The cases of several other women facing similar charges are working their way through UK courts. Another woman is set to stand trial later this year.

There have been calls for abortion law reforms in the UK after a woman was sentenced to 28 months in prison on Monday for carrying out an abortion after the legal term limit.

The 44-year-old mother of three was sentenced under a law passed in 1861 that carries a maximum penalty of life imprisonment, sparking calls for immediate legal reform across the political spectrum.

Abortion was legalised in the United Kingdom in 1967, and is legal up to 24 weeks, while any procedure after the 10-week mark must be carried out in a clinic or hospital.

However, in this case, Carla Foster procured abortion pills by misrepresenting the term of her pregnancy during a COVID-19 lockdown when access to abortion pills was relaxed.

She claimed that she was seven weeks’ pregnant whereas doctors concluded Foster’s foetus was between 32-34 weeks old at the time of her abortion. This means it had a strong chance of survival if it had been born in a medical facility.

However, the British Pregnancy Advisory Service (BPAS), the abortion care provider Foster misled about the term of her pregnancy to acquire the abortion pills, said it was “shocked and appalled” that the case had led to criminal charges, adding: “No woman can ever go through this again.”

“We are now seeing a mother of three prosecuted under laws that do not exist in the same way in any other country,” BPAS chief executive Clare Murphy told the BBC.

A law passed nearly two centuries ago applies in cases where a woman intentionally causes an abortion after the 24-week limit. Foster was initially charged with “child destruction” under the 1929 Infant Life Preservation Act, which she denied. She later plead guilty to charges under the Offences Against the Person Act passed in 1861.

The 162-year-old law states that women in the United Kingdom who use “unlawfully administered” medications to induce an abortion can be kept “in penal servitude for life”.

With another woman set to stand trial later this year,  lawmakers say action must be taken before another criminal prosecution occurs.

“Society has moved on, healthcare has moved on, and I think parliament has a role now to look at reforming our abortion laws,” said Labour MP Dame Diana Johnson, who has previously tried to repeal the 1861 act with a backbench bill.

“Removing the criminal law is a very sensible, reasonable step, but it’s not to deregulate abortion care and who can provide it.”

Mifepristone, the medication Foster used to terminate her pregnancy, is also at the centre of court battles in the United States as states seek to outlaw abortion pills following the repeal of Roe v. Wade.

Caroline Nokes, a conservative MP who chairs the Common Women and Equalities Committee told the BBC that parliament should “decide in the 21st century whether we should be relying on legislation that is centuries old”.

“This is not something that has been debated in any great detail for many years now,” Nokes said. “And cases like this, although tragic and thankfully very rare, throw into sharp relief that we are relying on legislation that is very out of date. It makes a case for the parliament to start looking at this issue in detail.”

A spokesperson for British Prime Minister Rushi Sunak said he was “not aware” of any plans to change the current approach to abortion.

“Our laws, as they stand, balance a woman’s right to access safe and legal abortions with the rights of an unborn child,” he said.

Asked to respond to the government’s statement on Sky News, veteran Labour MP Stella Creasy said it is “a bit worrying” that “the government does not even know that abortion is not legal in this country”.

“What many of us are worried about is that this could be the start of many more prosecutions and an attempt to chill a woman’s right to choose in the country,” Creasy said, noting that the cases of several other women facing similar charges to Foster are currently passing through UK courts. “Abortion is not a criminal matter, it’s a healthcare matter.”

Abortion is hotly contested in many parts of the world. While access to abortion has been eased in Colombia and Mexico in recent years, many US states have either banned abortions entirely or reduced the time in which women are able to get abortions. Florida, for example, recently made it illegal for a woman to get an abortion after six weeks of pregnancy when many women are not yet aware that they are pregnant.

Image Credits: Wei-te Wong.

Futures Without Violence’s Leila Milani (left) and Ruxana Jina, Director of the Data Impact Programme at Vital Strategies.

It took years – and much data-crunching – before the US government was persuaded that measuring women’s security is an important way to assess the security of where she lives – her city, state and country.

Most governments lack the data to make this calculation. Gender-based violence (GBV) is notoriously under-reported, and officials often have little idea about the extent or nature of GBV in their countries. 

Yet one-in-three women will experience physical or sexual in their lives, according to the World Health Organization (WHO).

While GBV can involve physical, sexual and psychological abuse by intimate partners and non-partners, as well as the sexual abuse of girls and trafficking of women for sex, its most common form is the abuse of women by intimate male partners, according to Fatima Marinho, Principal Technical Advisor at Vital Strategies.

A global health organisation that helps governments to strengthen their public health systems, Vital Strategies asserts that investment in data is “a missing component of interventions to end gender-based violence”.

“Most of the women who experience gender-based violence don’t experience [swift justice],” says Ruxana Jina, Director of the Data Impact Programme at Vital Strategies.

“It’s often intimate partners. It’s often at home. It’s often underreported, and it’s only through the data that we get the true story. Data unmasks the truth. It tells us the true story around the true burden.” 

Jina has worked to unmask GBV and femicide in a range of countries including India and South Africa, and some of the findings have been jarring.

Mumbai’s high burden of homicide and suicide

An autopsy-based analysis of the bodies of 1,467 Mumbai women, girls and non-binary people found that 12,3% of the dead – 181 women – had an “underlying history or indication of GBV”. This was deduced from the autopsy reports themselves, victims’ statements (if they were still alive when they reached the hospital), police reports and relatives.

Two-thirds of victims were married and the perpetrators were either husbands or intimate partners (61%) or family members (39%).

An extraordinarily high percentage of those 181 people with a history of violence died from suicide (86), with 10 dying from homicide and the remainder dying from accidents.

However, the study highlighted critical data gaps, such as the absence of a standardized data collection tool with respect to GBV in autopsies, which means that socio-demographic factors for the victim were missing. 

Another Mumbai-based data project involved monitoring and evaluating 12 hospital-based Dilaasa Centres, one-stop crisis centres that the city’s public health department has set up to provide medical services for GBV survivors and link them to the police and social services.

“The data wasn’t standardised,” Jina told a VitalTalks panel in New York last week.

The centres also didn’t measure outcomes, such as whether the women accessing services were having better health outcomes or better social protection, and whether more cases were being prosecuted. 

But working with government officials and people working in the centres, a Vital Strategies team was able to help to develop a monitoring and evaluation framework with standardised indicators.

“That’s been very important because it not only helps the government officials in Mumbai to ensure that the services that they offering are of high quality, it’s actually addressing the needs of the woman,” said Jina.

“These types of data on one-stop centres can help provide information on the effectiveness of the service delivery model that can help inform global recommendations and guide other countries decide on the organization of their services.”

Identifying vulnerable women in Brazil

Márcia Lima, National Secretary of Policies for Affirmative Action and Overcoming Racism in the Ministry of Racial Equality in Brazil.

Márcia Lima is the National Secretary of Policies for Affirmative Action and Overcoming Racism in the Ministry of Racial Equality in Brazil.

“It’s impossible to think about public policies without evidence,” said Lima. “Public policy based on evidence is the most effective way to improve social problems.”

However, Lima said that it was very hard to collect accurate GBV data because of “a culture of silence across all groups”.

In 2022, Vital Strategies developed an analytical method to estimate the burden of GBV in Brazil, finding that almost one-in-five women over 18 had experienced violence, while the same ratio of school girls had been abused.

The data also enabled researchers to develop a profile of who was most vulnerable to GBV. Race (black and brown women), age (between 14 and 39) and partners’ use of alcohol were key risk factors, said Marinho.

A sub-national data collection project shed more light on racial disparities, finding that black women are more likely than white women to be subjected to sexual and physical violence and that homicide rates for black and brown women have worsened but improved for white women.

“We can’t face GBV without addressing racism,” Lima told VitalTalks.

Data collection in a Brazilian city, Goiania, found that women who had been assisted for GBV were three times more likely to die by suicide. 

“We also analysed the public health data to identify missed opportunities for health services in addressing violence and predictors of femicide and all in all types of domestic violence,” said Marinho.

Fatima Marinho, Principal Technical Advisor at Vital Strategies

Grabbing the attention of policy-makers

Leila Milani, a Program Director with Futures Without Violence, said that it was important to “grab the attention of those who can make a difference – those who can put the funds into place to support more data to support more programming”.

She credits Dr Valerie Hudson, Professor of International Affairs at Texas A&M University, for ensuring that the US government took the security status of women more seriously.

“She looked at all the data points – 20 years’ worth of data points – that made the case for the link between the security of women and security of states, and for the first time, it got the attention of those who needed to pay attention,” said Milani. 

“She made the point that, where you see inequality and violence against women, that’s a  number one indicator of insecurity.”

On 25 May, the US released the country’s first-ever national plan to end gender-based violence, that Futures Without Violence helped to inform, said Milani.

The plan recognises GBV as “a public safety and public health crisis, affecting urban, suburban, rural, and Tribal communities in the United States” and that it is “experienced by individuals of all backgrounds and can occur across the life course”.

“We’ve had the Violence Against Women Act, which has funded a lot of the shelters and programming and training, but we’ve never had an actual plan. Many countries have already implemented plans, but the US had not stepped up to that obligation,” she added.

“One of its pillars is a commitment to increase the collection of data and research.”

WHO global estimates on gender-based violence, 2022.

Data for the future

“I often think about the data in terms of the root causes,” says Jina. “ Who are the people who are affected? Are there specific risk factors that we could be addressing? How do we then identify the best interventions? It’s one thing saying we have a problem, how are we acting on that problem? Then we need to evaluate that intervention to see if it is actually  making a difference.”

Lima called for “more the participation of civil society to the pressure government to create more and more information. Data is knowledge. Knowledge is power.”

Sharon Kim-Gibbons, Vital’s Vice-president of Public Health Programs, concluded the VitalTalk by asserting that data can play a key role in ending GBV – “but it’s a highly conditional”.

“Is the data complete? Is it accurate? Is it consistent? I think we’d also say that you have to ask the right women the right questions because the risk is not equal,” said Kim-Gibbons.

“We need national country-level surveys but also small qualitative focus groups. Public health is so complex. We all try to be as predictive and analytic as possible, but [understanding] is often so nuanced between cultural and social factors.”

INB co-chairs Roland Driece and Precious Matsoso

The African region of the World Health Organization (WHO) has condemned the weakening of equity clauses in latest draft of the pandemic accord and called for this week’s negotiations to focus on principles and key areas of concern rather than the detailed text.

The 47 WHO Africa group countries made their submission at the resumption of the Intergovernmental Negotiation Body (INB) meeting in Geneva on Monday. 

“The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table,” said Ethiopia on behalf of Africa.

“However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realisation of equity.”

Ethiopia representing the African region.

It described the draft (being referred to as WHO CA+) as “going backwards” on equity from the zero-draft. A key criticism of the current draft is that it does not propose any legal obligations to ensure that all countries have equitable access to pandemic-related products such as vaccines, tests and therapeutics.

Africa wants legally binding commitments on the transfer of technologies, know-how and intellectual property rights; capacity-building for local manufacturing to address pandemics; technical and financial support, and the establishment of a “comprehensive access and benefit sharing (ABS) mechanism” for pandemic pathogens.

In its statement in support of Africa’s call for stronger equity clauses, South Africa added “rebuilding or strengthening health systems” and “the use of IP rights and TRIPS waivers” to strengthen countries’ pandemic prevention, preparedness and response.

A new alliance of countries calling itself the Group on Equity stressed the need for “concrete provisions that effectively operationalise equity”.

Presented by the Philippines, the group cuts across WHO regions and includes China, India, Brazil, South Africa, Bangladesh, Colombia, Indonesia, Malaysia, Mexico, Pakistan and Thailand.

A group of Latin American countries represented by Colombia also supported Africa and the Equity Group’s call for strengthened equity clauses, declaring the need for “a practical and relevant instrument not simply a document filled with good intentions”.

Meanwhile, Brazil said that it is “essential that any measure related to sharing of pathogens be accompanied by the benefits that arise from their use in a unified system”, and warned that the inclusion of “so many measures” related to One Health might dilute the focus.

“It is urgent to have a fully agreed upon definition of pandemic and the method for declaring it, with clearly stated criteria, in order to be able to better grasp the scope of the instrument,” added Brazil.

Rising INB tension 

The INB Bureau has recommended that the current negotiations, in closed sessions until 16 June, should focus on “substantive issues” at this stage as the parties are still too far apart for text-based negotiations.

This approach had wide support, including from the European Union, which stressed that an “increased level of mutual understanding will be the best way to enable us to assess where we may concur and where we can move closer to each other”.

The EU called for a focus on “Chapter Two provisions and, of course, on equity issues”. Chapter Two is the guts of the draft and is home to virtually all the contentious clauses related to equity, covering all the key issues flagged by the Africa group.

Opening Monday’s INB meeting, co-chair Roland Driece said that tension was growing in the body, which he described as a “sign of maturity” as issues of conflicts became more evident.

With only 10 months left to fulfil its mandate, “time is pressing, and the text on the table is getting more concrete all the time,” said Driece, adding that six INB meetings remained in this time.

“We can feel that the tension is rising. I can feel it, where in the beginning everybody was kind and positive and you feel that people are now asking questions….  I take that as a sign of maturity, maturity in our process, and maturity of what we are doing. And it is only normal that we enter a stage where we are more critical of what we write down, more critical of what we might agree upon.”

Echoing Driece, co-chair Precious Matsoso added: “We have the best of our times laughing but it seems we’re getting now into the most difficult part where our strength will be tested.” 

Matsoso also explained to member states the gruelling process that the Bureau had gone through to formulate the latest draft, distilling all member state suggestions – amounting to 208 pages – into the 43-page draft.

After the open session of the INB, member states have moved into “drafting group” closed sessions until 16 June. 

The closed sessions continue to distress civil society organisations, which believe negotiations should be open.

Expressing concerns about participation and transparency, Health Action International said that the “secret meetings” sent the “wrong message”.

“We have serious reservations on how some topics are being addressed or, rather, discarded in these discussions; most notably the issue of health-oriented IP management as a substantive part of improving access to health technologies and contribute to a robust human rights-based approach that will harness international efforts for the attainment of universal equitable access,” added HAI’s Jaume Vidal during the session in which non-state actors were able to make their contributions.

somalia
Worried families gather outside the beachfront hotel in the Somali capital Mogadishu awaiting the return of their relatives.

A staff member of the World Health Organization (WHO) in Somalia was among the 16 civilians killed in a terrorist attack on a hotel in the capital Mogadishu on Friday night, the WHO confirmed.

The attack by al-Qaeda affiliate al-Shabaab targeted the Pearl Beach Hotel and Restaurant, an upscale location on Lido beach often frequented by high-ranking government officials and foreign diplomats.

The militants’ siege lasted over 10 hours before local security forces regained control of the hotel, killing seven attackers. Ten civilians were injured while 84 were successfully evacuated during the attack, according to a statement by Mogadishu police.

The WHO staffer killed in the attack was identified as Nasra Hassan, a 27-year-old female Somali national. Hassan joined the WHO country office in Somalia to support the agency’s drought emergency response operations in the southern region of Jubaland.

“We condemn in the strongest terms this heinous attack on a hotel that claimed so many lives, including the precious life of one of our dearest colleagues, Nasra,” Dr Malik Mamunur, WHO representative in Somalia said. “We condemn all attacks on innocent civilians and humanitarian workers and express our deepest condolences to the family members of all those who were killed in this attack.”

Around 1.1 million Somalis have been displaced by droughts since January 2021. Last year, as many as 43,000 people died as a result of the record droughts sweeping the country. Half of them were under the age of five, according to a report by the Somali government and the United Nations agencies.

The hotel attack occurred just a week after the bodies of 54 Ugandan peacekeepers were found dead at a military base 130km from the capital. The increase in al-Shabaab attacks across the country in 2022 resulted in the deadliest year for Somali civilians since 2017, UN Secretary-General Antonio Guterres told the security council in February.

Despite the unrest, WHO said it remains committed to working with the Somali government and local partners to address ongoing health needs and emergencies across Somalia.

“WHO is committed to continuing efforts to preserve health and respond to emergencies in Somalia,” the organization said in a statement, adding that the safety of WHO staff is a “paramount factor in ensuring ongoing life-saving response operations”.

Al-Shabaab held permanent positions in Mogadishu until 2011 and continues to control vast areas of rural territory across the country. While its militants have been pushed out of Somalia’s major cities and towns, they continue to mount irregular attacks on civilian and military targets.

WHO has delivered around $5 million of medical supplies in the past year. This aid is focused on essential health and nutrition care for Somalis affected by the extreme drought and food insecurity sweeping the wider Horn of Africa.

The extreme droughts in the Horn of Africa are considered a “grade 3” emergency by WHO, the organization’s highest alert level. Other “grade 3” crises include the humanitarian situation in Afghanistan and the ongoing conflicts in Ukraine, Yemen, Ethiopia and Syria.

About 3.5 million children under five were vaccinated against polio, measles, and cholera or protected against malnutrition under WHO programmes in 2021. The UN health agency has also worked with federal and state ministries of health across Somalia to establish a medical supply chain that can reach the most vulnerable people in the country.

“Being a health professional and working in a resource-starved and geographically challenged health system in a conflict zone, WHO supplies are proving to be a lifeline for millions,” Dr Yusuf Omar Mohamed, head of pharmaceuticals and supply chains at the Somali Ministry of Health said of WHO’s operations in the country. “Everyone wondered how a medical supply chain could work in Somalia, but I believe WHO has shown it to the world that if there is a resolve to serve humanity, obstacles can be turned into opportunities.”

Image Credits: Said Yusuf Warsame, AMISOM.

emerging outbreaks
From far left: Dr Nathalie Strub-Wourgaft, moderator, Dr Dimié Ogoina, Dr Jean-Jacques Muyembe, Dr Marie Jaspard, Dr Mimi Darko.

More R&D into already known emerging disease threats, from Mpox to Lassa fever would go a long way to both bolster developing countries’ preparedness as well as protecting the world, experts argue.

Member state negotiations resume next week over a draft WHO convention on pandemic prevention, preparedness and response – which is supposed to be ready by the May 2024 World Health Assembly. 

While parties prepare to debate the latest draft text published, distilled from a 208 page “compilation draft” of 34 different country and regional proposals, the lessons learned from recent or ongoing outbreaks can  provide concrete insights on how to make the world better prepared.

A group of high level experts from Africa, Europe, the Middle East and Latin America provided their insights at a recent seminar on “How Can Global Action Really Meet Local Needs in Emerging Outbreaks, hosted by the Graduate Institute’s Global Health Centre on the margins of the recent World Health Assembly.  

The event was co-sponsored by the International Geneva Global Health Platform, and PANTHER Health, an NGO dedicated to supporting rapid responses to emerging infectious diseases in Africa.

Insights from Mpox, Lassa fever are indications of preparedness 

Bernhards Ogutu, Chief Research Officer, of the Kenya Medical Research Institute (KEMRI).

Speaking at the event, Bernhards Ogutu, Chief Research Officer of the Kenya Medical Research Institute (KEMRI), said insights from current Mpox, Lassa fever and other “endemic pandemics in the south” are among the best indications of countries’ current level of preparedness for future outbreaks.

“Even when we think there are no pandemics there’s lots of them that we need to address and possibly need to see how well to do this as we get prepared for the next pandemic,” Ogutu said.

The INB text echoes the importance of research and development. Article 9 of the current draft states that: 

“The Parties shall cooperate to build, strengthen and sustain capacities and institutions for research and development for pandemic-related products, particularly in developing countries, including for related clinical trials and information-sharing through open science approaches for rapid sharing of scientific findings and research results.”

More research in endemic countries is needed

But those high notes of ambition are far from today’s reality said Jean-Jacques Muyembe-Tamfun, director of the Democratic Republic of Congo’s Institut National de la Recherche Biomédicale. He noted, for instance, that more research in endemic countries on the connection between smallpox and Mpox could have contributed to the more rapid roll out of countermeasures when the Mpox global health emergency hit countries worldwide last year. 

With knowledge about how the smallpox vaccine provides some protection against Mpox, more adequate research a decade ago into Mpox vaccines and treatments could have informed better policy guidance on priority countermeasures and target groups for their use, during the recent emergency. This might have yielded recommendations for continued smallpox vaccination in countries where Mpox is endemic, he suggested.

Instead, when the emergency hit, it was unclear how wide a net needed to be cast with the vaccines, which turned out to be in short supply, and were rarely put to use.  As for medicines, just one small study in the Central African Republic of the new treatment, Tecovirimat (TPOXX™), was only just beginning when the virus emerged.

Aligning with the INB’s draft text on supporting research in developing countries, Muyembe argued that his country remains critical for clinical trials on Mpox, the findings of which could help in developing tools that would protect the rest of the world against the new variants of an old disease. 

“DRC is the most affected country. We will not lack cases of Mpox to continue our studies and clinical trials in the field,” he said.

‘No regrets’ funding

A look inside the drafting process of the INB.

Funding has always been a subject of debate in global health and the INB’s June negotiations are no exception. In the working document, financing was captured in Article 19 and it describes sustainable financial resources as playing an important role in achieving the objective of the instrument. It pegged financing as the primary financial responsibility of national governments in protecting and promoting the health of their populations. 

The parties, however, are yet to agree on whether to include a proposed Paragraph 6 in Article 19 on Financing, stating that funding models “would take into account national financial capacity and capabilities.” Two options are being considered, one which would elaborate the principle in detail – and one which would not reference it at all:

Option 19.A6. The Parties agree that the funding models for pandemic prevention, preparedness and response need to take into account national financial capacity and capabilities, and to this extent shall: (a) establish programmes that convert debt repayment into pandemic prevention, preparedness, response and recovery investments in health, to be attained under individually negotiated “debt swap” agreements; and (b) commit to expanding partnerships with development finance institutions for providing additional funding to developing countries, through prioritized debt relief, debt restructuring and the provision of grants rather than loans that will guarantee that programmes protect essential health and related spending from encroachment, as well as to take advantage of the economic benefits of frontloading finance for prevention and preparedness or support investments. 

Option 19.B: not to include a paragraph.

At the Graduate School event, Veronika von Messling, Director-General for Life Sciences at the German Federal Ministry of Education and Research also stressed the importance of a ‘no regrets’ funding approach that permits flexible use of both national resources and donor-based funding that allows recipients to dynamically adapt plans in times of crisis. She described this as essential to long-term capacity strengthening in low and middle income countries.

“These are central elements for a global pandemic preparedness and response,” she said. “Continuous investment in national and international initiatives even before a pandemic. underline the importance of acting not only in times of crisis, but also in between.”

The formidable INB task ahead 

Members of the drafting group preparing for the upcoming INB meeting.

The Intergovernmental Negotiating Body (INB) will resume in its fifth meeting on the draft accord next week. 

The INB is the name of the group that is drafting and negotiating the WHO “convention, agreement or other international instrument on pandemic prevention, preparedness and response,” with a view to its adoption under Article 19 of the WHO Constitution, which allows the World Health Assembly to adopt “legally binding conventions or agreements” by a two-thirds vote. It is open to all Member States and Associate Members (and regional economic integration organizations)

From 12 June, the board, starting with Member States and followed by relevant stakeholders, will provide general comments on the Bureau’s most recent draft text, published on 2 June. At the 76th World Health Assembly, the INB said it has made progress in developing a framework for the accord, although negotiations are expected to continue steadily until May 2024. 

One Health – a key principle of the accord – or not?    

Excerpt from the briefing of the INB bureau drafting notes shared with member states earlier this month.

In a briefing last week, the “Bureau” of six member states guiding the negotiations, provided a mapping of the draft text and its proposed amendments by member states, reflecting the many choices still to be made.  

Those range from semantic choices between “but” or “and”, to the critical question of whether “One Health” will be included as a fundamental principle of the accord. Other challenges include how prescriptive to be regarding tasks that parties would fulfil, particularly with regard to prevention and surveillance. For instance, word choices like “are encouraged to” suggest voluntary action while “shall” conveys a mandatory meaning. 

While there appears to be agreement on referencing the importance of strengthening R&D and information sharing about research agendas and plans in the text, changes are being proposed to the section on preparedness monitoring and functional reviews (Article 8). Some member states oppose the establishment of a peer review mechanism for monitoring preparedness in which countries would review the plans and performances of other member states.

While there appears to be agreement on references in the text to the healthcare workforce, changes are being proposed to the section on preparedness monitoring, with some member states opposing the establishment of a peer review mechanism for monitoring preparedness, whereby countries themselves would review the preparedness plans and performance of other member states. 

The review instrument, fashioned on a similar mechanism used by the Human Rights Council, is called the “Universal Health and Preparedness Review’. It has already been piloted on a voluntary basis by some member states.

For the preparedness review and about 16 other controversial provisions touch on sensitive topics from the inclusion of “One Health” as a key accord principle (Article 8) to the sharing of genetic sequence data in exchange for rights to the benefits from drugs and vaccines developed (Article 12), the bureau draft contains 2-3 options for each key paragraph to allow member states to choose a direction.

For the more controversial provisions of the accord, which touch on sensitive topics ranging from the sharing of genetic sequence data to notification requirements during emergencies, the “Bureau” draft contains 2-3 options for each of about 16 key paragraphs – so that member states can concretely choose a direction.

Two options are presented for principle 8. Option 8.A: One Health – Multisectoral and transdisciplinary actions should recognize the interconnection between people, animals, plants and their shared environment, for which a coherent, integrated and unifying approach should be strengthened and applied with the aim of sustainably balancing and optimizing the health of people, animals and ecosystems, including through, but not limited to, by giving attention to the prevention of epidemics due to pathogens that are resistant to antimicrobial agents and zoonotic diseases. 

Option 8.B: not to include as a principle.

The journey ahead

Following the June meeting, the INB will host its sixth meeting in July 2023. Further meetings or drafting group sessions could be held in September, November, and December. The board is expected to submit its outcome for consideration by the 77th World Health Assembly in May 2024.

The six members of the INB Bureau include Ms Precious Matsoso (South Africa), former Director General of the National Health Department of South Africa and INB Bureau co-chair, representing Africa and Mr Roland Driece (Netherlands) Director of International Affairs at the Ministry of Health, Welfare and Sport, and INB Bureau co-chair, representing Europe. 

Other members are Ambassador Tovar da Silva Nunes (Brazil) Permanent Representative of Brazil to the UN in Geneva, representing the Americas; Dr Viroj Tangcharoensathien (Thailand) Advisor to the Ministry of Public Health, representing South-East Asia; Mr Ahmed Salama Soliman (Egypt) representing the Eastern Mediterranean region; and Mr Kazuho Taguchi (Japan) representing the Western Pacific region.

The full panel on how global action can meet local needs in emerging outbreaks can be viewed here.

  • Additional reporting by Elaine Fletcher.
CARE staff assist after the collapse of the wall of the Kakhovka Dam in Ukraine

Hours after the Kakhovka dam in Ukraine was destroyed, causing widespread floods, the World Health Organization (WHO) said that cholera and other waterborne diseases posed a risk, while the humanitarian agency CARE warned of landmine explosions.

The Kakhovka dam is located on river Dnipro in the city of Nova Kakhovka, in the Kherson region of Ukraine. Russian troops occupy the left bank of the river, while the right bank is under Ukrainian control. 

The wall of the dam collapsed early on Tuesday resulting in the flooding of tens of villages and parts of Kherson as well as the total destruction of the hydro-electric station providing electricity to the region. 

While the exact cause of the collapse is unknown, Russia and Ukraine have blamed each other for the destruction while some speculate that the dam could have been weakened in previous attacks. However, Norwegian seismic monitoring group Norsar registered seismic activity on the night of the collapse of the dam wall which indicates there was an explosion at the dam.

Since the dam collapse, thousands of people have been evacuated on both sides of the river and tens of thousands of hectares of agricultural land has been flooded. The authorities have not yet announced the official death toll following the dam collapse. 

“The impact of the region’s water supply, sanitation systems, and public health services cannot be underestimated,” Dr Tedros Adhanom Ghebreyesus, the WHO Director-General, said during a media briefing on Thursday.

“The exact information and the exact extent of the impact is yet to be seen because water continues to come downstream… figures at the moment show that initially 16,000 people were immediately at risk of flooding, on the river banks. Thousands have been evacuated,” Dr Teresa Zakaria, technical lead at WHO’s health emergencies program, told the briefing.

Ukraine
Dr Teresa Zakaria, WHO technical lead on health emergencies.

“The reservoir serves around 700,000 people downstream and there are over 30 settlements that are at a risk of flooding.” 

Zakaria added that while no cases of cholera have been reported in Ukraine since the war started in 2022, environmental samples show that the pathogens still exist in the region and  “that constitutes a risk”. 

Ukraine’s health ministry has also warned of water contamination caused by thousands of fish dying in the shallow water.

 

Landmines and oil

Meanwhile, Fabrice Martin, Country Director of humanitarian organisation CARE Ukraine, warned that “the area where the Kakhovka dam was, is full of landmines, which are now floating in the water and are posing a huge risk”. 

“We are very worried about the catastrophic consequences this explosion could have on the environment”, said Martin. “At least 150 tons of oil have been released into the Dnipro River with the risk of further leakage of more than 300 tons. This may lead to the Nyzhniodniprovskyi National Nature Park to disappear, which is more than 80 000 hectares of protected land.”

Ukraine’s president, Vladimir Zelensky, has accused Russian soldiers of firing on rescuers attempting to evacuate civilians affected by the flooding.

The dam also supplies cooling water to the Zaporizhzhia nuclear power plant around 160 kilometers away. The plant is currently under Russian control and the International Atomic Energy Agency (IAEA) has stated that there is no immediate danger to the plant and that it is monitoring the situation. 

The flooding has heightened the risk of water-borne diseases and food insecurity due to the destruction of agricultural lands. 

Ukraine’s agriculture ministry warned of a massive impact on farming, saying 94% of irrigation systems in the Kherson province, nearly 75% in Zaporizhzhia and about 30% in Dnipropetrovsk have been left without a water source. “Fields in the south of Ukraine next year can turn into deserts,” the ministry said, as reported in USA Today.

Support for Ukraine and Russia?

While emphasising that the WHO’s priority is to offer assistance and monitor health risks equally to all affected parties during a war, Dr Mike Ryan, WHO Executive Director of Health Emergencies, said that Ukrainians were in more need since Russia’s invasion. 

“Since the Russian invasion of Ukraine, we have focused on being able to support the people to whom we have the greatest access, and that has been people on the Ukrainian side of the conflict,” said Ryan.

“ We continue to engage with, coordinate with and receive information on a regular basis from the Russian authorities regarding the health situation of the people in occupied territories,” he added. 

The WHO does not have a permanent presence on the Russia-controlled bank of the river but that before the war, the agency had access to both sides of the river, Ryan added.

“We would be delighted to be able to access those areas and monitor health as we would in most situations. But again, it will be for the authorities of Ukraine and Russia to agree on how that could be achieved.”

“We have more presence at the moment and more visibility on needs [of the people] on the side of the river that is under Ukrainian control,” Zakaria added. 

“However, we are monitoring, especially through the leadership of our regional office in Europe, to make sure that all information coming from the other side of the river [controlled by Russia] is also monitored”. 

Marburg over in Equatorial Guinea

Forty two days since the last patient affected with Marburg Virus Disease (MVD) was discharged from treatment, Equatorial Guinea declared the outbreak as over, the WHO announced at the media briefing.

The announcement comes days after Tanzania announced that the MVD outbreak in the country was over. 

Equatorial Guinea reported its first three cases of MVD in February and subsequent cases in March. Seventeen people were confirmed to have contracted MVD, of which 12 died. In addition to this, 23 probable cases were reported and all of them died.  

United Nations Headquarters in New York.

Member states have been given nine days to comment on the ‘Zero draft of the Political Declaration on Pandemic Preparedness and Response, due to be adopted at the United Nations (UN) High-Level Meeting (HLM) on 20 September – with insiders describing the draft as “underwhelming”.

The HLM is essential for boosting waning political commitment to pandemic preparedness and response amid a myriad of urgent post-COVID recovery issues vying for politicians’ attention and financing.

The 14-page “zero-draft”, sent to member states on Monday with a comments deadline of 14 June, is deferential to the two ongoing negotiations on the pandemic accord and International Health Regulations (IHR)  amendments being conducted by the World Health Organization (WHO). These will only conclude in May 2024.

However, it also contains clauses that encapsulate the same red flags as in the two WHO pandemic negotiations – including how to ensure more accountability over public funds invested in the research and development (R&D) of vaccines, medicines and other tools; intellectual property constraints and technology transfer to low- and middle-income countries.

Alternative R&D funding mechanisms

While recognising the importance of the private sector in pandemics, the draft encourages the appropriate use of “alternative financing mechanisms” for R&D. This includes support for “voluntary initiatives and incentive mechanisms” that can separate R&D cost from “the price and volume of sales” and “facilitate equitable and affordable access to new tools” such as vaccines and therapeutics.

The draft encourages member states to investigate “innovative incentives and financing mechanisms” for public-health-driven R&D, such as stronger and transparent public-private partnerships and partnerships with academia.

However, the draft also asserts that “domestic public resources” are the “main source of financing for pandemic prevention preparedness and response”. To maximise these, member states are encouraged to pool resources, identify new revenue sources and improve public financial management.

“There should be language on the need to internationalise the rights to use government-funded inventions and know-how, either as global public good or to pool on a share and share alike basis,” said Jamie Love, director of Knowledge Ecology International (KEI),

He added that the inclusion of reference to TRIPS flexibilities was good “but suffer from the flaws of only reaffirming the right to use them, but not dealing with the many failures to do so”.

Seventeen equity clauses

There are 17 clauses devoted to equity, along with the acknowledgement of the need to “build trust” after COVID-19, when wealthy nations bought up and hoarded vaccines when supply was scarce – at the expense of low- and middle-income countries.

Support for the development of local and regional “manufacturing, regulation and procurement” also features, alongside a commitment to promote the transfer of technology to enable this.

However, Love said that reference to benefit sharing is limited to pathogens of pandemic potential, “which KEI sees as a weak basis for equity provisions, and we are disappointed there are no incentives to open source other inputs to countermeasures, such as data, inventions, know-how or cell lines, even though these are inadequately supplied”.

The draft also affirms the importance of universal health coverage based on primary healthcare, and the need to protect and train health workers – but steers clear of addressing the ongoing poaching of LMIC health workers by wealthier nations.

Role of WHO?

pandemic
Former Liberian President Ellen Johnson Sirleaf (left) and Former New Zealand Prime Minister Helen Clark (right), co-chairs of The Independent Panel.

The draft also affirms the centrality of WHO as the “directing and coordinating authority on international health work”  in relation to pandemic prevention, preparedness and response.

However, the Independent Panel for Pandemic Preparedness and Response has recommended the formation of a Global Health Threats Council by a UN General Assembly resolution that comprises the heads of state from each of the UN’s regional groupings and is independent of the WHO. 

“Pandemic readiness extends beyond health, and heads of state and government have no tradition of travelling to Geneva to report to the WHO Executive Board or World Health Assembly (WHA). An effective [Global Health Threats] council with adequate participation should not be solely under the mandate of the WHO; instead, it needs to operate with a strong General Assembly mandate and independence from the WHO,” Independent Panel leaders wrote in a recent article for Think GlobalHealth. 

The first reading of the zero draft for member states takes place on 12-13 June, with two other readings planned before a final draft is presented on 24-25 July.

Image Credits: John Samuel, UN Photo/Manuel Elias, @TheIndPanel.

Wildfires

New York City is choking on smoke from hundreds of wildfires ravaging Canadian forests. The sun rose ominously over the city on Tuesday morning, a fiery red orb obscured by the poisonous fog — as if the sky was sending a message: the climate crisis is in code red.

This eerie reminder of the need for urgent climate action cast a hazy shadow over the ambition, optimism and celebrations of World Environment Day, which concluded just hours before residents awoke to the cloud of pollution that continues to engulf New York City.

Canadian forestry officials reported over 400 active wildfires as of Wednesday afternoon, with more than 240 listed as “out of control”. Over 400 wildfires have scorched the forests of Quebec alone since the start of the year, double the average for the mid-year mark.

Wildfire smoke can be deadly. It contains tiny particles, or PM2.5, that can travel deep into the lungs and bloodstream, causing a variety of health problems, including asthma, heart disease, and respiratory illnesses. The particles come from sources such as the combustion of fossil fuels, dust storms, and wildfires. The resulting air pollution kills nearly 7 million people every year.

Live air pollution levels according to IQAir as of Wednesday afternoon.

At its peak, the smoke over New York City contained 142.6 micrograms of PM2.5 per cubic meter of air – nearly 30 times the World Health Organization’s safe air quality guideline. On Tuesday evening, the air quality in the city briefly surpassed New Delhi as the world’s most polluted in any major city.

New Delhi’s air pollution caused over 50,000 premature deaths in 2020, a small fraction of the total of 1.6 million across India. The air pollution crisis in India’s major cities has led to the rise of a so-called “pay-to-breathe” industry, where the ability to afford expensive air purifiers can determine whether residents stay safe from the smog, driving a new kind of life-or-death inequality.

PM2.5 levels reached 142.6 micrograms per cubic meter of air on Tuesday, according to IQAir.

Cities on the east coast of North America are not in danger of catching up to New Delhi or Mumbai in year-round air pollution, but climate change is set to make the occurrence of PM2.5 spikes more frequent and more dangerous for human health.

Warming global temperatures caused by human activity have intensified the hot and dry seasons when wildfires thrive. Scientists say carbon pollution from fossil fuel and cement companies is directly responsible for millions of acres of wildfires across the North American west coast.

And far from the skyscrapers of New York City, an invisible threat is growing: melting ice in the Arctic.

‘Arctic Amplification’

A new study projects the milestone of a sea ice-free Arctic in September could be reached a decade ahead of schedule.

Arctic sea ice is melting rapidly, shrinking at a rate of 12.6% every decade, according to NASA. Arctic temperatures have also increased four times faster than those in the rest of the world.

Yet a summer without sea ice in the Arctic was not projected to happen until at least the middle of the century. In its 2021 assessment report, the UN Intergovernmental Panel on Climate Change (IPCC) calculated the Arctic would only reach an ice-free state around 2050 under “intermediate and high greenhouse gas emissions scenarios”.

Scientists now project that milestone could be reached as early as the 2030s under a business-as-usual emission scenario. Even if emissions are cut drastically – a target the world is far from achieving – the melting of the sea ice in the Arctic cannot be stopped, the study found.

“The Arctic Ocean will become sea ice-free in September for the first time before 2050, irrespective of emissions scenarios,” the peer-reviewed study published in Nature Communications on Tuesday said.

The absence of Arctic sea ice will affect weather patterns and sea-level rise around the world.

The white ice reflects sun rays back into space. As the ice melts, more heat is absorbed by the dark waters of the ocean, creating a feedback loop known as “Arctic amplification”.

As the Arctic warms, the temperature difference between the North Pole and the Equator – a major force driving global weather patterns – increases. This could have dire consequences for the frequency of extreme weather events such as floods, heatwaves and resulting wildifres across the temperate regions of North America, Europe and Asia.

“We need to prepare ourselves for a world with a warmer Arctic very soon,” Seung-Ki Min, a lead author of the study and a climate scientist at Pohang University of Science and Technology in South Korea told CNN. “Our result suggests that the Arctic amplification will be coming faster and stronger. That means the related impacts will also be coming faster.”

Vanishing sea ice in the Arctic will also accelerate the melting of the Greenland ice sheet, with major effects on sea-level rise globally.

Image Credits: National Weather Service, Annie Spratt.

Covid-19
China lifted its Zero COVID policy restrictions in December 2022.

China will report around 11 million COVID-19 cases per week in June in its second major outbreak, data research firm Airfinity predicts. The current outbreak is caused by the XBB variant of the virus.  

This outbreak will be much smaller than the numbers reported during the first wave in late 2022, immediately after the country dropped its  “Zero COVID” policy.  

“Our modelling estimates the wave will peak at the beginning of June at around 11 million per week, with 112 million people being infected during this resurgence,” Airfinity said. 

This number is significantly lower than the figure suggested by Chinese pulmonologist Dr Nanshan Zhong who recently stated that the number of new COVID-19 infections in China could reach 65 million per week by the end of June.

Airfinity pointed out that the reason for this difference could be that its model indicates only symptomatic cases, while Zhong’s prediction possibly includes asymptomatic cases too. 

This is the first reinfection wave in China after the government scraped away the “Zero COVID” policy. Researchers have further stated that, moving forward, China will witness an infection cycle every six months with newer variants of the virus emerging,” according to the independent health analytics company.

According to the World Health Organization (WHO), China had 5829 confirmed cases of COVID-19 in the last seven days. However, this data is unlikely to reflect the correct picture since China stopped mass testing for COVID-19 last year when it abandoned its “Zero COVID” policy after mass protests. 

“We expect the second wave in China to be smaller and less severe than its first despite the impact of the new XBB variant. This is due to China experiencing a large wave around six months ago which provided protection to millions, booster uptake increasing since the last wave, and anecdotal evidence from the country does not suggest hospitals and morgues being overwhelmed as they were during the last wave,” said Dr Tishya Venkatraman, Airfinity’s COVID-19 epidemiologist, in a statement. 

“Even though the ongoing wave is likely to be smaller, it could still lead to a large number of deaths because of the size of China’s ageing population. We have seen this in Japan where the latest wave caused a significant number of deaths despite having high vaccine coverage and underlying population immunity from previous waves.”

China abandoned its “zero COVID” policy in December 2022 after the country saw widespread protests from people against the strict policy measures. Until then, people who have COVID-19 and their close contacts were forced to go to quarantine camps. 

Image Credits: Photo by Joshua Fernandez on Unsplash.

Traditional cooking in India

The high cost of energy and negligible progress in rolling out electricity in sub-Saharan Africa since 2010 are some of the factors behind why 2.3 billion people are still reliant on cooking fuels like coal and firewood that harm their health.

Meanwhile, the transition to renewable energy has been too slow – and there has been a substantial drop in international finance available to help developing countries make this transition.

These are some of the findings of the 2023 edition of Tracking SDG 7: The Energy Progress Report  released on Tuesday, which warns that the world is far off track to meet Sustainable Development Goal (SDG) 7,  “ensuring access to affordable, reliable, sustainable and modern energy”.

The goal is broken down into access to electricity and clean cooking (7.1), a substantial increase in renewable energy (7.2) and doubling the global rate of improvement in energy efficiency by 2030 (7.3).

The report is published by the SDG 7 custodian agencies, the International Energy Agency (IEA), the International Renewable Energy Agency (IRENA), the United Nations Statistics Division (UNSD), the World Bank, and the World Health Organization (WHO).

“Attaining [SDG 7] will have a deep impact on people’s health and well-being, helping to protect them from environmental and social risks such as air pollution, and expanding access to primary health care and services,” according to the agencies in a media release.

Dirty fuel pollutes household air

According to WHO, 3.2 million people die each year from illnesses caused by the use of polluting fuels that increase household air pollution. Africa alone faces 1.1 million deaths from air pollution, second only to malnutrition.

“The use of traditional biomass also means households spend up to 40 hours a week gathering firewood and cooking, which prohibits women from pursuing employment or participating in local decision-making bodies and children from going to school,” according to the report, which adds that traditional fuel perpetuates “gender inequity, deforestation, and climate damage”.

While access to cleaner cooking fuels has improved since 2010 when 2.9 billion used dirty household energy, some 1.9 billion people would still be without access to clean cooking in 2030 – with 60% of these living in Sub-Saharan Africa – if current trends are followed. 

The economic impact of COVID-19 and soaring energy prices might also push 100 million people who recently transitioned to clean cooking to revert to using traditional biomass.

Eastern Asia, Latin America and the Caribbean were the only regions to sustain progress in access to clean cooking between 2019 and 2021. 

“Access to electricity and clean cooking still display great regional disparities and should be the focus of action to ensure that no one is left behind. Investment needs to reach the least-developed countries and sub-Saharan Africa to ensure more equitable progress toward Goal 7,” said Francesco La Camera, Director-General of IRENA.

Impressive electrification in South and Central Asia

Globally, 91% of the world’s population had access to electricity in 2021 in comparison to 84% in 2010 – an increase pf more than a billion people.

In Central and Southern Asia, 414 million people had no electricity in 2010 but this was slashed to 24 million by 2021, with Bangladesh and India singled out for their progress.

Eastern and South-eastern Asia cut those without electricity from 90 million to 35 million during the same period. 

But in Sub-Saharan Africa, over 80% of the 524 million people in rural areas are without access to electricity in 2021 – almost unchanged since 2010. Globally, around 675 million people don’t have access to electricity.

Swing to renewables is too slow but accelerating

Solar panels provide electricity to Mulalika Clinic in Zambia.

Global use of renewable electricity has grown from 26.3% in 2019 to 28.2% in 2020, the largest single-year increase since the start of tracking SDG 7 progress.

international public financial flows in support of clean energy in low- and middle-income countries have been decreasing since before the COVID-19 pandemic and funding is limited to a small number of countries.

Efforts to increase renewables’ share in heating and transport, which represent more than three-quarters of global energy consumption, remain off target to achieve 1.5oC climate objectives.

In addition, international public financial flows in support of clean energy in developing countries stand at $10.8 billion in 2021, 35% less than the 2010–2019 average. And this is financial flow is concentrated in 19 countries, which received 80% of the commitments.

The report will be presented to top decision-makers at a special launch event on 11 July at the High-Level Political Forum (HLPF) on Sustainable Development, ahead of the second SDG Summit in September 2023 in New York.

Image Credits: Nigel Bruce/WHO, Shruti Singh/ Unsplash, UNDP/Karin Schermbrucker for Slingshot .