Omicron
A COVID-19 sanitation worker in Dalian, a port city in China’s Liaoning Province

The US and Australia lifted COVID-19 travel restrictions on Chinese travellers last Friday and Saturday respectively, effectively acknowledging that the world’s biggest pandemic outbreak is over.

Until the weekend, Chinese citizens had to present a negative COVID-19 test or proof of recovery to enter either country.

In late January, the Chinese government reported that 80% of the country had been infected by the virus – but insisted that its death toll was very low. However, this was mainly because it had a very narrow definition of deaths, only recognising those who have died of a respiratory illness and have had a scan to confirm lung damage caused by the virus. 

Trying to get a full picture of the pandemic’s trajectory in China has been difficult as, once it had abandoned its strict zero-COVID policy, China’s National Health Commission also stopped issuing detailed public reports, publishing the last report on 24 December 2022.

The most recent COVID-19 report by the China Center for Disease Control and Prevention (China CDC) shows that the country’s pandemic outbreak peaked on 23 December with 6.94 million positive COVID-19 tests being recorded on 23 December. 

That same day, China CDC reported that over 2,8 million people visited “fever clinics”. In contrast, only 481,000 people visited these clinics on 9 March, 2023, representing a decrease of 83.2% from the peak 

Meanwhile, hospitalisations peaked at 1.625 million on 5 January this year but plummeted by 99% to  8,629 on 9 March.

However, according to China CDC, hospital deaths peaked at 4,273 on 4 January but by 9 March, there were no COVID-related deaths.

Official Chinese figures reported to the World Health Organization (WHO) show that over 99 million Chinese were infected with COVID-19, but there have been only 120,227 deaths by 7 March.

However, independent health analytics company Airfinity modelled that daily deaths would reach 32,200 by 17 January with cumulative deaths from 1 December 2022 to 17 January to be 608,000 – almost three times the total fatalities reported by China to date.

“Deaths are forecast to peak at 36,000 a day on 26 January during the lunar new year festival. This is up from our previous estimate of deaths peaking at 25,000 a day,” said Airfinity. 

The full extent of COVID-19’s impact is unlikely to surface after Chinese authorities announced an internet crackdown on people spreading “false information” and “gloomy sentiments” about COVID-19 for a month around the lunar new year festivities in late January, according to The Guardian.

By 9 March, over 90% of the Chinese population – 1.28 billion people – had received the recommended two vaccines, while over 827 million people had received their first booster dose.

Last Friday, the Chinese parliament, the National People’s Congress, re-elected Xi Jinping as the country’s president for a third term, something that was already assured by the Communist Party congress last October,

However, Ma Xiaowei, the head of the National Health Commission scraped back into the position with the lowest number of votes, facing 21 objections and eight abstentions. Ma is blamed for the country’s zero-COVID policy that locked down millions of people for months at a time, and forced others into quarantine camps.

Image Credits: Jida Li/Unsplash.

Before the Framework Convention on Tobacco Control was adopted in 2003, the World Health Organization had worked for many years to prevent damage caused by tobacco consumption with the goal of passing an international agreement on tobacco regulation. The agreement, however, was not moving forward.

“The real breakthrough came as scientific evidence emerged showing the negative consequences of passive smoking and its impact on children,” Ilona Kickbusch, the founding director of the Global Health Centre at the Graduate Institute in Geneva, tells host Garry Aslanyan in the new episode of the “Global Health Matters” podcast. “These data and this evidence really made a significant difference in getting the negotiations started.”

Thanks to this development, the convention was eventually adopted, becoming the first international treaty negotiated under the auspices of WHO. Today, the agreement includes 182 parties, covering over 90% of the world population.

According to Kickbusch, the convention embodies an important example of how science and diplomacy can complement each other in achieving a goal or in driving a change. The expert discusses the role of science diplomacy in global health with Aslanyan and Aída Mencía Ripley, the Vice-Chancellor for Research and Innovation at Universidad Iberoamericana in the Dominican Republic.

Ripley shares how in the Dominican Republic science diplomacy was key to overcoming the challenges of the coronavirus pandemic.

“We were able to use science diplomacy to build some bridges and provide some of the early data on COVID sequencing for our country,” she recalls. “We were actually one of the first countries in the region that was able to do this, thanks to some of these international collaborations.”

Kickbusch also notes that the pandemic clearly showed how many global health issues are also subject to ideology, making hard evidence crucial.

“Being able to come together and create a global consensus also means we have to overcome ideology and we need to have really, really good data,” she says. “We can see that over the years, particularly in issues related to sexual health in the widest sense of the word, many of the international agreements, such as those guaranteeing access to medicines for stigmatized groups, were only possible because we had the hard science.”

Another important element for building consensus is promoting trust in governments and institutions, the two experts say.

“We are in a situation where trust in science and in policy-making is not as strong as it was ten or twenty years ago,” Kickbusch says. “We really need to work on that trust. We need to work on health literacy. We need to work on science literacy, both of the general population and of policy-makers and diplomats.”

Ripley highlights that in order to tackle health issues at the global level, it is essential to consider not only the hard science but also each society’s context.

“Global health is completely over-medicalized at this point,” she points out. “I think that some of the nuances that social and behavioral sciences bring to the table are crucial because we need to be able to understand people’s socioeconomic and political contexts in order to make sure that we meet people halfway, especially when we ask them to make major changes to their way of life, such as we did during the pandemic.”

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: TDR.

COVID origins
Redfield testified to the US Congress subcommittee on COVID-19 that he had been “sidelined” in the investigation into the origins of the virus by former NIH Director Anthony Fauci for promoting the lab leak theory. Fauci has called the claims “completely untrue”.

This week’s testimony by former CDC director Dr Robert Redfield to US Congress has reignited widespread speculation in the United States that the SARS-CoV-2 virus first emerged in a Wuhan research laboratory rather than in animals. The scientific debate about the origins of the virus took off this week just before the three-year anniversary of the World Health Organization’s declaration of the pandemic on 11 March 2020.

Redfield’s testimony on Wednesday, in which he stated it was “not scientifically plausible” that the virus had natural origins, comes on the heels of several weeks of US media reports that revealed support for the laboratory leak theory in several US government agencies. 

To sceptics, the information shared by Redfield and others remains “anecdotal”. Three years and 7 million deaths from the start of COVID-19’s global assault, researchers stress that the world is a long way from having definitive answers to how the SARS-CoV-2 virus made the jump to humans. 

The three keys to Redfield’s testimony 

The Wuhan Institute of virology is located 8 miles from the market where scientists believe SARS-CoV-2 first made the jump to humans.

In his testimony, Redfield, director of the CDC under former president Donald Trump at the onset of the pandemic, told Congress about three events that occurred shortly before the pandemic began which led him to believe the virus emerged from laboratory biosecurity failures.  

Those included a shift from Chinese civilian to military control of the lab and renovations to the facility’s ventilation system, as well as the deletion of the Wuhan Institute of Virology’s research database on coronavirus genome sequences that it was researching.

“The declassified information now shows in September 2019, three things happened in that lab,” Redfield told the Congressional subcommittee. Convened by the Republican House majority, the bipartisan group is once again investigating the origins of SARS-CoV-2. “Clearly there is strong evidence that a significant event happened in that laboratory in September.”  

“One is they deleted the sequences,” he said in reference to an online database of genome sequences of bat-related coronaviruses, which was taken offline  in September 2019 and has not resurfaced since. “That is highly irregular. Researchers don’t usually like to do that.”

“The second thing they did is they changed command and control of the lab from civilian control to military control. Highly unusual,” Redfield said, without elaborating his sources.

Media reports have shown that WIV likely operated as a “dual-use” facility with civilian and military functions and hosted military scientists.

One military scientist hosted by WIV was Zhou Yusen, director of the State Key Laboratory of Pathogen and Biosecurity at the Academy of Military Medical Sciences Institute of Microbiology and Epidemiology in Beijing, a joint investigation by ProPublica and Vanity Fair found.  He began researching coronaviruses as early as 2012, and was one of the first scientists to apply for a vaccine patent. 

“The third thing they did I think is really telling,” Redfield said. “They let a contractor redo the ventilation system in that laboratory.”  

Prior Congressional investigations tend to support Refield’s claim on the ventilation issues that plagued the Institute. In August 2021, the House Select Committee on COVID-19 released a memo detailing the malfunctioning of multiple air ventilation systems inside WIV in the months leading up to the pandemic.

Other media reports from 2021 suggested that the renovations on the defective ventilation systems were launched shortly before the pandemic exploded.

Department of Energy report  

Founded in 1952, the Lawrence Livermore National Laboratory in California operated by the US Department of Energy conducts high-level military research on bioweapons.

Redfield’s testimony follows the leak of a recent US Department of Energy report to the Wall Street Journal. The new DOE report assessed that COVID-19 “most likely” came from a lab leak. The agency described its assessment as “low-confidence”. 

The DOE assessment is significant due to the agency’s scientific expertise. It runs a total of 17 biolabs across the country, including Lawrence Livermore National Laboratory, which conducts high-level military research into biological weapons including viruses. US officials have declined to provide details on the intelligence that led to the DOE’s updated position. 

That report a Fox News appearance by FBI director Chrisopher Wray in which he said the bureau has “for quite some time” assessed that the origins of the pandemic are “most likely a potential lab incident in Wuhan.”

Despite differing analyses, Redfield, the classified Department of Energy report, and FBI all concluded that the lab leak was accidental and not the result of a Chinese biological-weapons programme.

A US intelligence community review ordered by President Biden in May 2021 produced two more points of consensus across all US agencies: that the virus first appeared in Wuhan no later than November 2019, and that it emerged without the foreknowledge of the Chinese government. 

“Show me the evidence”

FBI Director Christopher Wray publicly revealed the bureau’s belief in the lab leak hypothesis, but no evidence underpinning the assessment has been made public.

Despite the noise and political theatre of the Congressional hearings, the Department of Energy report remains classified, and the FBI has declined to comment further on the evidence underpinning the bureau’s “moderate confidence” in the lab leak theory. 

Other US agencies, privy to the classified assessments of the DOE and FBI, have not changed their position despite the new evidence. 

The World Health Organization has said that while zoonotic spillover remains the likeliest point of origin, the lab leak theory cannot be ruled out. WHO has said its investigation will continue until a definitive origin is identified. 

For many scientists, the classified nature of the US government reports make them impossible to assess. They have called for more transparency around the recent documentation. 

“I’m a scientist. I need to see the evidence rather than take the FBI director’s word for it,” University of Saskatchewan virologist Angela Rasmussen told the Associated Press. “The vast majority of the evidence continues to support natural origin.”

In contrast to the evidence supporting the lab leak theory, the reasoning behind the animal origin is publicly available. In an influential set of peer-reviewed papers published in July, researchers concluded that SARS-CoV-2 “occurred through the live wildlife trade in China” via the Wuhan market. 

Stephen Goldstein, a virologist at the University of Utah and one of the paper’s co-authors, remains open-minded about the lab leak theory. But like Rasmussen, says it is impossible to assess without access to the evidence. 

“It’s very difficult to say anything until we see what information drove this [DOE] updated analysis,” Goldstein told Vanity Fair. “If the data exists and is declassified and I can update my own analysis, wonderful.”

SARS-CoV2 lacks molecular structure of an engineered virus

The molecular structure of SARS-CoV-2 makes it highly unlikely the virus was engineered.

Redfield’s view that the virus could not have had natural origins is widely disputed by scientists. The SARS-CoV-2 virus has no known backbone, a critical molecular structure on which all engineered viruses are built, making it a bad candidate for bioengineering. 

“Virologists cannot create or design viruses out of thin air,” Robert Garry, professor of microbiology and immunology at Tulane University told the New Republic. “There would need to be at least something close to it in nature.”

The polarized nature of discussion around the origins of SARS-CoV-2 also overshadow a potential middle-ground: the virus was found in nature was brought to the Institute for study. But without the cooperation of Chinese authorities, no evidence that the virus was being studied at the lab has emerged.

Until the full-scope of the work that took place at the Wuhan Institute is made public, the origins of the virus that has killed over seven million people are likely to remain a mystery.

Image Credits: NIH, Creative Commons, LLN, FBI.

sodium
Nearly three-quarters of countries have yet to set policies to regulate sodium content in processed foods.

Eating too much salt kills nearly two million people every year, and without the rapid introduction of global policies to limit sodium content in processed foods, another seven million preventable deaths will occur by 2030, the World Health Organization (WHO) said in a new report.

Unhealthy diets are a major global health challenge, and sodium’s link to high blood pressure and cardiovascular diseases makes it one of the major contributors to nutrition-related deaths.

The average sodium intake globally is more than double the recommended 5-gram, or one teaspoon, daily limit, according to the report.

“That leaves people at risk for heart attack and stroke,” said Dr Tom Frieden, Director of Resolve to Save Lives, a non-profit organization that works to prevent deaths from cardiovascular diseases. “The world needs action, and now, or many more people will experience disabling or deadly, but preventable heart attacks and strokes.”

 

All 194 WHO member states have committed to the goal of reducing national sodium intake by 30% by 2025, and the science is clear: sodium is an essential nutrient but increases the risk of heart disease, stroke, and premature death when overconsumed.

At a press conference accompanying the launch of the report, WHO Director-General Dr Tedros Adhanom Ghebreyesus was blunt about the chances of reaching the 2025 target: “The world is off-track,” he said.

Only nine countries have fully implemented best-practice policies, leaving more than two-thirds of the world unprotected by policies limiting sodium content in food products. The lack of progress by governments in passing basic policies to regulate sodium levels has frustrated WHO officials.

“We cannot fail this completely achievable and affordable public health goal,” said Dr Francesco Branca, Director of Nutrition for Health Development at WHO. “Reducing sodium intake is one of the most cost-effective ways to improve health. It can avert millions of deaths every year at very low total programme costs.”

Governments must push industry

sodium
Higher-income regions achieved marginally higher policy implementation to regulate sodium than their lower-income counterparts.

The report sets out a series of so-called “best buy” policies, which it describes as easy to implement and highly cost-effective measures to reduce sodium intake. These recommendations, however, are not new. These were first endorsed by member states in 2017, yet many have yet to implement any of them.

“Best buy” policies include steps like reformulating foods to contain less salt, establishing public procurement policies to regulate sodium levels in foods purchased by institutions such as hospitals, schools and workplaces, and clear package labelling to help consumers avoid sodium-rich foods.

But these are no replacement for governments setting maximum limits for sodium in processed foods, WHO said. “Best buy” practices, while helpful, do not prohibit manufacturers from producing high-sodium foods and continue to place a significant burden of responsibility on consumers.

“Government-led mandatory maximum limits for sodium in processed foods promote industry-wide reformulation [by creating] a marketplace that restricts the less healthy food options regardless,” Branca said. “This type of policy requires no consumer action and places the burden of avoiding manufacturing less healthy products on the food industry.”

Top down limits on sodium content also safeguard against industry prioritizing short-term commercial interests while leveling the playing field for food manufacturers, preventing competition from developing based on sodium content.

“We know that unfortunately, self-regulation by the food manufacturing industry has repeatedly proven to be ineffective,” Frieden said. “The mandatory approach safeguards against commercial interests which may delay, weaken, distort or impede the development of healthy food and nutrition policies and programmes.”

By October 2022, just 5% of member states had implemented the recommended two mandatory sodium reduction policies. Another 22% had implemented their first mandatory policy. The remaining 73% have no hard restrictions on sodium content.

“We all have a role to play. WHO, governments, the private sector and consumers,” Tedros said. “Together we can make sure that food is a source of health, not a cause of death.”

Panellists Janet Mbugua, Dr Alaa Murabit,  Adriana Rubio, Goodness Ogeyi Odey and Mary-Ann Etiebet.

Millions of African girls are married before they turn 18, while others suffer female genital mutilation (FGM) and a multitude of preventable conditions, the closing plenary of the Africa Health Agenda International Conference (AHAIC) heard on Wednesday.

The plenary promised “bold and honest conversations” about the “backsliding on sexual and reproductive health and rights (SRHR)” on the continent, including scrutinising “social, economic, and cultural barriers driving the suppression of health rights”.

However, many of the panellists tiptoed around the prevailing religious and cultural conservatism despite an early appeal from the MC, Janet Mbugua, to address “the elephant in the room” – how to prevent the backsliding and ensure women and girls have “agency and power”.

Janet Mbugua

Mbugua runs the Inua Dada Foundation, a girls’ empowerment organisation, and spoke about a 16-year-old girl her foundation had assisted who “had never heard about sex or consent, but somehow ended up engaging in unsafe sex and becoming a teen mom”. 

“While there’s been so much progress, there’s equally been so much pushback. In fact, the more agency we have, the more it seems that our voices are silenced. We need to start having really tough conversations, really honest ones, and we need to push back against the pushback,” said Mbugua.

“Ultimately, if we don’t do that, we’re going to find ourselves here every so often asking ourselves: ‘Why are the rates of pregnancy on the rise? Why are we having adolescent girls compromised? Why the numbers are of HIV and AIDS on the rise?” said Mbugua.

Goodness Ogeyi Odey

Goodness Ogeyi Odey, Associate Editor at Wiley Journal, said that many young people did not understand consent, which was why “comprehensive sexuality education” was so important.

In Cross River State in Nigeria, where Odey comes from, many men assumed they could touch women in the market without consent, she said.

“That’s appalling. So we need to understand that, with sexual reproductive health and rights, consent is critical and young people have to understand and respect each other,” said Odey. 

“Many married couples say you can’t rape your wife because they don’t understand choice. They don’t understand consent. They don’t understand respect. They don’t understand bodily autonomy,” she said.

Odey added that many African countries had restrictive abortion laws yet they did not enable women and girls to get access to contraception or choices.

‘Bodily autonomy’

Natalia Kanem, UNFPA Executive Director

UNFPA Executive Director Natalia Kanem assured the plenary that her agency was “protecting sexual and reproductive health and rights in both development and humanitarian settings”. 

“We are helping young people to exercise their right to bodily autonomy, their body rights. We are helping young people to gain access to comprehensive sexuality education, so important to counter ignorance,” she added.

However, the obstacles are huge.

“Across Africa right now, 125 million women and girls alive today were married before their 18th birthday. Harmful practices like child marriage and certainly female genital mutilation violate the rights of the girl child,” she warned.

UNFPA is “countering harmful cultural norms and supporting the good norms, those that helped to end gender-based violence norms that call out harmful practices. This has to include promoting positive masculinities”, said Kanem.

Access to contraception

Mary-Ann Etiebet, head of MSD for Mothers

Mary-Ann Etiebet, head of MSD for Mothers, said that if women and girls had access to family planning, this could reduce the global maternal health burden by at least 30%.

“We need to ensure that every girl and woman has a fair and equal just chance to live life to their fullest capability and realise all of the opportunities in front of them,” said Etiebet, adding that this would never happen unless there was gender equity.

Dr Alaa Murabit, Director of Health at the Bill and Melinda Gates Foundation, agreed that access to contraception was the single most important SRHR intervention, and appealed for more money to be invested in SRH. 

“Women’s ability to control when and if they want to have children sets them on a completely different trajectory,” said Murabit.

Dr Alaa Murabit, Director of Health at the Bill and Melinda Gates Foundation

“We can’t talk about women’s health from menstruation to contraception to pregnancy to the entire lifecycle of a women’s health, without having tools that actually meet women where they are in communities where they are,” said Murabit.

“We’re talking about incredibly exciting things we have that can transform realities for women. We’re talking about contraception that women can take once every six months to ensure they have protection across the board. We’re talking about portable ultrasound that ensure that women who are pregnant have immediate reassurance and security,” she added.

“We’re talking about things we already have,” she said, remarking that not enough energy was being invested in these products _ or in urging policymakers to pass policies that ensure they can reach primary health care services.

“Let’s really rally around what we do have, let’s look at the resources we do have and talk about how we’re spending them and how we can spend them better.”

Adriana Rubio, General Manager of Roche Diagnostics, added that there were many innovations such as HPV tests, and other “homecare point-of-care testing” options and digital care to improve women’s lives.

“How do we remove regulatory barriers and make public policy embracing the value that innovation is bringing to allow us to realise the dream of universal healthcare?” Rubio asked.

Image Credits: United States Mission Geneva.

Women health
Community-level intervention is necessary to achieve women’s public health goals.

It takes community-level interventions to improve public health outcomes, especially when it comes to access to sexual and reproductive healthcare services by women and girls who are refugees and migrants, experts from the US-based Mayo Clinic said. 

“We know that the barriers for women are multifactorial and one solution is not going to fix our problem or increase cancer screening…We need to have these addressed by a multifactorial approach,” Brittany Strelow, a physician assistant at the Mayo Clinic said. 

Speaking at a webinar hosted by the World Health Organization (WHO) on Wednesday, Strelow shared her experiences with a community-centric project working with immigrant women in Rochester, Minnesota.   

Migrants and refugees face several challenges in the host countries, not only due to their civil status. Socio-cultural aspects like language and culture often stand in their way of accessing quality and timely healthcare. 

Strelow said that migrant women place a low priority on getting screened for cervical cancer and breast cancer because they struggle with other more important and basic things like finding affordable housing, food and nutrition.  

Language can be another major barrier for migrant women and girls to access sexual and reproductive healthcare. For example, in the US, one in ten residents are born abroad and around 7% of the residents do not speak English at all, Strelow pointed out. 

“Although we speak mostly in English in the United States, this can be applied on an international spectrum where an immigrant might be coming to another country that does not speak their native language.”

Danielle O’Laughlin, another physician assistant at the Mayo Clinic, added that women in their studies also struggled to access healthcare services due to religious and cultural barriers. In several cultures, women are not allowed to expose themselves even for medical examination or treatment to a doctor of the opposite gender. 

The WHO recently released a report outlining similar findings in a case study on the “Sexual Reproductive Health Rights and HIV Knows No Borders” project run by the International Organization for Migration (IOM), Save the Children and other governmental and non-governmental partners. 

The project, aimed at improving the access to HIV prevention methods and sexual and reproductive health of migrant women, girls and sex workers, worked with a variety of community-led approaches to achieving its goals. Initiatives like widespread sensitization on HIV transmission and screening, sexual and gender-based violence and setting up dialogue platforms with community, traditional and religious leaders helped the project see success. 

“In 2021 the project reached over 100 000 young vulnerable people, migrants and sex workers with health education on sexuality, HIV/AIDS, sexually transmitted infections, pregnancy and contraception through door-to-door visits and community events such as mobile clinics, outreach campaigns and community dialogues,” the report said. 

Over 14,000 young vulnerable people, migrants and sex workers were redirected to appropriate healthcare-based and non-healthcare-based interventions by this project. While healthcare interventions include HIV testing and distributing antiretroviral drugs, non-healthcare-based interventions include helping them access police, social welfare and counselling services. 

Image Credits: Photo by Rendy Novantino on Unsplash.

Jacqueline Acquah, Johnson & Johnson associate director responsible for vaccines regulatory affairs in emerging markets in Europe, Middle East and Africa.

The African Union (AU) is making good progress in operationalising the African Medicines Agency (AMA), having recently formed its Bureau and currently shaping its governing board.

This is according to Chimwemwe Chamdimba, Head of Health at the AU Development Agency (AUDA-NEPAD), who addressed a session of the Africa Health Agenda International Conference (AHAIC) in Rwanda on Wednesday.

AMA is being set up as a specialised health agency of the AU to ensure the regulatory harmonisation of medicines across Africa.

“We are hopeful that, in the next quarter, we should have the governing board of the AMA formalised by the congress of state parties,” Chamdimba told the session on the regulatory harmonisation, which was organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

Tackling fragmentation

“As the African Union, from the very beginning our thoughts have been to move from the fragmented 55 member states’ regulatory authorities, where manufacturers have to submit their [product] dossiers to each regulator, to the five regional economic communities (RECs),” said Chamdimba.

Chimwemwe Chamdimba, Head of Health at the AU Development Agency (AUDA-NEPAD)

She says that the RECs started harmonisation efforts as early as 2009, and the aim is to develop a common product application template that can be used by all the countries in the region.

By working together in the regions, national regulators had been able to do joint assessments and inspections, and this has started to “create trust between the regulator authorities within the RECs”, she added.

The AU is currently developing a continental regulatory reliance framework that will be piloted in the East Africa region.

In addition, the AU was working with partners such as Amref to train national regulators.

AUDA Nepad has also been mandated by the AU to lead private sector engagement in health and “we want as much as we can to have a more systematic way of engaging the private sector”, she added. 

“We all need to hold hands. The proof of the pudding is in the eating and we can only get feedback from the industry if they are willing to try the processes that we are putting in place on the continent.”

Timely access to medicines

Johnson & Johnson’s Jacqueline Acquah, the IFPMA’s co-chair of the Africa regulatory network, said that AMA was essential to ensure that patients had timely access to medicines.

“As a result of the globalisation of markets, we have a lot of products that move in within international commerce, and supply chains have become very, very complex,” said Acquah.

“The public has become more aware, and there’s a high expectation of our health systems. Unfortunately, the world over there’s a limited resource when it comes to global regulatory affairs. Regulatory resources are very, very limited so it’s important that national regulatory agencies collaborate more.”

As a result, said Acquah, regulators needed to develop a reliance on one another to avoid duplication of work and resources. 

“Regulatory reliance is when a regulator in one jurisdiction gives significant weight to the work that has been done by another regulator in another jurisdiction or an agency such as the World Health Organization (WHO) when making its own decisions,” she said.

“The regulatory agency is, however, still sovereign in the decision-making process, and also accountable for the decisions that they make.”

Egypt Drug Administration’s Dr Asmaa Fouad described regulatory reliance as “one of the magic tools that help regulators and industry and patient at the same time, so we achieve a triple win situation”.

Russia
The World Health Organization’s Executive Board 152nd meeting in February 2023

The World Health Organization on Wednesday said it is terminating the contract of the Director for the agency’s Western Pacific Regional Office (WPRO), following a prolonged investigation of allegations of abusive conduct towards his staff. 

The terse WHO announcement came at the conclusion of a two-day special session of the WHO Executive Board, tasked with reviewing the results of an internal WHO investigation into allegations of bullying as well as charges of racist behaviour leveled against Dr Takeshi Kasai, head of the WHO’s sprawling Manila office, one of six such regional offices maintained by WHO around the world.  

Last week, WHO member states in the Western Pacific Region voted to terminate Kasai’s contract as Regional Director – a post to which he was elected in 2019, after more than 15 years with the global health agency, Health Policy Watch reported.  

That left the Executive Board with little choice but to confirm Kasai’s removal from his RD post – and then recommend a course of action to WHO’s Director General in terms of his continuation with WHO in any role at all.  

According to Tuesday’s announcement, “The World Health Organization (WHO) received allegations of misconduct against the Regional Director for the Western Pacific during the latter half of 2021 and in 2022.  

“In line with the Organization’s policy of zero tolerance for abusive conduct, the allegations were investigated and subsequently reviewed in accordance with the normal procedures applicable to all WHO staff members. This included the right of the Regional Director to receive all relevant evidence and respond to the allegations in line with due process. These procedures resulted in findings of misconduct. 

“After careful consideration of the findings, and following consultation with the Regional Committee for the Western Pacific and the Executive Board, the Regional Director’s appointment has been terminated.”

Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at an April 2021 press conference.

WHO Internal Justice System Under Scrutiny  

The decision to fire Kasai is the first such decision to be taken following a string of high-profile investigations against a number of senior WHO officials.

Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo. But those cases ultimately failed to lead to the termination of three staff members that had been implicated. Since the victims were neither WHO staff or “beneficiaries” of aid the managers could not technically be held liable for failing to report their cases, an independent UN investigation decided.

Meanwhile, however, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022.  WHO has not yet announced any conclusion to its investigation into that case.

Kasai, in contrast, had been accused of abusive conduct and racism – but not sexual misconduct.  According to sources close to the Western Pacific Regional Office, four of the six original charges against him had been confirmed by a formal WHO investigation – leading to the vote last week in the WPRO Regional Committee.

Kasai’s removal was strenously opposed by Japan – which mustered 11 votes against his removal against 13 which voted in favor, sources told Health Policy Watch.   All six WHO Regional Directors are elected by member states, and confirmed by the Executive Board, rather than being appointed by the WHO Director General.

Election campaign for new WPRO RD to begin in April

In it’s announcement, WHO said that the election cycle for the next Regional Director for the Western Pacific will begin in April 2023, “when WHO Director-General Dr Tedros Adhanom Ghebreyesus invites Member States of the Region to submit proposed candidates.

“The election will take place at a closed meeting of the Regional Committee in October 2023, and the nomination will go to the Executive Board for approval. This follows the  standard process and timeframe, i.e. 5 years after the last election of a Regional Director for the Western Pacific.”

Ironically, Dr Temo Waqanivalu, a senior WHO official from Fiji, had reportedly been eyeing a run as a candidate to replace Kasai – until he was named in the media as the WHO staff member who allegedly harrassed a young UK colleague, Dr Rosie James, at the World Health Summit in Berlin.  Investigation into that case has been underway for over five months.

In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide.

But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO.

Until the new Regional Director takes office, Dr Zsuzsanna Jakab, who has served as Officer-in-Charge of the Western Pacific Region since August 2022, will serve as acting Regional Director, WHO said.  Dr Jakab has served as Deputy Director-General since 2019; prior to that, she was the WHO Regional Director for Europe.

The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia.

Image Credits: WHO.

Respiratory infections
A national cohort study in England and Wales found respiratory infections before the age of two nearly doubled the odds of premature death from respiratory conditions.

Respiratory infections contracted in early childhood nearly double the risk of dying prematurely from respiratory diseases as an adult, according to a new study published in The Lancet.

The study followed a British cohort of over 3,500 people from their births in 1946, and then again between the ages of 26 and 73 years of age. They found that those who contracted lower respiratory tract infections (LRTIs) like bronchitis or pneumonia before the age of two were 93% more likely to die prematurely from respiratory diseases as an adult. This was after adjustment  was made for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and adult smoking

“Childhood LRTIs have been shown to be linked to the development of adult lung function impairments, asthma, and chronic obstructive pulmonary disease, but no previous study has had long enough follow-up to prospectively connect these early childhood infections to adult mortality,” according to the study.

The risk of premature death caused by respiratory diseases in England and Wales is small, sitting at just 1.1% on average. For those who suffered LTRIs as infants, that risk jumps to 2.1%.

The study found this increased risk accounted for one in five premature respiratory disease deaths in England and Wales between 1972 and 2019, compared to three in five caused by smoking.

Globally, the chronic respiratory disease burden is significantly higher. In 2017, respiratory diseases accounted for an estimated 7% of worldwide deaths, killing 3.9 million people. Chronic obstructive pulmonary disease (COPD) caused the majority of these deaths, 90% of which occurred in low- and middle-income countries. By 2030, the World Health Organization projects COPD will be the third leading cause of death in the world.

While the Non-Communicable Disease Alliance notes that “the reasons for its increasing prevalence in low- and middle-income countries are not well understood,” the study’s findings indicate that addressing childhood exposure to respiratory disease could save hundreds of thousands of lives every year.

“To prevent the perpetuation of existing adult health inequalities we need to optimise childhood health, not least by tackling childhood poverty,” said Dr James Allinson of Imperial College London, lead author of the study. “Linking one in five adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood.”

The increased risk identified in the study affected participants regardless of socioeconomic background or whether they were smokers, challenging the conventional wisdom that adult mortality from respiratory diseases is exclusively linked to lifestyle choices like smoking.

The findings also build on previous studies demonstrating links between infants contracting respiratory diseases and lung function impairments, asthma, and chronic pulmonary disease in adulthood.

Researchers hope the mounting evidence of the long-term impacts of respiratory illness in children later in life will contribute to shaping global health response strategies to hit the Sustainable Development Goal of reducing non-communicable disease burden by a third by 2030.

“Current global efforts to reduce premature adult mortality focus largely on adult exposures,” said Heather Zar, chair of the Department of Paediatrics and Child Health at Red Cross Children’s Hospital and professor at the University of Cape Town who wrote the editorial accompanying the report’s release.

“Ensuring equitable global access to such interventions to prevent early life LRTI, particularly in low- and middle-income countries, will be crucial to reduce morbidity and mortality through the life course.”

“We hope that this study will help guide international health organizations in tackling this issue,” study co-author Rebecca Hardy of Loughborough University said.

Image Credits: Kelly Sikkema/ Unsplash.