Children in Muheza, Tanzania, await testing for lymphatic filariasis and onchocerciasis.

African leaders must take the lead in the fight against Neglected Tropical Diseases, invest in their control and elimination, and foster cross-border collaboration to achieve the goal of eliminating NTDs as public health concerns by 2030.

Neglected Tropical Diseases (NTDs) continue to pose a significant threat to the health and well-being of millions of people across Africa. As we strive towards the ambitious goal of eliminating NTDs as public health problems by 2030, it is imperative that we forge greater collaboration at global and regional levels. The Continental Framework and African Common Position on NTDs alongside the WHO Global Roadmap on NTDs (2021-2030) provide provides us with a clear roadmap for action, offering hope and a renewed commitment to tackling these diseases head-on.

Promising steps towards NTD elimination

Africa has made remarkable progress in the fight against NTDs, achieving significant victories against specific diseases. Blinding trachoma has been eradicated in Benin, Gambia, Ghana, Malawi, Mali, Morocco and Togo, while lymphatic filariasis has been eliminated in Egypt, Malawi and Togo. The eradication of Guinea worm extends to Benin, Burkina Faso, Cameroon, Central African Republic, Cote D’Ivoire, Ghana, Kenya, Mauritania, Niger, Nigeria, Senegal, Togo, and Uganda.

One of the key factors contributing to these successes has been the establishment of successful public-private partnerships. Non-governmental development organizations have played a crucial role by contributing to the donation of medicines for Mass Drug Administration (MDA) and supporting other vital NTD interventions, including research and innovation.

Additionally, mass drug administration targets diseases like lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, and trachoma, leading to a decline in prevalence.

Countries are also scaling up control efforts, employing case management, vector control, Water, Sanitation and Hygiene (WASH) strategies, and One Health approaches. These collective actions demonstrate Africa’s unwavering commitment to combating NTDs and improving the well-being of its people. 

Collective action and innovative financing are essential 

The NTDs prioritized by the WHO are a diverse group of 20 diseases and disease groups that have one thing in common: their devastating impact on impoverished communities.

Despite these successes,  we cannot afford to overlook the persistent challenges that continue to hinder progress in eliminating NTDs. Africa bears a significant burden, accounting for around 40% of global NTD cases. 

Among the 55 African Union Member States, 37 nations face the co-endemicity of at least five NTDs, disproportionately affecting impoverished and marginalized communities. The consequences of these diseases, such as blindness, disfigurement, social stigma, chronic pain, cognitive impairment, disabilities, and long-term irreversible damage, hinder education, employment, economic growth, and overall development, perpetuating the cycle of poverty.

Furthermore, a majority of NTD programmes across the continent suffer from insufficient funding, hindering sustained progress against these debilitating diseases. In alignment with this, WHO’s Case for Investment in NTDs highlights the gaps in funding for NTDs and emphasizes the necessity to consistently support cost-effective interventions and develop innovative financing strategies that can better facilitate collaborative actions across various sectors.

In terms of policy, interventions often occur in isolation, with limited coordination and integration at national and regional levels, further impeding efforts towards elimination.

Africa is leading the fight in reducing the burden of disease, including NTDs and malaria, through mechanisms such as the Africa Health Strategy and the Catalytic framework to end AIDS, TB, and Malaria. These efforts have shaped our response and set a clear direction for the control, elimination, and eradication of diseases by 2030. The WHO NTD Roadmap complements these initiatives, providing overall guidance.

Additionally, the recently established Continental Framework on the elimination of NTDs in Africa offers a vital roadmap to guide our collective efforts in combatting NTDs. By aligning with these ambitious frameworks, we can chart a course toward a healthier future for our continent. 

Coordinated policy integration is critical to overcome barriers 

President Umaro Sissoco Embaló of the Republic of Guinea Bissau and Chair of the African Leaders Malaria Alliance (ALMA).

Now is the time for African Union member states to unite, strengthen our resolve, and take decisive action against NTDs. To truly make an impact, we must fully embrace our responsibility, take ownership, and demonstrate leadership in reducing the prevalence, elimination, and eradication of NTDs. This entails reinforcing policies that promote effective control and elimination strategies. Moreover, fostering inter-state partnerships, especially through cross-border collaboration, is crucial in our fight against NTDs. 

Furthermore, investment in NTD programmes, research and development, and the advancement of local diagnostic tools are essential for informed intervention strategies. Mobilising domestic resources plays a pivotal role in this endeavour.

My own country, Guinea Bissau, serves as a great point of reference, leading the way in alternative financing for NTDs by establishing an integrated End Malaria and NTDs Council. This high-level multisectoral council will keep malaria high on the advocacy and development agenda and mobilise both public and private sector resources to support the elimination of both NTDs and malaria. I am encouraging all countries in Africa to establish their own Malaria and NTD councils and funds as a means of strengthening local interventions.

Addressing the social determinants of health also is paramount in our battle against NTDs. Poverty, inadequate sanitation, lack of clean water, and limited access to education perpetuate the cycle of NTDs. To break free from this cycle, we must collaborate across multiple sectors to tackle these underlying factors. This includes investing in sanitation infrastructure, promoting hygienic practices, and empowering individuals economically. By addressing the root causes of NTDs, we can create lasting change and enhance the overall well-being of our communities.

Harness data for greater progress

NTD scorecard for Guinea Bissau’s Southeastern neighbour, Guinea, for July to December 2022.

Data is an invaluable tool in the development and implementation of strategic interventions against NTDs. Since 2017, the African Leaders Malaria Alliance (ALMA) has been actively supporting African Union Member States in their efforts to control and eliminate NTDs through the use of NTDs scorecards for accountability and action.

So far, 17 countries have adopted these scorecard tools, resulting in significant outcomes. For instance, NTD scorecards have helped to secure additional domestic and partner resources to address the identified areas of underperformance. The scorecards have also improved the availability of real-time data by encouraging countries to include NTD indicators in their routine Health Management Information Systems. 

By strengthening surveillance and data collection efforts, countries can enhance their diagnostic capabilities and build resilient health systems capable of delivering high-quality and equitable healthcare to all. The fight against NTDs requires a united and coordinated effort from all fronts. By implementing these measures and committing the necessary resources, we can create a healthier and more prosperous Africa, ensuring that no one is left behind in our pursuit of a continent free from the burden of NTDs. 

As we move forward, let us draw inspiration from the progress made by countries within our continent and continually work towards mitigating persistent challenges head on. By collaborating, strengthening our health systems and addressing key gaps, we can eradicate NTDs and establish a healthier and more prosperous Africa that benefits everyone. This commitment requires investment at both national and international levels to ensure sustained progress. We must act now, and in unity.

His Excellency Umaro Sissoco Embaló is the President of the Republic of Guinea Bissau and current chair of the African Leaders Malaria Alliance (ALMA).

 

Image Credits: CDC, ALMA.

In groundbreaking new research, experts at the International Agency for Research on Cancer (IARC) have raised a cautious red flag about the artificial sweetener, aspartame, and its link to liver cancer, but stress that evidence is “limited”.

IARC’s Dr Mary Schubauer-Berigan described the artificial sweetener as “possibly carcinogenic to humans” based on “limited evidence” of links to a liver cancer called hepatocellular carcinoma. She spoke at an embargoed media briefing on Wednesday, just before the release of the new IARC report, early Friday morning.

But in light of the dearth of evidence, the World Health Organization (WHO) will not changed its guideline on aspartame consumption, the agency said in an assessment of exposure risks. The WHO guideline, set in 1981, holds that it is safe for most people to consume up to 40 milligrams of aspartame daily per kilogram of body weight. 

In the WHO risk assessment, issued simultaneously, the WHO and Food and Agriculture Organization’s Joint Expert Committee on Food Additives (JECFA) concluded that there was “no convincing evidence from experimental animal or human data that aspartame has adverse effects after ingestion”, said Dr Francesco Branca, the WHO’s Director of Nutrition and Food Safety. He also spoke at the Wednesday media briefing just ahead of the release of the IARC and WHO reports Friday.  

IARC assesses potentially carcinogenic substances, WHO determines safe levels of exposure

Aspartame’s chemical formula

While IARC assesses carcinogenic hazards, as such, JECFA looks at what levels of actual exposure to the hazard are really dangerous.

“It is very important to note that this was a hazard identification and not a risk assessment,” said Schubauer-Berigan, who heads the monograph programme at IARC, a Lyon, France-based research institution affiliated with the WHO.

“A hazard identification aims to identify the specific properties of the agent and its potential to cause harm,” she added.

IARC has four classifications: 1. causes cancer; 2A. probably causes cancer; 2B. possibly causes cancer and 3. unclassifiable as a cancer risk. It has given aspartame a “2B” classification.  

Advice for consumers

Ethiopia’s Coca-Cola Beverages soft drink bottling plant – Africa’s most popular beverage, by far.

Even so, WHO has already recommended that people should be moving away from sweetened drinks – whether sweetened with sugar or artificial ingredients, Branca said.

“If consumers are faced with the decision of whether to take cola with sweeteners or one with sugar I think there should be a third option, which is to drink water instead,” said Branca.

Franco Branca, WHO’s Director of Nutrition and Food Safety.

He pointed to a recent WHO guideline that showed artificial sweeteners may also be associated with an increased risk of type 2 diabetes and cardiovascular diseases, as well as not protecting against excess weight gain.

Common sodas contain between 200 and 300 mg of aspartame, meaning that an adult would need to consume between nine and 14 cans daily to exceed the WHO recommended threshold of 40mg/kg, “which is quite a large amount”, added Branca. 

“So definitely, WHO is not recommending that producers or authorities withdraw products from the market, but considering that there are some concerns identified by some studies… certainly advising the consumers to limit the consumption of sweeteners,” he added.

Moderation and switching to naturally sweet food such as fruit is important because “the consumption of products containing sweeteners has increased and the use of sweeteners, including aspartame has increased to try and respond to consumers’ demand to reduce free sugars”, said Branca. 

“This is particularly important for young children who will be exposed early enough to a taste adjustment,” said Branca.

Call to scientists to do more research

In discussing IARC’s assessment,  Schubauer-Berigan said that “the findings of limited evidence of carcinogenicity in humans and animals, and of limited mechanistic evidence on how carcinogenicity may occur, underscore the need for more research to refine our understanding on whether consumption of aspartame poses a carcinogenic hazard”. 

“One of the key limitations of the existing studies is that most of them measured artificially sweetened beverage consumption only at a single time point,” she added.

IARC had used studies in the US and Europe

Dr Mary Schubauer-Berigan, acting director of the IARC Monographs programme.

Branca agreed, adding that some of the evidence missing included epidemiological studies looking at human outcomes over a longer period, and better mechanistic studies to understand how aspartame could actually affect insulin balance or the risk of inducing cancer.

“We’ve in a sense, raised a flag here, indicating that we need to clarify much more the situation,” said Branca.

Dr Federica Madia, IARC’s senior toxicologist,  said that while aspartame’s key components were almost completely hydrolysed during digestion, there was consistent evidence of oxidative stress, some evidence that it increased insulin levels, and suggestions of impact on “chronic inflammation and increase angiogenesis”.

“The evidence is still limited, but it is there where we would like to go through and investigate more,” said Madia.

Dr Moez Sanaa, WHO’s Head of Standards and Scientific Advice on Food and Nutrition Unit, said: “We need better studies with longer follow-up and repeated dietary questionnaires in existing cohorts. We need randomized controlled trials, including studies of mechanistic pathways relevant to insulin regulation, metabolic syndrome and diabetes, particularly as related to carcinogenicity.”

Aspartame’s links to other health conditions

Aspartame has been linked to a wide range of other serious health conditions aside from cancer. A July roundup by the US-based public health group, Right to Know, cites peer-reviewed studies 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. 

Branca said that JECFA had only found associations with type 2 diabetes and cerebrovascular disease and that these findings were in observational studies and “difficult to interpret”.

Research published last week looking at aspartame’s possible links to Parkinson’s disease found “multiple studies demonstrated decreased brain dopamine, decreased brain norepinephrine, increased oxidative stress, increased lipid peroxidation, and decreased memory function in rodents after (aspartame) use”. 

However, Branca said this study had been published too late for IARC or JECFA to consider.

“We have not clearly identified a potential mechanism of action. Potentially insulin sensitivity could be a pathway but we need to have more demonstrations about that,” said Branca.

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.

Image Credits: Coca Cola, Regular Toxicology and Pharmacology /Elsevier, James Hall/Twitter .

hunger
A woman shows how her maize ears have dried in the drought stricken garden. Due to droughts exacerbated by climate change, people living in the Mauritanian Sahel were at risk of food insecurity in 2012.

The world is on track to miss the United Nations’ target of eradicating hunger by 2030 by 600 million people, according to a flagship UN report on food security released Wednesday.

The report, jointly published by the Food and Agriculture Organization, the International Fund for Agricultural Development, the United Nations Children’s Fund, the World Health Organization, and the World Food Programme, found that the number of people facing hunger has increased by 122 million since 2019, to 735 million.

The number of people experiencing food insecurity stabilized in 2022 after hitting record numbers in 2021, but the situation remains grim. Hunger continued to rise in Western Asia, the Caribbean, and all African subregions. Africa continues to be the worst affected, with one in five people facing hunger on the continent — more than double the global average.

“Recovery from the global pandemic has been uneven, and the war in Ukraine has affected nutritious food and health diets,” said Qu Dongyu, director-general of the FAO. “This is the ‘new normal’ where climate change, conflict, and economic instability are pushing those on the margins even further away from safety.”

Global hunger remained virtually unchanged from 2021 to 2022 but is still far above pre-pandemic levels.

The report found that the number of people who did not have constant access to food rose to 2.4 billion in 2022, nearly 30% of the global population. Of those, 900 million faced severe food insecurity. Food inflation rose by 7% between 2019 and 2021, resulting in 42% of the global population — over 3.1 billion people — not being able to afford a healthy diet.

“One of the major messages of the report is that if we run the contrafactual – what would have happened if there was no COVID-19 – we would have seen a decline [in hungry people],” FAO Chief Economist Maximo Torero told Devex, adding that the same could be said for the war in Ukraine.

Children under five continue to be especially hard hit by the global food crisis, with millions suffering from malnutrition. Nearly 200 million were undernourished, while 37 million were overweight.

“There are rays of hope, some regions are on track to achieve some 2030 nutrition targets. But overall, we need an intense and immediate global effort to rescue the Sustainable Development Goals,” UN Secretary-General Antonio Guterres said in a statement during the report’s launch at UN headquarters in New York. “We must build resilience against the crises and shocks that drive food insecurity — from conflict to climate.”

Climate models underestimate odds of ‘synchronized’ global crop failures

The onset of the Russian invasion exacerbated the global food crisis. Russian President Vladimir Putin has leveraged the importance of the Black Sea corridor to global food security obtain concessions from the international community.

The Black Sea grain corridor that allows for the safe passage of ships carrying grain out of Ukraine’s ports is set to expire on Monday. If the deal is not renewed by Russian President Vladimir Putin, it could have dire consequences for the global food crisis. Prices could rise even further, and millions more people could go hungry.

UN Secretary-General Antonio Guterres has proposed that Putin extend the deal in return for reconnecting a subsidiary of Russia’s agricultural bank to the SWIFT international payment system, according to Reuters. All Russian banks have been cut off from SWIFT since June 2022.

The release of the UN report on food security came as the world was experiencing its hottest week on record. The unprecedented surface and ocean temperatures coincided with the onset of El Niño, a climate pattern that makes the ocean water in the Pacific Ocean warmer than usual.

El Niño events, which occur naturally but are influenced by human-caused climate change, are expected to become more frequent and intense as the planet warms. The resulting temperature spikes could have a significant impact on weather patterns all over the world.

The record-breaking temperatures “highlight the far-reaching changes taking place in Earth’s system as a result of human-induced climate change,” the World Meteorological Organization said.

“We are in uncharted territory, and we can expect more records to fall as El Nino develops further,” said Christopher Hewitt, Director of Climate Services at the World Metereological Organization. “This is worrying news for the planet.”

Climate change is already having a dire impact on the world’s food supplies, and the situation is only expected to worsen. New research suggests that climate models may underestimate the risk of simultaneous crop failures across the world’s breadbaskets, a finding that could have dire consequences for global food security.

The study, published in the journal Nature Communications last week, found that climate models have been “excellent” at projecting the mean response to continued greenhouse gas emissions, but that the models may underestimate the likelihood of concurrent extreme weather events that could lead to crop failures.

“Concurrent crop failures in major crop-producing regions constitute a systemic risk,” said the team of scientists from University of Columbia. “Evidence for high-risk blind spots such as an underestimation of synchronized harvest failures as identified here, manifests the urgency of rapid emission reductions, lest climate extremes and their complex interactions might increasingly become unmanageable.”

The war in Ukraine has limited the world’s access to one vital breadbasket. Climate change could hit multiple breadbaskets simultaneously, with dire consequences for millions of people around the world.

Image Credits: Pablo Tosco/Oxfam, Breta Valek.

Winnie Byanyima, the executive director of UNAIDS, launching the 2023-Global AIDS update report in Geneva on Thursday.

Despite the giant strides the world has made in combating the HIV epidemic, the high rate of infections among women and girls in sub-Saharan Africa, as well as childhood HIV infections, continue to hamper progress.  

“Four thousand adolescent girls and young women acquired HIV every single week. That’s a crisis every single week. 3,100 of those are from Sub-Saharan Africa. So it’s a sub-Saharan crisis,” Winnie Byanyima, the executive director of UNAIDS, said at the launch of the 2023-UNAIDS Global AIDS Update report in Geneva, on Thursday.  

However, she asserted that ending AIDS by 2030 is an achievable goal. 

“The data and evidence in the report we are releasing today shows that there is a path that ends AIDS by 2030,” Byanyima added. “The path that ends AIDS is the same path that will help societies to be prepared for future pandemics and that will also help countries to achieve the sustainable development goals.” 

Adolescent girls and women bear higher burden of infections

In 2022 alone, women and girls accounted for 63% of all new HIV infections in sub-Saharan Africa. Less than half of the districts with very high HIV incidence in the region currently have HIV prevention programmes dedicated exclusively to adolescent girls and young women. 

saharan
On the left, change in number of new HIV infections in 2022 when compared with the numbers in 2010. On the right, number of new HIV infections, 2022, among adolescents and young people (aged 15–24 years), by sex, selected countries, eastern and southern Africa.

Targeted prevention programmes for women and young girls, among other interventions, will cause a ripple effect in the population by directly reducing the number of new HIV infections among children, the report contends. 

Between 1996 and 2022, HIV treatments have averted almost 21 million AIDS-related deaths around the world. The number of AIDS-related deaths has also dropped by 69% since 2004 when it peaked, the report added. However, the disease killed one person per minute in 2022. 

Concerted efforts targeted at women and young girls have halved the number of new infections since 2010, but young girls and women remain among those most vulnerable to contracting HIV. 

“Fewer new HIV infections in women [globally]  and higher coverage of treatment among people living with HIV have led to a 58% drop in the annual number of new infections in children globally between 2010 and 2022, to 130 000, the lowest since the 1980s,” the report states.

Political action crucial to boost progress

A common thread among the various success stories of countries that have recorded reduction in HIV/AIDS transmission and death rates is the presence of strong political commitment to draft policies that place the people and communities at its core. 

“HIV programmes succeed when public health priorities prevail, as experiences in multiple countries attest,” the report added. 

Countries like Botswana, Cameroon, Nepal, Zimbabwe, and Cambodia have all achieved tremendous reductions in the number of new HIV cases, and AIDS-related deaths due to scaling up evidence-based policies and implementing focused prevention programmes, the report said. 

In 2020, UNAIDS announced an ambitious set of goals for countries to work towards by 2025. The so-called the ’95-95-95′ plan aims for 95% of all people living with HIV to know their HIV status; 95% of those who have HIV infection to receive sustained antiretroviral therapies; and 95% of those who receive antiretroviral therapies to have their viral loads suppressed, which will help people live longer, prevents further progression of the infection and sexual transmission of the virus. 

According to the 2023 UNAIDS report, Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe, have already achieved the targets set by the 95-95-95 program. At least 16 other countries, including eight in sub-Saharan Africa, and Thailand, are close to achieving their targets set by the program. 

The gains in combating HIV-AIDS, however, have been limited outside of sub-Saharan Africa. 

Around 23% of the new HIV infections were in Asia and the Pacific region, and the number of new infections in eastern Europe and central Asia has increased by 49% since 2010. The number of new HIV infections in the Middle East and North Africa region has increased by 61% since 2010, the report revealed. 

“These trends are due primarily to a lack of prevention services for people from marginalized and key populations and to the barriers posed by punitive laws, violence and social stigma and discrimination.”

Byanyima condemns Uganda’s criminalization of same-sex relationships

While acknowledging the positive steps some countries have taken to prioritize community-specific HIV preventive measures, Byanyima spared no words in condemning Uganda’s recent action to criminalize same-sex relationships. 

“In 2022 and 2023, Antigua and Barbuda, Cook Islands, Barbados, St. Kitts & Nevis, and Singapore decriminalized same sex sexual relations. Unfortunately Uganda, my country, took the opposite direction and that’s not positive,” she said.  

Consensual same-sex intercourse is a criminal act in 67 countries across the world. Over 160 countries criminalise some aspects of sex work and 20 countries criminalise transgender persons. All of these actions have direct impacts on the status of the HIV epidemic in a region. 

“In 2022, compared with adults in the general population (aged 15-49 years), HIV prevalence was 11 times higher among gay men and other men who have sex with men, four times higher among sex workers, seven times higher among people who inject drugs, and 14 times higher among transgender people,” the report pointed out. 

Barriers hold back more rapid progress 

Lack of access to, and continuity of treatment is one of the key barriers holding back more progress, the report finds, in addition to delay in diagnosing the infection in regions like Latin America, European Union, and European Economic Area. 

In 2022, around 9.2 million people living with HIV were still not receiving treatment and around 2.1 million who were receiving treatment were not virally suppressed. 

Only around 50% of those living with HIV in eastern Europe, central Asia, the Middle East, and North Africa, were receiving treatments in 2022, according to the report. 

When it comes to children and adolescents living with HIV globally in 2022, only 57% receive treatment. While the number of AIDS-related deaths among children reduced by 64% between 2010 and 2022, HIV still claimed the lives of 84000 children in 2022. 

“Early infant diagnosis coverage has risen in eastern and southern Africa (to 83%) but remains very low in western and central Africa (23%),” it said.  

Another barrier preventing poor countries from implementing HIV prevention and treatment programmes is the lack of funds. From the substantial increase in HIV funding recorded in early 2010s, funds have now declined to 2013 levels, the report finds.  

In 2022, US$20.8 billion was available for HIV programmes in low and middle income countries. This is 2.6% less than the amount that was available in 2021. By 2025, the world requires US$29.3 billion to combat HIV. 

“So there is a gap of eight and a half billion [USD]. What this shows is that we are in a world where we are not yet on the path that ends AIDS, but we also show that we can choose to get on that path. It’s a choice,” Byanyima remarked. 

Saharan
Resource availability for HIV in low- and middle-income countries by source, 2010–2022 and 2025 target.

Decline in HIV incidence is directly related to an increase in HIV funding. 

“Some countries where HIV incidence is declining, including the Dominican Republic, India, Kyrgyzstan and Togo, are putting between 3% and 16% of HIV spending towards prevention programmes for people from key populations,” the report said. 

In 2022, around 90 countries together signed a voluntary licensing agreement to purchase generic versions of a pre-exposure prophylaxis (PrEP) drug for HIV. Several upper middle-income countries with significant HIV burden were not included in this purchase deal, thus placing those populations in a more vulnerable position. 

“It could take years before generic manufacturing of the medicine is in full swing… Removing these hurdles would give HIV prevention a major boost,” the report stated.

Image Credits: UNAIDS, UNAIDS.

Europe could face an average of 120,000 premature deaths attributable to heat each summer by 2050 if more effective adaptation plans are not implemented, according to a team of researchers from the Barcelona Institute for Global Health (ISGlobal). 

Meanwhile, as record heat was experienced across the world, lawmakers in the European Parliament voted on Wednesday to restore at least 20% of degraded land and sea ecosystems by 2030, despite opposition by several conservative Members of the European Parliament.

Some 68,000 premature heat-related deaths are anticipated by 2030 and 94,000 by 2040, according to the ISGlobal research published in Nature Medicine on Monday. Last summer (2022) was the hottest on record in Europe, and 61,000 people died due to the high temperatures, they said.

“We call on national governments and European agencies to create more ambitious and effective adaptation plans to avoid all these deaths in Europe,” IsGlobal senior researcher Marcos Quijal, who contributed to the study, told Health Policy Watch in an interview.

The study was released on the heels of an announcement last week by the World Meteorological Organization (WMO) that the first week of July was the hottest week on record for the planet as a whole, highlighting “the far-reaching changes taking place in Earth’s system as a result of human-induced climate change”. 

Europe is experiencing up to 1°C more warming than other continents, Quijal said. The team’s paper raises a red flag about the threat exposure to heat poses, especially to high-risk populations in Europe and globally. 

Italy has the most deaths overall, per capita

The summer of 2022 was the hottest season on record in Europe and included a series of acute heat waves and droughts. Eurostat, the European statistical office, reported unusually high mortality during that summer. 

However this latest report, conducted in collaboration with the French National Institute of Health, provides the first robust estimates of the premature mortality directly attributable to excessive heat, as such. 

The researchers examined mortality data between  2015 and 2022 for 823 regions in 35 European countries, representing 543 million people. Then, using epidemiological models, they predicted temperature-attributable mortality for each region and week of the summer. Specifically, they looked at deaths between 30 May and 4 September 2022, finding 61,672 heat-related deaths with a 95% confidence interval. 

The country with the highest number of heat-attributable deaths over the entire summer of 2022 was Italy (18,010), followed by Spain (11,324) and Germany (8,173). However, when looking at deaths per capita, the top three countries to experience heat-attributable deaths were Italy (295 deaths per million), Greece (280) and Spain (237).

The European average was around 114 deaths per million.

When looking at how hot each country was, France was the warmest country, experiencing temperatures that were 2.43°C above the average values for the period 1991-2020, followed by Switzerland (+2.30°C) and Italy (+2.28°C).

The worst temperatures fell between 11 July and 14 August, causing 63% (38,881) of total heat-related deaths. 

Women and elderly are most at risk

“Climate change projections for the continent indicate that temperatures, and their health impacts, will rise at an accelerated rate unless strong mitigation and adaptation actions are put in place,” the researchers wrote, highlighting that the most vulnerable people are at the most significant risk of premature heat-associated mortality. 

Quijal told Health Policy Watch that more data would still be needed to understand better what makes individuals vulnerable and then target the continent’s plan and policies to assist those people. 

Using epidemiological models to estimate the sex- and age-specific mortality burden associated with the heat, the researchers found that older adults with pre-existing cardiovascular and respiratory diseases, women and socially isolated or socio-economically disadvantaged individuals are at highest risk. 

There were 63% more heat-related deaths in women than men, with women over the age of 80 being the most vulnerable. Moreover, the older people got, the more susceptible they were to heat-related deaths, with 4,822 people under the age of 64 dying in 2022, compared to 9,226 between the ages of 65 and 79 and 36,848 over the age of 80. 

“Our results call for a reevaluation and strengthening of heat surveillance platforms, prevention plans and long-term adaptation strategies,” the researchers concluded.

European lawmakers vote for biodiversity – urban green spaces reduce air pollution and excess heat

On Wednesday, lawmakers in the European Parliament voted 336 to 300 in favor of a bill that will restore at least 20% of degraded land and sea ecosystems by 2030, despite opposition by several conservative MEPs.

Thirteen MEPs abstained in the vote for the Nature Restoration Law, initially proposed by the European Commission in June 2022. 

More than 80% of habitats in Europe are in poor condition, according to the Commission.

This is the first “continent-wide, comprehensive law of its kind,” the European Commission explains on its website. “It is a key element of the EU Biodiversity Strategy, which calls for binding targets to restore degraded ecosystems, in particular those with the most potential to capture and store carbon and to prevent and reduce the impact of natural disasters.”

The Commission said restoring ecosystems would thus help limit global warming.  In cities, green spaces also help mitigate the urban “heat island” impacts of warming, whereby temperatures in cities can be 5-8 °C above surrounding rural areas, due to their large expanses of heat-absorbing concrete. The same green spaces filter and thus reduce air pollution, which can compound the health effects of excess heat. Conservative MEPs, however, who opposed the bill said that it could threaten food security, block new renewable energy projects and put farmers at risk.

In a letter signed by 6,000 researchers and now published as a preprint article, scientists debunked several of the myths presented by the conservative MEPs. For example, they write that “protecting  and  restoring  nature,  and  reducing  the  use  of  agrochemicals  and pollutants, are essential for maintaining long-term production and enhancing food security.” 

Specifically, the bill was supported by MEPs from Europe’s Socialists & Democrats, Left, Greens and Renew Europe parties. MEPs in the European People’s Party, the European Conservatives, Reformists and the Identity and Democracy parties were opposed. 

The European Commission, the European Parliament and the Council of the EU will now start inter-institutional negotiations with EU countries to develop a final set of rules and regulations that must be implemented.

After the vote, rapporteur César Luena (SD, ES), said: “The Nature Restoration Law is an essential piece of the European Green Deal and follows the scientific consensus and recommendations to restore Europe’s ecosystems. Farmers and fishers will benefit from it and it ensures a habitable earth for future generations. “

Image Credits: Pawel Janiak/ Unsplash.

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

Dr Bente Mikkelsen, is the World Health Organization’s Director of Noncommunicable Diseases 

 

 

 

Image Credits: KSchermbrucker/PiH, World Economic Forum.

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.

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.

Rehabilitation
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.

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.