Neurodegenerative

A new Lancet study of elite Swedish football players is the latest addition to a mounting pile of science linking high-level sports to the development of neurodegenerative conditions.

The observational study tracked over 6,000 male footballers in Sweden’s top professional league between 1924 and 2019. It found they were 1.5 times more likely to develop neurodegenerative diseases than their non-footballing counterparts.

Concerns about the impact of professional sports on the brains of athletes have risen sharply in the past decade. Alarm bells rung out over the American football world as early as 2007.

Yet before the publication a 2017 paper by researchers at University College London, only four (European) football players were known to have had chronic traumatic encephalopathy (CTE).

Today, that number is in the thousands.

Repeated head trauma

The Swedish study adds to observational data on a cohort of Scottish pro-footballers published in the New England Journal of Medicine in 2021, which found the athletes were three and a half times more likely to develop neurodegenerative diseases than the control group.

They were also three times more likely to have a neurodegenerative disease listed as their cause of death than an average person.

In both studies, overall mortality was found to be slightly lower among the footballers.

“While the risk increase in our study is slightly smaller than in the previous study from Scotland, it confirms that elite footballers have a greater risk of neurodegenerative disease later in life,” Peter Ueda, an assistant professor at Karolinska Institutet, the academic institution that ran the study.

“As there are growing calls from within the sport for greater measures to protect brain health, our study adds to the limited evidence-base.”

The “dose relationship”

While the academics differed on CTE risk calculations, both the Swedish and Scottish studies made an interesting observation: goalkeepers were at the lowest risk.

Goalkeepers, unlike outfield players, rarely head the ball. Repeated head impacts are believed to be the root cause of CTE, as they cause hundreds of small lesions within the brain that impair its function over time.

“It has been hypothesized that repetitive mild head trauma sustained through heading the ball is the reason football players are at increased risk, and it could be that the difference in neurodegenerative disease risk between these two types of players supports this theory,” Ueda said.

Experts from the Boston University Hospital Brain Bank who have been leading the charge on raising awareness of CTE in sports are more confident.

“The cumulative exposure to these mild repetitive head impacts is what we believe leads the player to a risk for CTE,” Dr Mary Ann McKee told the American Academy of Neurology. “In fact, in all our studies, if we look at the number of concussions, it doesn’t relate to CTE or CTE severity.”

The Swedish and Scottish studies also did not control for length of each athlete’s career, a factor which American researchers have found to be highly significant.

From ice hockey, to American football, to rugby, to bobsledding, no sport appears safe from the medical impacts of head injuries.

While the major concern over exposure to repeated head trauma is that it can lead to increased risk of neurodegenerative disease in the late stages of life, some die much earlier.

The recent deaths of two prominent American football players – aged 38 and 33 – are just two examples. As of May 2022, McKee said the brain bank had studied the brains of three athletes that died under the age of 34, indicating they developed their ALS in their 20s.

One died in his late 20s and two in their early 30s. One was a high school football player, another was a college football player.

The last was a semi-pro soccer player.

Image Credits: Albinfo.

Most people can’t afford to see a dentist because of the cost.

Global health leaders need to prioritize action against oral diseases – which impact nearly half of the world’s population.

While noncommunicable diseases (NCDs), which cause some 74% of all deaths, are getting increased attention from global health influencers, there is one elephant in the room that has received insufficient attention to date. Oral disease.

That’s despite the fact that oral diseases may be the most prevalent of all NCDs – affecting some 3.5 billion people, or nearly half the world’s population.

Notwithstanding some recent progress, political recognition of the need to adequately fund and respond to the public health implications of that disease burden remains painfully slow.

While we are finally seeing the leading NCDs, including, diabetes, cardiovascular and respiratory diseases, cancers and even mental health, in conversations at all levels of political discourse, oral health still falls off the agenda too often.

Today on World Oral Health Day, it is worth reminding our leaders of the significant challenge oral disease represents globally.

Worldwide oral diseases account for about 1 billion more cases than all five of the leading NCDs combined. An estimated 2.5 billion people suffer from untreated dental caries. Tooth decay can have all kinds of manifestations: it can make sleeping and eating painful and difficult, and over longer periods it can cause abscesses that convert into severe infections. On rare occasions, it can result in death. There’s a societal cost too: work and schooling can often be affected.

The occurrence of oral diseases, which are mostly preventable and treatable, is increasing globally, increasing by 50% over the past three decades. It’s a rate that outpaces population growth and occurs mainly in low- and middle-income countries.

Awareness growing – but not fast enough

The situation is changing – although not rapidly enough.

The adoption by World Health Organization (WHO) Member States of a historic inaugural  resolution on oral health at the World Health Assembly in 2021 drew an important line in the sand.

And the recent launch of the Global Oral Health Status Report (GOHSR) now gives for the first time considerably more accurate data on the global burden of oral diseases and unsurprisingly paints a picture of high disease burden amongst the most vulnerable and disadvantaged population groups within and across societies.

The recent development by the WHO of a comprehensive Global Strategy on Oral Health (2023-2030), with a bold vision for universal coverage of oral health services by 2030 was another milestone.

The plan, which is set to be adopted this year at the 76th session of the World Health Assembly, calls on governments to ensure that “80% of the global population is entitled to essential oral healthcare services.”

This would be achieved through, among other measures, countries prioritizing the integration of oral health into their national health services and ensuring there are enough trained dental health professionals. But this also implies making dental services affordable to those who need it.

Major constraints stopping so many people on low incomes from seeing a dentist include the lack of access to appropriate care and the catastrophic cost associated with the oral health services that may be available.

We need a reset.

Bringing oral health into the NCDs ‘fold’

Bringing oral health into the NCDs ‘fold’ is important for a number of reasons.

Firstly, good oral health is a vital part of our daily lives. It allows us to do the basics of talking, breathing, chewing and smiling. It ultimately helps with our self-esteem. But good oral health rests mainly on prevention and the failure to do so can lead to oral diseases that if left unattended can have severe physical and mental impacts. Everyone knows just how painful a simple toothache can be.

Secondly, the inequalities in the global oral disease burden to a large degree mirror the same imbalances found across the range of chronic diseases globally. They require coordinated responses. But at the same time they need to be flexible: the GOHSR has revealed the extent of national and regional differences in oral health challenges. Therefore, there is no ‘one-size-fits all’ and national oral health policies need to be tailored according to local epidemiology and dynamics.

Thirdly, it’s no surprise that oral diseases disproportionately affect the poor and the vulnerable: bad or rotten teeth as well as missing teeth are more often than not a sign of under-privilege. Most impacted are people on low incomes, people living with disabilities, the elderly living alone or in care homes, refugees, prison inmates, those living in remote and rural communities and other marginalized groups. Ultimately this affects millions of people in terms of self-esteem and their “public” persona and can, on many occasions, affect their job prospects too. Even for those people able to obtain treatment, the costs are often high and can lead to significant economic burden.

Fourthly, all those drivers most commonly associated with other NCDs – alcohol consumption, tobacco use, consumption of trans fats and processed foods high in salt and sugars – have a similar impact on people’s oral health. Therefore, it makes no sense to be talking about how to respond to a certain set of chronic diseases without including the most prevalent NCD: oral disease.

Relationship between oral health and general health

Lastly, and perhaps the least understood is the relationship between oral and general health and the associations between different NCDs.

There is a growing body of science pointing towards potential links between poor oral health and a number of noncommunicable diseases. The most solid research has identified a strong relationship with diabetes, and increasing evidence suggests a link with cardiovascular disease.

This growing understanding of the broader health impacts of oral disease together with the dramatic increase in its global burden mean it is time to rethink our priorities.

Looking towards the next milestone, the UN High Level Meeting on Universal Health Coverage (UHC) is set to convene in September on the sidelines of the UN General Assembly.

If governments are truly genuine about their resolve to fight NCDs by driving momentum towards the idea of universal health coverage, then reconfiguring priorities around oral health will be inescapable. Public health systems will need to adjust through expanded private and public insurance policies and programmes that enable people to access a dentist in the same way they would a doctor or other healthcare professional. This in essence is the true meaning of UHC.

Ihsane Ben Yahya is the FDI World Dental Federation President and Dean of the Dental Faculty at the Mohammed VI University of Health and Sciences in Casablanca, Morocco

Katie Dain Is the CEO of the NCD Alliance.

Image Credits: Atikah Akhtar/ Unsplash, World Dental Federation , NCD Alliance.

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market, prior to the outbreak of COVID-19, from top left: (a) King rat snake  (b) Chinese bamboo rat (c) Amur hedgehog (d) Raccoon dog (e) Marmot and (f) Hog badger.

New evidence indicating that raccoon dogs from the Huanan Seafood Market in Wuhan may have been infected with SARS CoV2 in January 2020 was published on a shared database by China’s Centers for Disease Control and Prevention in January  – but removed recently after scientists started asking questions.

This was revealed at a media briefing on Friday by World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyusus.

“This data could have, and should have, been shared three years ago,” Tedros chastised, as he appealed to China to “be transparent” in sharing data about the origins of the COVID-19 pandemic.

WHO had only become aware of the data last Sunday from China CDC relating to samples taken at the Huanan market in Wuhan in 2020, said Tedros – although this had been published on a shared GSAID online database in late January, but “taken down again recently”. 

While the data was online, scientists from a number of countries downloaded that data and analysed it, and their findings were reported earlier this week by The Atlantic.

“A new analysis of genetic sequences collected from the market shows that raccoon dogs being illegally sold at the venue could have been carrying and possibly shedding the virus at the end of 2019,” according to the publication.

Positive swabs

This evidence came from swabs of the market that had tested positive for SARS-CoV2, which also included genetic material from raccoon dogs.

The international team that had assembled the analysis consisted of “virologists, genomicists, and evolutionary biologists”, according to The Atlantic.

The evidence may finally point to the “Animal X” vector that scientists examining the orgins of the virus believe was the most likely conduit for SARS-CoV2 between carrier bats and humans – rather than the laboratory accident theory that has gained currency recently.

“As soon as we became aware of this data, we contacted the Chinese CDC and urged them to share it with WHO and the international scientific community so it can be analysed,” said Tedros. 

The WHO also convened the Scientific Advisory Group on the Origins of Novel Pathogens (SAGO) on Tuesday and asked both the scientists who had analysed the data and China CDC  to present their analysis of the data to the group.

“This data do not provide a definitive answer to the question of how the pandemic began, but every piece of data is important in moving us closer to that answer, and every piece of data relating to studying the origins of COVID-19 needs to be shared with the international community immediately,” said Tedros.

“We continue to call on China to be transparent in sharing data and to conduct the necessary investigations and share the results. 

“Understanding how the pandemic began remains both a moral and scientific imperative.”

Seafood and fresh food market in Wuhan, Hubei, China, where live mammals, including raccoon dogs, were also caged and kept for slaughter.

Molecular evidence

Dr Maria van Kerkhove, WHO lead on COVID-19, said that the scientists had told SAGO this week that there was “molecular evidence” that some of the animals sold at the Huanan Market, including raccoon dogs, “were susceptible to SARS CoV2” – evidence that had been missing until now.

“We need to make clear that the virus has not been identified in an animal in the market or in animal samples from the market, nor have we actually found the animals that infected humans,” stressed Van Kerkhove.

“What this does is provides clues to help us understand what may have happened. One of the big pieces of information that we do not have at the present time is the source of where these animals came from. Where these animals traded? Were they the wild animals or domestic animals where they farmed, where were they farmed?”

China CDC needs to explain

“The big issue right now is that this data exists and that it is not readily available to the international community,” she said.

She said that China CDC needed to explain why it had taken down the data, as all the WHO knew was that it had been uploaded to the site as part of their work and in writing a publication, a pre-print of which was available.

“I don’t know the situation or the circumstances in which the data was released and taken down,” she added.

“Unfortunately, this doesn’t give us the answer of how the pandemic began, but it does provide more clues,” said Van Kerkhove, who reiterated that there are many more studies that need to be carried out. 

“Right now, there are several hypotheses that need to be examined, including how the virus entered the human population, either from a bat through an intermediate host, or through a biosecurity breach from a lab and we don’t have a definitive answer of how the pandemic began,” she said.

Earlier evidence of links to raccoon dogs

This is not the first time, by any means, that infected racoon dogs have been linked to the early stages of the SARS-CoV2 outbreak. In July 2022, Health Policy Watch reported on research led by the University of Arizona’s Michael Worobey, that suggested that mammals in the Wuhan market place, including racoon dogs, were carrying the infection in early 2020.

The Science Magazine study found that SARS-CoV2 susceptible mammals, such as red foxes, hog badgers, and common racoon dogs, were sold at the market in late 2019 and that SARS-CoV2 environmental samples were  found in cages which had previously housed the racoon dogs, as well as other equipment used around the mammals and vendors selling those live mammals in early 2020.

The clusters of early cases around the market also occured at a frequency that was far higher than could be expected in comparison to the volumes and frequency of visitors to other major commercial locations in the city, Worobey’s study found.

The researchers also found that both early lineages of SARS-CoV-2, dubbed A and B were “geographically associated” with the market: “Until a report in a recent preprint, only lineage B sequences had been sampled at the Huanan market,” the researchers added.

“If SARS-CoV2 did not emerge at the Huanan market, how surprised should we be at the coincidence of finding the first cluster of a new respiratory virus at – of all places – one of a handful of markets in a city of 11 million,” said Michael Worobey of the University of Arizona and one of the authors of the study, said in a tweet on the study.

Image Credits: Nature , Arend Kuester/Flickr.

A child getting an oral polio vaccination.

Health authorities in Burundi have declared a national public health emergency response to an outbreak of circulating poliovirus type 2.

The World Health Organization’s (WHO) Africa region announced on Friday that polio had been detected in an unvaccinated four-year-old boy in Isale district in western Burundi and two other children who had been in contact with the child. 

Five samples from wastewater surveillance confirmed the presence of the circulating poliovirus type 2. 

Circulating vaccine-derived poliovirus are variant polioviruses that can emerge if the weakened live virus contained in oral polio vaccine, shed by vaccinated children, is allowed to circulate in under-immunized populations for long enough to genetically revert to a version that causes paralysis.

The Burundian government plans to implement a vaccination campaign to combat polio in the coming weeks, aiming at protecting all eligible children under the age of eight against the virus.

Meanwhile, the Global Polio Eradication Initiative (GPEI) announced on Thursday that a further six cases of circulating poliovirus type 2 had been detected in children in the DRC’s eastern Tanganyika and South Kivu provinces.

“The detection of the circulating poliovirus type 2 shows the effectiveness of the country’s disease surveillance. Polio is highly infectious and timely action is critical in protecting children through effective vaccination,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are supporting the national efforts to ramp up polio vaccination to ensure that no child is missed and faces no risk of polio’s debilitating impact.”

According to WHO, circulating poliovirus type 2 is the most prevalent form of polio in Africa and outbreaks of this type of poliovirus are the highest reported in the region, with more than 400 cases reported in 14 countries in 2022. 

These are the first instances of circulating poliovirus type 2 that are linked with novel oral polio vaccine type 2 (nOPV2) since roll-out of the vaccine began in March 2021. 

“While detection of these outbreaks is a tragedy for the families and communities affected, it is not unexpected with wider use of the vaccine,” according to GPEI.

“All available clinical and field evidence continues to demonstrate that nOPV2 is safe and effective and has a significantly lower risk of reverting to a form that cause paralysis in low immunity settings when compared to monovalent oral polio vaccine type 2 (mOPV2),” it added.

“To date, close to 600 million doses of nOPV2 have been administered across 28 countries globally, and the majority of countries have seen no further transmission of cVDPV2 after two immunization rounds.”

Equatorial Guinea’s Marburg testing conundrum

Dr Ahmed Ouma, acting director of the Africa CDC

Meanwhile, in mid-February, health authorities in Equatorial Guinea confirmed the country’s first ever case of Marburg virus disease in the western Kie Ntem province with concerns that cases may be undetected as the country has limited testing capacity. 

Over one month later, 12 cases — one confirmed case and 11 probable – and 12 deaths have been reported. The Africa CDC on Thursday attributed the inability to confirm the suspected cases to limited testing capacity in Equatorial Guinea.

According to the US Centers for Disease Control and Prevention (CDC), the polymerase chain reaction (PCR) test is one of the methods for diagnosing Marburg virus disease. 

While noting that Equatorial Guinea and several other African countries acquired and expanded their PCR testing network during the COVID-19 pandemic, Dr Ahmed Ouma, acting director of the Africa CDC, told Health Policy Watch that availability of the infrastructure for testing is just one of the several elements required for testing for the disease. 

In addition, he said there is also the need for manpower (laboratory scientists) and reagents. These three, he said, need to be at the same place for an effective diagnosis strategy.

“In the beginning, there was no capacity within Equatorial Guinea. That capacity has now been made available. Training is ongoing, and we expect that the situation of not being able to get laboratory diagnosis out quickly is going to change,” Ouma said.

Noting the variation in testing capacity on the continent, Ouma added that access to the affected population was a challenge in some areas, as the required equipment may not be easily deployable in rural areas affected by Marburg.

“We have a situation here where it was a very rural community that was affected and we are working around the clock with the government of Equatorial Guinea to ensure that laboratory capacity is on the ground,” he added.

Despite the challenges of diagnosis, Ouma revealed available knowledge regarding clinical diagnosis and management are being deployed in responding to the outbreak. This includes quarantining and managing cases that present like human hemorrhagic fever — monitoring individuals with such symptoms “so that they are not a danger to themselves and the rest of the community”.

Cyclone Freddy linked waterborne disease outbreaks

On 12 March, Malawi experienced landfall of Cyclone Freddy that has caused flooding, displacement of people and massive destruction of sanitation facilities now impeding current response efforts. Other countries affected by the cyclone are Madagascar and Mozambique. 

“The second passage of Cyclone Freddy has displaced 87,603 people and caused 238 deaths in Madagascar, Malawi and Mozambique. This is a 111% increase in the number of new displaced persons and a 1,685% increase in the number of new deaths. Cumulatively 70,014 displaced persons and 132 deaths have been reported from three AU Member States,” Ouma said.

Regarding the health impacts of the cyclone, Ouma said Africa CDC is working with several agencies including the World Food Programme (WFP), particularly focusing on mitigation initiatives to ensure that those who have been displaced are in an environment that has decent and acceptable sanitary facilities.

“We are ensuring that we avoid any outbreak of waterborne diseases and we are also working with the government to provide health facilities where they can be able to access health whenever they need it. Other arms of governments in the affected countries and other partners are actually also working very hard to provide water, food and transportation to safer ground and mitigate the possibilities of unhealthy and unsanitary living conditions. This is how we reduce or completely stop the outbreak,” Ouma said.

Image Credits: Sanofi Pastuer/Flickr.

A genetic revolution is coming. It’s time the medical community and policymakers discuss it.

As technology advances and the price for genetic testing decreases, it is likely that within the next five years, DNA sequence information will be part of a patient’s medical records. Such a move would revolutionize the way doctors diagnose and treat medical conditions while at the same time raising complicated ethical questions.

By allowing access to a patient’s complete DNA sequence, doctors could more accurately diagnose various medical conditions, including genetic disorders. In addition, it would help doctors to better decide which medical tests are needed to establish a diagnosis and better understand how a patient’s genetics may affect the results of those tests.

At the same time, doctors could preempt the risk for certain medical conditions, at a different level of certainty, from cardiovascular disease to Alzheimer’s, Huntington’s disease to breast cancer.

Taking cardiovascular disease as an example, if doctors could see that a particular patient has a strong predisposition to it, they could tailor a personalized treatment plan designed to prevent or mitigate the condition. Of course, the plan would not only be based on genetics but would include historical information and a current medical workup. However, the patient’s genetic information would be the catalyst for the prevention and treatment plans.

 Another aspect would be the impact on treatment allocation, whereby doctors could start prescribing medication according to genetic characteristics, improving many of today’s anguishing patient journeys. Instead of testing medications until the right drug is discovered, doctors could match the most suitable medication to each patient right away. That would be a considerable leap in the quality of care.

Barriers to integration

 The increased availability of direct-to-consumer genetic testing has spawned the shift toward integrating DNA into medical records. These tests provide people access to their genetic information without involving a healthcare provider or health insurance company.

However, when people receive the results, they often bring them directly to their physician, who then must deal with whatever has been discovered. 

For example, a woman concerned she might have the BRCA gene that puts her at much higher risk of developing breast cancer or ovarian cancer, could send a saliva sample to the US and find out if she is BRCA positive within a few weeks. Then, if she is, she will most likely approach her physician concerned, asking for additional tests, such as an annual MRI or information about surgical preventive measures.

Financial burden

However, as a physician can only address results from a high-quality, clinically validated laboratory, they will have to explain that a second genetic test, and likely a more expensive one, is first needed. 

Of course, insufficiently reliable direct-to-consumer genetic testing can have a high emotional cost and uncertainty during the interim period prior to validating the results. 

Moreover, this information would inevitably increase the financial burden on the health system. While early detection undoubtedly saves lives, when insufficiently reliable or inconclusive in terms of the results or what can be done with them, can also lead to a lifetime of excessive testing and medical consultations and follow-ups.

An additional barrier would be the need to re-educate a large number of healthcare practitioners, as many doctors and other medical professionals will need to learn how to read and interpret genetic information.

Ethical questions arise

However, the most significant barrier to implementation should be the multitude of ethical questions that must be addressed before DNA sequencing is available to almost everyone. The medical community and policy makers must develop new regulations for managing personalized genetic data.

 For example, there are significant risks of invasion of privacy if a person’s genetic information gets out. There is also a possibility that this genetic information could be misused by an insurance company, which could raise rates due to a ‘high risk’ marker to develop a future medical condition found in a person’s genetic makeup. 

A more liberal stance is to provide the patient with their full genetic workup. An alternative is to provide him or her access to solely genetically actionable genes (ie. genetic findings that have defined and known medical consequences and treatment recommendations).

However, ‘actionable’ is a dynamic concept, whereby as research develops, and our knowledge increases exponentially – and what is not actionable today, might be actionable in a year. Should the physician be responsible to constantly re-check the patient’s genetic makeup and notify them? 

Should patients have to opt-in or sign a consent to see their DNA sequence? Or should they opt out if they do not want to see it?

The future standard of care will include the integration of genetic information into the medical decision process. This calls on medical professionals and policy advisors to be prepared and address ethical, legal and regulatory issues – today.

Dr Tal Patalon is Head of KSM Research and Innovation Center, which helps to develop tech-based medical solutions to inform global health policies and enhance healthcare services. She also oversees the Tipa Biobank Project, the largest Israeli biosample repository. She is also an active clinician, specializing in family and emergency medicine. 

Image Credits: Sangharsh Lohakare/ Unsplash.

Professor Anna Gilmore

When London Mayor Sadiq Khan introduced a ban on junk food advertising on the city’s buses and tubes, he faced a backlash from big food companies.

Meanwhile, tobacco companies went all-out trying to stop Montevideo in Uruguay and Kampala in Uganda from banning smoking in public areas, including resorting to litigation.

Tobacco company Phillip Morris took the government of Uruguay to court to try to prevent it from banning smoking in closed public spaces, Mayor Carolina Cosse told the inaugural Partnership for Healthy Cities Summit on Wednesday.

The summit brought together mayors and officials from more than 50 cities to discuss how to prevent noncommunicable diseases (NCDs) and injuries.

Not only did Uruguay win its case, but the court ruling set a precedent by establishing that commercial benefit should not be considered above public policy, said Cosse.

“So in Uruguay, we know very, very well that, when we talk about multinationals, their ambition is limitless,” said Cosse.

Montevideo’s Mayor Carolina Cosse

In Uganda, British American Tobacco (BAT) fought the government’s efforts to eliminate smoking in public areas, said Kampala’s Mayor Erias Lukwago.

In 2016, Uganda’s Parliament introduced a Bill to ensure public spaces were smoke-free – but BAT “fought our efforts left, right and centre, even mobilising local farmers”, added Lukwayo.

After Parliament passed this Bill, BAT took its opposition to the Constitutional Court.

“We got embroiled in protracted litigation until 2019 when we won the case, but even after winning the case, they started indulging in some other shenanigans,” said Lukwayo.

These involved overt efforts such as mobilising and transporting tobacco farmers to demonstrate against the law, and more covert efforts to undermine the implementation of the law.

“We banned single cigarette sales, apart from banning cigarette adverts and smoking in public places,” said Lukwayo. 

“But implementation is a challenge thanks to BAT and all those struggles they have engineered. What BAT does is to instigate small traders to violate the law and enforcement is a challenge on our side because we are very thin on the ground.”

Kampala’s Mayor Erias Lukwago

Addressing the big four

Anna Gilmore, Professor of Public Health at the University of Bath in the UK, said that the “commercial determinants of health” was complex, and that “most commercial actors play an incredibly vital role in society”. 

However, she singled out four products – alcohol, tobacco, ultra-processed food and fossil fuel – as being responsible for between 19 and 33 million deaths a year.

“That’s at least a third of all global deaths. Just by addressing those we can really achieve a huge amount,” said Gilmore.

“The problems aren’t just these products,” said Gilmore, adding that the World Health Organization’s (WHO) Best Buys report, published in 2017, explained how to tackle NCDs and harmful products.

“But many countries and cities and local governments are struggling to put these policies in place because they face opposition from incredibly powerful commercial actors,” added Gilmore.

Big corporations consistently opposed Best Buy policies “using the same arguments and strategies” – and that it was possible to “predict and prepare and counter those industry efforts to derail policy”, said Gilmore.

“But at the end of the day, of course, political will is vital.”

Stick and carrot

A newer tactic being used by some cities was “carbon advertising bans” such as for holidays, for large vehicles, or anything that’s going to increase pollution”, said Gilmore.

Cities could also expand smoke-free, alcohol-free, junk-food-free public places, and reduce the density of outlets selling unhealthy food products. 

“What about introducing ‘polluter pays’ type approach? We’ve seen that recently in Spain, tobacco companies have to pay for the litter that they create?” asked Gilmore.

However, she also said that incentives could be used to reward positive contributions. Cities could use their local procurement and contracting policies to “contract people who pay a fair wage and who limit their ratio between executive pay and average worker pay” to address growing inequality

They could also contract small accountancy firms instead of large ones, and use locally sourced food from small producers for school feeding schemes.

London Mayor Sadiq Khan

Incentives for healthy canteens

Montevideo’s Cosse, who won an award for her city’s food policy innovations, said her city used incentives to promote healthy canteens in the city’s public institutions and hospitals.

“A healthy canteen can sell soft drinks, but they cannot publicise them. They’re obligated to have a healthy menu with vegetables and fruit and easily accessible clean water,” said Cosse. 

If an institution was awarded a healthy canteen certificate, they were entitled to “freebies” such as a free audit, which could save them $3,000 a year.

At the start of the summit, Michael Bloomberg, WHO Global Ambassador for NCDs and Injuries, warned that, ‘in low- and middle-income countries, 40% of all deaths are people under 70 dying from NCDs and injuries”. 

“Sadly, the death toll will only grow, unless we do something. It won’t take a miracle. It will take smart policies – and the political will to implement them and defend them,” added Bloomberg.

The Summit was hosted by Bloomberg Philanthropies, WHO, Vital Strategies, and Mayor Khan.

Image Credits: Bloomberg Philanthropies.

Cholera
Floods and cyclones increase the risk of cholera outbreaks.

Five months after the World Health Organization (WHO) announced that countries affected by cholera had to start rationing vaccine doses due to shortages, there is no immediate solution – yet cases are spiking.

In 2022, 36 million vaccine doses were produced and a similar number is expected this year.

“The South Korean manufacturer is making significant efforts with the help of [vaccine platform] Gavi, Bill and Melinda Gates Foundation and others to improve their production. Whether this will suffice to meet the need, that’s another story,” Philippe Barboza, team lead for cholera at the World Health Organization (WHO) told a briefing on Wednesday.

He added that there are plans to bring in a new manufacturer from South Africa for oral cholera vaccines but that will take time. 

“This is possibly a long-term solution. The question is what are we going to do in between?” 

The caseload for cholera during the first two months of 2023 is 40% higher than the caseload for the whole of 2022, according to WHO. The outbreak is severe in Burundi, the Democratic Republic of Congo (DRC), Malawi, Mozambique and Tanzania, said Barboza.

Barboza added that it is important to go back to the basics – improving access to clean water and sanitation – to achieve the goal of ending cholera by 2030. 

“Access to basic water and sanitation is a long-term solution. Many northern countries have controlled cholera only by improving water and sanitation. Unfortunately, this is something which still requires more political engagement and support,” Barboza said. 

African countries are particularly vulnerable

Cholera
Case Fatality Rate chart that shows Africa suffers worse than other countries across the world.

The case fatality rate (CFR) is 2.9% in Africa while the global average is 1.9%, according to Dr Otim Patrick Ramadan, the incident manager for cholera at the WHO African Regional Office. 

Along with the lack of clean water and sanitation, African countries suffering from cholera outbreaks are also grappling with several other climatic and non-climatic issues. 

“The cholera outbreak is happening in several contexts. We have had natural disasters, like Cyclone Freddy and we are currently trying to understand the extent and impact of the cyclone on Madagascar, Mozambique and Malawi. This has caused a lot of flooding.

“So we have seen outbreaks happen in the context of this cyclone, the flooding in Nigeria, Mozambique, and Malawi. And then the extreme end of those climatic events is also the drought in the greater Horn of Africa, Kenya, Ethiopia and Somalia,”  Ramadan explained.

Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. The Vibrio cholera bacteria spread in dirty water, and the spread can be accelerated during floods as well as when there is a shortage of clean water.

Regions with conflict are also vulnerable to cholera, such as parts of Cameroon, northeastern Nigeria, DRC, the North Kivu area of South Sudan, Somalia and Ethiopia, he added.

These challenges grouped with already existing public health challenges like Mpox, polio and measles cripple the countries’ capacities to respond. 

The vaccine challenge

 In October 2022, the WHO advised countries with cholera outbreaks to ration vaccine shots since the global stockpile of the vaccine was depleting rapidly. Countries were asked to administer single doses of the cholera vaccines instead of a two-dose regimen. 

The standard preventive approach to cholera is a two-dose regimen, in which the second dose is administered within six months of the first dose. This provides immunity against cholera for three years. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that a single dose has proven to be effective in previous outbreaks, although the immunity it provides is limited. 

However, he emphasized that this is only a temporary solution and that a holistic and strategic approach must be adopted to prevent cholera outbreaks. 

“In the long term, we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks. The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation”. 

Explaining that the situation around vaccines at present is not any different than what it was in October 2022, Barboza said that the demand for vaccines is increasing and unmet. 

Image Credits: World Health Organization (WHO), World Health Organization (WHO).

IQAir air pollution map for PM 2.5 (2022). Only countries in blue meet the WHO guidelines.

Ninety percent of 131 countries exceeded the World Health Organization’s (WHO) air pollution guidelines for fine particulate matter (PM 2.5) in 2022, according to a new report that combines data from official monitoring stations and “citizens science” monitors around the world. .

The report was the fifth such World Air Quality Report to be released Tuesday by the Swiss firm managing the air quality monitoring site IQAir, which crowd sources real-time monitoring data from both citizen scientsts and more official sources. Altogether, that includes data from over 30,000 air quality monitoring sensors and stations across 7,323 locations in 131 countries. 

However, critics point out that the reporting combines data from low-cost monitoring sensors and stations with the more robust monitoring by governments and research institutions, which is typically reported on by WHO and research institutions. That, mix, some scientists and researchers, contend, can point to general trends, but it is not always reliable or consistent.

“The IQ database raises awareness and that is OK, but the transparency of the data is not a given. It is what it is,” one expert, who asked not to be named, told Health Policy Watch.

Low cost monitors becoming more reliable

On the other hand,  low-cost air quality monitors are becoming increasingly reliable, as well as popular – to cover critical gaps in coverage in low- and middle-income countries that cannot afford more expensive tools, supporters of the initiative maintain.

“In 2022, more than half of the world’s air quality data was generated by grassroots community efforts. When citizens get involved in air quality monitoring, we see a shift in awareness and the joint effort to improve air quality intensifies. We need governments to monitor air quality, but we cannot wait for them. Air quality monitoring by communities creates transparency and urgency. It leads to collaborative actions that improves air quality,” states Frank Hammes, Global CEO, IQAir.  The firm’s for-profit branch also markets air purifiers, filters and face masks.

PM 2.5 is made up of tiny particles in the air, including sulfates, nitrates, black carbon, and ammonium, which are considered among the most health-hazardous air pollutants.  PM 2.5 concentrations are also considered to be the best metric for estimating health impacts from air pollution. In line with this, updated WHO guidelines recommend that countries should ensure an annual average of five micrograms per cubic meter (μg/m3) or less to protect people’s health – a measure that even high income countries with strong air quality management systems often fail to meet.

Only six countries meet WHO guidelines

In fact, according to the data published by the company, only Australia, Estonia, Finland, Grenada, Iceland, and New Zealand met the WHO guideline in 2022.  

Countries with the most polluted air were Chad, (89.7 µg/m3, over 17 times higher than the WHO guideline), Iraq (80.1 µg/m3), Pakistan (70.9 µg/m3), Bahrain (66.6 µg/m3) and Bangladesh (65.8 µg/m3). However in the case of arid states in Africa, the Middle East and South Asia, dust storms can also be a huge factor in pollution levels, experts say.  

Pakistan’s Lahore was the most polluted metropolitan area in 2022, while eight of the world’s 10 worst polluted cities were in Central and South Asia.

The most polluted city in the US was Coffeyville, Kansas, while 10 of the 15 most polluted cities in the US were in California. Las Vegas was deemed the cleanest major city.

WHO has not published country-by-country averages for the past several years – so it is difficult to make comparisons between the IQAir’s “citizen science” findings and more official sources of data. 

Six million die annually from air pollution

Air pollution is the world’s largest environmental health threat, killing an estimated 6-7 million people each year, according to WHO and the Global Burden of Disease report 2019.

The total economic cost equates to over $8 trillion dollars, which is over 6% of the global annual GDP, according to the World Bank. Exposure to air pollution causes and aggravates several health conditions which include, but are not limited to, asthma, cancer, lung illnesses, heart disease, and premature mortality.

“Sustained exposure to PM2.5 concentrations above the annual average guideline level result in a chronic impact on individuals’ respiratory and circulatory systems leading to long-term complications such as heart disease and decreased lung function,” according to the report.

While the number of countries monitoring air has steadily increased over the past five years, there were “significant gaps in government-operated regulatory instrumentation in many parts of the world”, according to IQAir. 

“Low-cost air quality monitors sponsored and hosted by citizen scientists, researchers, community advocates, and local organizations have proven to be a valuable tool to reduce the massive inequalities in air monitoring networks across the world, until sustainable regulatory air quality monitoring networks can be established,” it added.

Only 19 African countries had the ability to monitor their air quality, and only 156 stations producing all the included data for the continent,

“In 2022, more than half of the world’s air quality data was generated by grassroots community efforts,” said IQAir CEO Frank Hammes. “We need governments to monitor air quality, but we cannot wait for them.”

 Aidan Farrow, Greenpeace International’s air quality scientist, said that “too many people around the world don’t know that they are breathing polluted air”. 

“Air pollution monitors provide hard data that can inspire communities to demand change and hold polluters to account, but when monitoring is patchy or unequal, vulnerable communities can be left with no data to act on. Everyone deserves to have their health protected from air pollution,” added Farrow, whose organisation collaborated with IQAir on the report.

Healthcare workers
Countries rich and poor suffered during the COVID pandemic due to healthcare worker shortages, but rich countries were able to import more workers.

Eight more countries in the global south have dangerously low numbers of healthcare workers in the wake of the COVID pandemic, a new WHO report has found. 

The World Health Organization’s 2023 report on “Health workforce support and safeguards” found that some 55 countries now rank below the global median in terms of their density of doctors, nurses and midwives per capita. 

That is in comparison to 47 countries in 2020 when the last report was produced, based on data collected just prior to the outbreak of the COVID pandemic. 

The WHO report series tracks countries where the number of professionally trained healthcare workers falls below the global median of 49 per 10,000 population. It also examines countries’ rankings in terms of a Universal Health Service coverage index. 

The negative health, economic and social impacts of COVID-19, coupled with the increased demand for healthcare workers in high-income countries experienced during the pandemic, likely helped trigger more outward migration of healthcare workers from countries that are already suffering from low health workforce densities, the report found. 

“Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems do not have enough and many are losing their health workers to international migration,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a press release that accompanied the report. 

Rich countries still falling short on global code of practice for international recruitment of health professionals 

The outward migration of healthcare workers from low or middle income countries in search of better wages and working conditions is a longstanding issue, which has only become more serious as the global workforce becomes more mobile generally. 

For instance, the proportion of foreign-trained physicians increased from 32% in 2010 to 36% in 2020, in eight OECD countries already blessed with a high density of healthcare workers.

The voluntary Global Code of Practice for the International Recruitment of Health Personnel, adopted at the 2010 World Health Assembly, aims to curb aggressive recruitment of healthcare workers from the global south by rich countries – as well as supporting fair and transparent employment terms for those who do choose to migrate elsewhere.  

Healthcare Workers
Factors acting on healthcare workers demand and supply in the market.

Accompanying the code, WHO was mandated to track and periodically update member states on trends in health workforce numbers in countries deemed “vulnerable”, as well as examining how such worker migration is affecting progress toward the goal of Universal Health Coverage. 

Since 2010, member-states have reported every three years on data and trends regarding international migration of healthcare workers. 

The fourth round of review was launched in May 2021 against the background of the COVID-19 pandemic, which caused severe disruptions to healthcare services in many countries, as well as increasing rich countries’ reliance on international healthcare workers, the report stated. 

African countries are the hardest hit 

Among the countries that recently joined the list of those with vulnerable health workforces are Rwanda, Comoros, Zambia and Zimbabwe in the African region; Timor-Leste in the South-East Asia region; and Lao People’s Democratic Republic, Samoa and Tuvalu in the Western Pacific region of the WHO. 

Among all 55 countries with sub-par numbers of health care workers, 37 are WHO’s Africa region, eight in the Western Pacific region, six in the Eastern Mediterranean region, three in south-east Asia region and one country in the agency’s Americas region, the report found.  All of these countries have a healthcare workforce density of less than 49 workers per 10,000 people. 

These countries also rank at 55 or less on WHO’s Universal Health Coverage (UHC) service coverage index – which tracks access to key, lifesaving services on a scale of 0, to 100. Service coverage is calculated as the average of 14 “tracer indicators” for access to four broad groups of health services: reproductive, maternal, newborn and child health; infectious diseases;  noncommunicable diseases; and service capacity and access. 

Policy research has documented the linkages between the size of a country’s healthcare workforce and health outcomes. And the global data collected by WHO also shows a strong association between health workforce density, and UHC coverage rankings overall. 

Healthcare workers
Healthcare workforce density per 10,000 population. The countries in the blue rectangle are the ones added in the updated list, with healthcare worker density less than 55 per 10,000 population.

Approximately 15% of health care workers globally are working outside of their country of birth, WHO has found. But this varies widely by region – with the proportion of foreign-trained nurses reaching 70% to 80% in some affluent Gulf countries in WHO’s Eastern Mediterranean Region. About 10-12% of foreign trained doctors and nurses hail from countries deemed vulnerable by WHO due to their lack of sufficient numbers of indigenous healthcare workers.  

While the 2010 WHA resolution did not prohibit international recruitment of healthcare workers, it calls on the countries, particularly the high income countries, to ensure that their recruitment does not adversely affect the healthcare systems and delivery of healthcare services in the source countries. 

Call to countries to reduce adverse effects of international recruitment 

The WHO also recommends that healthcare workers migration agreements signed between two governments should explicitly ensure that benefits to the source country are “commensurate and proportionate” to the benefits accrued by the healthcare system of the destination country. 

It also recommends that such safeguards be applied to all low and middle income countries, regardless of their ranking on the list. 

Scarcity of healthcare workers in low and middle income countries, and their outward migration in search of better pay and conditions, has been a longtime global health policy issue. The COVID-19 pandemic only exacerbated an existing inequalities that hobble the development of robust health systems in many developing countries.

In 2020, the International Council of Nurses estimated that there is a global shortage of six million nurses and the effects of the pandemic will drive health worker migration from the low and middle income countries. A WHO report on the State of the World’s Nursing profession, published in that same year, estimated that one in eight nurses globally have migrated from elsewhere. 

Healthcare workers
Estimation of healthcare workers shortage across the world in 2013 and in 2030.

In 2020, when the list of vulnerable countries was first compiled, the UHC service coverage index benchmark was was 50 out of a score of 100. However, after COVID-19 caused widespread health, social and economic impacts, WHO increased the threshold to 55. 

“The increasing demand for health and care workers in high-income countries might be increasing vulnerabilities within countries already suffering from low health workforce densities,” observes the new WHO report. 

“WHO is working with these countries to support them to strengthen their health workforce, and we call on all countries to respect the provisions in the WHO health workforce support and safeguards list,” stated Tedros.

Image Credits: Photo by Carlos Magno on Unsplash, World Health Organization (WHO), World Health Organization (WHO).

Covid-19 pandemic
Thousands of small white flags stand sentinel outside the Washington D.C. Armory in October 2020, each representing an American who died from COVID-19.

Three years after the World Health Organization’s (WHO) declaration of the COVID-19 pandemic, the era of hourly headlines updating death and case counts has come to a merciful end. But the virus is still killing around 1,000 people worldwide every day, and it isn’t going anywhere. 

As of 7 March, WHO has confirmed over 750 million cases of COVID-19 and 6.8 million deaths – widely viewed as a considerable underestimate by experts. 

The world’s choice to move on from the pandemic is reflected in the increasingly sparse data on case, test and death counts that once underpinned the breathless news cycle at the height of COVID-19’s assault. 

Last week, Johns Hopkins University announced it was shutting down its global COVID-19 tracker due to the lack of data. The interactive map had been a trusted source for journalists, academics, researchers and policy makers since it launched shortly after the virus began its escape from China. 

Yet WHO has said it is not ready to declare an end to the pandemic, and some experts worry that the virus could mount a counter-attack. COVID-19’s continued circulation provides it with ample opportunities to mutate and become more transmissible by learning to sidestep immune responses. 

“Whatever the virus is doing today, it’s still working on finding another winning path,” Dr Eric Topol, head of Scripps Research Translational Institute told the Associated Press.

With public trust in global health institutions in free fall and deep global divisions permeating the COVID-19 landscape, Topol fears the world is not prepared for a more infectious variant to emerge.

“I wish we united against the enemy — the virus — instead of against each other,” he said.

‘Never Again’

Former United Nations (UN) Secretary General Ban-Ki Moon, Nobel laureate Joseph Stiglitz, and current Timor-Leste President and Nobel Peace Prize winner Jose-Manuel Ramos Horta joined nearly 200 global figures in signing an open letter calling on world leaders to “never again” allow pharmaceutical companies to choose profits over saving lives. 

The letter, published on the third anniversary of the WHO’s pandemic declaration on 11 March, pinned millions of preventable deaths on the “private monopolies” created by vaccine patents and the pharmaceutical industry’s “desire to make extraordinary profits” over “the needs of humanity”.

“Instead of rolling out vaccines, tests, and treatments based on need, pharmaceutical companies maximized their profits by selling doses first to the richest countries with the deepest pockets,” the letter said. “Billions of people in low and middle-income countries, including frontline workers and the clinically vulnerable, were sent to the back of the line.”

Equitable sharing of vaccines globally could have saved an estimated 1.3 million lives in the first year of vaccine availability – one every 24 seconds – according to an analysis published in Nature based on modeling by The Lancet. 

Helen Clark, former Prime Minister of New Zealand and co-chair of the Independent Panel for Pandemic Preparedness and Response established by WHO, said the vast public funding backing the science that contributed to the vaccines meant they should have be treated as global common goods. 

“Nationalism and profiteering around vaccines resulted in catastrophic moral and public health failure which denied equitable access to all,” she said. “We need to fix the glaring gaps in pandemic preparedness and response today, so that people in all countries can be protected when a pandemic threat emerges.”

IP-related suffering

Vaccines
A United States delivery of 655,200 COVID-19 vaccine doses through COVAX to Ethiopia on September 23, 2021.

The letter also noted that this is not the first time intellectual property claims by pharmaceutical companies over life saving medicines have caused unnecessary suffering.

“In the AIDS pandemic, pharmaceutical monopolies have resulted in an appalling number of unnecessary deaths – and it has been the same story with COVID-19,” said Winnie Byanyima, Executive Director of UNAIDS. “But governments still have not learned that lesson. Unless they break the monopolies that prevent people from accessing medical products, humanity will sleepwalk unprepared into the next pandemic.”

The pharmaceutical industry, meanwhile, points the finger at vaccine nationalism displayed by governments. Industry groups also highlight the scientific achievements of the COVID-19 vaccine race, which brought safe vaccines to market in record time and catalyzed hundreds of promising medical trials based on mRNA technology. 

“The pharmaceutical industry has been advocating for equitable vaccine distribution to vulnerable populations in low-income countries since 2021, and has worked as a key partner in COVAX,” Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) told Health Policy Watch in an email. 

“It must be recalled that after [the] initial fast roll-out of COVAX vaccines, which saw Ghana receive the first batch of vaccines less than three months after the first distribution in Europe, India – which was the principal source of licenced vaccine supply – shut its borders for almost seven months, and it took far too long for high income countries to step up and start dose sharing,” he said. 

The United States and European Union were also slow to share their vaccine supplies as they struggled to get their domestic outbreaks under control, resulting in millions of doses sitting in warehouses as poorer countries begged for them to be shared. 

In its 2022 annual report, the UN World Intellectual Property Organization (WIPO) estimated the social benefit of COVID-19 vaccines – a calculation of lives saved, health costs avoided, and value of saving economies from mitigation measures like lockdowns – at $70.5 trillion, 887 times pharmaceutical revenues of $130.5 billion. 

Vaccines have saved tens of millions of lives globally since the onset of the pandemic, according to the Lancet’s Infectious Diseases Journal. But unequal access in low-income countries has limited their impact, highlighting the need for global vaccine equity.

“Singling out intellectual property as the cause of lack of access also diverts attention from focusing on key hurdles such as weak health systems, supply chain challenges, vaccine nationalism, and gross misinformation, all of which significantly contributed to slow vaccine uptake,” Cueni said. “Governments must engage to create a social contract that enhances equity in future pandemic responses.” 

Negotiating a pandemic accord 

WHO Director-General Dr Tedros Adhanom Ghebreyesus has called on countries to not repeat the mistakes of COVID-19 in negotiating a new pandemic accord.

WHO member states are currently negotiating an accord to guide the global response to the future pandemics, including equitable access to medicines such as vaccines, but progress has been slow. 

The latest negotiations on the zero draft of the global pandemic accord were dominated by concerns over equity and financing, echoing the now familiar battle lines that have defined international climate adaptation and biodiversity negotiations. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus, who has stated he hopes to preside over the initial approval of a WHO pandemic accord in 2024, when a final draft is due to be presented to the World Health Assembly, appealed to member states in his opening remarks to “not repeat the same mistakes” of the COVID-19 pandemic. 

He repeated that message on Monday in a ceremony at the University of Michigan, Ann Arbor, where he received a global public health award, saying that the importance of global cooperation is among the three lessons of the pandemic – along with the importance of health and science:

“Instead of a coherent and cohesive global response, the pandemic has been marked by a chaotic patchwork of responses. This is because of narrow nationalism,” Tedros said. “We can only face shared threats with a shared response, based on a shared commitment to solidarity and equity.”

Rooted in equity and human rights

Echoing that, Ban-Ki Moon said the pandemic accord must be “rooted in equity and human rights,” and place “the needs of humanity above the commercial interests of a handful of companies” in a comment accompanying the People’s Vaccine Alliance open letter.

“The great tragedy of the COVID-19 pandemic has been the failure of multilateralism and the absence of solidarity between the Global North and the Global South,” Ban-Ki Moon said in his statement accompanying the open letter. “We need a return to genuine cooperation between nations in our preparation and response to global threats.”

But negotiations are still in their early stages, and it is too early to judge whether they will be successful. 

The US, Japan and India have expressed opposition to the current accord draft’s stipulation that 5% of GDP be designated for pandemic preparedness, with India calling the provision “overly prescriptive”.  

Western Pacific countries, inscluding small island states that are already facing the earliest consequences of climate change, meanwhile, have requested that “specific recommendations in recognition of the impacts of climate change” be considered. 

A confluence of crises  

Former United Nations Secretary General Ban-Ki Moon called the global response to COVID-19 a “failure of multilateralism and an absence of solidarity.”

It is hard to keep count of the generational crises that have hit the world since WHO declared the COVID-19 pandemic. 

Estimates of lives lost in Russia’s invasion of Ukraine number well over 200,000, with hundreds of thousands more injured, and millions displaced. The largest earthquake since Fukushima shook Turkey and Syria, claiming 50,000 lives and counting. 

The visceral images of the devastation wrought by these catastrophes empower their death counts with shock value, but also put into perspective the numbness with which the 1,000 daily global deaths from COVID-19 are met three years into the pandemic. 

This confluence of crises over the past three years has created a perfect storm where the eye of the hurricane looms over the livelihoods of the world’s most vulnerable.

The virus as a test run for other challenges…

In a 2022 analysis by Nature, researchers found that up to 667 million people were living in extreme poverty – nearly 100 million more than before the pandemic and Russia’s invasion of Ukraine. 

The virus showed that a threat anywhere could be a threat everywhere – a trait shared with the overlapping crises of climate change, conflict, economic inequality, migration and global health.  And if the pandemic was the test run, it has shown the world is not up to the challenge of meeting any of these challenges.  

Climate change declared its arrival as a regular part of the day-to-day lives of billions around the world as floods submerged over a third of Pakistan last August, and drought-related hunger gripped the Horn of Africa this year with increasing severity.  Meanwhile, the world’s efforts to curb global warming to 1.5 degrees continue to fall far short. 

Russia’s invasion of Ukraine sent shockwaves through the world’s fertilizer and energy markets, further exacerbating a global food crisis that had already reached historic heights. 

Over 345 million people will face food insecurity in 2023 – over double pre-pandemic levels, with 200 million more people struggling to feed themselves and their families than in 2020, the World Food Programme said. Another 900,000 worldwide are facing famine, 10 times more than five years ago. 

Meanwhile, the past decade has seen the top 1% capture around half of all new wealth created since 2020, worth $42 trillion, according to a January 2023 report by Oxfam published on the opening day of the World Economic Forum in Davos, Switzerland. 

“While ordinary people are making daily sacrifices on essentials like food, the super-rich have outdone even their wildest dreams,” Gabriela Bucher, Executive Director of Oxfam International said. “Forty years of tax cuts for the super-rich have shown that a rising tide doesn’t lift all ships – just the superyachts.”

The legacy of the pandemic is not yet fully written. But as it stands, it is a story of inequality. 

Image Credits: Ron Cogswell, US State Department, World Bank.