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

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

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

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

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

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

Regulation aligns with mortality

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

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

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

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

Image Credits: Max Kleinen/ Unsplash.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From bad roads and boats to mere minutes

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

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

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

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

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

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

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

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

Anne Nderitu, Operations Manager for Swoop AERO.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Helping to achieve universal health coverage

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

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

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

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

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

Image Credits: Josephine Chinele, UNICEF Malawi.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: WHO.

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

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

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

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

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

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

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

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

Clinical results highlight the complexity of Alzheimer disease

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

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

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

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

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

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

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

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

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

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

A ‘new era’ in the dementia fight

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

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

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

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

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

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

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

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

Oral polio vaccination – despite a post-COVID rebound, 20.5 million children still missed out on routine vaccinations in 2022.

Routine childhood immuniaztions rebounded in 2022 from the set-backs of the COVID pandemic.  But coverage still fell short of pre-COVID numbers in 2019, with 20.5 million children missing out on one or more routine vaccines last year as compared to 18.4 million in 2019.

The new data is contained in a report published jointly Tuesday morning by the World Health Organization and UNICEF.  The data tracks a wide range of vaccines, but uses immunization against diptheria, tetanus and pertussis (DTP) as a marker for immunization coverage globally.

In 2022, 20.5 million children missed out on one or more DTP vaccines, as compared to 24.4 million children in 2021, according to the new global data set.

Of the 20.5 million children who missed out on one or more doses of their DTP vaccines in 2022, 14.3 million did not receive a single dose, so-called ‘zero-dose’ children. The 2022 figure represents an improvement over the 18.1 million zero-dose children in 2021 but remains higher than the 12.9 million children that missed all DTP doses in 2019.

“These data are encouraging, and a tribute to those who have worked so hard to restore life-saving immunization services after two years of sustained decline in immunization coverage,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But global and regional averages don’t tell the whole story and mask severe and persistent inequities. When countries and regions lag, children pay the price.”

Indeed, progress was greater in large, and better-resourced countries like India and Indonesia, the WHO/UNICEF report notes. It was much less so in many other low-income countries.

Of the 73 countries that recorded substantial declines in coverage during the pandemic, 15 recovered to pre-pandemic levels and 24 are on route to recovery, the report finds. However, another 34 have seen vaccination rates stagnate at pandemic levels, or even continue to decline.

“These concerning trends echo patterns seen in other health metrics,” said WHO.

Additionally, while DTP is used as a marker, vaccinations against various childhood diseases still vary widely.  For instance, vaccination against measles – one of the most infectious pathogens – has not recovered as well as other vaccines, putting an additional 35.2 million children at risk of measles infection, WHO said in a press release.

First dose measles coverage increased to 83 per cent in 2022 from 81 per cent in 2021 but remained lower than the 86 per cent achieved in 2019. As a result, last year, 21.9 million children missed the routine measles vaccination in their first year of life – 2.7 million more than in 2019 – while an additional 13.3 million did not receive their second dose, placing children in under-vaccinated communities at risk of outbreaks.

Overall, coverage with three DTP doses in 57 low-income countries supported by Gavi, The Vaccine Alliance, increased to 81% in 2022, as compared to only 78% in 2021, however, this remains below the pre-pandemic rates of  86% recorded in 2019, UNICEF said.

“Beneath the positive trend lies a grave warning,” said UNICEF Executive Director Catherine Russell. “Until more countries mend the gaps in routine immunization coverage, children everywhere will remain at risk of contracting and dying from diseases we can prevent. Viruses like measles do not recognize borders.”

Image Credits: UNICEF South Africa/2013/Hearfield, Sanofi Pastuer/Flickr.

The Rwandan national ballet performs at the opening of Women Deliver 2023

Women Deliver, one of the world’s largest gatherings on gender equity and sexual and reproductive health and rights (SRHR), opened in Kigali in Rwanda on Monday amid a global backlash against abortion.

“We’re facing enormous headwinds against gender equality, including the COVID-19 pandemic, the climate crisis, and a growing anti-rights movement worldwide,” said Maliha Khan, President and CEO of Women Deliver, at the opening press conference.

“The only way we can push past them is if we double down on our efforts and work together. The time has come for us to unite against the global rollback of rights – change is inevitable, progress is not. We have to work at it.”

An estimated 6000 delegates are attending the week-long conference, which has attracted global politicians, activists and philanthropists.

“Each delegate and speaker has converged here with a collective purpose: to identify and act upon evidence-based solutions,” said Maliha. “This week centers on creating empowering spaces for the feminist movement, holding leaders accountable, and creating a groundswell of voices for gender equality. This groundswell of collective action is critical to urge political leaders to act.” 

Anti-rights president addresses opening

However, surprisingly Hungary’s rightwing president, Katalina Novak, was invited to address the opening along with Rwandan President Paul Kagame. As Family Minister in the populist government of Viktor Orban, Novak has been party to anti-LGBTQ laws and the tightening of abortion regulations in her country.

Novak has also told women not to expect the same pay as men, while her government has outlawed adoption by unmarried couples, thus excluding LGBTQ couples from adopting children, and refused to ratify the Istanbul Convention, designed to protect women from violence.

Other speakers include Nobel Peace Prize laureate Malala Yousafzai, US politician Stacey Abrahams, Mozambican former first lady Dr Graça Machel, and former Irish President Mary Robinson.

“Women Deliver underscores the vital role of democratic systems in advancing gender equality,” Phumzile Mlambo-Ngcuka, Chair of the Women Deliver Board and former UN Under-Secretary-General, told the media briefing.

“Open democracies foster an enabling environment for women’s political participation, policy and law shaping, as well as the protection of women’s rights and the creation of equal opportunities. They facilitate improved access to education and healthcare for girls and women while establishing effective mechanisms to combat gender-based violence.”

Women Deliver developed out of the Safe Motherhood Initiative, with an exclusive focus on reproductive, maternal, and newborn health, and has evolved into an independent organization focusing on gender equality.

Women Deliver itself has undergone an internal transformation after facing allegations of racism from staff members three years ago.

Meanwhile, on Monday, the World Health Organization launched a new digital resource at the conference, RESPECT, to help end violence against women and girls  

RESPECT outlines a set of action-oriented steps to support policy makers and programme implementers to design, plan, implement, monitor and evaluate programmes using seven strategies to prevent violence against women. Each letter of R-E-S-P-E-C-T represents one of these strategies. The framework, grounded in a gender equality and human rights approach, builds on an increasing body of evidence on what works to prevent violence against women.

The UN has warned that millions of people could face hunger if the deal is not saved.

Russia has withdrawn from a UN-brokered agreement that allowed Ukraine to safely export grains from its ports in the Black Sea. The move is expected to have a significant impact on global food prices, imperilling the food security of millions around the world. 

“I deeply regret Russia’s decision to terminate the implementation of the Black Sea Initiative, which has been a lifeline for global food security in a troubled world,” UN Secretary-General António Guterres said on Monday. “Hundreds of millions facing hunger and consumers confronting a global cost-of-living crisis will pay the price.”

The first months of Russia’s full-scale invasion of Ukraine saw global food prices surge as Russian naval blockades trapped around 20 million tonnes of grain in Ukraine’s Black Sea ports, triggering the worst global food crisis since 2008. 

The United Nations warned food-insecure countries in the Middle East and Africa were at risk of famine if the blockades continued, while the International Monetary Fund estimated the lives of 345 million people were put in immediate danger by the shock waves sent across global food markets by the war.

The mounting global food crisis and international pressure led to a rare instance of successful diplomacy between invader and invaded. The Black Sea grain initiative, which came into effect a year ago, created a safe corridor for commercial ships to enter and exit the Black Sea, allowing Ukrainian grain exports to resume.

The deal helped ease the upward pressure on global food prices, with around 33 million metric tons of grain and oilseeds exported under the deal.

Prices for grains and oilseeds have already risen in response to Russia’s exit from the deal. Aid agencies are bracing for further increases.

Consequences for the global food crisis

The 10 countries/territories with the highest numbers of people facing life-threatening levels of food insecurity.

As the last ship protected by the agreement set sail from the port of Odesa on Sunday morning, fears grew that the progress made in stabilising the global food crisis could be lost overnight.

The confluence of COVID-19, the war in Ukraine and climate shocks have overlapped to create the “largest and most complex hunger and humanitarian crisis in more than 70 years”, the World Food Programme said in its annual report last month. 

A record 349 million people experienced acute hunger in 2022, while 772,000 balanced on the knife’s edge of famine. Around 2.4 billion people did not have constant access to food. 

According to the UN, 47% of exports from Ukraine under the deal have gone to high-income countries, 26% to upper-middle-income countries, and 27% to low and lower-middle-income countries. 

Russia has criticized Ukraine for not exporting more to low-income countries. The UN, EU, United States and Ukraine argue the grain deal benefits people around the world due to its deflationary effect on food prices, which are at a 10-year high.

Ukraine was WFP’s top provider of grain in 2021, accounting for 20% of the total purchased by the UN agency. That number rose to 80% in the first half of this year.

European Commission President Ursula Von der Leyen condemned Russia’s “cynical move” to exit the agreement. The EU is “working to ensure food security for the world’s most vulnerable”, and will continue to help Ukraine deliver its agri-food products to global markets, she said. 

The UN has warned that millions of people could face hunger if the deal is not saved. Countries facing high levels of food insecurity such as Afghanistan, Yemen, Somalia, South Sudan and Syria will be the hardest hit. 

“Today’s decision by Russia to terminate the implementation of the Black Sea Initiative will strike a blow to people in need everywhere,” said Guterres.

Will Russia return to the deal?

Russia has pulled out of the Black Sea grain deal before. In November, Russia announced it was leaving the agreement, stoking panic in global food markets. Under pressure from Turkey, it rejoined the deal one day later. 

Kremlin spokesperson Dmitry Peskov said on Monday that the Black Sea grain deal has been “terminated”, but that Russia would rejoin the agreement “as soon as the relevant agreements are fulfilled”.

Russian demands include lifting obstacles to its own grain and fertilizer exports, reopening an ammonia pipeline from Odesa to Russia, and reconnecting the Russian Agricultural Bank to the SWIFT international payment system.

Moscow has repeatedly criticized the deal as one-sided, providing a lifeline to Ukrainian farmers without benefiting Russia. 

“Absolutely nothing has been done – I want to stress that. It’s one-way traffic,” Russian President Vladimir Putin said of the grain deal last week. “Not a single point linked to the fact Russia has its own interests has been fulfilled.” 

EU and US sanctions do not directly target Russia’s food and agriculture sectors, but have blocked the export of machinery needed for agriculture and complicated Russian efforts to export food and fertilizer.

EU officials said negotiations are still ongoing, and Turkish President Recep Tayyip Erdoğan said on Monday he believes Putin “wants the Black Sea Grain deal to continue”.

The United Nations and European Union have offered to reconnect a subsidiary of Russia’s Agricultural Bank to the SWIFT international payments system if it operates independently and agrees to regular UN audits. 

Russia was made aware of this proposal by UN Secretary-General Antonio Guterres last week, but pressed on with its exit from the deal.

Despite the stalemate, the deal still stands, a senior EU official told the Wall Street Journal on Monday. 

Image Credits: Breta Valek.

INB co-chairs Roland Driece and Precious Matsoso

Pandemic accord negotiations resumed on Monday with World Health Organization (WHO) member states expressing a hunger for text-based talks to begin on a first draft amid grave concerns about whether enough progress will be made before the northern hemisphere summer break.

Roland Driece, co-chair of the Bureau of the Intergovernmental Negotiating Body (INB), told the body’s sixth formal meeting that while he understood member states’ eagerness for a first draft on which to start text-based negotiations, discussions on Chapter Two of the compilation text (referred to as WHO CA+), focusing on equity, should be completed first.

“I would rather have a first draft that has substance which we all feel is strong enough to have real line-to-line discussions on, than having something in between which is not good enough yet,” said Driece. “So I would rather have a good first draft than a quick first draft, but we will come back with a proposal on how to get there.”

Informal inter-sessional meetings

Since the last INB meeting a month ago, member states have met in informal sessions to discuss three controversial issues in Chapter Two of the compilation draft. These sessions focused on research and development related to pandemic products, particularly vaccines and medicines (Article 9); access to these products and benefit-sharing, including sharing genomic sequencing of whatever pathogen is causing the pandemic(Article 12) and supply chain logistics (Article 13).

This week’s meeting will continue negotiations on Chapter Two, focusing on Articles 15 to 19, then Articles one to three, if there is enough time.

Member states generally regarded the informal sessions as being useful to enable them to understand countries with different positions better, as well as for elucidating how clauses could be practically implemented.

But while some countries felt that the informal sessions could be used to generate new text to enhance the compilation draft of the pandemic accord, others were adamant that the negotiations should not splinter further.

US Ambassador Pamela Hamamoto

“The informals clearly provided a valuable opportunity for member states to clarify their proposals and ask questions, which we believe helped improve our collective understanding of what may or may not be feasible for the accord,” said US Ambassador Pamela Hamamoto. 

“We suggest laying out a process this week for ongoing work by the co-facilitators, further empowering them to convene additional discussions on their respective articles, and if possible, to develop draft text to bring back to our next formal meetings,” she added.

“In this way, we can take strong collective steps under the guidance of the Bureau to move from helpful but still high-level discussions to more specific line-by-line negotiations and begin to build the first draft of the negotiating text together.”

African proposals missing amid concern about onerous meeting schedule

South Africa’s Dr Aquina Thulare

South Africa’s Dr Aquina Thulare, speaking on behalf of 47 African countries, noted that a number of suggestions from the continent had not made their way into the latest compilation text.

Nigeria posited that the informal meetings could “be used as an opportunity to highlight and discuss some of these issues and also see a way to re-import them into the document”.

But Namibia and Botswana were against “having to fight to incorporate our proposals through the informal process”. 

Kenya asked the INB’s Bureau to clarify when and where member states will be able to add text to the Bureau’s compilation. 

“In our view, this should be the preserve of the formal meetings of the INB, and as such, we propose that informal sessions maintain focus on clarity seeking and consensus building as their main mandate,” said Kenya.

Many under-resourced countries are also struggling to keep up with the heavy burden of meetings and fear being excluded if the INB splinters into even more informal sessions.

This was clearly articulated by Fiji, which said that while the informal sessions may assist in speeding up talks, “we run the risk of losing necessary representation and meaningful participation in the process”. 

“Therefore, the inter-sessional meetings should be seen as a useful method to enable better understanding and shifting negotiations forward. but the substantive negotiations must happen within the formal processes of the drafting group, and the INB.”

While sympathetic to this position, New Zealand proposed that the informal sessions could, nonetheless, be “empowered to identify convergence and divergence, restructure articles where it makes sense, and draw on member states’ proposals to help identify compromise text”.

Bureau co-chair Roland Driece reassured the INB that the informal sessions were never intended to replace formal discussions, but rather to “find the room”.

“Decisions are always here in this room and not in the informals,” said Driece, but added that the informal meetings were essential to enhance appreciation of one another’s viewpoints.

“We hear that not some of you struggle a little bit and we have to recognise as a Bureau that it’s not 100% clear on what the mandate of co-facilitators is or what the exact aim of a group is and we are working our way through this,” said Driece.

“But there is no other option than to keep on talking till we reach where we want to go,” he added. “I understand that nobody is willing to put all its cards on the table yet to show complete transparency about where they want to go or what their room to manoeuvre is, but at least everybody needs to show as much of their own cards [as possible]  in order to for the other ones to understand how to move on.”

Robust ‘One Health’ approach essential for prevention

France’s Ambassador Anne-Claire Amprou

Meanwhile, France speaking for the “One Health” group, stressed that pandemic prevention “is at the heart of the mandate” given to countries to negotiate a pandemic accord.

“We must take into consideration the ties between people and animals, both wild and domestic, and the environment in order to understand the fundamental factors and the trends that lead to the emergence and re-emergence of diseases,” stressed France’s Ambassador Anne-Claire Amprou. 

“The One Health approach is fundamental in order to fight risk factors and guarantee multiparty and multidisciplinary collaboration between the environment, human health and animal health experts.

“We have a unique opportunity to reinforce ties between these sectors by focusing on existing systems and capacities to ensure prevention preparedness and rapid response to pandemics. The pandemic accord could not be completed without a One Health approach that is robust and strong.”

New method of work 

European Union’s Director General for Health and Food Safety  (DG Santé) Sandra Gallina,

The European Union’s Director General for Health and Food Safety  (DG Santé)  Sandra Gallina, supported the “new method of work” introduced during the closed drafting session of the June INB meeting.

“The interactive and constructive discussions on key topics that prevailed during the meeting marked a significant shift and they are precisely what we need in order to increase the level of understanding of each other proposals,” said Gallina. 

“In particular, the opportunity given to delegations during the drafting group to present their proposals on access and benefit sharing, and the question and answer sessions that followed, proved to be very useful to increase the level of understanding of the various proposals,” she added.

Gallina stressed that this methodology, along with the informal inter-sessional meetings, should be applied to key topics related to the entire pandemic prevention, preparedness and response (PPR) cycle. 

Commenting that much of the current discussion had focused on response, Gallina urged “interactive and constructive discussion on key topics linked to prevention and preparedness” as “the best way of handling future pandemics is to prevent them from happening in the first place”.

Way forward to the first draft

Concluding the opening plenary, co-chair Driece said that the Bureau was “ a bit squeezed” between the time constraints of delivering an accord by May 2024 and accommodating countries’ concerns about having to attend so many meetings.

Driece added that it was not practical to reinstate the entire compilation text as the basis for negotiations and that the Bureau had done its best to summarise countries’ positions.

“We’ve always said if you feel that we left something out which you have proposed, for example, a third option where we present two or a second option where we present one, this room is the place to tell us that.”

On presenting a first draft for text-based negotiations, Driece said that the Bureau felt this was not possible until discussions on Chapter Two of the compilation text had been completed.

“I would rather have a first draft that has substance which we all feel is strong enough to have real line-to-line discussions on, than having something in between which is not good enough yet. So I would rather have a good first draft than a quick first draft, but we will come back with a proposal on how to get there.”

Médecins Sans Frontières (MSF) supporters protesting in front of the New York Stock Exchange in 2020, demanding that Johnson & Johnson makes bedaquiline available for all people with drug-resistant tuberculosis for no more than a dollar a day.

The licensing agreement reached between Johnson & Johnson (J&J) and the Stop TB Partnership on Thursday to allow the generic production of the tuberculosis drug, bedaquiline, is simply a “stop-gap” measure that applies to a limited number of countries, according to Médecins Sans Frontières (MSF).

At least nine countries in the Eastern Europe and Central Asia region with some of the world’s highest burden of drug-resistant TB are likely to be excluded from this deal, according to MSF.

While the countries included in the deal have not yet been made public, J&J has an exclusive commercial agreement with Russia’s Pharmstandard to supply bedaquiline to a number of countries in Eastern Europe and Central Asia and these are thus unlikely to benefit from the Stop TB deal.

Over the past week, J&J has faced public outrage for seeking to extend its patent on bedaquiline, the primary medication to treat drug-resistant TB. The global patent is due to expire next Tuesday but medicine access activists have accused the company of seeking secondary patents in 66 countries. 

US author John Green’s social media posts about the extension of the bedaquiline patent received significant traction, causing #PatientsnotPatents to trend on Twitter on Thursday.

In the midst of the media row, the Stop TB Partnership announced on Thursday that, “following lengthy negotiations”, J&J had granted licenses to its Global Drug Facility (GDF) to “tender, procure, and supply generic versions of bedaquiline for the majority of low-and middle-income countries, including countries where patents remain in effect”.

The GDF plans to launch a global, competitive tender for bedaquiline by the end of July and has reached out to potential suppliers about the process, according to the Stop TB announcement.

But MSF’s Christophe Perrin described the deal as “just a stop-gap because bedaquiline will only be available to a limited number of countries that will be included in this agreement, procuring through the Global Drug Facility”. 

“We remain concerned that J&J retains the global authority to determine access to lifesaving generic versions of bedaquiline in countries with a high burden of TB, even after the expiration of the main patent next week,” said Perrin.

“By continuing to pursue an extension of their monopoly on the drug in many countries, including 34 high-TB-burden countries where J&J still has a secondary patent on bedaquiline, J&J is maintaining control over countries’ ability to offer more people the treatments they need to stay alive and healthy.  

“We reiterate our call on J&J to publicly announce it will not enforce any secondary patents on bedaquiline in any country with a high burden of TB, and withdraw and abandon all pending secondary patent applications for this lifesaving drug,” added Perrin.

However, J&J has denied claims that its patents have prevented TB patients from access to bedaquiline.

“Unfortunately, the most significant barrier to treatment access for patients today is the fact that millions of patients with TB go undiagnosed every year. This is a challenge that we have invested significant resources to overcome and must all get behind if we are to achieve the global goal of ending TB,” said the company.

Key medicine for drug-resistant TB

Bedaquiline is the cornerstone of the best available regimens to cure drug-resistant TB (DR-TB), which is a tough-to-treat form of TB that nearly half a million people get each year, according to the Treatment Action Group (TAG).

“Many countries with high burdens of TB are unable to fully scale up access to DR-TB treatment due to the high cost, up to 70% of which is driven by the price of bedaquiline,” according to TAG.

“Recent estimates suggest that generic versions could shave up to 80% off the price of the drug, resulting in major savings for already cash-strapped TB programs in low- and middle-income countries. Around three-quarters of people in need of treatment for DR-TB live in countries affected by the secondary patents, including countries experiencing active conflicts or humanitarian crises such as Ukraine, Cameroon, Sierra Leone, and Malawi,” added TAG.

The current price that Pharmstandard currently charges the Russian Federation for bedaquiline is around 17 times higher than that agreed on between J&J and Stop TB.

Image Credits: The Global Fund / Evgeny Maloletka, Médecins Sans Frontières.