The INB in session during negotiations in June 2023.

Members of the Intergovernmental Negotiating Body (INB) face another sleep-deprived week as talks on the World Health Organization’s (WHO) pandemic agreement resumed on Monday and run until Friday.

There are many outstanding articles and little prospect that the agreement will be completed in time for the World Health Assembly (WHA) next week, but participants hope that the broad outlines of the agreement and the way forward will have been reached by Friday.

Whatever agreement is reached needs to be tabled at the WHA, which will decide on the way forward.

There is already a proposal on the table for two key and complex aspects of the pandemic agreement –  One Health and a pathogen access and benefit-sharing (PABS) system – to be decided on by 2026.

INB co-chairs told reporters after what was supposed to be the last meeting on 10 May that member states were finally entering into the give-and-take spirit of talks after two years of little compromise.

“The closer you get to the endpoint, the more willingness there is to move. We worked very hard and deep into the night, but there’s just so much so many issues that we need to agree upon and which are sometimes very technical or political,” said INB co-chair Roland Driece.

“I think this is the last mile,” added co-chair Precious Matsoso, who said that One Health, PABS, intellectual property and human resources had preoccupied delegates.

This week’s agenda (see below) is focused on the key articles on which there is not yet agreement:

Common definitions

At least part of Monday’s talks, on definitions, will be helped by the agreements reached by the Working Group on amendments to the International Health Regulations (WGIHR). The IHR and the pandemic agreement will use the same definitions.

The WGIHR worked until the early hours of Saturday morning, agreeing “in principle on a large, ground-breaking package of amendments” to the IHR, according a media statement from  WHO.

“These amendments build on over 300 proposals made by countries in the wake of the COVID-19 pandemic. They set out to improve the ability of countries to prepare for, detect and respond to Public Health Emergencies of International Concern (PHEICs), and will be part of a package to be put forward to the World Health Assembly (WHA),” 

WGIHR members are due to meet again this week to “wrap up their work on the few remaining issues that need to be finalised”, according to WHO.

A few disagreements on technology transfer and finances prevented the end of the process, according to sources.

WGIHR co-chair Ashley Bloomfield still hopes to reach an agreement on what to present to WHA, but it’s hard to imagine when his committee will have much time as many are also on the INB.

‘Robust’ IHR amendments

“Amending the International Health Regulations reflects the critical need to bolster our collective defences against current and future public health risks, all whilst firmly adhering to the principle of national sovereignty and respecting equity,” said WGIHR co-chair, Dr Abdullah Assiri.

“We have coalesced around a robust set of amendments which will make international cooperation more effective and easier to implement.”

The IHR were first adopted by the World Health Assembly in 1969 and last revised in 2005, to manage public health outbreaks and emergencies. All 194 WHO Member States plus Liechtenstein and the Holy See are party to the IHR. 

“The International Health Regulations have served the world well for nearly 20 years but our collective experience in using this vital tool for the management of multiple public health emergencies, including the COVID-19 pandemic, has demonstrated important areas in which they could be strengthened for the benefit of all 196 State Parties,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“Countries have come together around improved international mechanisms to protect every person in the world and future generations from the impact of epidemics and pandemics, with a commitment to equity and solidarity.”

Amending the IHR and developing a pandemic agreement are complementary processes.

“The IHR focuses on building countries’ capacities to detect and respond to public health events which could take on international dimensions, whilst the draft pandemic accord focuses on a coordinated international response to pandemics, with equitable access to vaccines, therapeutics and diagnostics at the centre,” according to the WHO.

Image Credits: WHO.

Testing bacteria for resistance to antibiotics at the Liverpool School of Tropical Medicine

The World Health Organization (WHO) has updated its list of antibiotic-resistant bacteria that pose the greatest threat to human health, ranking the 15 families of bacteria that feature as “critical”, “high” and “medium” threats. 

The Bacterial Priority Pathogens List (BPPL) 2024’s “critical” list features bacteria that are high burden, can resist treatment and spread resistance to other bacteria.

A new entrant on the “critical” list is a third-generation cephalosporin-resistant Enterobacterales. It joins tuberculosis resistant to rifampicin, and gram-negative bacteria resistant to last-resort antibiotics.

Gram-negative bacteria have built-in abilities to find new ways to resist treatment and can pass along genetic material that allows other bacteria to become drug resistant as well.

“The list provides guidance on the development of new and necessary treatments to stop the spread of antimicrobial resistance (AMR),” according to the WHO

AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to medicines. It is driven largely by the misuse and overuse of antimicrobials.

High priority bacteria include fluoroquinolone-resistant salmonella and shigella; gonorrhoeae that is resistant to third-generation cephalosporin and/or fluoroquinolone, and Staphylococcus aureus that is methicillin-resistant

“Antimicrobial resistance jeopardises our ability to effectively treat high-burden infections, such as tuberculosis, leading to severe illness and increased mortality rates,” said Dr Jérôme Salomon, WHO’s Assistant Director-General for Universal Health Coverage.

Not enough support for new drugs

But there is not enough support for the development of new antibiotics, according to a new report released this week by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)

The report reviews the antibiotic pipeline data against bacterial pathogens identified by the WHO and other public health agencies as of the greatest concern. 

Only 10 new antibiotics or combinations were approved by stringent regulatory authorities between 2017 and 2023, and only two of these are defined as innovative by the WHO. None constitute a new class of antibiotics. 

There is currently just one antibiotic candidate in Phase III clinical trials across the four bacterial pathogens defined as a critical priority by WHO. Only two of the seven high-priority pathogens have innovative candidate antibiotics in development, with five having three or fewer candidates at any stage of clinical development.

James Anderson, IFPMA’s Executive Director of Global Health acalled for “urgent action” to reinforce the pipeline of antibiotics and protect the world from rising drug resistance. 

“Robust pull incentives are crucial in encouraging the research and development investment needed, and by demonstrating the impact that these can have, this report underscores the economic and health imperative for governments to act boldly in a year when the UN is focused on combatting AMR,” said Anderson.

Using predictive health intelligence and data analytics experts from Airfinity, the report found that, if no new incentives are introduced that could encourage investment into antibiotic R&D, the pipeline will continue to decline, delivering only eight approvals by 2033. Under this scenario, in 10 years’ time, the pipeline is expected to contain 26 treatments, of which only 6 are in late stages of development.

However, if “effective incentives” are introduced by 2025, 19 new antibiotics could be approved and a pipeline of 72 treatments in 2033.

Some of the examples the IFPMA cites as promising incentives include a novel subscription model being rolled out in the UK. This involves paying companies a fixed annual fee for antimicrobials based primarily on their value to the National Health Service (NHS), as opposed to the volumes used. 

Last year, Japan announced that it will pilot a revenue guarantee model to help subsidies companies that work to address AMR.

 

However, the IFPMA wants a global model to reward the successful development of new antibiotics. 

“There needs to be a level of global coordination and enough countries involved to make sure that the total economic package is sufficient to attract the necessary R&D investment,” according to the IFPMA.

Image Credits: DFID/ Will Crowne, IFPMA.

Processed foods are a major drive for excess salt consumption.

More than one in three adults in WHO’s European Region aged 30-79 has hypertension, or high blood pressure – and a key factor is excess consumption of salt, according to a new WHO report published this week.

The report “Action on Salt and Hypertension,” calls on governments to take “mandatory” measures to reduce the public’s salt intake, including much tougher limits on the salt content of processed foods.

“From the food industry’s perspective, high-salt foods tend to yield the most profit,” states the WHO press release accompanying the report. “But the fact is that these foods put customers’ health at risk. Population-level salt reduction through mandatory reformulation produces rapid results, is feasible, is cost-saving and ultimately saves lives.”

Cardiovascular disease, including hypertension, ischaemic heart disease and related ailments, currently kill some 10,000 people a day in WHO’s European Region, which includes some 53 member states from Great Britain to central Asia.

According to the new report, produced by WHO’s European Regional Office, men are almost 2.5 times more likely to die from cardiovascular diseases (CVDs) than women.  And the probability of premature death (30-69) from CVDs is almost five times higher in eastern Europe and central Asia as compared to Western Europe.

And 52 out of 53 countries in the European Region have an average daily salt intake above the WHO recommended maximum level of 5 grams (around one teaspoon) per day. The highest levels of salt consumption are in central Asia, the Russian Federation and eastern Europe. Tiny Malta is the sole country meeting the WHO guidelines.

Malta is the sole country in the 53 member European Region that meets WHO guidelines for salt intake.

“CVDs and hypertension are largely preventable – and controllable,” said Hans Kluge, WHO Regional Director for Europe. “Four million, a staggering figure, is the number of deaths caused by cardiovascular diseases every single year – primarily in men, particularly in the eastern part of our WHO region.

“These are the facts, but this is something we can change….. Implementing targeted policies to reduce salt intake by 25% could save an estimated 900 000 lives from CVDs by 2030.”

‘Opposing fundamental interests’

Street food and processed foods are amongst the leading culprits of excess salt consumption, the WHO report concludes. And therefore “regulating the amount of salt in processed foods has the potential to have a positive impact on people’s health.”

The report recommends that governments therefore introduce mandatory policies to reduce salt intake – including tougher limits on the amount of salt permitted in common processed and manufactured foods; on foods prepared and sold to the public in canteens and food outlets; as well as better labelling of foods sold to consumers in groceries.

“Reducing salt at population level highlights the opposing fundamental interests of public health and the food industry,” the report states.”From a food industry perspective focused on profit, salt contributes to food safety by increasing shelf-life and is a cheap way to make food more palatable.

“In addition, the body gets used to the taste of salt and craves food with a higher salt content. It is these high-salt foods that tend to yield the most profit. In contrast, the public health perspective is focused on the significant health and economic costs to society caused by high salt intake.

“The food industry can lobby for limiting reductions in salt, sugar and fat content of food, as well as influence the private health sector which may have less interest in prevention if payment is based on treatments provided. When facing industry opposition, it is important that policy-makers remember that population-level salt reduction through reformulation produces rapid results, is feasible, is cost-saving and ultimately saves lives.”

Image Credits: WHO/S. Volkiv, WHO/Action on Salt and Hypertension.

Delegates at a WHO intergovernmental negotiating body meeting.

The latest draft of the World Health Organization’s (WHO) pandemic agreement, which was sent out to member states on Wednesday (15 May), shows just how far the talks still have to go.

Health Policy Watch obtained a copy of the draft agreement, which we are sharing on our paywall-free site:

READ: Latest Pandemic Agreement Draft, reflecting progress up to 10 May

Around a third of the text is still white, indicating either that it has not been agreed on or not even discussed. According to a stakeholder briefing, there were some 300 paragraphs to negotiate on at the last meeting of the Intergovernmental Negotiating Body (INB).

However, some of the most significant articles are awash with yellow and green highlights, indicating progress.

Yellow means the text has been agreed to in a working group. Green means it has been agreed to in the plenary of the Intergovernmental Negotiating Body (INB).

Chapter 1 (Articles 1-3), dealing with aims and definitions, is largely white text but unlikely to take much time to reach agreement on.

Chapter 2 (Articles 4-20) is operation room of the agreement, dealing with equity throughout the chain of pandemic prevention, preparedness and response

One Health (Article 5) is mostly yellow.

Article 11 (technology transfer and know how) is also largely yellow, but there are a number of brackets around phrases such as “voluntary”.

The controversial Article 12 on pathogen access and benefit-sharing (PABS) is a mass of yellow and green.

A new addition to the PABS Article, which is neither yellow or green, is the proposal that, during a “public health emergency of international concern (PHEIC) or pandemic emergency”, manufacturers party to the PABS system “grant to WHO royalty free, non-exclusive manufacturing licences, that can be sub-licensed to manufacturers in developing countries for the production of vaccine therapeutics and/or diagnostics”.

Articles 7, 14, 18, 19 and even 20, on sustainable finance, seem close to agreement.

Chapter 3 (Articles 21-27) on institutional arrangements and final provisions, is largely agreed on.

The INB Bureau has also decided on a timetable for the final talks, with virtual meetings set to be held from 20-24 May, ending two days before the start of the World Health Assembly (WHA) on 27 May:

If there is no agreement by the WHA, the INB will simply present the latest version of the agreement.

When the negotiations ended on 10 May, INB co-chairs Roland Driece and Precious Matsoso said the negotiations had finally started to make progress in the past two weeks.

“The closer you get to the endpoint, the more willingness there is to move. We worked very hard and deep into the night, but there’s just so much so many issues that we need to agree upon and which are sometimes very technical or political,” said Driece.

“I think this is the last mile,” said Matsoso, adding that One Health, PABS, intellectual property and human resources had preoccupied delegates.

But at this stage, it is unclear just how long this “last mile” will be – whether INB delegates will be able to get something together before this World Health Assembly, starting on 27 May, or whether it will need to be stretched to another date months or even a year down the line.

Image Credits: WHO.

Tanzania’s President Samia Suluhu Hassan and Norway’s Prime Minister Jonas Gahr Støre (centre) co-chaired the summit.

In a ground-breaking move, global leaders on Tuesday made an unprecedented financial pledge to tackle the dirty cooking fuels crisis, which silently claims millions of lives across Africa. 

The Summit on Clean Cooking in Africa, chaired jointly by the leaders of Tanzania and Norway, alongside the African Development Bank, secured financial commitments from governments, development institutions and companies. 

The summit was co-hosted in Paris by the Clean Cooking Alliance (CCA) and the International Energy Agency (IEA). 

This was the largest amount of money to be pledged to clean cooking energy at a single gathering, and earmarked for a continent where four in five people still cook on open fires. As such, the summit was billed as a potential turning point for Africa, and particularly African women who shoulder much of the health burden from cookstove pollution.

Lack of access to clean cooking affects over two billion people globally, with over half living in Africa, often reliant on open fires and rudimentary stoves, fuelled by charcoal, wood, agricultural wastes and animal dung. 

In Africa, more than 850 million people still depend on wood and charcoal for cooking, the leading cause of indoor air pollution, with devastating effects on health. 

In fact, toxic indoor smoke is the second biggest cause of premature death in Africa, predominantly affecting women and children. Household air pollution causes nearly half of pneumonia deaths among children under five years of age.

Impact on women

“Successfully advancing the clean cooking agenda would contribute toward protecting the environment, climate, health, and ensuring gender equality,” Tanzanian President Samia Suluhu Hassan told the summit in Paris.

Hassan has called for the generous replenishment of the African Development Fund, which  includes $12 billion for clean cooking with the goal of ensuring clean cooking for all by 2030.

“Insufficient funding and a lack of awareness about the economic opportunities within the clean cooking industry hamper efforts to scale interventions,” she said.

Hassan cited three major challenges facing clean cooking in Africa, including the lack of access to adequate, affordable and sustainable solutions, lack of global attention to the problem and the absence of smart partnerships to ensure clean cooking access for all.

“Amidst these challenges, central to Tanzania’s own commitment is delivering on or recently-launched 10-year Clean Cooking National strategy, which aims to ensure 80% of Tanzanians use clean cooking solutions by 2034,” she said.

Norwegian Prime Minister Jonas Gahr Støre said his country will invest approximately $50 million to support clean cooking energy.

“Improving access to clean cooking is about improving health outcomes, reducing emissions, and creating opportunities for economic growth,” he said.

Respiratory and cardiovascular diseases

The global clean cooking energy campaign received a boost at the United Nations Climate Change Conference in the United Arab Emirates (UAE) in November last year with the launch of the African Women Clean Cooking Support Programme(AWCCSP) which aims to provide clean cooking technologies to women and girls in Africa to reduce the use of firewood and charcoal.   

Dirty cooking causes respiratory and cardiovascular diseases, increases planet-heating emissions, and robs women’s of their time, experts said at the conference.

IEA Executive Director Fatih Birol emphasized the significance of the Summit’s outcome. “This summit had delivered an emphatic commitment to an issue that has been ignored for too long” Biro states, underscoring the potential of the $2.2 billion commitment to support  fundamental rights such as health, gender equality and education, while also mitigating emissions and restoring forests.

Akinwumi Adesina, President of the African Development Bank Group, announced plans to increase financing for clean cooking to $200 million annually over the next decade, while also scaling up the provision of blended finance for clean cooking through Sustainable Energy Fund for Africa(SEFA).

“We are delighted to play a leading role… to definitively tackle lack of access to clean cooking, that affect a billion people in Africa,” he said.

Mary Robinson, former president of Ireland, arrives at the summit.

Following the Summit, the IEA announced plans to employ a “double-lock system” to ensure sustained momentum behind clean cooking efforts.

This system entails effective tracking methods to ensure pledges and commitments are fulfilled, alongside continued efforts to engage more partners and generate additional funds to meet the $4 billion annual capital investments required until 2030 to achieve universal access to clean cooking in sub-Saharan Africa.

More than 100 countries, international institutions, companies, and civil society organizations signed The Clean Cooking Declaration, reaffirming their commitment to prioritizing the issue and enhancing efforts toward achieving universal access for all.

Nearly one in three people globally still use open fires or basic stoves for cooking thus causing untold health damage, lower living standards and widening gender inequality, according to IEA report titled, A Vision for Clean Cooking Access for All.

 Women suffer the worst impacts from the lack of clean cooking. The burden of fuel collection and making meals typically falls on women and takes on average 5 hours a day.  

 “Clean cooking is a topic that rarely hits the headlines or makes it onto the political agenda,” said Birol. “And yet, it’s a cornerstone of global efforts to improve energy access, gender equity, economic development and human dignity,”

Former President of Ireland, Mary Robinson, cautioned against unfulfilled promises.

 “We need to know what kind of new money is coming in and how it will be spent. We have to test everything these days, as so many promises are made and not fulfilled,” she said.

“The fact that 900 million women in Africa still cook on dirty stoves should not be tolerated in the 21st century,” Robinson asserted.  “And to hear it only requires $4 billion, with $300 million being allocated each year for the next few years. Isn’t that very doable?”

Scientists have concluded that heatwaves in April across Asia were made more frequent and intense due to climate change.

Heatwaves across Asia this April that sent temperatures soaring above 40℃ were made hotter and more likely by human-induced climate change, according to an analysis by an international team of leading climate scientists from the World Weather Attribution (WWA) group.

The group has done more than 70 studies on a range of extreme weather events around the world so far. 

Heatwaves exacerbated conditions for internally displaced people across West Asia, especially 1.7 million displaced Palestinians in Gaza, and affected daily life in South and Southeast Asia, the analysis said. 

Millions of people who live in informal housing and work outdoors, like farmers, construction workers and street vendors are disproportionately affected by extreme heat. 

“Climate change is bringing more days with potentially deadly temperatures to Asia every year,” said Mariam Zachariah, Researcher at the Grantham Institute – Climate Change and the Environment, Imperial College London. “Unless the world takes massive, unprecedented steps to reduce emissions and keep warming to 1.5°C, extreme heat will lead to even greater suffering in Asia.”

This April in South and Southeast Asia, Myanmar, Laos and Vietnam broke temperature records for their hottest April day, and the Philippines experienced its hottest night ever. In India, temperatures reached as high as 46℃. The heat was also extreme in West Asia, with Palestine and Israel experiencing temperatures above 40°C.

April 2024 was also the hottest April on record globally, scientists said.

The heat has already been fatal. So far at least 28 heat-related deaths have been reported in Bangladesh, five in India and three in Gaza during the month of April, while surges in heat deaths have also been reported in Thailand and the Philippines this year. Given that the health systems are still not equipped to capture heat-related deaths, these figures of deaths are likely undercounts.

The heat has also led to crop failure, loss of livestock, water shortages, mass die-off of fish, widespread school closures, and has been linked to low voter turn-out in India’s on-going national elections.

Heatwaves are more frequent

Heatwaves with temperatures above 40°C are now more frequent in West Asia due to the warming caused by human activities, the scientists at WWA concluded. Climate change made heat about five times more likely and 1.7°C hotter in the region. Such extreme temperatures in West Asia could become more frequent and intense if global temperatures continue to rise.

Currently, the planet has warmed nearly 1.2°C on average compared to the pre-industrial era though it has breached higher temperature marks on several occasions. Scientists at the WWA said that if the global warming reaches 2°C, as they are expected to in the 2040s or 2050s, unless emissions are rapidly halted, similar heatwaves will occur about once every five years and will become another 1°C hotter in West Asia.

In the Philippines, climate change made this year’s heatwave 1°C hotter, while the El Niño effect, which is a global climate phenomenon, made the heatwave a further 0.2°C hotter. If global warming reaches 2°C, similar heatwaves in the Philippines will occur every two to three years and will become another 0.7°C hotter. 

In South Asia, similar 30-day heatwaves can be expected to occur once every 30 years. However, they have already become about 45 times more likely and 0.85°C hotter due to climate change.

In West Asian countries and territories of Syria, Lebanon, Israel, Palestine and Jordan, climate change made heatwaves about five times more likely.

Scientists said that the impact of the heat will depend on how well societies are able to deal with small changes, and how much temperature fluctuation a place is used to. 

“If you have cold years and hot years on a regular basis, your societies are much more adapted to changes in temperatures. Whereas if you usually have a relatively stable climate with temperatures always the same year to year, and also often all year round, which is in more tropical regions, then changes even if they are smaller are much more dire,” explained Friederike Otto, senior lecturer in Climate Science at the Grantham Institute at Imperial College London. 

Heatwave-air pollution interplay

The analysis covers South Asia that has the most number of polluted cities in the world, and where air pollution levels are deadly. While it did not take into account the impact of air pollution, scientists acknowledged the interplay and that the scale of impact will become clear in the near future.

“We know from research that air pollution compounds heat risks. And we also know that a lot of these cities have really high and dangerous levels of air pollution. So we have to wait for some time before we can say something more about the scale of impacts that we’ve seen on health during these events,” said Carolina Pereira Marghidan, climate risk consultant at the Red Cross Red Crescent Climate Centre, and researcher at the Royal Netherlands Meteorological Institute.

“It is clear that air pollution and heat together create really heightened risks to health for people,” she said, answering a question from HPW during an online press conference.

Low-cost solutions 

As global temperatures continue to rise, communities, especially those in extreme distress are being forced to resort to low-cost solutions, scientists said. 

“Last year during heatwaves for example, across Syria, people have taken some actions to alleviate the pressure that heat is causing and they usually involve the use of water and shade where possible. But mostly water. So, for example, wearing clothes or of course staying hydrated are really important measures to take during the heat. I’ve also read reports that people have put damp cloths over their tents to reduce indoor temperatures,” said Marghidan.

“One of the most important things is to inform people that heat waves are coming, but they are dangerous. And just remind people of the measures that are available,” Otto said. 

She elaborated that providing access to drinking water is the most effective way to reduce the distress caused by extreme heat. Improving shade and rebuilding cities to have well-insulated homes and lots of green spaces are other ways to respond, she said. 

Image Credits: Unsplash, WWA , WWA.

Siv Mey, 16, does a reading test and experiments with different lenses for her first pair of glasses in Cambodia.

It’s one of the world’s oldest health technologies with recorded use by the Greeks and Romans – and modern eye glasses appearing on the noses of Venetian monks and scholars as early as the 13th century. 

And yet only about 36% of the estimated 1.25 billion people who need corrective eyewear for common distance vision impairments actually have a suitable set of glasses today, according to the latest WHO data. 

And that leaves some 800 million children, adults and older people struggling to study, work and perform basic life tasks safely, effectively and unaided. 

On Tuesday, a new WHO global effort that aims to change all of that launched at WHO headquarters in Geneva. The SPECS 2030 initiative aims to increase access to corrective eyewear for common vision problems like short-sightedness by 40% by 2030. 

Its engine of action includes a new WHO-hosted Global SPECS network, including some 31 intergovernmental agencies, philanthropies, and NGOs – which have committed to bring down costs and ensure better access to eyesight services, particularly at the community and primary health care level. 

WHO’s 40% aim for increasing coverage of eyecare services for refractive error (e.g. short- and near- sight) would move the world from just 36% to 76% coverage by 2030.

SPECS 2030 – Reinventing Access to an Ancient Health Technology  

WHO’s Bruce Aylward

While hundreds of millions of people lack access to basic corrective eyewear, “if you live in a high-income country you are six times more likely to have access to corrective lens than low-income countries,” said Bruce Aylward, a senior WHO advisor who opened the two-day meeting of WHO member states,  NGOs and other network partners. 

“And men are more likely to wear corrective lenses as compared to women – so there is a gender element as well,” Aylward pointed out. 

“It’s not acceptable that a child has difficulty in school or a parent has trouble doing their job because they don’t have this simple tool,” added WHO Director General Dr Tedros Adhanom Ghebreyesus, in a pre-recorded message to the meeting.

Jane Waithera, who was born in a small Kenyan village, with alibinism that made her severely myopic as well as photophobic, described how she had trouble even seeing the cows while guiding her grandmother’s herd as a small child. 

“I would struggle to keep my eyes open when I walked outside,” she related.  “Sometimes the cows would get lost and I couldn’t find them.”

One mobile clinic with services was life-changing 

Jane Waithera, Kenya, would struggle to see the cows while herding as a child.

Waithera, now a disability and inclusion entrepreneur, also recalls the “life-changing” moment when someone in her village told her “you have low vision”.  Soon after that, a mobile clinic came to town. It happened to offer a basic eye test – and she got her first pair of reading glasses. Lifechanging, but still only a first step. 

“They did not help me outside, she observed, recounting the pain she endured in sunlight. “So it was not a comprehensive pair of glasses that met all of my essential needs,” she said. 

Subsequently, she had to travel five hours one way to get to an eye hospital where she could do more extensive tests.  

 “And then there was the cost of buying spectacles.” she remarked, “And if I have to wear transition lens that I can use inside and outside, they are more costly.”

All of that left her with the indelible conviction about the importance of expanding eye care services at primary health care level. 

“You can imagine if this more comprehensive screening had been available in my local village – how much time and travel that would have saved me,” she said. “And my village is not even that remote. 

“And unfortunately, the situation is still the same today,” she remarks noting that while the same basic services exist in the mobile clinic that visits her hometown village – it is no more comprehensive than when she was 10-years-old. 

Nor has eye care yet been incorporated as an “essential service,” in Kenya’s milestone new national public health insurance scheme. And that leaves people and families to bear the high costs of tests and eye glass purchases on their own. 

Boosting capacity at primary care level  

(Left to right) Dr Nor Fariza Ngah, Malaysia; Warapat Wongsawad, Thailand; and Vinayak Prasad, WHO discuss the diversity of national eye care challenges and policies.

That’s a norm in many parts of the world – where the cost of eyeglasses must be borne by out-of-pocket by individuals or through private health insurance schemes, WHO officials say.  

Even in an upper middle-income country like Malaysia, where there is a significant professional capacity and a robust array of government eye care services, people prescribed with corrective lenses still go to the private sector to purchase their glasses, said Dr Nor Fariza Ngah, a Deputy Director General in the Ministry of Health.  

“So this is where we see that the ecosystem might not be complete,” she said, speaking at the meeting. 

She agreed with Waithera that more comprehensive care also needs to be made available at the primary health level, saying: 

 “In some of the remote areas it can take three days of walking to see the eye care professional,” Ngah explained. “So if we have a one-stop center where they get screened, prescribed and dispensed the glasses immediately, then they can go back to their village and come back maybe six months or more later for monitoring. 

Finally, the issue of workforce capacity to deliver services needs to be addressed, Waithera said, pointing again to her own personal experience. 

“This clinic that I found at 10 years of age, I still find the same personnel in the clinic. But who is going to take the mantle when they retire? We need to increase the number of personnel.” 

Eye care may be first entry point to universal health coverage 

A group of women at a health clinic in Peru wait to have their vision tested.

Meanwhile, eyecare is not about glasses alone, stressed Alarcos Cieza, head of WHO’s unit for rehabilitation and disability in the Department of Noncommunicable diseases. 

“It’s about a whole range of services,” she said, with particular emphasis on the word “services”.  These include not only testing, diagnosing and treating so-called “refractive errors” – nearsightedness or farsightedness, but also for cataracts and other vision-related impairments and diseases, such as glaucoma. 

Conversely, cataract surgery, on its own may sometimes be insufficient to correct a person’s vision impairment if they lack a diagnosis and prescription for correct spectacles at the end of the procedure, said Stuart Keel, a WHO technical officer leading the SPECS initiative, describing how issues are intertwined.   

All in all, because it is such a fundamental sense, vision issues may often be the “very first door” through which many people may be motivated to get a broader health check. This, in turn, may lead to the identification of other underlying risk factures and health issues, said Warapat Wongsawad, an ophthalmologist at the Thai Ministry of Public Health. 

“In fact, SPECS may be the very first door that people check their health and integrate into the community levels of the health system,” he said, referring to the new WHO initiative.

About one-third of cataract surgeries have poor outcomes – and half of those outcomes are due to uncorrected refractive error – usually related to the lack of spectacles.

No one-fits all solution for countries 

Michael Gichangi, Ministry of Health, Kenya: building public awareness is also important.

While the new WHO initiative aims to tackle the full range of systemic issues impeding access to eye care, from diagnosis to affordability of spectacles, there are no one-size-fits-all solutions, speakers and participants at the event stressed. 

Not only are the health systems around eye care very diverse, but vision problems can differ widely by country. For instance, in some fast-developing Asian countries, an increasing percentage of children are now being diagnosed with myopia because they spend insufficient time outside in natural sunlight – which is essential for the development of distance vision capacity as they grow up. 

A recent study undertaken in Thailand pointed to this emerging problem, noted Wongsawand: “The study is very clear that we need more outdoor activity in the sunlight, maybe just an hour a day and it’s a very easy concept. 

“But it’s still very hard to tell the Ministry of Education to implement this and this is essential to  ensure the prevention and control of an epidemic of myopia in children.

In other countries, such as Kenya, spectacles for near-sightedness are still not universally available. And there is also a lack of awareness about the causes and solutions to vision impairment, said Dr. Michael Gichangi, an ophthalmologist in Kenya’s Ministry of Health.  

“People may think, for instance, that if you use spectacles for some time that will cure them and they won’t need them again,” he said.

Adapting goals to countries 

Stuart Keel (left) and Alarcos Cieza (right): a boom in childhood myopia in Asia versus low levels of access to reading glasses in some parts of Africa.

“In Asia we have a myopia boom – a huge number of children in the population, versus some places in Sub Saharan Africa where there’s still a very low average of access to simple reading glasses for near vision impairment,” said Keel. “So while we have developed these global desired outcomes, these of course need to be adapted to countries.”

A World Health Assembly Resolution, approved in 2021, makes it clear that access to eye-care is essential to attainment of universal health coverage (UHC) – with two main goals set for increased access to cataract surgery as well as to spectacles. 

Goals set by the World Health Assembly in 2021 for improving eyecare by 2030

And a key objective of UHC is integration of such services into public health systems, affordable and available to everyone, pointed out Silvio Mariotti, senior WHO manager in the NCDs Department. 

“But how to go about integration?” he asked. Taking cataracts as an example, he pointed out that more than 50% of cataract surgeries worldwide are performed by the private sector. 

“At the same time, that’s the overall number. In many countries, the majority of surgeries are done by the government sector, and in some high income settings, almost all are done by the private sector. 

“So while the ultimate aim is universal coverage, and global targets are necessary to move countries together toward a common goal, country level plans will decide what is feasible.”

-Correction: The initial version of this story quoted an official at the meeting stating that upwards of 500 million people who need corrective eyeglasses, lack access. The correct number is upwards of 800 million, according to WHO.  

Image Credits: Miguel Jeronimo – WHO, Stuart Keel/WHO, WHO / NOOR / Sebastian Liste Vision in Peru, 2018, WHO/Stuart Keel .

A novel vaccine is equipped with antigens of multiple types of coronaviruses, creating a fuller immunity.

Researchers have developed a new all-in-one vaccine aimed at priming the body to respond to a range of different strains of coronaviruses, including the ones not yet known.

The researchers from Cambridge, MIT and CalTech published their findings recently in Nature Nanotechnology. Their vaccine was successfully tested on mice and will likely enter human clinical trials in early 2025.

Rory Hills, the first author of the study, told Health Policy Watch. “We are keen to implement the […] technology outlined in this study to develop broad vaccines against other pathogen groups including influenza. We would at least aim to protect against large groups of influenza viruses if not fully universal flu vaccine.”

Proactive vaccinology, creating vaccines for pathogens that do not exist as yet, is a promising branch of science allowing for a swift response to possible pandemics.

“Our focus is to create a vaccine that will protect us against the next coronavirus pandemic, and have it ready before the pandemic has even started,” said Hills.

Chains of antigens

The vaccine’s key part are receptor-binding-domains (RBDs), the part of the virus that enables it to enter host cells. For coronaviruses, they are placed at the tips of the characteristic ‘spikes’ resembling a crown, to which the viruses own their name.

The RBDs attach to structures on the cell membranes of the host organism, allowing the pathogen to enter and  infect the cell. The body’s immune reaction involves specialised T-cells developing receptors which capture the virus’s RBDs before it can attach to healthy cells.

It’s the T-cell’s ‘memory’ of the specific ‘shape’ of the RBDs that they have already encountered counts as immunity gained with vaccination.

The new catch-all coronavirus vaccine’s key component is a whole chain RBDs coming from different varieties of coronaviruses, connected with the so-called ‘spy-tag,’ a nano-superglue connecting the antigens to form a chain.

Each chain of four RBDs, or a quartet, is attached to a nanocage, a ball of proteins held together by incredibly strong interactions, which makes the construction base of the vaccine.

Broad immunity new to health systems

The vaccinated organism learns to create a response to the included antigens and even other ones that are similar. Mice in the trial developed an immune response to SARS-Cov-1, the virus that caused a multi-continent outbreak in the early 2000s, even though that virus was not included in the vaccine.

“We’ve created a vaccine that provides protection against a broad range of different coronaviruses – including ones we don’t even know about yet,” Hills highlighted.

As proactive vaccinology is only emerging, there are no medical procedures in place to accommodate for it and enable vaccination programs.

It is “new from a regulatory perspective and we will need to work with governments and regulators to develop approval processes and determine the best implementation,” predicted Hills for Health Policy Watch.

Hills sees several possibilities for using the catch-all vaccine., including “a strong vaccine against COVID-19 with the added benefit of protecting against additional coronaviruses”.

Alternatively, and, Hills said, “more likely,” is to “have this vaccine and a small library of other similarly broad vaccines against other pathogen groups developed, validated, and are ready to implement.”

“In the event that a coronavirus or other pathogen crosses over you could have pre-existing vaccine stocks ready and a clear plan to quickly scale up production if needed.”

Image Credits: Nature.

Test tube rack stocked with electronic cigarettes.

A $3-million “educational” deal between tobacco giant Philip Morris International (PMI) and Medscape, a medical education provider for healthcare professionals, has been abandoned after the BMJ and The Examination exposed it last month.

The deal involved a PMI grant to Medscape to fund continuing medical education (CME) accredited courses on smoking cessation for doctors and other healthcare providers. 

With waning tobacco sales, PMI has moved into selling smokeless tobacco products and e-cigarettes alongside cigarettes.

However, Medscape has “bowed to pressure and agreed to permanently remove a series of accredited medical education courses on smoking cessation funded by the tobacco industry giant Philip Morris International (PMI)”, according to The BMJ.

“Medscape has acknowledged its ‘misjudgment’ in a letter to complainants and says that it will not accept funding from any organisation affiliated with the tobacco industry in the future,” the journal added.

When the exposé was first published, Professor Anna Gilmore, director of the Tobacco Control Research Group at the University of Bath, UK, said that Medscape had “now lost all credibility and has some serious questions to answer. PMI lost all credibility decades ago, despite its ceaseless and highly misleading attempts to rehabilitate its image. It has now sunk to a new low.”

A few years back, PMI established the Foundation for a Smoke-Free World headed by former World Health Organization (WHO) official Derek Yach to promote its tobacco-free products. 

The intention of the Medscape course appears to be to downplay the negative health effects of non-cigarette nicotine products.

“Medscape had planned to deliver 13 programmes under the deal—called the PMI Curriculum, according to the internal document. It had also planned podcasts and a ‘TV-like series’,” The BMJ revealed.

Medscape describes itself as “the leading online global destination for physicians and healthcare professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education and CME”.

The tobacco industry has a long history of sponsoring academics and research aimed at downplaying the negative impact of tobacco and smoking.

In its response to The BMJ, a PMI spokesperson said: “Health agencies around the world have recognised the beneficial role that smoke-free products can play to improve public health.

“We are concerned that known special interest groups are actively blocking medical education that the [US] Food and Drug Administration and medical community have determined are needed. These actions stand to prolong use and possibly increase consumption of combustible cigarettes – the most harmful form of nicotine use.”

But Professor Tim McAfee, former director of the US Centers for Disease Control and Prevention’s Office on Smoking and Health, ctold The BMJ that PMI’s partnership with Medscape “the ultimate example of the fox not only signing up to guard the hen house but offering to sit on the eggs.” 

“It is a perversion of ethics surrounding continuing medical education to allow the very companies that caused and profit from the continuing epidemic of tobacco-related death and disease to be involved in any way,” added McAfee, who is based at the Department of Social and Behavioral Sciences at the University of California in San Francisco.

Image Credits: Unsplash.

Ghana’s FDA headquarters

Ghana outlawed alcohol promotion by celebrities back in 2015, but a music promoter is challenging government in court to fight for his ‘right’ to advertise various brands.

Predatory commercial exploitation that encourages harmful activities has been identified by UNICEF and the World Health Organization (WHO) as one of the two main crises threatening the health and future of children in every country.

The other major crisis is the climate emergency that is rapidly undermining the future survival of all species. 

“Companies make huge profits from marketing products directly to children and promoting addictive or unhealthy commodities, including fast foods, sugar-sweetened beverages, alcohol, and tobacco, all of which are major causes of non-communicable diseases (NCDs),” wrote UNICEF and the WHO in The Lancet.

They advocate marketing limits on alcohol to protect children.

Yet celebrities are accelerating alcohol promotions. Jennifer Lopez, Ryan Reynolds, Dua Lipa, Emma Watson and are some of the many celebrities with endorsement deals with Big Alcohol or their own alcohol brands. 

They are promoting alcohol through their social media channels where they reach millions of children and young people.

David Beckham embodies the conflict between promoting child rights, health, and development on the one hand and making money through promoting and selling more alcohol on the other hand. He is both a UNICEF Goodwill Ambassador and collaborates with Big Alcohol giant Diageo.

Alcohol harm in Ghana 

In Ghana, the West African country of 33.5 million people, this conflict is playing out in public as a music producer has taken the government to court seeking to overturn a 2015 ban on alcohol promotion by celebrities.

In Ghana, children and youth are more protected from domestic and international celebrity alcohol promotions than kids in other countries because the country has banned celebrity alcohol advertisements. 

Ghana’s Food and Drugs Authority (FDA) is the regulatory authority tasked with implementing and enforcing this ban but it faces opposition from some celebrities in Ghana.

In 2016, according to WHO data, 74% of the adult population abstained from alcohol in the past year. But those Ghanaians (mainly men) who consumed alcohol, did so heavily. Around 7% of men had an alcohol use disorder and, on average, 13 litres of pure alcohol per man was consumed annually.

Almost half of all young boys between the age of 15 to 19 years who consume alcohol engaged in binge alcohol consumption in Ghana in 2016, according to a 2021 UNICEF Situation of Adolescents in Ghana report. 

Substance use among adolescents, particularly the use of tobacco and alcohol, is a public health concern linked to chronic health problems later in life, particularly  non-communicable diseases (NCDs). 

Ghana is facing a rising burden of NCDs such as diabetes, hypertension, and stroke among others, and health experts have linked this to unhealthy diets, cigarette smoking, alcohol use and physical inactivity.

Alcohol abuse has a serious impact on both the drinkers and communities.

Common-sense limits

In 2015,  the government decided to take action by placing common-sense limits on alcohol marketing, and Ghana’s Food and Drug Authority (FDA) implemented a ban on well-known personalities advertising alcoholic beverages aimed at  protecting children from being misled into thinking alcohol is normal and beneficial.

Most of  Ghana’s celebrities comply with the ban,  but there are notable exceptions who have expressed their opposition, including Wendy Shay, Shatta Wale, Brother Sammy, Kuami Eugene, and Camidoh. 

They are already using other forms of alcohol promotion, such as portraying alcohol in music videos and movies. They have spoken out against the ban and are using their considerable platforms to campaign against it. 

In November 2023, the Supreme Court heard a case brought by music producer Mark Darlington Osae, the co-founder of Ghana Music Alliance, against the Ghana FDA, aiming to revoke the celebrity alcohol promotion ban.

He claimed that that ban is discriminatory and unconstitutional, as it discriminates against celebrities.

Those celebrities who are pushing back against the policy also claim it has no effect in preventing consumption and only limits their income. 

On 8 May, the Supreme Court delayed the verdict on the case once again.

The issue is not new in Ghana. It was discussed in 2017 and in 2009, when Members of Parliament called on the regulatory authority to introduce measures to reduce alcohol advertisement to protect children.

The government, civil society and community groups across Ghana want to maintain the protections from children and youth being exposed to celebrity alcohol, and some celebrities are in full support of the ban.

Predatory practice or creative liberty?

Celebrity marketing of alcohol brands is not new in Ghana or around the world. 

“In 2018, it was estimated that about 40 celebrities were affiliated with alcohol brands, while today there are more than 350 celebrity affiliated brands worldwide,” wrote Chanelle Wilson in Croakey.

As celebrity-led promotion of alcohol is proliferating on digital platforms, alcohol brands find easier, tailor-made, and more harmful ways to directly reach impressionable and vulnerable young people. 

In Ghana, as well as in the wider African region, and around the world, the alcohol industry is investing in using more celebrity endorsements for alcohol brand promotions – and they need returns on those investments, meaning more alcohol sales, consumption, and profits. 

For countries like Ghana this means more harm and costs due to alcohol.

Given the state of Ghana’s developmental and public health challenges, celebrities could be using their platform to educate and spread health promotion messages, rather than engaging in “predatory commercial exploitation”.

Ghana might be an example of what countries can do. Better and internationally coordinated government-led regulation of alcohol marketing is needed, independent of the alcohol industry, to better reflect community standards and stop the bombardment of children and at-risk groups with alcohol promotions.

Labram Musah is Program Director at the Vision for Alternative Development (VALD), Ghana. VALD promotes alternative initiatives and support development at all levels of society by advocating for comprehensive policies on tobacco, alcohol, sugar-sweetened beverages, climate justice, road safety, and general health and well being.

Kristina Sperkova is the International President of Movendi International,  a global movement based in Sweden, with 150 member organisations in 60 countries that works for development through alcohol prevention. 

 

Image Credits: Artem Labunsky/ Unsplash.