World Health Assembly
World Health Assembly 76 in progress.

Pandemic treaty negotiations need to be completed by member states and there’s just one year left to meet that deadline, warns the World Health Organization’s Director General.  

As the World Health Assembly closed its doors on it’s 75th Anniversary edition (WHA 76), which had to be extended by an extra day due to the prolonged debates last week over Russia’s invasion of Ukraine, Palestine and other geopolitical disputes, Director General Dr Tedros Adhanom Ghebreyesus reminded delegates of two things.

First, the first WHA in 1948 took four weeks. Second, the biggest challenge facing delegates still lies ahead: reaching agreement on a draft pandemic accord, which is supposed to be submitted to the next WHA in exactly one year’s time.

“Your challenge as Member States states is to negotiate a strong accord for approval, just 12 months from now,” he said. 

“This accord is a generational opportunity that we must seize. We are the generation that lived through the COVID-19 pandemic, so we must be the generation that learns the lessons it taught us and makes the changes to keep future generations safer.

“In particular we must work hard to counter the misinformation about the accord that is circulating among member states,” he stressed. “The idea that this accord would cede authority to WHO is simply fake news. This is an accord by member states and will be implemented in member states in accordance with their own laws.”

Accomplishments despite geopolitical division 

In his closing remarks, the Director General recapped the accomplishments of this year’s Assembly, which marks 75 years since the creation of the WHO.  Those, he said, included the approval of a 20% increase in assessed contributions by WHO member states that puts the organization on a more sustainable financial footing. 

Member states also approved, in principle, the creation of a new WHO “investment fund” that aims to complement existing WHO resources, the details of which will be worked out over the coming year.  Simultaneously, they rejected the idea of a “replenishment fund” similar to those organized by UNAIDS and The Global Fund, which recruit billions from countries and philanthropies every few years in glamorous bidding events graced by heads of state and celebrities.     

“Both the increase in assessed contributions and investment fund are historic,” said Tedros adding that WHO would work with member states to bring the latter idea “to fruition.”

He cited other key accomplishments of this year’s WHA as resolutions and decisions bolstering the integration of the behavioural sciences into the work of WHO and a set of updated “Best Buys” for countries’ NCD policies.

Drowning
WHA actions addressed a range of issues, including one on drowning prevention that caused over 230,000 deaths annually.

This year’s WHA actions also addressed standardization of medical diagnostics, more inclusion for people living with disabilities, drowning prevention, critical and operative care in emergencies, food fortification with micronutrients, indigenous health, improving infection prevention and control, maternal and child health, medical oxygen, primary health care, refugee and migrant health, rehabilitation services, and traditional medicine.

Geopolitical divisions take center stage to the very end

“The challenges we face are daunting and complex. They are made harder by the geopolitical context in which we live,” Tedros observed, referring to the political debates that at times delayed discussion on more technical issues for hours or days.  

Azerbaijan
The delegate from Azerbaijan defends his country’s policy on border crossings, on Tuesday.

Even the Assembly’s final hours saw one last spat erupt, this time between Azerbaijan and Armenia.  The two countries sparred for about 15 minutes in the plenary over arrangements at border crossings in the Azerbaijan controlled region of Nagorno-Karabakh, which Armenia said hinders freedom of movement by the region’s ethnic Armenians between the two countries. 

“We live in a world of deep divisions, and at times those divisions have been evident at this health assembly. We cannot pretend they don’t exist, nor can we be paralyzed by them. When we agree, you must work with full determination and cooperation,”  Tedros observed shortly after the volleys of accusations ceased.  

“And when we disagree, we must continue to work to find common ground. As we do, we will often find that our disagreements can be overcome, and our divisions can be narrowed. In other words, we will find that health can be a bridge to peace.” 

Health as a bridge to peace 

One of the challenging moments Tuesday was a fight over the deadlock on a new WHO Global Health and Peace initiative, which Tedros has made a flagship of his tenure. The decision on the initiative finally was approved after a prolonged closed door session Tuesday morning (see related story).

“The vital connection between health and peace is not a new idea,” said Tedros, who himself hails from a war-torn Tigrayan region of Ethiopia. 

Global Health and Peace initiative was one of the issues discussed today at the last day at the WHA76.

“And nor is it something that lies outside the mandate of WHO,” he added, rebutting critics who say it risks duplicating roles already being played by various humanitarian relief groups. “It has been there since the very beginning in our Constitution, which says that the health of all people is fundamental to the attainment of peace and security.

“It is dependent upon the fullest cooperation of individuals and states,” Tedros said. “This is what COVID-19 has taught us: that pathogens have no regard for the lines humans draw on maps, not for our politics, nor for our politics, religions, or anything else that we use to divide ourselves from each other. To pathogens, we’re all one.” 

Food fortification and drowning 

Among the less noticed but vitally important resolutions approved by this year’s assembly were ones recommending food fortification to combat micronutrient nutrition, as well as a resolution to combat a widespread but neglected cause of death: drowning. 

Government moves to increase food fortification with key micronutrients, while not a panacea, can go a long way in combatting the most pressing problems of undernutrition faced today, Lawrence Haddad, executive director of the Global Alliance for Improved Nutrition (GAIN), said in an interview just ahead of the resolution’s approval by WHA last week. 

“It’s very exciting because some three billion people don’t have access to a healthy diet, so they afford to get the nutrients from fruits, vegetables, pulses, eggs, dairy and fish,” Haddad said. “While we are working on how to make these foods more available, affordable, and desirable, in the interim you have a solution, fortification, that adds vitamins and minerals to things that low-income people are already eating, such as wheat, maize, rice and cooking oil.”

Fortified food
Some 372 million preschool children and 1.2 billion women of reproductive age worldwide are at risk of at least one micronutrient deficiency.

Some 372 million preschool children and 1.2 billion women of reproductive age worldwide are at risk of at least one micronutrient deficiency, which can cause a range of conditions from debilitating anaemia to birth defects such as spina bifida and other neural tube disorders. 

Food fortification with vitamin B-9 (folate) is a key measure that can prevent spina bifida from developing in the foetus of pregnant women.  Other common micronutrients that can be added to foods to prevent a range of diseases and conditions include such as, iron, vitamin A, zinc, calcium and vitamin D. 

Many low income countries don’t fortify basic foods 

“While many countries are actually fortifying these basic staple foods, including all of the high income countries, in Latin America and Africa, not that many do,” Haddad observed. 

“And this is a very inexpensive, proven, WHO-approved intervention,” he added, noting that a raft of low and middle income countries, including Columbia, Malaysia, Ecuador, Philippines and Ethiopia had led the work on the resolution’s approval.  

Like virtually all WHA measures, the resolution on food fortification is non-binding. But it will amplify the issue on national agendas, unlock donor funding and a raft of WHO guidance and support, he said, pointing to all of the policy wheels that WHA actions can set in motion.

“This resolution will really help us,” said Haddad.  “It’s a window opening. It’ll mean that countries will report to WHO on their food fortification status. The millers will begin adding micronutrients to their grains, the oils can be fortified by oil refiners cheaply – at just 0.1% of the retail price.”

And non-government actors like GAIN can swing into action with technical support.  

“It’ll facilitate, encourage, inspire more and more governments to do this,” he said. “And GAIN will help any government that wants us to help them with the technical things that they have to get right – like safety, reporting using digital data. It’s exciting. It’s a first-ever.”

Image Credits: WHO, WHO , WHO, WHO, WHO .

WHA
WHO Director General Dr Tedros Adhanom Ghebreyesus travels with health workers in the Democratic Republic of Congo.

In one of its last decisions before concluding, the World Health Assembly Tuesday asked WHO’s Director General to continue developing a draft roadmap for WHO’s new  Global Health and Peace initiative – but stopped short of adopting the proposed plan after some member states balked over elements of the strategy. Instead the Assembly agreed to “take note” of the roadmap and ask WHO’s Director General to report back next year on “progress made on strengthening the roadmap as a living document” through consultations with member states and other stakeholders.  

The Global Health and Peace Initiative was launched jointly by Oman and Switzerland in 2019 and primarily aims to use health as an entry point to build peace, following on from a proposal by Director General Dr Tedros Adhanom Ghebreyesus, who saw it as a centrepiece of his leadership.  

The initiative’s objective is to “strengthen the role of WHO and the health sector as contributors to improving the prospects for peace.” It also aims to strengthen resilience to the impact of armed conflict or violence, while empowering communities. 

However, the language of the draft has proven to be contentious with many countries reacting to what some delegates fear might be too much WHO encroachment into the humanitarian sector, and what others saw as potential interference into the business of states waging war in, or supporting, dozens of regional conflicts around the globe. 

Brazil, South Africa and India express reservations 

Health for peace
Brazil’s joint statement along with India and South Africa requested more discussion on the roadmap – but countries emerged from a closed session with agreement on the draft.

“Although its main focus is health and health workers, it borders on the most delicate subject: peace and security, peace, nation and state sovereignty,” said Brazil which made a joint statement on behalf of South Africa, India as well. 

“The seriousness is such that we should not rush into taking decisions unless everyone is truly comfortable with the roadmap,” Brazil’s delegate added in a session on Tuesday, WHA’s closing day. After huddling in a closed door session for nearly an nour, member states finally agreed to “take note” of the roadmap draft and ask for its continued development – without endorsing it per se.  

Two-pronged objective for WHO

The published version of the draft roadmap, etches a two-pronged objective for WHO:

  • “Ensure that health programs are “peace and conflict sensitive”. This means they are designed and implemented in a way that proactively seeks to mitigate the risks of inadvertently exacerbating social tensions, contributing to conflict, or undermining factors of social cohesion in a given society or community (also known as ‘do no harm’ principle). 
  • Where the context, capacities and risks allow, design and implement health programs that are “peace responsive” – meaning, that seek to improve the prospects for peace by, for example, strengthening social cohesion, equity, inclusivity, dialogue, or community resilience to the impact of armed conflict or all forms of violence.    

The roadmap also spells out the possible contribution that WHO can make alongside other UN agencies. It also refers to the role of non-State actors in conflict settings – although it does not spell that out in detail. 

While some may fear WHO’s encroachment in the business of states or other international actors, the initiative notes that: “The Global Health and Peace Initiative is grounded in WHO’s foundational documents. 

“The WHO Constitution recognizes that “the health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and States,” while resolution WHA 34.38 (1981) highlights the health sector’s role in promoting “peace as the most significant factor for the attainment of health for all.”

Regional conflicts and instability, together with climate change, have put more people on the move around the world than ever before – leading to increased WHO interest in supporting fragile states – before a crisis peaks.  

WHO estimates that roughly 80% of its humanitarian caseload, as well as 70% of disease outbreaks to which it responds occur in fragile, conflict-affected and vulnerable settings.

The current session of WHA also saw multiple geopolitical eruptions between member states, including over a resolution against Russia on its invasion of Ukraine; Chinese objections to Taiwan’s participation as an observer; the health status of Palestinians in Israeli occupied territories; and on Tuesday, at the closing plenary, between Azerbaijan and Armenia. 

  • Correction: an earlier version of this text reported that the health and peace roadmap had been “adopted”. In fact the decision adopted by the WHA was to continue developing the roadmap, with a report from the director-general  due to be made at the WHA in 2024 on progress made. 

Image Credits: WHO/L.Mackenzie, WHO.

India describes its candidacy for the post of WHO external auditor – WHA approved despite the steep price hike attached.

The World Health Assembly has re-elected India to serve as WHO’s external auditor for the next four years – but there was a steep price tag attached to this year’s appointment.

WHO will pay nearly $1 million for India’s services over the coming three-year term of 2024-2027  – amounting to US$ 2.268 million, according to India’s bid, disclosed in an annex of audit “fees” that accompanied the appointment documents. 

That is as compared to $1.35 million ($450,000 annually) that India received for performing the same audit service between 2020-2023 – for a difference of $918,000, according to the same report by the WHO Director General.

Three competing offers were all much cheaper

India’s bid was also by far the most expensive for the audit service. In an era when member states have talked constantly about the need for WHO to streamline and economize, competing offers for audit services by Egypt ($1.708 million; Kenya (1.862 million) and Tanzania, ($1.8million), would have saved the Organization $500,000 or even more – had any of them been accepted.

But in a secret ballot by WHA member states, India prevailed over all of the other candidates – garnering  114 votes against 42 for Tanzania – amongst the 156 member states that voted. 

India’s offer was by far the most expensive among the candidates

European Union and United States calls for more scrutiny

Following India’s reelection, Sweden on behalf of the European Union (EU) called on the external auditor to be more proactive in its role – monitoring efforts to make WHO more efficient, transparent and accountable in its use of the public funds provided by member states.

“We call on the newly elected external auditor to actively monitor these activities and work with the Secretariat and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme [IOAC] in order to develop the necessary corporate practices in these areas and ensure implementation,” the EU noted.

Recent IOAC reports have highlighted the importance of the external auditing role, describing it as relevant to ensure in-depth knowledge and understanding of the work of the WHO. The report’s findings should be taken into account in the finalization of the formal arrangements that will follow the election, Sweden added. 

In its remarks, the United States called for further elaboration of WHO appointment procedures. It noted that the UN inspection unit has long recommended that a subsidiary committee of an organization’s governing body should screen external auditor candidates against established criteria and requirements as a requisite stage in the appointment process. 

“We understand this is also a best practice used across UN system organizations now,” the United States told WHA’s Committee B, which deals with WHO administrative matters..

It suggested the WHO Executive Board’s Programme, Budget and Administration Committee (PBAC) as an appropriate subsidiary body to screen and help guide the health assembly on making efficient and formed external auditor appointments in the future.

“We would also recommend in this regard that the Secretariat propose amendments to its relevant financial regulations and external auditor Terms of Reference as necessary to clarify and formalize such a role for the PBAC in future external auditor appointments,” the US added.

Stefan Anderson contributed to the reporting on this story.

Image Credits: WHO.

Protests against Uganda anti-homosexuality bill

There has been swift and widespread reaction to Uganda’s Anti-Homosexuality Act, which introduces severe punishment for homosexuality including the death penalty, being signed into law by that country’s president on Monday.

US President Joe Biden called for its “immediate repeal”, describing it as “a tragic violation of universal human rights—one that is not worthy of the Ugandan people, and one that jeopardizes the prospects of critical economic growth for the entire country”. 

 

EU High Representative Josep Borrell warned that “the Ugandan government has an obligation to protect all of its citizens and uphold their basic rights. Failure to do so will undermine relationships with international partners.”

“This law is contrary to international human rights law and to Uganda’s obligations under the African Charter on Human and People’s Rights, including commitments on dignity and non-discrimination, and the prohibition of cruel, inhuman or degrading punishment,” added Borrell.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), UNAIDS, and the US President’s Emergency Plan for AIDS Relief (PEPFAR) issued a joint statement calling for the law to be reconsidered as it was harmful and jeopardised Uganda’s progress to stop HIV.

“Trust, confidentiality, and stigma-free engagement are essential for anyone seeking health care. LGBTQI+ people in Uganda increasingly fear for their safety and security, and increasing numbers of people are being discouraged from seeking vital health services for fear of attack, punishment and further marginalization,” said the organisations.

Previously, UN High Commissioner for Human Rights Volker Türk described the law as “probably among the worst of its kind in the world”.

“The Bill confuses consensual and non-consensual relations – the former should never be criminalized, whereas the latter requires evidence-based measures to end sexual violence in all its forms – including against children, no matter the gender or sexual orientation of the perpetrator,” said Türk.

Unconstitutional?

Despite a warning by Ugandan  Deputy Attorney General (DAG) Kaafuzi Jackson Kargaba  that the law was open to a number of legal challenges, particularly with the inclusion of the death penalty in a country that has effectively ended the use of capital punishment, Ugandan President Yoweri Museveni went ahead and made it law.

Museveni sent the Bill back to Parliament for its reconsideration in early May, but MPs voted to retain the death penalty for “aggravated homosexuality” – defined as sex with a child or disabled person or while living with HIV. The law also makes provision for a 20-year prison sentence for “knowingly promoting homosexuality”.

The Bill had the support of all but one of the MPs, many of whom have persistently equated homosexuals with paedophiles.

During the sitting, Speaker Anita Among took issue with Kargaba for pointing out the flaws in the earlier Bill and when he tried to explain his position in Parliament, she refused to allow him to speak.

“We have a culture to protect. The Western world will not come to rule Uganda,” said Among.

Ironically, however, US conservative Christian groups have been pushing for the legislation since 2014 when a “kill the gays” Bill was passed but never implemented after being overturned in a legal challenge, and Among has been part of the high-level government officials meeting with these groups, including the Arizona-based Family Watch International.

Ugandan gay activist Frank Mugisha, previously told Reuters that if the Act becomes law, he will challenge it in court on grounds that it was unconstitutional and violated various international treaties to which Uganda is a signatory. 

However, Mugisha also said that he feared mob violence and the mass arrest of LGBTQ people, adding that his community would be too afraid to seek treatment at health centres and warned of the mental health damage, including an increased risk of suicide.

“This legislation… is here to erase the entire existence of an LGBTQ person in Uganda, but also it radicalizes Ugandans into hatred of the LGBTQ community,” LGBTQ activist Frank Mugisha told MSNBC’s Rachel Maddow in a recent interview.

Since Parliament passed the Bill, hate crimes and violence against LGBTQ people have risen sharply, according to the Human Rights and Awareness and Promotion Forum (HRAPF), a legal aid organisation. In addition, police have arrested people on suspicion of being LGBTQ, according to HRAPF.

 

Digital health
At a session on Saturday, WHO, member states and other stakeholders assess the progress, realities, challenges and odds stacked against an ambitious global strategy on digital health.

On Saturday at the World Health Assembly, the World Health Organization (WHO) laid out the current realities of its digital health agenda as contained in the 2020-2025 global strategy on digital health.

WHO member states see digital health as an important vehicle for accelerating progress towards WHO’s ‘triple billion’ targets of universal health coverage, health emergencies response and healthier populations.

Even though the strategy was launched just before the COVID-19 pandemic began, the pandemic response demonstrated that countries’ investments in digital health also strengthened the resilience and responsiveness of health systems, the Director of the Department of Digital Health and Innovation, Alain Labrique, told the WHA.

An ambitious strategy

Digital health
A summary of the WHO’s strategic action plan on digital health.

The development of a global strategy on digital health underwent a two-year co-creation journey before its adoption at the 73rd World Health Assembly (WHA). The initial draft of the strategy document was drafted and disseminated for comments through an internal consultation in early 2019, followed by a series of global and regional consultations. The strategy aims to improve health for everyone, everywhere by accelerating the development and adoption of “appropriate, accessible, affordable, scalable and sustainable person-centric digital health solutions to prevent, detect and respond to epidemics and pandemics”.

The strategy also aims to develop infrastructure and applications that enable countries to use health data routinely to  achieve WHO and UN Sustainable Development Goals. 

It argues that the value and uptake of digital health solutions is  contingent upon a range of l factors including: accessibility, efficiency and sustainability; affordability; and versatility with respect to different health applications  Applications also need to maintain patient privacy and data security. 

To achieve “radical improvements” in health outcomes, the strategy called for investment in governance, institutional capacity, workforce training, planning, and management. 

“By aligning with national strategies for digitizing the health sector, WHO believes digital health can enhance efficiency, cost-effectiveness, and potentially introduce new business models for service delivery. 

Accomplishments so far less clear 

Presently, WHO is working to ensure that member states have the capacity, guidance, and tools necessary to undertake digital transformation, Labrique told member states on Saturday. Although he said the WHO is enabling member states with “the necessary interoperability architecture to enable domestic, regional, and global digital health goals,” he did not provide specific details on how this is being done.

Moreover, WHO said is facilitating the development of competency-based frameworks to enable the training of digitally enabled health workers of today and of the future. “We are working collaboratively with multiple stakeholders to address the digital divide and enable equitable, safe, and ethical access to life-saving technologies for all.”

Just what that really means in countries, however, is much less clear, critiques say. Observers say that WHO’s rollout of its strategy has been lackluster with leadership ill-equipped for the task, to date. 

Most recently, for instance, WHO created briefing notes for countries, donors and on a  new WHO “Digital Health Clearinghouse”  that “assesses, curates and catalogs digital solutions that meet minimum requirements in the delivery of digital health interventions at the primary health care level.”

But while the clearinghouse was supposed to commence work in early 2023, with “solutions for specific health domains in early 2023, starting with Digital Documentation of COVID-19 Certificates (DDCC),” there is as of yet, no online address for the effort on WHO’s Digital Health page.

The digital health effort is housed in WHO’s Science division. Translating the high hopes of the strategy into results will therefore be a challenge facing new WHO Chief Scientist Jeremy Farrar, former director of Wellcome Trust.

A planned WHO data portal, Data.who.int, being developed in another WHO division, Data Analytics and Delivery for Impact (DDI) is supposed to consolidate WHO’s own wealth of digital health data assets, and provide greater interactivity between WHO headquarters, regions and country offices. It also has yet to get off the ground. 

Countries making progress

Many member states have already earmarked digital health for more investment – after the Pandemic served as a wake-up call. 

In its remarks, the government of Indonesia, which currently holds the G20 Presidency, affirmed its commitment to strengthening global and regional digital health systems  – along with the  national investments it is making now. 

“Indonesia has included digital health as one of our health transformation agenda priorities. Through the formation of digital transformation offerings of health, we aim to build an integrated system that ensures all processes run effectively and provides the best health care services to all to ensure a single national health data which is integrated and safely stored,” the country’s delegate stated. 

UK calls for ‘more work’ by WHO on digital health  

Meanwhile, the UK government, while acknowledging WHO’s current efforts, said that the agency needs to do more.  

“While there has been significant progress on digital transformation, [way] more work is needed to unlock its benefits in health and social care, said the UK delegate. 

“WHO’s leadership is vital in bringing together governments and other key stakeholders to advance the digital health agenda and address shared challenges such as data governance, interoperability, and incentivizing innovation,” he stated.

The UK also urged the WHO to focus on “aligning and harmonizing” digital health standards and ensuring that more detailed updates on progress are included in future WHA reports. 

In its submission, the International Pharmaceutical Students Association called on WHO and member states to empower young health care professionals to bridge the digital literacy gap in the community by including digital health and formal healthcare education curricula. 

The association also called for the creation of an enabling environment for young innovators by establishing clear funding and mentorship mechanisms. It also recommended the implementation of a harmonized digital strategy that includes community pharmacies.

Image Credits: WHO.

chemical pollution
The WHA resolution coincided with the start of a second round of international negotiations on a treaty to curb plastic pollution in Paris on Monday morning. / Photo: Factory smoke laced with chemical pollution.

The World Health Assembly (WHA) approved a landmark resolution on Monday calling on the World Health Organization (WHO) to scale up its efforts to fight the impact of chemicals, waste and plastic pollution on human health and produce the data to back it up.

The non-binding commitment spearheaded by Peru is the first time ever that the health effects of chemicals and plastic pollution have been directly addressed at the WHO’s member state assembly. The watershed moment for the UN health body follows years of collaboration with the UN Environment Programme (UNEP) on the safe management of chemicals and air pollution. 

The resolution passed with near-unanimous support, with 40 countries including Canada, Mexico, the European Union and its member states signing on as co-sponsors. 

“This is an environmental topic”

The success of the Peruvian effort to elevate the issue to the WHO’s agenda was far from certain when negotiators sat down in Geneva last week to kick off the WHA. In fact, the resolution seemed like a long shot.

“It was not easy,” Bernardo Roca-Rey, a member of the Peruvian team who wrote the resolution, told Health Policy Watch. “When we launched the negotiations on the very first draft, several delegations were still reluctant because they were saying this is an environmental topic, not human health.” 

Previous WHA sessions would likely have dismissed Peru’s proposal outright, veterans of the organization observed. 

“Years ago, it was difficult to bring all these [environmental] topics to health ministers,” Maria Neira, the director of Environment, Climate Change and Health at the WHO said at a side event discussing the resolution last Thursday. “They thought, well maybe this is important, but we have to deal with malaria, we have to focus on tuberculosis – we focus on diseases.”

Peru led the charge on the resolution 

Spatial view of large-scale illegal gold mining in the Madre de Dios region in the Southeastern Peruvian Amazon.

Peru had a week of negotiations and a wealth of knowledge about the issues to make its case. 

The country’s experience with illegal gold mining in the Peruvian Amazon meant its team was intimately aware of the consequences of dismissing the health effects of environmental crises. Peru’s rainforests are home to the highest levels of atmospheric mercury on earth, endangering the lives of miners, indigenous communities and wildlife exposed to its water and air.

“New chemicals are being developed every day, the demand and production of new chemicals continue to grow every day, and there is more and more evidence of the impact this is having on biodiversity, the environment and human health,” Roca-Rey said. “This is not only an environmental problem, it is also a human health problem.”

Generate more data on the health impacts of plastics pollution

Large data gaps continue to limit our understanding of the health impacts caused by plastic pollution.

The Peruvian delegation also highlighted the critical need for organizations like WHO to generate more data on the health effects of plastic pollution. 

The limited evidence base that exists suggests that microplastics can interfere with the function of cells in internal organs, block endocrine receptors that affect the behaviour of hormones, and find their way into breast milk, raising fears over their potential impact on the health of babies.

The resolution asks WHO Director-General Dr Tedros Adhanom Ghebreyesus to prepare a report on the “human health implications of chemicals, waste and pollution” and identify “existing data gaps” limiting scientific understanding of the health impacts caused by plastic pollution. 

“We know we have microplastics in our food, but we are still not actually aware of the extent that this is impacting human health,” Roca-Rey said. “We just found out less than two years ago that we have microplastics in our bloodstream. I don’t think we are fully aware of the extent of the issue.”

Multiple pathways exist for microplastics to enter the body. Widespread incineration of plastic waste is a major contributor to air pollution, particularly in developing countries. Other pathways include the ingestion of fish and wildlife, contaminated water, and the contamination of food and beverages with microplastics from plastic containers and utensils.

A WHO report would also have huge impacts in the wider plastics debate, Roca-Rey said. 

“More and more research is happening, but the problem is that this research doesn’t necessarily have the certification of an international organization checking that the information is reliable,” he said. “Members states are sometimes reluctant to accept this evidence.”

The success of Peru’s arguments in gaining WHA support for the resolution point to the ongoing shift in attitudes across WHO and other UN agencies towards the understanding that threats to the environment, health, climate and biodiversity must be seen as intertwined rather than isolated – a pivot known internally as the “One Health” approach.

“This is really a milestone,” Roca-Rey said. “It has put the topic fully on the WHO agenda.”

Image Credits: UNEP, Coordenação-Geral de Observação da Terra.

Access
Dr Tedros Adhanom Ghebreyesus, WHO Director-General speaks about WHO initiatives to extend universal healthcare access to another billion people.

The World Health Assembly (WHA) on Monday greenlit a slew of decisions and resolutions that aim to bring another one billion people under the coverage of universal health coverage (UHC), as the 76th WHA session drew closer to its end. 

The plan is the bedrock of WHO’s vision to deliver on so-called “triple billion targets” WHO Director General Dr Tedros Adhanom Ghebreyesus set as a goal in 2018. The targets, that aim to ensure stronger emergency response, access to UHC and beter health and well-being for 1 billion people each, form the backbone around which this year’s discussions have taken place. 

A core focus of the UHC target is the expansion and strengthening of primary healthcare access – viewed as a key means of bringing  more people closer to vital health services. 

“Strong primary health care is especially vital for delivering life saving services, maternal and child health, including routine immunization,” stressed Tedros in his opening remarks at the WHA last Sunday.  Countries definitely agreed, stressing over and over in comments Saturday and Monday the relevance of primary health care services. 

Landmark resolution on harmful chemicals, including plastics 

In terms of WHO’s pillar of work on better health and well-being, WHA also approved a landmark resolution calling for countries to scale-up work addressing harmful chemicals. The resolution refers to the need for countries to explore emerging linkages between plastic pollution and human health.

The resolution, spearheaded by Peru, is the first time ever that WHA has addressed the plastics issue – already widely acknowledged to be a growing environmental blight

Racing to catch up after last week was dominated by protracted debates over divisive topics like Ukraine and Palestine, WHA delegates settled into a routine of long statements and rapid approval of the wide range of technical items remaining on their agenda for this year’s session, which ends Tuesday.   See related story:

Landmark Resolution on Chemical Pollution Passes World Health Assembly

New thrust on fake medicines and rehabilitation services 

Among other key action-points addressed on Monday was a decision aiming to strengthen countries’ control over substandard and falsified medical products, as well as a resolution committing countries to boost rehabilitation services, to meet growing demands as non-communicable diseases rise. 

As part of the substandard medicines initiative, the Assembly’s Committee A, which reviews programmatic work items, OK’d the establishment of an independent evaluation to monitor the member states performance. 

In their comments, countries stressed that substandard diagnostics and medical devices are a problem along with fake and substandard medicines, per se; all are targeted in this week’s decision. 

“The lack of access to affordable, appropriate, good quality and safe medical devices is a major public health issue,” said Botswana, speaking on behalf of 47 countries in the Africa region. “African member states calls for resources to ensure availability of skilled human personnel, and to meet maintenance needs for the medical devices.”

With regards to rehabilitation, the resolution, led by Israel, aims to bolster services to the billions of people who suffer from disabilities or chronic disease that impairs their physical, mental or social functionality.

In 2019 around 2.4 billion individuals had conditions that would have benefited from rehabilitation, WHO estimates – a 63% increase over the past three decades.  And since then, COVID-19, conflicts and other humanitarian crises are also adding significantly to the demand for such services.

Many individuals simply do not receive the rehabilitation they require, despite the high cost. “A majority of those with unmet needs live in low- and middle-income countries, where as much as 50% of people do not receive the rehabilitation they need,” the background text for the resolution states.  WHO is already providing assistance to 35 countries to gather data, develop national plans and strengthen the rehabilitation workforce.

The resolution urges member states to build national rehabilitation programmes – particularly at primary health care level, and to “ensure the integrated and coordinated provision of high-quality, affordable,
accessible, gender sensitive, appropriate and evidence-based interventions for rehabilitation along the continuum of care.”

It also calls upon WHO to develop a global rehabilitation baseline report by 2026, as well as global health system rehabilitation targets and indicators “for effective coverage” for 2030.

“Best Buys’’ to combat NCDs

Last week, WHA delegates approved WHO recommendations for an expanded set of “Best Buys” that countries should use to prevent and control NCDs. These include stronger taxes and warning labels on unhealthy foods, so as to combat non-communicable diseases that now constitute 70% of deaths.  

Non-communicable diseases have been a major focus during this year’s WHA discussions.  

“As the global population is growing. People are living longer, and the emergence of non-communicable diseases, the need for rehabilitation services is on the increase. A recent WHO report suggests that 2.4 billion people are in need of rehabilitation services, and to meet this huge demand the importance for promoting, and investing in community-based rehabilitation (CBR) has never been more urgent,” said Malawi. 

Support for disability inclusion

The WHA also endorsed a new WHO strategy to strengthen disability inclusion within countries and health ministries. While the strategy found widespread support, WHA member states raised questions about steps WHO, as an agency, is also taking to include people with disabilities and stakeholder groups into the work of the organization.

“We would like to know what the plans are to ensure that organizations of people with disabilities are systematically included in the technical work of the organization as is stated in the strategy,” Mexico asked. 

“This would help us to ensure that disability is really incorporated in the work of the WHO for issues on recruitment, and to adapt a physical and digital infrastructure through the universal design and reasonable adjustments for different tools.”   

Other countries highlighted the lack of data on people with disabilities as well as intersectional issues, such as the challenges pregnant women living with disability face in accessing healthcare.  

Visa restrictions limit participation by global south in professional events

Access
Denmark underscored the need to improve trust in public health communication.

After the experience of the pandemic in which public behaviour was a key determinant in the uptake of vaccines, WHA members also expressed support for a new strategy to  mainstream behavioural sciences in the work of the global health agency.

“We saw how trust is a core aspect of a successful pandemic response, vertically as trust between citizen and state, and horizontally as trust in your fellow citizen,” said the WHA delegate from Denmark. 

“Low public trust is a worldwide public health concern. It needs a stronger global collaboration, and it needs global initiatives.” 

“However, building sustainable trust in authorities and among communities does not happen overnight. It requires some deep insight, structural approaches, and it can be a slow process,” he added. 

But as WHA drew to a close, countries also brought up a range of other concerns around the WHA’s policies and recommendations.

Universal health care
Jamaican representative alludes to inequity in conferences and workshops in global health, while speaking at the World Health Assembly.

For instance, developing countries face visa restrictions in trying to share knowledge around topics like health and behavioural sciences, the delegate from Jamaica suggested – referring to a “gap” faced by participants from the global south in getting to professional meetings and conferences.  

“We appreciate and support the priority placed in the report on fostering dialogue with academic institutions and practitioners to help reduce the gap,” the delegate said.

Image Credits: WHO, WHO .

WHO staff Dr Simon Ssentamu verifies the oxygen cylinder supply at a health facility in Cox’s Bazar, Bangladesh during the COVID-19 pandemic.

GENEVA – The global will to ensure that COVID-19 is a “never-again” pandemic is dissipating fast, according to many delegates attending the World Health Assembly (WHA) and its plethora of side events – threatening initiatives such as local manufacturing of vaccines.

Jeremy Farrar, the newly appointed Chief Scientist at the World Health Organization (WHO), reminded a forum on mRNA vaccines that, in previous outbreaks, the global health community had “made a promise of ‘never again’, but interest waned over time and it will pass again”.

“If we don’t invest in the whole global R&D ecosystem in the next year, there won’t be local vaccine production by the next pandemic,” Farrar warned delegates gathered in a white marquee on the lawns of the French Mission attending a event organised by the Medicines Patent Pool (MPP).

But it’s not just vaccine production. It is also diagnostic tests and treatments – and ensuring that countries’ health systems are able to offer services to all citizens, regardless of their ability to pay.

Timely testing

On Friday, the WHA passed a resolution to strengthen countries’ diagnostic testing capacity, stressing support for the local production of diagnostic tools and tests in low- and middle-income countries (LMICs).

COVID-19 tests were scarce in many parts of Africa, leading to a misconception that the continent had not suffered that much from the virus. Meanwhile, Tanzania struggled to identify a deadly Marburg outbreak recently because of a lack of access to laboratories and testing.

“Timely access to the right testing tools is one of the most critical parts of any medical intervention to curb an outbreak and save lives, so it’s encouraging to see access to testing being discussed at a global level,” said Dr Salha Issoufou, Director of Operations for Médecins sans Frontieres (West and Central Africa) in response to the resolution.

“We urge all governments to make sure everyone has access to lifesaving tests by swiftly adopting WHO guidelines in national policies, developing national essential diagnostics lists (EDL), and ensuring nationwide access to essential tests for all diseases relevant to the local context, including neglected diseases, and beyond pandemics alone.”

Keeping vaccine factories ‘warm’ outside pandemics

During COVID-19, vaccine delivery to Africa – which imports 99% of its vaccines – was frozen for months after India slapped an export ban on vaccines being made by the Serum Institute of India to deal with its own infection crisis.

The months’ long delay underscored the need for regions to be able to make their own vaccines. But ensuring this is expensive.

 “mRNA is a buzzword at the moment, but how do we keep the factories warm when there isn’t a pandemic?” asked Morena Makhoana, CEO of the South African company, Biovac, which is involved in vaccine production.

His own company faced a crisis recently when the South African government opted to switch its order of the pneumococcal vaccine from Biovac to India’s Cipla, which was producing it far cheaper.

Martin Friede, WHO’s head of vaccine research, recounted at the mRNA event how factories set up to produce influenza vaccine had closed one by one as governments’ support dried up once the threat of H1N1 had passed.

Seth Berkley, CEO of Gavi, the world’s biggest purchaser of vaccines, said that Gavi was committed to giving priority to regional manufacturers, and was currently working with 33 companies.

However, he warned that these vaccines will cost more and would need to be subsidised, not just by donors but by countries where manufacturers are based.

Dr Jean Kaseya, the new head of Africa CDC, told an event at the WHA that his continent has a potential market of 1.3 billion people – and that regional manufacturing of vaccines and medicines is a key pillar of Africa’s New Public Health Order. 

Africa CDC has set a bold target of purchasing 60% of the vaccines it needs from African producers by 2040 – an almost impossible task without massive investment and political will.

Even the recently formed Pandemic Fund has shied away from regional production in its first call for proposals because of the cost, said Priya Basu, executive lead of the fund’s secretariat.

The World Bank estimates LMICs need to invest $30 billion a year for the next five years to pandemic-proof themselves, said Basu.

Regulatory hiccups and pathogen sharing

A key component of regional production also rests on medicines and vaccines being passed by regulatory authorities – and in Africa’s case, each of the 55 countries has different regulatory authorities. The Africa Medicines Agency (AMA) is being set up to streamline this.

IFPMA’s Thomas Cueni (centre) flanked by Jayashree Iyer, CEO of Access to Medicines Foundation (left)  and WHO’s John Rheeder.

But Thomas Cueni, the plain-speaking Director-General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), described the AMA as “a bit of a mess at the moment”, particularly as the main countries on the continent have not yet ratified it.

Cueni also said there was a huge gap between “the political rhetoric and reality on the ground” in relation to regional manufacturing, and it was “toxic” to expect that the North would always pay.

The IFPMA also wants the rapid sharing of pathogens without strings attached – such as access benefit-sharing agreements – one of the points of disagreement in the current pandemic accord negotiations.

“The rapid sharing of SARS-COV-2’s sequencing enabled the pharmaceutical industry to start developing vaccines, treatments and diagnostics in record time. The first vaccine was approved 326 days after the virus sequence was known. This sharing of data and information mustn’t be jeopardized in the future, and the principle needs to be kept in any solutions for pandemic preparedness,” said Grega Kumer, the IFPMA’s Deputy Director of Government Relations.

He added there had been cases where access to pathogens was either blocked or delayed because of access benefit-sharing agreements derived from the Nagoya Protocol, which led to delays in vaccine production. For instance, this has been the case for seasonal influenza, Ebola or Zika.

Pandemic-proofing humans and health systems

People also need to be pandemic-proofed. COVID-19 also showed that humanity is extremely unhealthy – with NCDs in particular whittling away resistance to infection. Those with co-morbidities, particularly obesity and diabetes, were far more likely to die from the virus.

Thus the WHO’s updated guidelines on tackling NCDs that were adopted by the assembly are extremely timely.

Member states at the WHA also expressed alarm that over a billion people cannot access health services because there is no universal health coverage (UHC) where they live, and they cannot afford to pay for healthcare. 

“In a transformative policy shift, member states across high-, middle- and low-income countries expressed a strong commitment to reorient their health systems based on primary health care (PHC) as a foundation for achieving health for all and reaching the furthest left behind first,” said the WHO after the adoption of a resolution to this effect.

“About 90% of UHC interventions can be delivered using a PHC approach; from health promotion to prevention, treatment, rehabilitation and palliative care, potentially saving 60 million lives by 2030.

UHC will also be discussed at a United Nations High-Level Meeting in September, where a political declaration is expected to commit all countries to UHC.

Are politicians out of the loop?

Joy Phumaphi (left) former Minister of Health of Botswana and co-chair of the Global Preparedness Monitoring Board, Terrence Deyalsingh, Health Minister of Trinidad and Tobago, and Precious Matsoso, co-chair of the pandemic accord negotiations.

Two processes are currently underway at the WHO to sharpen up the governance of future pandemics: negotiations for a pandemic accord to provide guidelines for how countries should behave during pandemics, and the amendment of the International Health Regulations, the only binding global rules for health emergencies.

But at an event on pandemic leadership, the Health Minister of Trinidad and Tobago, Terrence Deyalsingh, warned that politicians had to deal with a host of post-pandemic issues – particularly economic woes – and preparing for the next pandemic was no longer a priority.

A similar point was made by eSwatini’s Health Minister, Lizzie Nkosi, who questioned whether politicians were aware of pandemic accord negotiations – let alone preparing for new pandemics: “Are Ministers of Health in countries able to follow the processes in the negotiations and take the issues to their teams?”

Global health leaders are pinning their hopes on the United Nations High-Level Meeting on Pandemic Prevention, Preparedness and Response in September to reignite the political will seen at the height of the COVID-19 pandemic.

Michael Kazatchkine, a member of the Independent Panel for Pandemic Preparedness, is part of a lobby for the establishment of a high-level Global Health Threats Council to keep the issue alive. 

“This is very much a debated issue here in Geneva everywhere. Clearly, we need more work on this to make sure that we’re all on the same page, but what is certain is that saying ‘never again’ with regard to pandemics will remain just words unless we ensure that sustained high-level political engagement,” said Kazatchkine.

Meanwhile, a new pandemic lurks

A researcher explores evidence around the wildlife trade, possibility the source of the next pandemic.

Yet scientists warn that another pandemic is lurking, and is even more likely to erupt as humans encroach more on animals’ territory and the world gets heats up. 

The Intergovernmental Panel on Climate Change (IPCC) warned in its report last March that, without swift climate action, we will see an escalation of infectious diseases such the vector-borne dengue, Zika and malaria, and water-borne typhoid and cholera.

Chadia Wannous, One Health co-ordinator for the World Organization of Animal Health (WOAH), stressed at a number of panels during the past week that primary prevention of pandemics has to focus on “zoonotic spillover” – the messy interface between humans and animals as shown at the Huanan Market in Wuhan, the likely ground zero for the COVID-19 pandemic, where all kinds of wild animals were caged in poor conditions. 

At the opening of the WHA, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that an even worse pathogen than SARS-COV-2 might be ahead, while Maria van Kerkhove, WHO’s lead on COVID-19, also warned that while the emergency may be over, COVID-19 is not yet done killing humans.

Total R&D ecosystem overhaul?

Meanwhile, Wellcome Trust, one of the biggest private donors of infectious disease response, kicked off a global conversation about what needs to be done in a discussion paper released a few days back that declares: “The R&D infrastructure ecosystem for infectious disease is unfit for purpose and requires ambitions overhaul.”

At the heart of the discussion paper is this wish: “We want to see progress towards an infectious disease R&D ecosystem that efficiently and sustainably develops and brings to the market the range of vaccines, diagnostics and treatments required to address the growing threat posed by infections. At its heart, this ecosystem should be structured to provide appropriate products to the people that need them, wherever they live in the world, at an affordable price and in a timely way.”

Wellcome’s four-point vision for transforming infectious diseases R&D.

Wellcome points out that “resources are not allocated to research activities efficiently or equitably with whole fields suffering long-term neglect”. Key problems include “empty pipelines” for major infectious disease threats, especially affecting low-resource settings, barriers to registration, and lack of access.

“Individuals’ ability to access lifesaving products often depends more on economics and geography than on need,” the Trust points out.

Between now and the end of the year, Wellcome will engage key stakeholders on how to change four key areas around establishing health priorities, streamlined clinical trials and regulatory approaches, the strategic scale-up of geographically diverse and sustainable manufacturing capacity and how to both “centre access and affordability while incentivising innovation”.

Factor in three UN high-level meetings – on UHC, pandemic preparedness and tuberculosis – in September. Plus the two pandemic negotiations – on the pandemic accord and how to amend the International Health Regulations (IHR) to make them fit for the next pandemic – that are due to be concluded by the next WHA in May 2024.

It’s going to be a busy  12 months.

Image Credits: WHO/Fabeha Monir , Wildlife Conservation Society.

Digital health
(L-R) Dr Conrad Tankou, Yifan Zhou, Sarah Tuytschaever, Joseline Carias Galeano, Sameer Pujari, and Dr Ilona Kickbusch at the event.

Achieving universal health coverage by 2030, as resolved by the World Health Assembly this week, should ideally bring along with it a bouquet of possibilities through digital technologies. 

Digital health technologies have improved the delivery of healthcare services by improving access to COVID-19 vaccination in Canada, and by improving access to breast and cervical cancer screening in Cameroon. 

A nuanced panel discussion organized by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and the International Pharmaceutical Students’ Federation (IPSF), and the commission, Governing Health Futures 2030: Growing up in a Digital World, at the sidelines of the World Health Assembly in Geneva deliberated on how to harness digital technology in service of global health.

Digital health must benefit vulnerable people

The COVID-19 pandemic disrupted the functioning of health systems around the world by cutting off access to much-needed regular medical care for millions of people. Not only did the pandemic push back the progress the world made in tackling diseases like HIV and tuberculosis, it also complicated people’s access to COVID-19 vaccines. 

Setting up an electronic documentation and information system at a clinic that provides care to vulnerable populations in Canada was one of the ways in which digital health worked wonders. 

As a member of a student group that worked closely with such clinics in Canada, Yifan Zhou, the chairperson of external relations at the IPSF, said that they focussed on not leaving behind vulnerable groups when designing digital solutions to solve healthcare problems. 

The student group also helped set up a digital model that provides appointments for vaccinations at clinics instead of walk-ins, which served as a preventative measure around COVID-19. 

“It’s important that digital solutions are designed for the communities that they serve. They don’t have to be really fancy, they just need to be practical to solve a problem,” Zhou pointed out. 

Dr Conrad Tankou, an Africa Young Innovators for Health awardee and medical doctor, added that while there is ample potential to combine the power of digital technology in healthcare, especially with the involvement of young people, there are difficulties in acquiring adequate resources to make it happen. 

“Clearly you need resources to be able to build the solution. And then you stumble on another situation where you need resources to carry pilots (projects). You need resources to carry out clinical trials, then you stumble on other resources, be able to get regulatory approvals and then bring it to the market,” he explained. “How do you as a young person navigate all of this?” 

As a possible solution to these burning questions, Tankou set up the Global Innovation and Creative space (GIC) in Africa, which brings together young professionals to collaborate on co-creating digital solutions to address healthcare problems. 

“The idea was to build a solution where women in remote areas can have access to screening and diagnosis [for cervical and breast cancer],” he said, adding that over time, this tool integrated other hardware technologies which enabled these women to access healthcare services from specialized healthcare service providers in cities, from their remote regions, based on their diagnosis.  

 Legal and ethical questions

Any conversation about leveraging digital technologies comes with legal and ethical concerns. Establishing governance principles rooted in the human rights of the patients and people these technologies serve is essential to take the idea forward, said Joseline Carias Galeano, general manager at RECAINSA. 

“We believe that in order to have digital health solutions, we need to have strong legal regulations that can secure the rights of the people.” 

This highlights the need for close collaborations between different sectors like academia, industry, governance, and technology. 

“I always feel like everyone has a piece of the puzzle,” said Sarah Tuytschaever, the digital care transformation lead at UCB. 

“It sounds much easier than it is, but how do we align all the incentives of these different factors and actually form that partnership?…And then when it comes to implementation, what we are always forgetting is we focus on the patient outcome.”

‘Cautiously optimistic’

While digital health is the buzzword in global health circles in the recent past, it is important to remain cautiously optimistic about its potential, said Sameer Pujari, lead for AI and digital frontier ecosystems at the World Health Organization (WHO). 

Highlighting the importance of scalability of the technologies used in improving healthcare and the incoming evidence even in food fortification aspects of global health, Pujari said, “There’s a lot of opportunities.. make sure that everyone who’s working on AI is cautiously optimistic and we use AI in a responsible fashion. I think that’s most important.” 

As the health sector evolves to include more digital tools to enhance quality, efficiency and reduce costs, it is equally crucial to ensure that it is not only gender-neutral but also demographically neutral, thus bringing in more men in healthcare delivery, which is currently dominated by women. 

“I urge young people to help us and to take the lead to rethink health systems and what health systems you want,” said Dr Ilona Kickbusch, senior distinguished fellow at the Geneva Graduate Institute. She added that seasoned global health leaders must consciously involve young professionals in co-designing digital health systems. 

“If we manage to develop a footprint for sustainable and equitable digital-first health systems, then we’ll have done our job. And we need that sooner rather than later.”

Image Credits: Twitter/Governing Health Futures 2030.

Elvis Ndikum Achiri of Global Youth 4 Clean Air and Climate Health Action in Cameroon shares his experience of working with communities affected by air pollution.

When Elvis Ndikum Achiri, a long-time veteran of tobacco control campaigns, began collecting data on air pollution in his community in Cameroon, he was surprised to discover how many people around him, both young and old, suffered from related illnesses even though they had never smoked – including a beloved high school teacher who had recently died from asthma.  

Since then, Achiri has become a national advocate in the air pollution space as the coordinator for the Global Youth 4 Clean Air and Climate Health Action in Cameroon. 

He shared his experiences at a World Health Assembly (WHA) side event on Thursday, “Breathing Life into Clean Air Action”.  The event, hosted by the Geneva Graduate Institute, brought together activists with UN agency leaders and funders of air pollution work to explore what civil society leaders are doing on the ground and how they can help drive real change.

Speaking of his teacher who had passed away due to asthma, Achiri said, “When we connect the experience between the patient story and the reality of the disease, the cause, the risk factor, then we begin feeling differently [about] what is happening.” 

Air pollution kills seven million people annually, said Dr Maria Neira, Director of Environment, Climate Change and Health at the World Health Organization (WHO) and moderator of the event. But in addition to data, individual stories are critical in persuading the public and politicians to take action, Achiri pointed out. 

Solutions available, but political will is needed

(left to right) Gillian Holmes, Elvis Ndikum Achiri, Nathan Borgford Parnell; and Dr Maria Neira, WHO. Background: a clean air view of Pretoria, South Africa.

Some of the key takeaways from the event was that while there are solutions readily available, real change will need to involve local governments and affected communities.

“There is a greater awareness particularly among governments about the connections between climate and air pollution and how it could be managed,” said Nathan Borgford-Parnell, science affairs coordinator at the Climate and Clean Air Coalition Secretariat who rued the lack of a political will. 

“This is the moment, and we need to capture it,” Bogford-Parnell said. “We cannot afford to let this thing go by.” 

‘Urban Better’: a 3 point paradigm for healthier cities

Dr Tollulah Oni, (above on screen) founder of Urban Better, outlines the 3-part paradigm of ‘Urban better including: ”the air we breathe; spaces and places; the food we eat.

Dr Tollulah Oni, the director of clinical research at the University of Cambridge and the founder of Urban Better, a citizen driven campaign for clean air pointed to a fact that few people know: air pollution now the second largest cause of death in Africa. 

“Only a fraction, sort of 6% of children on the continent, reside within 50 kilometres of an air pollution monitoring station. So how can we change what we are not even measuring? This is what we need to tackle,” she said.

In response, she created the ‘Urban Better’ initiative which aims to act on what Oni describes as the three main leverage points for healthier cities: clean air, healthy spaces and places for physical activity and access to healthy, nutritious foods.

In particular, policymakers need to be thinking about public spaces that enable people to exercise and move about safelyas part of health equity, Oni said.

“We say… okay, how do we think about open infrastructure as critical health infrastructure, and so we work through the air we breathe, our places and spaces, and the food we eat as three critical pathways through which we can create health in the context of climate vulnerability,” Oni said. 

She explains that by addressing air quality, as well as the physical “spaces and places” where people move about,  the rampant rise in non-communicable diseases can be addressed.  

“We know that leisure physical activity has additional benefits, both physical and mental well being. In the same cities, we’re seeing that physical activity is not something that is supported,” she lamented. 

“But what we spend a lot less time on is looking at the built environment that needs to support but it’s currently largely poorly optimized for this. So we really need to start thinking about moving from individual awareness to a supportive environment,” she added.

Citizens for clean air

With respect to clean air, in particular, Urban Better has spun off youth action groups in Cape Town, Lagos and Accra, which have engaged in fact-finding around air pollution in their communities to design solutions they can advocate to local officials. 

The initiative also engages youths by giving them portable air quality devices that they can use to collect air quality data in their neighbourhoods as they run. The participants post the data on an interactive platform. 

Participants then post the data on an interactive platform and use it to generate key messages at the local level and engage with their peers and local leaders to find solutions. 

Professional athletes have been a part of the initiative and one of the youth made it to the climate summit COP27 last year, taking their advocacy to the global stage. 


“They used those data stories to generate key messaging that they then used to then re-mobilize the the peers,” Oni said. “[They were] Pushing towards increasing that demand for clean air and you can see how that connects to both inspire and conspire really trying to build this community.” 

In identifying pollution sources, the groups also take to the streets on bicycles and with wearable pollution monitors to identify pollution hotspots. 

In video clips of their findings, the same sources reappear over and over again, with dirty vehicles topping the charts from Cape Town to Lagos.  Waste burning takes second place, while traditional wood-burning cookstoves and dust from roads,  construction and natural sources, come third. 

‘Majority Demographic’

Urban Better’s interactive data platform in action in Cape Town, South Africa.

Oni spoke of the immense readiness among the youth to get involved in solutions, stressing that their potential has not yet been fully harnessed. 

“My experience is that there is just so much hunger and so much drive to be part of the solution,” Oni said. “We do ourselves a disservice when we simply pat ourselves on the back by engaging youth to say, ‘Oh, look how good we are, we engaged.’ 

“They have so much more to contribute,” Oni added. “I say this every time I speak right we’re particularly on the African continent, we really have to front and centre the majority demographic.”

To curb waste-burning, look to women, youth and vulnerable groups

Dr. Andriannah Mbandi, Lead, Waste, UNFCCC Climate Champions speaks remotely about how waste management is also an issue of equity.

Air quality is an equity issue. Poorer communities, women and those in developing countries are the worst-affected. Solutions too, the speakers agreed, have to engage women, youth and vulnerable communities.

“If you know anything about waste in Africa and a lot of developing regions, you will understand that the informal sector provides waste services and provides almost all waste management on the continent,” said Dr. Andriannah Mbandi, who leads the waste programme at UNFCCC Climate Champions. “That means if you’re looking at waste, curbing waste mismanagement, you need to look at women, youth and vulnerable groups.”

Waste contributes to about 12% of greenhouse gases, 20% of methane, and 11% of black carbon globally. Open waste burning also contributes about 29% of fine particulate matter emitted annually, Mbandi said to point out the link between waste, air pollution and climate change.

Need for flexibility, no magic bullet

Gillian Holmes, programme director at the Clean Air Fund, asked those attending what they’d recommend funders to consider in awarding grants. 

Oni said flexibility is the key. “We can’t have a very prescriptive and linear approach to building for investing in clean air. So we have to create the space for unintended and unanticipated urges and allow that pivoting to happen.” 

Sergio Sanchez,  senior policy director of the Global Clean Air, Environmental Defense Fund agreed, adding that there is no catch-all solution to the problem of air pollution. 

Lagos Youths Cycle for Clean Air in ‘Urban Better’ event

“One of the lessons is that there’s no silver bullet,” Sanchez said speaking remotely from Mexico. “It’s a long term effort. All institutions need to be aligned across the society.”

The key ingredients are a strong social advocacy and political will, and that funders “be consistent and allocate the resources to cities, to countries to address this issue,” he said. 

Sanchez spoke on the example of Mexico City, where strong public advocacy helped trigger political action on key pollution drivers that has significantly improved air quality over the past decade.   

Children among the most vulnerable groups

Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, in the United Kingdon.

While most premature deaths from air pollution occur among older people, children are also among the most vulnerable groups. Many die or suffer through lifelong impacts from polluted air, said Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, in the United Kingdon. 

The impact of air pollution on children has become a major issue in the United Kingdom following the death of 9-year-old Ella Kissi-Debrah from asthma in 2013. Ella later became the first person to have air pollution listed as a cause of death following a protracted legal battle by her mother, Rosamund Adoo-Kissi-Debrah, who has since set up the Ella Roberta Foundation to advance the cause of air quality.

“There’s now plenty of evidence to link air pollution with infertility, miscarriage, prematurity and intrauterine growth restriction,” said Kingdon. “A study published just last month by teams at King’s College and Imperial College London showed that air pollution directly impacts the development of a new-born brain in a negative way.”

Kingdon also spoke of the links between air pollution, poverty and race. 

“If you grow up in poverty, you’re much more likely to be exposed to poor air quality. And in a study last month from Harvard, researchers were able to confirm the link between air pollution causing death, and poverty,” she said.

The study done in the US found that Black Americans are exposed to higher levels of air pollution every year compared to White Americans, and thus likely to be more prone to its health effects. 

Become Air Pollution “Terminators”

Dr Maria Neira, Director of Environment, Climate Change and Health at WHO.

Neira, meanwhile, called upon participants in the session to become “air pollution terminators” and play a more active role in pressing policymakers.

“Anything we can do to mitigate the causes of climate change will be generating massive results in terms of public health,” Neira said. “Unless our citizens understand that this is an issue we will not be able to put pressure on our politicians.”

WHO first took up the air pollution issue in 2015, when it passed a landmark resolution “Health and the environment: addressing the health impact of air pollution”.

The resolution identified 13 measures that member states should strive to implement, including more continuous monitoring of air pollution levels; public awareness-raising; stricter air pollution standards; and mitigation measures.  

Since that time, more and more member states are monitoring air quality with some 6000 monitoring sites reported in WHO’s last update.  But significant gaps still exist, particularly in sub-Saharan Africa where few monitoring stations exist.

Air pollution
Mounting scientific evidence on the adverse health effects of air pollution shows cutting PM2.5 concentrations would save the lives of millions.

Despite global efforts to tackle the issue, air pollution deaths overall have not declined significantly. While there are now positive signs of transition to cleaner household fuels in South Asia and Sub Saharan Africa,  ambient (outdoor) air pollution continues to rise in many developing cities, seeing rapid population growth, and along with that, soaring traffic and waste management issues due to uncontrolled sprawl.  

The trajectory is not only deeply worrisome from a health standpoint but also from a climate perspective, insofar as the major sources of air pollution also are climate polluters. 

Traffic, coal, oil and gas power generation, waste burning and fires all emit huge amounts of planet warming CO2 as well as methane, black carbon, and ozone precursors, which are short-lived climate pollutants (SLCPs).  Cleaning up SLCPs would also generate quick wins for climate as their lifespan is measured in weeks to decades, as compared to centuries for CO2, pointed out Borgford-Parnell.  

“Here [at WHA] we are talking about addressing the causes of those diseases and air pollution is one of the big causes of the problem,” Neira concluded. “The multi-sectoral approach is needed.”

Health Policy Watch was a co-sponsor of this event along with the Clean Air Fund and the Climate and Clean Air Coalition. 

Image Credits: Clean Air Fund , US Mission Geneva .