Tobacco
Tobacco advertising is banned at the World Cup, but companies are finding ways to get around the rules.

Tobacco companies in Indonesia, India and Mexico circumvented international football governing body FIFA’s advertising ban on their products by associating them with the World Cup, according to a new social media analysis by public health group Vital Strategies.

Data recorded by Vital Strategies’ digital media monitoring system found 354 instances of tobacco marketing in public posts across Facebook, Instagram and Twitter between September to December 2022 around the World Cup in Qatar.

The overwhelming majority of posts (92%) originated in Indonesia, followed by India (6%) and Mexico (2%). Over 70% of the marketing instances were found on Instagram.

“Despite tobacco being the antithesis to athleticism and health, tobacco marketing on social media platforms continues to use sports to mislead youth and hook them on these deadly products,” said Nandita Murukutla, vice-president of global policy and research at Vital Strategies.

“As traditional marketing channels shut out tobacco promotion, tobacco marketers have set their sights on social media to connect their products with sports, especially football, and have a direct channel to youth.”

Global regulatory efforts continue to struggle to reign in the prevalence of tobacco, which remains the leading cause of preventable death in the world, claiming more than eight million lives a year.

The largest advertising opportunity in the world

The final between France and Argentina was watched by around 1.5 billion people, according to FIFA.

FIFA banned tobacco advertising, promotion and sponsorship from the World Cup in the late 1980s. The last World Cup to feature a tobacco sponsor, RJ Reynold’s Camel, was held in Mexico in 1986.

But the unparalleled reach of the world’s most popular sports tournament makes it a one-of-a-kind opportunity for tobacco companies, and many still use the World Cup to market their products on the local and national level.

The opening match between host Qatar and Ecuador – a decidedly low-stakes affair – pulled in 550 million viewers, FIFA said, while the historic final between Argentina and France glued some 1.5 billion people around the world to their televisions. The tournament also generated almost six billion engagements on social media, resulting in a cumulative reach of 262 billion accounts.

“FIFA’s ban on tobacco promotion is a good first step, but by itself lacks teeth,” said Sandra Mullin, senior vice president for policy, advocacy and research at Vital Strategies. “FIFA and football celebrities must work more actively and explicitly to distance themselves from the tobacco industry by calling out its underhanded youth-oriented marketing practices.”

FIFA took its first overt step to fight tobacco use during the 2002 World Cup when it joined forces with the World Health Organization (WHO) to ban smoking on the tournament grounds for the first time. In Qatar in 2022, Qatar’s Ministry of Health, the WHO and FIFA partnered to implement the most stringent anti-tobacco measures ever applied at the World Cup – policies which were highly publicized.

Indonesian tobacco giant Djarum left to freely market to children

“Limited edition” World Cup cigarette packs promoted by Djarum during the tournament.

Indonesian tobacco giant Djarum, identified by Vital Strategies as the largest offender hijacking the World Cup to advertise its tobacco products, has a long history of associating itself with sports.

The company runs “corporate social responsibility” schemes that award scholarships to children for badminton, one of Indonesia’s most popular sports, and runs national football programmes for youth players. Djarum was also the main sponsor of Indonesia’s pro football league from 2005 to 2011 and purchased Italian football club Como 1907 in 2019.

Djarum’s history of football-related branding made the World Cup a unique opportunity. The company quickly moved to capitalise on fan enthusiasm around the tournament to market limited-edition World Cup cigarette packs featuring colourful designs created by local artists. The campaign appears to be a clear attempt to market to children as studies have found colourful packing increases youth susceptibility to smoking.

Through its affiliate brand Djarum Super Soccer, whose social media accounts share football news and highlights to over one million combined followers, the company promoted the “Soccerphoria” event series. These watch-party cum festivals unfolded across four major cities with a combined population of around 16.5 million, including the capital, Jakarta, and featured live World Cup matches, concerts, mural painting, and stalls selling branded clothes and other Djarum merchandise.

Special edition World Cup e-cigarettes advertised by GeekVape, the official partner of French club Paris Saint-Germain.

Danilla Riyadi and Jason Ranti, two popular Indonesian musicians who took part in the tobacco-branded festivities, have nearly two and a half million combined followers on Instagram alone.

Geekvape, the e-cigarette manufacturer and official partner of French football giant Paris Saint-Germain, also sold special edition World Cup e-cigarettes in Indonesia.

Indonesia is notorious for its lax approach to regulating tobacco and its marketing. The country is home to the second-largest cigarette market in the world and the third-highest number of smokers behind India and China.

Nearly two-thirds of men over the age of 15 and 19.2% of youth aged 13 to 15 (including 35.6% of boys) use tobacco. The government has been slow to reign in the country’s tobacco giants, and commitments to raise excise tax for tobacco products have so far failed to curb the explosion of smoking rates among its youth.

The advertising efforts of tobacco giant Djarum to market to young people through sports – and parallel government inaction – are likely to worsen the crisis.

Tobacco companies shift gears in India, matching global advertising trends

Advertisements by tobacco company-owned brands clearly display their logo over top of fast food advertisements.

In India’s tougher regulatory environment, tobacco companies pivoted to a new strategy to profit from the World Cup: marketing affiliate brands.

While there was no direct marketing for tobacco products related to the 2022 World Cup in India, Vital Strategies uncovered extensive advertising campaigns pushing ultra-processed food brands owned by tobacco giants. Some brands clearly displayed the tobacco company logo in the corner of images promoting crisps.

Tobacco advertising, promotion and sponsorship have a long history in India, notably in the highest levels of cricket, the country’s most popular sport, but the shift away from tobacco towards ultra-processed foods is in line with wider developments in football advertising around the world.

Ultra-processed foods and alcohol, like tobacco, are well-established risk factors for non-communicable diseases, yet they continue to be marketed ubiquitously across international football leagues and tournaments.

Budweiser and McDonald’s were the key sponsors for the 2022 World Cup, while Coca-Cola was an official partner. A viral ad by Pepsi featuring stars like Lionel Messi, Paul Pogba and Ronaldinho links Pepsi to footballing greatness.

Meanwhile, a study on the 2018 World Cup found that around 1,806 advertisements for alcohol and ultra-processed foods were played during just 13 matches on British television networks, making around 7.5 billion impressions.

The e-cigarette problem

E-cigarette advertisements are following in the footsteps of old-school cigarette branding.

Vital Strategies’ analysis observed that several online retailers used images of football players to promote e-cigarettes, often with World Cup-related promotions featuring pictures of football players alongside e-cigarette products and discounts.

One such post featured Guillermo Ochoa, the goalkeeper of the Mexican national team, holding an e-cigarette and exhaling smoke through his nose, with the caption “Vamos Mexico,” linking e-cigarettes with national pride and a beloved figure. Other promotions linked e-cigarette use with friendship and community, similar to how football is seen as a common interest that brings people together.

Tobacco advertising and sponsorships are not allowed in Mexico’s national football league, but e-cigarettes can still be advertised to Mexico’s 45 million Formula 1 fans at racing events like the Mexico Grand Prix.

The e-cigarette industry is estimated to grow to $46.9 billion in the United States alone by 2025. All major tobacco companies now own at least one e-cigarette brand.

Studies on the health effects of e-cigarettes and vapes are still in their early stages but have so far found them to be less dangerous than tobacco.

While major study by King’s College London found “drastically lower” levels of exposure to cancer and other toxicants in people who vape compared to smokers, the report’s lead author, Ann McNeill, said that “the evidence we reviewed indicates that vaping is very unlikely to be risk-free”.

However, said McNeill, professor of tobacco addiction at King’s College London, “smoking is uniquely deadly and will kill one in two regular sustained smokers”.

“We strongly discourage anyone who has never smoked from taking up vaping or smoking,” she said.

Regulators in the European Union and United Kingdom have already banned the advertising of e-cigarettes, but much of the world has yet to follow suit.

Image Credits: Republic of Korea, FIFA, Stillblowingsmoke.org.

Water
Thousands of delegates from over 170 countries gathered in New York this week for the first United Nations meeting on water security since 1977.

At the first international conference on water security in five decades, governments, international organizations and civil society groups from over 170 countries committed to nearly 700 new initiatives to address a global water crisis that is causing record droughts, threatening food security, and threatening global supplies of drinking water. 

This week’s UN Water Conference is only the second of its kind. The last high-level meeting convened by the UN on water security was in Argentina in 1977.

The substance of the voluntary commitments in the conference’s outcome document – the Water Action Agenda – varies widely. They range from new investments in sanitation and hygiene services, to investments in desalination technologies, to transnational collaborations to preserve shared lakes, rivers, wetlands and aquifers.  

Around a quarter of commitments relate to water-related biodiversity preservation, health and hunger targets, while over half relate to climate change, according to preliminary data provided by UN Under-Secretary-General Li Junha at a press conference on Friday.

Putting water on the climate agenda

While no binding commitments were made, the Water Action Agenda made one thing crystal clear: water must be central to all future climate negotiations.

That must begin with COP28, scheduled to take place from November to December of this year in Dubai, said Henk Ovink, special envoy for international water affairs in The Netherlands, which co-hosted the conference along with Tajikistan. 

“We have to make sure that water will never be left out of any COP, be it the Convention on Biological Diversity or a climate COP,” Ovink said. “We see a [binding] pact for the future where water is core and central. This conference did not give us the mandate to do so, but we brought the world together to ensure that there is a follow-up.” 

Despite the fundamental impacts of climate change on water quality and access, it has so far been neglected in the climate agenda. COP27 in Sharm el-Sheikh was the first-time ever that water was mentioned in a high-level climate negotiation outcome document – and even then, it was only mentioned in the cover text. 

UN officials said they hope this week’s conference will be remembered as a turning point.  

“The past three days have proven that water truly unites the world,” Junha said. “From now on, water should be in every major global agenda for discussions among the member states.”

Li added that the framework set out in the Water Action Agenda will contribute to a series of high-level negotiations this year, where countries will have a chance to turn their voluntary  commitments into binding statements or resolutions. Those include the Sustainable Development Goals (SDG) Summit in September and COP28. 

“There is a direct connection between this conference and COP28,” Ovink said, adding that discussions about fixing water at the center of the COP28 agenda with United Arab Emirates representatives began even before last year’s meeting in Sharm-el Sheikh. 

States issue call for Special UN Envoy for water

Coinciding with this week’s event, some 149 member states called upon UN Secretary General Antonio Guterres to appoint a special envoy for water to oversee and coordinate international water security efforts.

Water, unlike biodiversity and the climate, does not have a dedicated forum in the UN. The call signaled the growing political will to solidify water’s position on the UN agenda.  

“We suddenly understood a strong request from the member states to appoint a special envoy for water,” Junha said. “I’m pretty sure that the Secretary-General will give very serious consideration to that.”

Demand for fresh water will outstrip supply by 40% within the decade

Water
Access to clean drinking water is a human right under international law. Today, women and children spend 200 million hours every day collecting water.

After years of inaction, a raft of reports published throughout the conference appear to have focused international attention around the growing urgency of water degradation, drought and depletion of resources.   

A new report by the Global Commission on the Economics of Water, published on day one of the conference, predicted that global demand for water will outstrip supply by 40% as early as 2030.

This shortfall could lead to between 1.7 billion and 2.4 billion people living in cities facing water scarcity within the next 30 years as population growth pushes urban demand for water up by an estimated 80%, according to the new UN World Water Development report published on the eve of the conference.

Another 10% of the world population lives in countries experiencing chronically “high or critical water stress”. 

“It is easy for some to think that water simply comes from the tap, but this limited perspective fails to acknowledge the vital ecosystems from which our water comes,” said Ibrahim Thiaw, UN Executive Secretary for the Convention to Combat Desertification. “When rivers run dry or become polluted, when groundwater is over-exploited, and when ecosystems are degraded, it is only then that we begin to understand the true value of water.”

Some 4 billion people worldwide experience water stress at least one month per year, according to UNICEF. Half of the world’s population could face water scarcity as early as 2025, the agency projects. 

Deaths increasing from lack of WASH services 

https://twitter.com/UNESCO/status/1639311361862778884?s=20

The United Nations University rang out another alarm bell: 2019 saw increased rates of mortality from the lack of access to water and sanitation services (WASH) in 164 countries compared with 2016 World Health Organization estimates. 

That follows years of mortality reductions from unsafe water and sanitation reported by the World Health Organization due to the gradual improvement of WASH services. 

Even as access to safe drinking water and sanitation have increased over the past decades, some 2 billion people still lack access to clean drinking water. Around 3.6 billion people – or 46% of the world’s population – still lack access to basic sanitation. 

Unsafe water and sanitation continue to cause over a million deaths from infectious diseases annually – far surpassing the 50,000 killed globally by natural disasters, the UNU report estimated.

“Far more people die from lack of access to water then die from lesser climate disasters,” said Dr Charlotte MacAlister, a senior researcher at the UNU, told the Associated Press. “I’m not saying that people aren’t dying, but far more people are dying from lack of safe water, safely managed water, and safely managed sanitation.”

The world is also far off-track to meet the SDG goal of universal access to safe drinking water and sanitation, the 2023 Global Water Security Assessment said.

Globally, Africa was the only region to make progress in reducing WASH-related deaths between 2016 and 2019. But it continues to suffer from the lowest levels of access to safe sanitation services and drinking water overall. 

Nearly 31% of people across Africa’s 54 countries do not have access to basic water drinking services, and 82% live without access to proper sanitation. 

“Deaths due to inadequate WASH provision are preventable and should no longer occur anywhere in the 21st century,” UNU said. “This is unacceptable.”

Draining humanity’s ‘lifeblood’

The UN Secretary-General called on the world to “bring the water agenda to life”.

“We are draining humanity’s lifeblood through vampiric overconsumption and unsustainable use and evaporating it through global heating,” UN Secretary General Antionio Guterres told the conference. “Water is a human right — and a common development denominator to shape a better future.”

Without a “quantum-leap” in the actions being taken by member states to address the water crisis, Gutetres said, the world’s lifeblood may soon run dry. 

The commitments submitted to the Water Action Agenda will be vetted by the UN Department of Economic and Social Affairs (UNDESA) and other research institutes to assessthat countries can follow-through on their targets.

The results of the audit will be published at the high-level political forum hosted by UNDESA in July this year, laying the groundwork for future UN negotiations. 

Image Credits: UN, UNICEF, US Mission to the UN.

Lucica Ditiu, Executive Director Stop TB at the World TB Summit in Varanessi, India

After major setbacks during the pandemic, TB diagnosis and treatment appears to have rebounded with the number of undiagnosed TB-infections estimated at less than three million people in 2022- the lowest ever. 

That’s according to preliminary data released by the Stop TB Partnership, on Friday, World TB Day. 

“In 2022 the gap between the estimated number of people with TB and those diagnosed and treated was the lowest ever—with less than 3 million missing people with TB. This gap was 3.2 million in 2019, 4.3 million in 2020, and 4.2 million in 2021,” stated the Partnership in a press release coinciding with the One World TB Summit, in Varanessi India.

At the Summit, the Partnership also announced a new “high-level advocacy platform” to reinvigorate commitments to eliminate TB as a public health threat by 2030, in line with the Sustainable Development Goals.  

“We are making history because we are meeting here in India, which is the highest burden of TB but also the highest ambition to end TB,” declared Lucica Ditiu, executive director of the STOP TB Partnership at a press briefing in Varanessi. 

Along with India’s Minister of Health, Mansukh Mandaviya, the briefing included leading health officials from other countries that have pledged to lead the charge in the campaign, including Indonesia and Brazil as well as South Africa and Nigeria.   

“We are changing the narrative about TB. We are saying “Yes we can end TB!” declared Ditiu, in reference to the Summit’s theme, hearkening back to the “Yes We Can” campaign slogan that helped propel former Barack Obama to the US Presidency in 2008.  

“There are things that are happening in all of these amazing countries and beyond,” she added, citing, for India: “the fact that people receive, every month, direct cash for treatment, that people are paired with friends who support them through the treatment.” 

Working with communities, private sector, care providers to increase testing

We have been working closely with communities, private sector care providers and others to increase awareness about increased testing and reaching all those who are affected by TB,” said Mandaviya, at the press briefing.   

Added Dr Ethel Maciel, Brazil’s deputy minister of health,  “Poverty is very close to TB disease, so we should fight against this. The new government has a special plan to fight against hunger and poverty, as well as increasing social protections and respect for human dignity. We all know that high TB affects the most vulnerable, the most vulnerable get even more vulnerable from this disease. 

“All of the things we learned in the COVID pandemic, we can put towards eliminating TB.  Close collaboration, sharing knowledge. We can do much more when we are united, when we have transparency. Today is a day of hope – that we can end TB. 

Maxi Rein Rodonuwu, director general, disease prevention and control, Ministry of Health, Indonesia

Indonesia, with the world’s fourth largest burden of TB, also made significant progress in 2022. 

Almost three-quarters of the estimated TB caseload was diagnosed and treated, with the overall treatment success rate at 84%—the highest rates recorded for Indonesia. Key to the success of the National TB Program was the deployment of screening campaigns similar to what was used for COVID-19, said Maxi Rein Rondonuwu, Director General of Disease Prevention and Control at the Ministry of Health.

Coalition of leaders set to launch initiative at UN General Assembly 

Speaking at the TB Summit opening, Indian Prime Minister Narendra Modi appealed to the G20 group of industrialized nations to support TB elimination. India holds the presidency of the G-20 this year, with heads of state set to meet in September in New Delhi.  

“The theme of the G20 is a resolution for the shared future of the entire world,” said Modi. “India’s efforts are a new model for the global war on TB. People’s participation in the fight against TB is India’s big contribution. India is now working on the target of ending TB by the year 2025. I would like that more and more countries get the benefit of all campaigns, innovations and modern technology of India,” added the Prime Minister. 

Along with the heads of state of India and Brazil, the coalition set to lead the “Yes We Can” campaign also includes Indonesia, South Africa, and the newly elected President of Nigeria, Bola Tinubu. The ‘Coalition of Leaders’ will be formally launched during the United Nations (UN) General Assembly week in New York City in September 2023.

Rebounding from the pandemic 

About 1.1 million children and young adolescents aged under 15 years are diagnosed with TB every year, and over 225,000 of them lose their lives.

Last year’s rollback in undiagnosed TB cases came as high TB burden countries—including Brazil, Nigeria, India and Indonesia—increased the number of people diagnosed and enrolled on treatment, exceeding the numbers seen before the COVID-19 pandemic. 

Despite this progress, TB was once again the world’s biggest infectious disease killer in 2022 – the delayed effect of setbacks in diagnosis and treatment over three pandemic years. So 2023 remains a critical moment as the international community prepares for the second UN High Level Meeting (UNHLM) on TB, 22 September 2023 (UNHLM), on the margins of the UN General Assembly in New York City. 

“With the world regaining strength as the COVID-19 pandemic wanes, ending TB as a global health threat is a critically important goal,” said Ditiu. 

New innovations 

“We have new innovations now to help us save lives—new diagnostic tools, shorter, less toxic treatment regimens, and new digital tools—and when we add the political muscle that the UNHLM will gather to the many dedicated health care professionals already in the front lines, ending TB looks increasingly possible,” she added.

These innovations include:

  • Rapid molecular tests that can identify TB and resistance patterns in the bacteria;
  • Shorter treatment regiments, for drug-sensitive and drug-resistant infections;
  • New digital tools, such as AI enabled ultraportable X-ray systems for screening for TB; 
  • Vaccine candidates that have advanced to phase 3 clinical trials.

Globally, investments in TB research and development have started to climb, surpassing US$1 billion for the first time ever. 

TB advocates hope that the coming High Level Meeting will propel governments and other funders to attain the US$2 billion per year investment goal pledged by countries at the first High Level Meeting in 2018, with a roadmap for increasing funding to US $5 billion per annum as envisioned by the Global Plan to End TB. 

They cite new data that shows every US$1 invested in TB yields US$46 in benefits.

 “What we need is quite simple, given that TB kills 1.6 million people every year,” added Ditiu. “We need increased political commitments from all high TB burden countries, and significantly more financing so that we can meet new challenges and embark upon a much faster path to new vaccines. We know what it takes to end TB; we need to roll up our sleeves and make it happen.”

India’s model system 

Mansukh Mandaviya, Minister of Health, India, describes country’s advances in TB diagnosis and treatment.

India’s model system combines digital health tools, economic incentives,  and old fashioned social support systems with a facelift.  

A real-time TB information system called NIKSHAY, triggers direct cash transfers to TB patients who continue their treatments. In the last five years, using this system, US$260 million has been disbursed to nearly 8 million people with TB to support their nutrition, Indian officials say. 

“Under the Prime Minister’s TB Free India Campaign, launched in September 2022, nearly 1 million people with TB have received commitments from individuals in society who will support them through their treatment journey,” said Suvanand Sahu, the deputy executive director of the Stop TB Partnership. 

“This initiative is unique in the world and is a great intervention for TB awareness, stigma elimination, community ownership and crowdfunding.”

At the same time, responsibility for implementing the campaign has been decentralized to state, district and village levels, with awards given to recognize states and districts who are making rapid progress towards ending TB. 

“TB Champions” also are recognized for their contributions to end TB in their community. Currently more than 30,000 TB Champions are supporting the TB response in India.

“India is providing models to fight TB. Trace, Test, Track, Treat and Technology is the strategy we are implementing to end TB in India by 2025,” said Modi in his keynote address.  

India also ramping up generic production of improved TB treatment  

At a separate press briefing on Thursday, WHO said it was also extending a TB Flagship Initiative for another five years- as new, promising TB vaccines approach market approval stage. 

WHO will establish a TB Vaccine Acceleration Council to spur movement on promising vaccine candidates, said WHO Director General Dr Tedros Adhanom Ghebreyesus at the briefing. 

“The only TB vaccine developed to date, the BCG vaccine, is more than 100 years old, and does not adequately protect adolescents and adults, who account for most TB transmission,’ he said, adding the new Council would “facilitate the development, licensing and use of new TB vaccines.

WHO welcomes India’s removal of patent from TB drug bedaquiline

Tereza Kasaeva, WHO Assistant Director, and head of the global TB programme.

Speaking at the press briefing  Dr Tereza Kasaeva, WHO Assistant Director-General, said “we are very optimistic about having new vaccines. There are about 16 vaccine candidates in the pipeline and at least one of the vaccines at the Phase III clinical trial stage is showing efficacy at least 50%. 

BioNTech has also identified a promising mRNA TB vaccine candidate, with Phase 1 trials due to begin soon, she reported, adding:  “If it will go the right way, quite soon, we may have new, effective TB vaccines.  

Kasaeva also welcomed the Indian Patent Office’s rejection of Johnson & Johnson’s request to  extend the patent on a critically important TB drug, Bedaquiline, which is set to expire in July. 

The decision opens the way for generic manufacture of the TB drug at far reduced prices; the drug currently costs about US500 a year in India. As India is the world’s leading TB drug producer, generic manufacturer will increase the flow of cheaper generics to many other low and middle income countries.     

The pharma company had sought to extend the patent, originally granted in 2008, until 2027, under a slightly new formulation – a tactic described as “evergreening” to prolong a patent’s lifespan. 

“As you know, Janssen Pharmaceuticals [a J&J subsidiary] has a monopoly over Bedaquiline, one of the most effective drugs for the treatment of drug resistant TB,” Kasaeva said. “And this monopoly will continue until July 20, 2023. The generic manufacturers are quite ready to enter the market with quality-assured tablets of Bedaquiline. So that’s why from that point of view, we are considering this news as positive.”

Image Credits: Stop TB Partnership, Stop TB Partnership.

 

Health clinic destroyed by cyclone Freddy, which made a double landing on the southern coast of Africa in the past month.

More than 300 health facilities have been destroyed or flooded in Madagascar, Malawi and Mozambique in the wake of Cyclone Freddy, WHO estimates.

That has left hundreds of communities without adequate access to health services even as the cyclone’s double whammy of devastation has raised public health risks including the increased spread of cholera, malaria, COVID-19, and as malnutrition, WHO African Region officials said at a press briefing on Thursday.  

In Mozambique alone, the number of cholera cases more than doubled over the past week from 1023 to 2374 new cases recorded as of 20 March.

Malawi, which has been battling its worst-ever cholera outbreak, fared somewhat better despite all odds.  It continued to record a decline in cases, with new infections dropping to a total of 1424 for the week ending 20 March as compared with 1956 the previous week. That decline came even as a second wave of Cyclone Freddy-linked flooding and infrastructure damage was still sweeping the country. 

The fierce Indian Ocean storm, dubbed the longest and most devastating to hit the Southern coast of Africa, made landfall on the continent’s southern coast for a second time in a month in mid-March, leaving more than 220 people dead so far.   

Dr Charles Mwansambo, Secretary of Health, Malawi

Speaking at the WHO African Region briefing, Dr Charles Mwansambo, Secretary of Health, Malawi, said that 14 districts had experienced floods and mudslides since the disaster began with torrential rains between the 11th and 13th of March.

“That’s almost half the country because Malawi has 28 districts. And due to that severity, our president declared a state of disaster in the 14 affected districts,” Mwansambo told journalists. 

According to Mwansambo, while there is an ongoing search for missing persons, more than 500,000 people have been internally displaced in the country, some of whom are being housed at 576 established camps. 

“We knew this cyclone was coming but we didn’t imagine that it would be of this magnitude,” he said.

Meanwhile, WHO African Regional Director Matshidiso Moeti noted that with a double landfall in less than a month, the impact of Cyclone Freddy is immense and deepfelt. 

“While we work to understand the full extent of the devastation, our priority is to ensure that affected communities and families receive health assistance for immediate needs as well as to limit the risks of water-borne diseases and other infections spreading,” she said.

Image Credits: NASA Worldview, WHO .

Tanzanian health workers being trained to tackle with the Marburg outbreak.

The World Health Organization (WHO) hopes to be able to fast-track the testing of various Marburg candidate vaccines following outbreaks of this rare and deadly viral haemorrhagic fever in Tanzania and Equatorial Guinea.

“WHO is leading an effort to evaluate candidate vaccines and therapeutics in the context of the outbreak,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

“The developers are on board the clinical trial protocols are ready. The experts and donors are ready. Once the national government and the researchers give the green light,” he added.

Four or five candidate vaccines already have doses ready for human trials, WHO’s Dr Ana Maria Restrepo told a media briefing.

Restrepo, who heads the WHO’s R&D Blueprint team, said that a Marburg consortium had been working together since the Equatorial Guinea outbreak had been confirmed in January.

“We are working through a platform that is cooperative that involves all the regulatory and ethics committees in Africa,” stressed Restrepo.

There are 28 potential candidate vaccines for Marburg, according to WHO R&D Blueprint. The virus is from the same family as Ebola and has an 88% fatality rate.

“Marburg belongs to the same family of viruses as Ebola, causes similar symptoms, transmits between humans the same way and like Ebola, has a very high fatality ratio,” warned Tedros.

“In the meantime, we’re not defenceless. Careful contact tracing isolation and supportive care are powerful tools to prevent transmission and save lives.”

Tanzania reports first-ever outbreak

Meanwhile, Tedros said that Tanzania had confirmed eight cases, including five deaths, by testing samples at a WHO-supported mobile laboratory set up last year “to prepare for viral haemorrhagic fever outbreaks, including Ebola and Marburg”.

National responders, WHO and the US Centers for Disease Control and Prevention (CDC)  “have been deployed to the affected region to carry out further investigations, monitor contacts and provide clinical care,” added Tedros.

A week ago, Tanzanian health authorities initiated a frantic search for the cause of the mysterious disease that had claimed several lives in the country. 

Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.

Tanzania Chief Medical Officer Tumaini Nagu said multiple isolation units to help monitor and isolate people displaying symptoms are now operational. 

“The government is closely monitoring the situation and taking appropriate measures to contain the disease,” Nagu told Health Policy Watch.

Tanzania Chief Medical Officer Tumaini Nagu

Lack of capacity

Equatorial Guinea has struggled to identify cases because of a lack of laboratory capacity but had confirmed nine cases with a further 20 probable cases. 

The first case from the eastern province of Kié-Ntem was confirmed in early February by the Institute Pasteur in Senegal. Two other people from Kié-Ntem province were diagnosed by a mobile laboratory at the Regional Hospital of Ebibeyin. 

A month later another case was identified in Litoral province in the western part of the country that was epidemiologically linked to a confirmed case in Kié-Ntem, while cases have also been confirmed in Centro Sur province.

The wide geographic distribution of cases and uncertain epidemiological links between cases “suggests the potential for undetected community spread of the virus”, according to WHO.

The provinces that share international borders with Cameroon and Gabon, and the WHO is working with those countries identify any potential cases, Tedros confirmed.

Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control.

At the Africa CDC press briefing on Thursday, acting director Dr Ahmed Ouma, said the center is providing Equatorial Guinea with needed technical support, infrastructural development and capacity building required to test for Marburg virus disease. 

“The government is responsible for the testing and to release those results to us,” he said, adding that the turnaround time for result is currently five days and this is being improved upon by the authorities and partners.

“The capacity is still being built,” he said. “The main lab is still not fully functional. We are finalizing calibration this week. And that main lab should be up and running in a few days as soon as the calibration and capacity building is done. And I think before the middle of next week when all that has been completed, they should be up and running. And that will make it easier to do more samples and [will be] a little bit faster.”

Meanwhile, health authorities are expecting genomic analysis results soon to see whether there is any connection between the outbreaks in Equatorial Guinea and Tanzania.

Dr Matshidiso Moeti, WHO Regional Director for Africa, said that gene sequencing analyses are being conducted in both countries to reveal any possible connections for both outbreaks. “We know that the world is interconnected in many ways, [but] the likelihood is not that high,” Moeti told journalists.

“The confirmation of these new cases is a critical signal to scale up response efforts to quickly stop the chain of transmission and avert a potential large-scale outbreak and loss of life,” said Moeti. “Marburg is highly virulent but can be effectively controlled and halted by promptly deploying a broad range of outbreak response measures.”

At the Africa CDC press briefing on Thursday, acting director Dr Ahmed Ouma, said the center is providing Equatorial Guinea with needed technical support, infrastructural development and capacity building needed to test for Marburg virus disease. 

“The government is responsible for the testing and to release those results to us,” he said, adding that the turnaround time for result is currently five days and this is being improved upon by the authorities and partners.

“The capacity is still being built,” he said. “The main lab is still not fully functional. We are finalizing calibration this week. And that main lab should be up and running in a few days as soon as the calibration and capacity building is done. And I think before the middle of next week when all that has been completed, they should be up and running. And that will make it easier to do more samples and [will be] a little bit faster.”

Image Credits: Muhidin Issa Michuzi.

Uganda’s Speaker of Parliament, Anita Among, during the passing of the Act.

The United Nations (UN) High Commissioner for Human Rights Volker Türk has called on Uganda’s President Yoweri Museveni not to promulgate the Anti-Homosexuality Act his country’s Parliament passed on Tuesday night.

Describing the Act as “probably among the worst of its kind in the world”, Türk said that, “if signed into law by the president, it will render lesbian, gay and bisexual people in Uganda criminals simply for existing, for being who they are”. 

Meanwhile, US Secretary of State Antony Blinken said that the Act would “undermine fundamental human rights of all Ugandans and could reverse gains in the fight against HIV/AIDS”, and urged the Ugandan government to “strongly reconsider the implementation of this legislation”.

The Act introduces “the offence of homosexuality”, with a potential life sentence for a same-sex “sexual act”. It also criminalises a person who “holds out as a lesbian, gay, transgender, a queer or any other sexual or gender identity that is contrary to the binary categories of male and female”.

It also proposes the death penalty for “aggravated homosexuality”, including sex acts with children, disabled people or those drugged against their will, or committed by people living with HIV. 

Landlords face prison sentences for renting premises to homosexuals, journalists face 20-year sentences for “promoting homosexuality” and even lawyers may face fines for representing gay clients.

The Act was proposed by Asuman Basalirwa from Bugiri and had the near-unanimous support of MPs.

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

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

“The Bill confuses consensual and non-consensual relations – the former should never be criminalized, whereas the latter require evidence-based measures to end sexual violence in all its forms – including against children, no matter the gender or sexual orientation of the perpetrator. This bill will be a massive distraction from taking the necessary action to end sexual violence,” the UN High Commissioner said.

Rise in anti-LGBTQ activity

“Not only does it conflict with Uganda’s own constitutional provisions stipulating equality and non-discrimination for all – it also runs counter to the country’s international legal obligations on human rights and political commitments on sustainable development, and actively puts people­’s rights, health and safety at grave risk,” he added.

There has been a rise in homophobic sentiments, particularly among politicians and religious leaders in Uganda and neighbouring Kenya over the past few months

The OHCHR said that,  according to a report from a civil society group, in February alone more than 110 LGBTQI+ people “reported incidents, including arrests, sexual violence, evictions and public stripping”.

“Let us be clear: this is not about ‘values’. Promoting violence and discrimination against people for who they are and who they love is wrong and any disingenuous attempts to justify this on the basis of ‘values’ should be called out and condemned,” Türk said.

Meanwhile, UNAIDS has warned that, if the Act becomes law, it will curtail “the human rights of people living with HIV and some of the most vulnerable people of Uganda to access life-saving services”. 

“If enacted, this law will undermine Uganda’s efforts to end AIDS by 2030, by violating fundamental human rights including the right to health and the very right to life,” said UNAIDS East and Southern Africa Director Anne Githuku-Shongwe.  

“Research in sub-Saharan Africa shows that, in countries which criminalize homosexuality, HIV prevalence is five times higher among men who have sex with men than it is in countries without such laws,” said UNAIDS, calling on Museveni not to enact the Bill as it will  “cost lives and it will drive up new HIV infections”. 

“The harmful Act stands in marked contrast to a positive wave of decriminalization taking place in Africa and across the world, in which harmful punitive colonial legislation is being removed in country after country. Decriminalisation saves lives and benefits everyone.”

Describing the Act as “an extreme violation of human rights”, International AIDS Society (IAS) warned that it “threatens to reverse the country’s progress in the HIV response”. “Criminalizing LGBTQ+ people is wholly incompatible with an effective HIV response,” said the IAS.

In opposition to HIV response

“While Uganda has made considerable gains in reducing the impact of HIV, gay men and other men who have sex with men, trans people and sex workers continue to be less likely than the general population to access HIV treatment, prevention and care services and will be further threatened by this legislation.

“In 2021, key populations (gay men and other men who have sex with men, people who inject drugs, trans people, and sex workers) and their sexual partners accounted for 51% of new HIV acquisitions in central, eastern, southern and western Africa. This underscores the urgent need for governments in the region to work with, not against, communities most vulnerable to HIV.”

The IAS also noted that the Act is also “completely in opposition to President Museveni’s stated support for the HIV response. UNAIDS and others lauded the President when he launched The Presidential Fast-track Initiative on ending HIV & AIDS in Uganda by 2030, the first such initiative globally.”

A partly submerged house in Nsanje in Malawi after Cyclone Freddy.

Submerged houses, collapsed buildings, uprooted trees and floating household items are what remains of Mtemangawa Village in Nsanje district, located in southern Malawi, bordering Mozambique.

This is where one of the longest-lasting storms in the southern hemisphere, Tropical Cyclone Freddy, entered Malawi on March 12, 2023. 

Home to about 300 000 people, Nsanje is Malawi’s poorest district. Some 81% of its population is ranked as poor and 56% as ultra-poor, meaning that they live on less than one US dollar a day.

“Rising water levels were noticed around 2pm on Monday, 13 March,” recalls resident Laika Kawela. “We ignored it. Our area is usually like that during the rainy season. But by 6pm, water spread all over our entire village. Luckily, we ran to higher ground carrying only the nearest basic things.”

Kawela only managed to save her family and her mobile phone. All her belongings, including her and her husband’s HIV antiretroviral (ARV) drugs, were washed away.

“For close to a week, we have missed our medication. We have been disconnected from many things, including medical services,” laments Kawela.

Kawela’s family is amongst the 660 families seeking temporary shelter at Kapalokonje camp. They have survived on anything they could in the past week as a truck full of relief food only arrived on Tuesday, a week after their displacement.

“We have been squeezing ourselves into the few surviving structures nearby for a week as we waited for aid. We had two tents mounted at this camp yesterday. Food prices in the district have more than doubled and many of us cannot afford it. We have been starving,” she tells Health Policy Watch.

Her main worry is how she can pick up her life again: “My house is not habitable. It will require a lot of maintenance. This applies to many people here. Where are we going to start from? Other than life, I don’t have anything else.” 

Kawela is one of the estimated half a million people who have been displaced by Cyclone Freddy in the country’s 15 affected districts. Her situation is a reflection of what many people living with HIV are facing after being displaced by the disaster. 

According to the Coalition of Women Living with HIV (COWLA), over 250 women living with HIV in the affected districts are disconnected from treatment.

A collapsed house in Nsanje in Malawi after Cyclone Freddy.

Collapsed system

Public health experts say that the cyclone came at an unexpected time and it has had a severe impact on people’s health. Services have been disrupted by damaged roads and bridges, and there is an acute shortage of staff as some health workers have also been displaced and lost property. Many local health centres have lost some or all their supplies, leading to a critical shortage of supplies in these facilities.

“The previous cyclones (Ana and Gombe) severely damaged our water, sanitation and hygiene infrastructure along with shelters, all of which exacerbated the current cholera outbreak,” said Dr Titus Divala, a public health expert.

“I can’t even begin to imagine how and when we will be able to get out of this. Considering the poor shelter, scabies and many other communicable diseases will also increase. It’s going to be painful. Authorities and their development partners need to act quickly,” Divala predicts.

Satellite image of Cyclone Freddy before it hit Mozambique on 10 March.

Roads washed away

According to the Ministry of Health (MoH), Nsanje has been disconnected from health facilities as roads have been washed away.

Even before the cyclone, Malawi’s health sector had been struggling to deal with the most prolonged cholera outbreak in a decade. The outbreak started last March and has claimed 1,686 lives.

MoH spokesperson, Adrian Chikumbe says the fight against cholera has been affected by the cyclone in some places.

“Patients are failing to go to facilities either because the facilities are affected or roads are impassable,” Chikumbe told Health Policy Watch.

A report from the ministry and the Public Health Institute of Malawi report warned that Cyclone Freddy has contributed to the breakdown of water and sanitation facilities, leading to contaminated water sources and collapsed latrines.

“Congregate settings like camps are a fertile ground for disease outbreaks,” they warn.

However, the MoH has trained volunteers and Health Surveillance Assistants (community health workers) to monitor the camps amid ongoing assessments in the affected areas, the report, which was issued on Monday, adds.

Professor Adamson Muula, Head of Community and Environmental Health at Kamuzu University of Health Sciences, notes that living with friends, relatives or strangers at the camp is a nightmare for survivors – even in countries that are used to managing displaced individuals.

“The schools, churches and other places, which have turned into shelters, are not designed to cater for displaced individuals. The schools are created to offer services to children and adolescents for classes. They are not meant to house adults. Many of the survivors don’t know when they will leave these shelters. We also need to be aware that there are psychological ramifications which must be attended to,” Muula said.

Pregnant women, people with chronic medical conditions including high blood pressure and heart diseases, and those on ARVs, are particularly at risk, he warns.

“Those on tuberculosis and HIV treatment, their medication and health records have been lost. All these people are in camps now or staying in strange environments. The system has been compromised and we need to intervene before things become worse,” he said.

However, Muula observed that the current tragedy is largely man-made: “This is not the time to blame one another. But as the dust settles, there is a great need for soul-searching and an honest discussion about how to prevent future losses of life. No doubt, these cyclones will continue to come, more frequently.”

More extreme weather events

Malawi President Lazarus Chakwera declared a state of disaster on 13 March 13, and 14 days of national mourning from 15 March. The death toll on Wednesday stood at 507 deaths, with 1,332 people injured, according to the Department of Disaster Management Affairs.

Last Monday, United Nations Secretary-General, Antonio Guterres warned that, unless countries dramatically scale up their efforts to counter the climate crisis, the world faces a global disaster as the planet is “nearing the point of no return”.

Global emissions of carbon dioxide and other greenhouse gases keep increasing, largely because of the burning of fossil fuels, deforestation, and intensive agriculture, said Guterres at the launch of the sixth synthesis report of the Intergovernmental Panel on Climate Change (IPCC).

“Emissions should be decreasing by now and will need to be cut by almost half by 2030 if warming is to be limited to 1.5°C,” the report warns, referring to the temperature target adopted by most countries in the Paris Agreement in 2015.

Herbert Mwalukomo, Executive Director for the Centre for Environmental Policy and Advocacy, said that Malawi should expect more extreme weather events.

“The global community must wake up. The piecemeal solutions to climate change will not help. The UN report is very clear that the pace and scale of what has been done so far and current plans are not sufficient,” said Mwalukomo.

“Developed countries must shift away from carbon energy in their own countries now if they care about climate change. No amount of preparedness will help if emissions continue to rise.”.

Mwalukomo said that the most immediate policy action is to enact a national Disaster Risk Management Bill. 

“Cabinet, the Ministry of Justice and the Department of Disaster Management Affairs must do the needful to ensure that the Bill is tabled in the current sitting of Parliament. The Bill is not a magic bullet, but it will go long way to ensure that Malawi has a legal framework for preparedness, effective response and recovery from disasters,” he said.

“As citizens, we have to invest in our own preparedness. We cannot continue building and living in areas that are prone to flooding. It is a suicide mission. We also have to pay attention to early warning messages provided by the Department of Meteorological services,” he said.

Dodma says the world has for some time known that it is in a climate crisis and the department is putting in place adaptation plans including early warning system, anticipatory plans and bringing back the environment.

Charles Kalemba, Commissioner for Disaster Management Affairs, said that “disasters will continue to happen, it’s not a new thing. We are prepared for anything that may come in future”.

The department’s main strategy to reduce the impact of future disasters, he added, was encouraging people to relocate from flood-prone areas through local councils that need to find suitable safe places for the citizenry.

“We have asked councils to be aggressive in enforcing laws on illegal settlements especially those settling at the foot of mountains. They need to relocate these people, especially in Blantyre where such residents were hard hit,” Kalemba said.

Image Credits: NASA Worldview, Josephine Chinele.

Plastic
Most plastics that are produced end up in landfills in poorer countries.

Human health is in grave danger because of plastics across their entire lifecycle, a new study has found. The study, conducted by an international consortium of scientists, has pointed out that from production to disposal, plastics are bad news. 

The team of scientists, led by the Boston College Observatory on Planetary Health, Australia’s Minderoo Foundation and the Centre Scientifique de Monaco, called for a strong and comprehensive global plastics treaty to be adopted as soon as possible, to put the world on track to end plastic pollution by 2040. 

The study, published in the journal Annals of Global Public Health on Tuesday, stated that the current patterns of producing, using and disposing of plastics are leading to snowballing impacts on health from the womb to old age.  

“It is now clear that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices”, stated an editorial accompanying the report. 

Along with pushing for the expedited adoption of a global plastics treaty, the study also recommends that a Permanent Science Policy Advisory Body be created to guide the implementation of the treaty. 

“The main priorities of this body would be to guide member states and other stakeholders in evaluating which solutions are most effective in reducing plastic consumption, enhancing plastic waste recovery and recycling, and curbing the generation of plastic waste,” the study’s authors added. 

Impacts on health from cradle to grave

That plastics cause harm to the planet is not news. However, this is the first study to look in detail into the dangers to human health from plastics at every stage of production, use and disposal. Among the key findings:  

  • Of the more than 10,000 materials used in plastics production, some 1,254 pose high health concerns. Those include toxic, mutagenic and carcinogenic monomers – of which PVC is perhaps best known, but there are many others.
  • At the use stage, some 63 of the more than 90 chemicals associated with plastics packaging rank in the highest category for human health. Many of the chemicals used in food packaging can leach out onto food, leading to human exposures.
  • Finally, at disposal stage, those same chemical components or additives can be released or leached out during recycling and recovery processes, the report found.  And most of the world’s plastics are not recovered at all – they are simply dumped into landfills, incincerated or shipped elsewhere – contaminating soils, fresh water aquifers, oceans and fisheries – with further ecosystem and health impacts.

“This is the first analysis to look at hazards to human health caused by plastics across their entire life cycle – cradle to grave – beginning with the extraction of the coal, oil and gas from which nearly all plastics are made, through production and use, and on to the point where plastic wastes are thrown into landfills, dumped into the ocean or shipped overseas,” Dr Philip Landrigan, director of the Program on Global Public Health and the Common Good at the Boston College Observatory on Planetary Health and the study’s lead author explained in a press release. 

Plastic
A range of chemicals are used, present and released throughout the life cycle of plastics.

Occupational health hazards, premature births and birth defects

Workers involved in plastics production suffer higher mortality from a range of causes from traumatic injury to lung cancer to interstitial lung disease. They are also highly likely to contract diseases like mesothelioma, angiosarcoma, breast cancer and decreased fertility. 

But plastics also cause a variety of health impacts across the population, from pregnancy and early childhood to older ages.  

“Because of the exquisite sensitivity of early development to hazardous chemicals and children’s unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer,” the study pointed out.  

“Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life.”

Massive adverse enviornmental, economic and social justice impacts

Elaborating on the production cycle of plastics, the scientists also summed up the massive adverse environmental, economic, human health and social justice impact that prolonged plastic use creates. 

Plastics are produced from coal, oil or gas, in an energy intensive process. The current modes of plastic disposal are highly inefficient. 

Plastic
A wall made of plastic waste in Singapore.

“Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally,” the study pointed out. “The result is that an estimated 22 megatonnes of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950.”

Apart from causing widespread pollution across terrestrial, aquatic and atmospheric environments globally, the reckless use of plastics causes significant economic costs. 

“We estimate that, in 2015, the health-related costs of plastic production exceeded $250 billion globally, and that in the USA alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA and DEHP exceeded $920 billion”.

Around 90% of the plastics produced are not recycled or reused, and often end up in landfills in poorer countries. This adversely affects people who are already vulnerable and had nothing to do with creating the plastics crisis and lack the power and resources needed to address it. 

“Plastics’ harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North,” the study said. “Social and environmental justice principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics’ negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs”. 

Global Plastics Treaty

Plastic
The adoption of the resolution receives a standing ovation from the delegates present in Nairobi, Kenya, in 2022.

In 2022, Heads of State, Ministers of environment and other representatives from UN Member States at the fifth United Nations Environment Assembly in Nairobi, Kenya, approved a resolution to draft a Global Plastics Treaty by the end of 2024. This agreement on addressing the pollution caused by plastics would be internationally binding. 

“And as we embark on this journey, let us be clear that the agreement will only truly count if it has clear provisions that are legally binding, as the resolution states,” Inger Andersen, the executive director of the United Nations Environment Programme (UNEP) remarked after the resolution was passed. According to UNEP, plastics will account for 20% of oil and gas consumption by 2050. 

“It will only count if it adopts a full life-cycle approach – stretching from design to production to circularity to reducing, managing and preventing waste.”

Switzerland and Ecuador reiterated the importance of a global plastics treaty in Davos in January 2023, in the world’s journey to end plastic pollution. 

While the treaty is currently under negotiations, it is expected that the powerful oil and gas producers will oppose the creation of a comprehensive treaty with teeth. 

The first session of the Intergovernmental Negotiating Committee (INC) took place from 28 November to 2 December, 2022 in Uruguay. The second session of the INC is scheduled to take place in Paris from 29 May, 2023 to 2 June, 2023. 

“Our report is intended to inform the Treaty negotiations. The Global Plastics Treaty is still two to three years away. But it will resonate with other treaties, including the agreement reached earlier this month known as the Oceans Treaty,” Landrigan said. 

The Permanent Science Policy Advisory Board, recommended by the study, will aim to inform the work of the treaty by arming the negotiators and participants with scientific evidence. 

“All big global agreements, or treaties, need scientific support. They need access to individuals with expertise to make sure the treaty reflects the most recent science. These treaties are never static, they must continually be updated to reflect the best current knowledge”. 

Image Credits: Photo by Hermes Rivera on Unsplash, The Minderoo-Monaco Commission on Plastics and Human Health, Photo by Nick Fewings on Unsplash, UNEP.

During the COVID-19 pandemic, people living with cancer, heart diseases, chronic respiratory diseases, diabetes and other non-communicable diseases (NCDs) experienced difficulties in accessing their routine medicines, according to a new report released by the World Health Organization on Wednesday.

While 21% of WHO member states reported stockouts of the five many medicines for people with NCDs, only 4% of high-income countries were affected whereas a third of low-and middle-income countries were affected.

“The COVID-19 pandemic has exacerbated the challenges that people living with NCDs face in accessing essential medicines,” said Dr Bente Mikkelsen, the WHO’s NCD Director.

“Many have had their treatment disrupted, which can lead to serious health consequences. It is therefore very important not only that treatment and care for people living with NCDs are included in national responses and preparedness plans, but that innovative ways are found to implement those plans.”

Numerous pharmaceutical supply chains were affected, according to the WHO, which called for improvement of “the transparency of the overall pharmaceutical information ecology as a foundation for pandemic planning and response”.

“If we are unable to identify weaknesses in the global NCD supply chain, we cannot hope to mend them,” the WHO noted in a statement on Wednesday.

“Without effective monitoring and transparent data, it is difficult to identify weaknesses in the global NCD supply chain. This requires countries to look at their supply chain, strengthen and expand medicine shortage notification systems, build in flexibility in their regulatory measures and minimize barriers to trade.”

Globally, more is spent on medicines for NCDs than any other therapeutic class. 

Although a few short-term interventions were adopted to respond to pandemic needs, the WHO wants “a longer-term strategy to strengthen access and delivery mechanisms during emergencies and mitigate future outbreaks”.

 “Let’s not forget: COVID-19 may be out of sight, but access to NCD medicines is still out of reach for many,” said Mikkelsen.

Co-chairs of the UN Water Conference, President Emomali Rahmon of Tajikistan and King Willem of Netherlands, at the opening ceremony.

“We are draining humanity’s lifeblood through vampiric overconsumption and unsustainable use and evaporating it through global heating,” United Nations Secretary-General António Guterres told the start of the UN 2023 Water Conference. which also coincided with World Water Day.

At the conference, national governments and stakeholders from all levels of society will collaborate to make voluntary commitments to accelerating progress on Social Development Goal Six, to promote access to safe water, sanitation and hygiene.

These voluntary commitments will form the Water Action Agenda, designed to deliver rapid, transformative change in the remainder of this decade.

“We’ve broken the water cycle, destroyed ecosystems and contaminated groundwater,” Gutteres added.

“Nearly three out of four natural disasters are linked to water. One in four people lives without safely managed water services or clean drinking water. And over 1.7 billion people lack basic sanitation. Half a billion practice open ablutions. And millions of women and girls spend hours every day fetching water.”

In addition, 1.4 million people die annually and 74 million will have their lives shortened by diseases related to poor water, sanitation and hygiene, according to the World Health Organization (WHO).

Global water demand is projected to increase by 55% by 2050.