavy fines. But no mechanism exists to protect people from breaches of air pollution limits or pollution from industrial sites like chemical factories, industrial farms or coal plants. And that has to change, said the European Commission’s Veronica Manfredi. “If we protect the economic interests of our citizens so well, maybe it is also time to have similar protections for their lungs,” said Manfredi, director of Zero Pollution and Green Cities at the European Commission. “Even just loss of time is recognized by the European Court of Justice (ECJ) as damage.” She was speaking at an event: Cleaner air: Time to capture the benefits, hosted by the European Policy Centre. Penalties, damages and access to justice Air pollution is responsible for over 300,000 premature deaths in Europe every year. The new air pollution rules navigating the EU’s lawmaking labyrinth are the first update to the bloc’s Ambient Air Quality Directive (AAQD) since 2008. The AAQD sets binding air quality standards for a range of air pollutants harmful to human health such as nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone which apply to all member states. The tighter rules proposed by the Commission aim to end the impunity by which polluters across the EU breach air pollution limits. Updated penalties would levy fines proportionate to the financial turnover of companies breaking air quality rules to offset any economic benefit drawn from the breaches. The Commission proposal is furthermore based on the EU’s “collective redress” model for consumer protection, which allows consumer and public organizations to seek collective settlements on behalf of consumers. The Representative Actions Directive, which was adopted in 2020 and came into full force across the bloc in June, empowers consumers to seek financial compensation for damages in areas such as data protection, financial services, and air travel. The update to the AAQD would allow individuals to do the same for health damages caused by air pollution. “We are envisioning something similar for people that are victims of pollution problems that lead them to health issues,” said Manfredi. “The new provisions entail a clear legal basis for the first time for people whose health has been damaged by air pollution to seek compensation.” Cost-benefit paradox The average annual population-weighted a PM2.5 concentration in European countries for 1990 (left) and 2019 (right). The European Environmental Agency estimates 96% of urban EU citizens are exposed to PM2.5 levels above WHO standards. Europe stands to gain hundreds of billions of euros from cleaner air. EU-wide benefits of meeting the air quality targets set by the Commission are estimated to be between €42 billion and €121 billion anually, according to a new report by the European Policy Center (EPC) published on Thursday. The costs of implementing the rules is less than €6 billion per year. “It is a paradox that we have a seven-to-one benefit ratio, but then there are still lots of resistance and concerns,” said Stefan Šipka, lead author of the EPC report. “And that is actually the lowest [estimated] ratio.” Premature deaths from air pollution have fallen by two-thirds from an estimated one million deaths in the 1990s to around 300,000 deaths in the EU region today. Implementing the stricter air quality limits set out by the Commission successfully could reduce that number yet again by over 75%, experts estimate. “It is still an absolutely unacceptable number,” said Manfredi. “It puts into tragic perspective even the number of appalling deaths we have experienced during the – after all – just two year COVID-19 pandemic.” The European Parliament’s Environment, Public Health and Food Safety (ENVI) Committee has approved the revision of the Ambient Air Quality Directive in June – a major step towards the finish line. But the directive needs to clear votes in the European Parliament and the EU Council, the body representing EU member states, before it is finalized. See the related Health Policy Watch story on a new TDR Global Health Matters podcast here: https://healthpolicy-watch.news/impossible-to-have-healthy-people-on-a-sick-planet-fighting-back-against-air-pollution/ Image Credits: Sébastien Bertrand, Daniel Moqvist. Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Water and Sanitation Crises Hit Women and Girls Harder than Men 06/07/2023 Megha Kaveri A major burden of collecting water falls on women and girls. Water and sanitation crises across the world affect women and girls more than men and boys, particularly since the responsibility to collect water in seven out of 10 households without individual water supply falls on the female family members. This is a key message in the latest edition of the joint WHO/UNICEF report on progress on household drinking water, sanitation, and hygiene (WASH) 2000-2022 the first to provide a look at data from a gender perspective. The data conclusions dovetail decades of observations about the disproportionate impacts of unsafe and inaccessible water, sanitation and hygiene on women and girls. Globally, 1.8 billion people live in households without a source of water on the premises, the report finds. Women and girls, regardless of their age, bear a little over twice the burden of fetching water from sources outside their homes compared to men and boys. This leaves them with much less time to engage in education and employment, among other activities. In almost all the countries surveyed for the report, men and boys spent less than 10 minutes per day fetching water for such households, compared to 53 minutes per day for women and girls. Time spent by people fetching water. Lack of access to sanitation and hygiene And if the lack of an on-site water supply eats into the time available for education or employment of women and girls, inadequate sanitation facilities makes their lives even more precarious. “Unsafe water, toilets, and handwashing at home robs girls of their potential, compromises their well-being, and perpetuates cycles of poverty,” said Cecilia Sharp, UNICEF director of WASH and Climate, Energy, Environment and DRR (CEED). “Every step a girl takes to collect water is a step away from learning, play, and safety.” Proportion of world population having access to safely managed sanitation services as of 2022. “Women and girls not only face WASH-related infectious diseases, like diarrhoea and acute respiratory infections, they face additional health risks because they are vulnerable to harassment, violence, and injury when they have to go outside the home to haul water or just to use the toilet,” said Dr Maria Neira, WHO director for Environment, Climate Change and Health, about the reports findings. WASH and Sustainable Development Goals Access to safely managed drinking water around the world has improved from 69% in 2015 to 73% in 2022, with a sizable improvement in rural areas. However, 2.2 billion people worldwide still lack access to safely managed drinking water in 2022. If the world is to achieve the Sustainable Development Goal (SDG) for Clean Water and Sanitation (SDG-6), it has to accelerate progress by three to six times, the report pointed out. Accessibility to drinking water is closely correlated with the level of income in a country, it stated. In a high-income country, almost all households have access to safe drinking water on site, or within a 30-minute walk. In contrast, in low-income countries, less than a third of the safe drinking water sources are located within the premises of a household. And only half of households can access a safe drinking water source within a 30-minute walk. Sanitation even further behind Progress on sanitation lags even further behind. Around 3.4 billion people across the world still lack access to what WHO and UNICEF define as a “safely-managed” sanitation point – which they both define as an improved latrine or better. And while access to safe sanitation sources has risen in the past seven years from 49% in 2015 to 57% in 2022 – that’s still far behind safe water access. Open defecation continues to be a widespread practice in some 36 countries – with rates of 5%-25%. Among 13 countries, at least one in four persons regularly defecate in the open, including Chad (63%), Niger (65%), and South Sudan (60%) . The practice not only increases people’s risk of exposure to disease pathogens but also makes it difficult for women and girls, in particular, to maintain privacy and dignity, as well as making them vulnerable to physical, sexual, or verbal violence. Image Credits: Photo by Rifath @photoripey on Unsplash, UNICEF. WHO, UNICEF, WHO. Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Aspartame: WHO and IARC to Release New Data on Carcinogenic Risks Next Week 05/07/2023 Megha Kaveri & Elaine Ruth Fletcher Sugar crystals with aspartame in it (Round, white materials in the image). WHO is set to release new data on Friday, 14 July on the carcinogenic risks of consuming aspartame, the artificial sweetener that is omnipresent in low-calorie soft-drinks, sweets and other processed foods, its head of nutrition, Dr Francesco Branca confirmed on Wednesday. A full WHO risk assessment on safe levels of exposure to the sugar substitute, which hasn’t been assessed since 1981, is due to be completed this week by the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA), Branca said, speaking at a WHO press briefing on Wednesday. “The assessment of aspartame has been,in the first place, a hazard identification process. This has been closed. This is now followed by a full risk assessment process,” Branca said. “The two assessments will be then put together in a final release that will be completed and disseminated next week – a full risk assessment will be available next week.” His comment came days after a Reuters report stated that aspartame is set to be declared as “possibly carcinogenic to humans”, by the International Agency for Research on Cancer (IARC), a WHO-affiliated agency that recently completed a separate assessment process on the sweetener. The new IARC monograph is due to be released 14 July, simultaneously with the JECFA assessment. IARC’s assessments looks at carcinogenicity, WHO evaluates exposure risks While IARC’s assessments look at whether a substance is potentially hazardous, or not, the JECFA assessments look at how much, if any, of a product is actually safe to consume, a WHO spokesperson explained, in a comment to Health Policy Watch. “In its Monographs Programme, IARC conducts hazard identification, which is the first fundamental step to understand carcinogenicity. Hazard identification aims to identify the specific properties of the agent and its potential to cause harm, i.e., the potential of an agent to cause cancer. “The classifications reflect the strength of the scientific evidence as to whether an agent can cause cancer in humans, but they do not reflect how high the risk of developing cancer is at a given exposure level. “The JECFA Programme (Joint FAO/WHO Expert Committee on Food Additives) conducts risk assessment, which determines the probability of a specific type of harm (e.g., cancer) to occur under certain conditions and levels of exposure. “The evaluations are independent but complementary and are conducted one after the other in the months of June-July 2023,” the spokesperson explained. “Given the close collaboration between the IARC Monographs and the WHO/FAO JECFA Secretariat, we have planned to present the results of both evaluations at the same time.” This will allow to clearly communicate the different purposes of a hazard Aspartame’s links with health conditions Along with cancer, aspartame has in the past been linked to a wide range of serious health conditions. A 2 July roundup by the US-based public health group, Right to Know, cites evidence around the sweetener’s links to cardiovascular disease, Alzheimer’s seizures, stroke and dementia, along with a range of head, stomach and mood disorders, and even weight gain. In May 2023, the World Health Organization signaled a change in its policies, advising the public not to consume non-sugar sweeteners for weight loss, including aspartame. The recommendation was based on a systematic review of the most current scientific evidence, which suggests that consumption of non-sugar sweeteners is in fact associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality, as well as increased body weight. Even so, evaluations by the US Food and Drug Administration (FDA), and the European Food Safety Authority have so far rebuffed claims that there is significant evidence of health risks. The FDA states that aspartame is “safe for the general population under certain conditions of use. A “possibly carcinogenic to humans” IARC classification, which is the classification reportedly assigned to aspartame, is the lowest cancer classification level on the agency’s scale – other than “not classifiable at all”. It means that there is some limited evidence that the additive causes cancer in humans. “Probably carcinogenic” is the next step in the scale – in which red meat belongs along with glyphosate, the widely used weedkiller, first marketed by Monsanto and now controlled by Bayer. Substances with the most robust evidence receive the highest classification – “carcinogenic”. Those range from outdoor air pollution and diesel exhaust to processed meat and asbestos. All have convincing evidence showing they cause cancer, IARC says. National regulatory agencies have not always followed IARC’s recommendations. For instance, the US Environmental Protection Agency still considers glyphosate to be “not likely to be carcinogenic in humans.” Image Credits: Maxwildcat, CC BY-SA 4.0. 18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
18 Million Doses of Malaria Vaccine Due to Be Distributed Soon to 12 Countries in Africa 05/07/2023 Megha Kaveri A resident of Tanzania tucked into a mosquito net, to protect himself from mosquito bites. Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters. “At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.” At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people. The malaria vaccine race Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement. Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. “We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.” Sudan conflict: increase in sexual violence Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher. “I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. “Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.” There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. “We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. Image Credits: Peter Mgongo. Posts navigation Older postsNewer posts