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

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

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

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

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

Landmark resolution on harmful chemicals, including plastics 

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

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

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

Landmark Resolution on Chemical Pollution Passes World Health Assembly

New thrust on fake medicines and rehabilitation services 

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

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

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

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

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

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

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

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

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

“Best Buys’’ to combat NCDs

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

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

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

Support for disability inclusion

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

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

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

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

Visa restrictions limit participation by global south in professional events

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

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

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

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

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

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

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

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

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

Image Credits: WHO, WHO .

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

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

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

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

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

Timely testing

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

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

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

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

Keeping vaccine factories ‘warm’ outside pandemics

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

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

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

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

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

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

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

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

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

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

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

Regulatory hiccups and pathogen sharing

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

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

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

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

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

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

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

Pandemic-proofing humans and health systems

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

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

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

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

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

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

Are politicians out of the loop?

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

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

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

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

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

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

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

Meanwhile, a new pandemic lurks

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

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

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

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

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

Total R&D ecosystem overhaul?

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

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

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

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

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

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

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

It’s going to be a busy  12 months.

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

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

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

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

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

Digital health must benefit vulnerable people

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

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

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

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

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

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

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

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

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

 Legal and ethical questions

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

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

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

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

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

‘Cautiously optimistic’

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

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

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

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

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

Image Credits: Twitter/Governing Health Futures 2030.

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

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

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

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

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

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

Solutions available, but political will is needed

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Citizens for clean air

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

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

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

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


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

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

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

‘Majority Demographic’

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

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

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

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

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

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

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

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

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

Need for flexibility, no magic bullet

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

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

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

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

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

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

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

Children among the most vulnerable groups

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

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

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

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

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

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

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

Become Air Pollution “Terminators”

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: Clean Air Fund , US Mission Geneva .

WHA president Chris Fearne prepares to announce the results of the secret ballot

Russia’s objection to the nomination of Ukraine for the World Health Organization’s (WHO) Executive Board delayed Friday’s World Health Assembly – while the US and the Democratic People’s Republic of Korea (DPRK) also took diplomatic potshots at each other.

What was supposed to be a straightforward endorsement of the 10 members put forward by member states to fill the vacancies on the 34-person board turned into a lengthy delay as officials organised a secret ballot.

The European Union and Monaco objected, saying that the outcome of the vote was already clear.

Meanwhile, Russia also objected to the process of the ballot, which it described as “merely procedural and not an election since the member-states cannot vote against any single candidate in the ballot”. 

It also took exception to New Zealand being one of two representatives to count the ballots: “New Zealand has repeatedly spoken against our delegation… We have no trust the teller will be carried out correctly.” 

South Africa was deemed an acceptable replacement for New Zealand, and the ballot went ahead – once again resulting in Russian humiliation with 123 member states supporting all 10 new members, 13 abstentions and six spoiled ballots (35 countries were absent).

“We are encouraged by the unanimity and resolve of the World Health Assembly in standing up to Russia’s unprecedented assault on WHO governing bodies,” said Ukraine, noting that Russia continued to attack health facilities and kill civilians and health workers.

One of the newly elected board members is from North Korea, something that disquietened the US.

“The US takes this opportunity to reinforce the expectation of members of the executive board and calls on the government of the DPRK to respect human rights, fulfil its obligations under UN Security Council resolutions and engage in serious and sustained diplomacy,” it noted.

In response, North Korea’s representative described the US as “Satanic” and its comments an “abuse” of the WHA.

Russia, North Korea, Syria and Egypt all objected to the politicisation of the WHA. The Executive Board is composed of 34 persons who are technically qualified in the field of health, each designated by a member state and elected for three-year terms.

(Additional reporting by Megha Kaveri)

WHA76: Committee A finally passes NCD plan

New global guidelines to tackle non-communicable diseases (NCDs) were finally passed by the World Health Assembly on Friday afternoon after a mammoth day-and-a-half of member states’ inputs.

The guidelines update the World Health Organization’s (WHO) “Best Buys” published in 2017 and focus on the four key risk factors for NCDs – tobacco, alcohol, unhealthy diet and physical inactivity – and the four main associated diseases – cardiovascular disease, diabetes, cancer and chronic respiratory disease. 

Earlier in the week, Bente Mikkelsen, WHO’s Director of NCDs, explained the key changes adopted on Friday to what she described as an “implementation roadmap” to tackle NCDs, which are responsible for three-quarters of global deaths.

“In 2017, we had a total of 88 interventions, and 39 of them had cost-effective estimates,” Mikkelsen told the event convened by the NCD Alliance and Vital Strategies.

“We now have 90 interventions, and 58 interventions with cost-effectiveness estimates. And also very importantly, in 2017, we only looked at [evidence from] 20 countries, and today we have 62 countries grouped in all three income categories.”

Twenty-eight interventions are considered to be the most cost-effective and feasible for implementation in comparison to 16 recommended in 2017.”

These include taxes on sugary drinks, curbs on the marketing of unhealthy products and warning labels.

Vital Strategies’ Dr Nandita Murukutla described the interventions that are “inexpensive for governments to implement, including those that target behavioural risk factors such as tobacco use, unhealthy diets, alcohol consumption and inadequate physical activity”.

“The effectiveness of excise taxes, marketing restrictions and labelling policies, for instance, have been demonstrated to reduce the consumption of unhealthy products,” added Murukutla, Vice President of Global Policy and Research.

“Were governments to adopt the recommendations as official policies, they could, in a unified and coordinated approach, significantly reduce the proliferation of unhealthy products and make an impact on the growing trajectory of NCDs, including heart and lung disease, diabetes, and cancers,” she added.

However, NCD advocates believe that the “Best Buys” need to be further strengthened to prevent interference in health policy by industries selling products that harm people  – tobacco, alcohol, ultra-processed food and fossil fuel.

“The industries that produce and market these products are more interested in profit than in healthy people and healthy communities,” said José Luis Castro, President and CEO of Vital Strategies, at the WHA side event hosted by his organisation and the NCD Alliance.

Castro believes that “Best Buys” should be modified to include “more explicit recommendations against corporate influence” because “corporate influence worldwide has been identified as the main reason why Best Buys’ implementation falls short”.

Self-Care a Foundational Component of Health System Sustainability” at the 76th World Health Assembly
Self-Care a Foundational Component of Health System Sustainability” at the 76th World Health Assembly

The United for Self-Care Coalition made calls to expand the current World Health Organization’s (WHO) guidelines on self-care during a panel event, “Self-Care a Foundational Component of Health System Sustainability,” at the 76th World Health Assembly on Wednesday.

The United for Self-Care Coalition, a new coalition of like-minded groups and experts, marked their call to action with a panel hosted by coalition member the Global Self-Care Federation (GSCF) to discuss 

“We are in a unique moment, as we see it from a federation standpoint as it pertains to the role of self-care in overall health care systems,” GSCF Chair Manoj Raghunandanan told those in attendance. 

Global Self-Care Federation Chair Manoj Raghunandanan
Global Self-Care Federation Chair Manoj Raghunandanan

A rise in chronic conditions, an ageing population, and the COVID-19 pandemic have all impacted already-overstretched resources over the past few years, he said.

For Raghunandanan, the COVID-19 pandemic has changed how people view self-care due to the amount of time spent in lock downs and, for many people, an inability to see medical practitioners in person.  

“The COVID-19 pandemic was the great accelerator,” Raghunandanan said. “We had a period where consumers and patients were relying upon themselves to care for themselves, to adjudicate their care to provide for themselves, and during that time, we realised that in many cases, they could be successful at doing this.”

What is self-care?

Self-care is defined as the ability of individuals, families and communities to promote health, prevent disease and mental health, and cope with illnesses and disability, with or without the support of health workers.

United for Self-Care Coalition has called on the WHO to boost health literacy, promote digital health, enhance self-care capacity and guidance, recognise self-care as an enabler of UHC and invest in self-care. The coalition is already part of the UHC2030 platform, which aims to increase Universal Health Coverage by 2030. 

Democratising access to self-care interventions

Many see the current WHO guidelines as simply needing to do more.

Manjulaa Narasimhan, a scientist in the Department of Reproductive Health and Research at WHO
Manjulaa Narasimhan, a scientist in the Department of Reproductive Health and Research at WHO

Manjulaa Narasimhan, a scientist in the Department of Reproductive Health and Research at WHO, explained, “We look at things like how can we reduce the levels of violence, stigma, discrimination and coercion, that many people face even within health systems. We look at what kind of education and support they might need, including psychosocial support and other types. What kind of access to justice might people need?”

Self-care practices can hold enormous potential to improve people’s quality of life, helping to manage the burden of non-communicable diseases (NCDs) while helping to develop health systems’ sustainability and reduce increasing costs. 

One such way forward could be increased telemedicine, health-related services and information available via electronic devices and technologies. This allows longer-distance patient-clinician contact, care, advice, reminders, education, intervention, monitoring and remote admissions.

Academic Austen El-Osta gave examples to the panel, including the UK National Health Service, who, he told the audience, “bought a quarter of a million blood pressure monitors and distributed these to patients. These patients are effectively self-caring, releasing pressure from primary care and the health system. Of course, we’re all familiar with the many fantastic digital health apps and tools that we use and excellent med tech.

“The big question is how do we democratise access to self-care interventions and best practices?” El–Osta said. “We have the guidelines; we’ve got some anecdotal evidence. We’ve got a lot of work on NCDs and technology. So all of these are coming together now.”

Another example explored was how pharmacists could help unburden struggling health systems. 

Mariet Eksteen, Global Lead for Advancing Integrated Services at Advancing Pharmacy Worldwide
Mariet Eksteen, Global Lead for Advancing Integrated Services at Advancing Pharmacy Worldwide

“Often pharmacy and pharmacists are the patient’s first point of call in any healthcare inquiry that they have,” stated Mariet Eksteen, Global Lead for Advancing Integrated Services at Advancing Pharmacy Worldwide. “Pharmacists could be an exceptionally well-positioned resource to support the concept of self-care because we could assist patients with a rising level of health literacy as well as knowledge in their communities, which as a result, could also lead to increased levels of preventative care.”

Why a WHO resolution is needed

A WHO resolution on self-care, as opposed to guidelines, would provide the following:

  • A framework for its integration into future economic and health policies.
  • Promoting awareness.
  • Political commitment.
  • The mobilisation of resources.

There would then be better support for the UH2030 goals. 

Sandy Garçon, the founding director of the Self-Care Trailblazer Group, echoed calls for the WHO to work on the current guidelines, stating, “There needs to be the right kind of policies, the right kind of funding, and the correct type of programming. Many countries are already moving in this direction, but we need more.”

“We always welcome political and legal policy and standards framework that we can rely on to help us create that ecosystem we want,” agreed Kawaldip Sehmi, CEO of the International Alliance of Patients’ Organisations. “From patients of self-care first, then health professionals second. Now it’s time to take care of ourselves.”

Image Credits: Screenshot.

From left: Magdalena Sepúlveda Carmona, Executive Director, Global Initiative For Economic, Social And Cultural Rights; Saman Zia-Zarifi, Executive Director, Physicians For Human Rights; and Viviana Muñoz Tellez, Coordinator, Health, Intellectual Property And Biodiversity Programme, South Centre
From left: Magdalena Sepúlveda Carmona, Executive Director, Global Initiative For Economic, Social And Cultural Rights; Saman Zia-Zarifi, Executive Director, Physicians For Human Rights; and Viviana Muñoz Tellez, Coordinator, Health, Intellectual Property And Biodiversity Programme, South Centre

As the world continues to learn the lessons of the COVID-19 pandemic, a new set of principles aiming the help guide the future of human rights in global medical emergencies was published and discussed on Tuesday at an event of the 76th World Health Assembly (WHA). 

The event, titled “Beyond Panic & Neglect: Building a Human Rights Framework for Public Health Emergency Prevention, Preparedness, and Response,” looked at a new set of principles and Guidelines on Human Rights and Public Health Emergencies, which were developed through a three-year partnership between the Global Health Law Consortium (GHLC) and the International Commission of Jurists (ICJ.) 

The overarching human rights principles and obligations fall into eight categories:

1 – Universal enjoyment of human rights

2 – International solidarity

3 – Rule of law

4 – Equality and non-discrimination

5 – Human rights duties related to non-State actors

6 – Transparency and access to information

7 – Meaningful and effective participation

8 – Accountability and access to justice for those harmed by human rights violations and abuses

Principles bring together lessons from COVID and previous pandemics, epidemics

The principles, formulated by 150 individuals from other health and human rights organisations and WHO officials, draw upon lessons from past epidemics and pandemics, including cholera, dengue, ebola, HIV and zika. In addition, the experts looked at situations where an inadequate response to effective public health policies and human rights obligations led to devastating outcomes.

“What was needed is a contemporary treatment that also accounted for what needed to be done to ensure a broader rights-based approach to public health emergencies, including upholding the right to health and related rights. These new principles, we believe, represent a breakthrough in the ongoing effort to ensure that human rights are protected and upheld in times of crisis.” Ian Seiderman, legal and policy director at the ICJ, told those gathered. 

“This event here marks our first public dialogue on the new principles and guidelines and their subject matter, focusing on the role of international human rights law in guiding approaches to public health emergencies.”

The principles bring together an overarching scope of the universal enjoyment of human rights, including equality and non-discrimination, transparency and access to information and accountability and access to justice for those harmed by human rights abuses or violations. 

Principles coincide with pandemic treaty

From left: Magdalena Sepúlveda Carmona, Executive Director, Global Initiative For Economic, Social And Cultural Rights; Saman Zia-Zarifi, Executive Director, Physicians For Human Rights; Viviana Muñoz Tellez, Coordinator, Health, Intellectual Property And Biodiversity Programme, South Centre; and moderator Gian Luca Burci, Adjunct Professor, International Law, Geneva Graduate Institute
From left: Magdalena Sepúlveda Carmona, Executive Director, Global Initiative For Economic, Social And Cultural Rights; Saman Zia-Zarifi, Executive Director, Physicians For Human Rights; Viviana Muñoz Tellez, Coordinator, Health, Intellectual Property And Biodiversity Programme, South Centre; and moderator Gian Luca Burci, Adjunct Professor, International Law, Geneva Graduate Institute

The release of the principles coincided with the release of a new “Zero+” draft of the proposed World Health Organization (WHO) pandemic accord that is currently under negotiation by member states. 

“We saw many governments shift from complacency and neglect to rapid action, often in panic mode to respond to a public health threat that was spreading uncontrollably,” stated Roojin Habibi, a co-founding member of the Global Health Law Consortium, who led the development of the principles. “Around the world, we saw countries deploy various measures, from mask mandates to lock downs to quarantines and isolation in response to this public health threat.

“The international community must learn to move beyond cycles of panic and neglect, which leaves human rights at the margins of decision-making and policymaking. The principles developed through a consensus-based and deliberative process amongst 30 of the world’s leading thinkers in global health law and human rights provide an authoritative interpretation of international law to help guide that learning.”

The WHO drafted pandemic treaty states that “all lives have equal value, and that therefore equity should be a principle, an indicator and an outcome of pandemic prevention, preparedness, and response,” and this was a point emphasised by Dr. Viviana Munoz Tellez of the South Centre, an intergovernmental organisation based in Geneva that helps developing countries promote their common interests in the international arena, who brought up the issue of vaccine inequity. 

“We could have averted, at minimum, about a million and a half deaths,” Tellez said. “The idea was, when we have vaccine doses, we will distribute at least 20% proportionally and highlight the more vulnerable populations that need to go first. But, unfortunately, that did not happen, mainly because the more affluent countries had advanced marketing commitments.

“We had competition rather than cooperation. That was one of the big problems.”

The role of the private health sector

The private health sector has also come under heavy scrutiny since the pandemic. However, one aspect that the principles address observes that the state must regulate and monitor private actors. The principles themselves put no obligations directly on the remote, non-state actors. Instead, they state that across all pandemic prevention, response and recovery measures, states have the responsibility to ensure that non-state actors do not impair any of the human rights laws and must regulate and monitor ” engaged non-state actors to prevent them from impairing the enjoyment of human rights and provide for redress and accountability.”

Magdalena Sepúlveda Carmona, executive director of Global Initiative For Economic, Social and Cultural Rights, stated on private actors that, “Something that started happening before the pandemic is the privatization, commercialization, and financialization of public services such as health care, water, sanitation and education. There are many ways in which private actors can be involved in health care.

“We need to act now. We must ensure that everybody has access to a universal resilient health system that is affordable or at no cost for those who need it. And that is included in the principles.”

The hope, the presenters said, is that the COVID-19 pandemic would bring about changes in legislation that would help the world prepare and deal with any future health emergencies.

“We have to use these principles to put in place legislation, rules and regulations to say the next time this happens, we have to think about how we’re going to address this problem,” Saman Zia-Zarifi, executive director of Physicians For Human Rights told the panel. “It can’t just be that we will give money to companies to support their workers who can’t come to the office, but we will keep open the informal sector where the majority of people in most countries live and work.”

The new principles allow actors to play their part in change.

“These principles can act as kind of a North Star for everyone,” Zia-Zarifi stated. “They establish some clear directions of movement. They don’t tell governments what to do but give them a direction of movement and a way of thinking.”

The Geneva Graduate Institute, The Global Health Centre and the International Geneva Global Health Platform, the International Commission of Jurists, the Global Health Law Consortium, the Global Initiative for Economic, Social and Cultural Rights, and Physicians for Human Rights organised the panel.

Image Credits: Screenshot.

Universal health coverage
The delegate for Barbados addressing the World Health Assembly during discussions on universal health coverage.

An impossibly long list of member states lined up to address universal health coverage (UHC) and non-communicable diseases (NCDs) at the World Health Assembly on Thursday afternoon, indicating the centrality of these issues for countries.

There was near-universal support for primary health services to be the backbone of UHC, with disease prevention as the other key pillar – particularly to prevent NCDs.

A number of countries including Canada, the US and Norway called for sexual and reproductive services accessible to young people to be included as part of primary health. 

Many member countries called for the three United Nations High-Level Meetings – on UHC, tuberculosis and pandemic preparedness – in September to be aligned with the WHO’s processes, including negotiations on a pandemic accord.

Huge support for WHO’s ‘Best Buys’

The WHO’s updated policy options and interventions to prevent and control NCDs – referred to as “Best Buys” – also enjoyed widespread support.

A number of Caribbean countries are at the forefront of fighting NCDs and obesity, including Barbados.

“Barbados is privileged to be one of the front-runner countries that WHO has identified to take part in the acceleration plan to stop obesity,” its delegate said.  

Barbados launched a national school nutrition policy in February “to address challenges related to poor dietary habits and lack of physical activity among schoolchildren”,  while its tax on sugary drinks introduced in 2015 resulted in a 4.3% reduction in their consumption.

Canada underlined the importance of integrating mental health into broader NCD prevention strategies but noted that stigma “remains a barrier to mental well-being globally, especially for younger people”. 

Norway called for strategies to fight NCDs to be “free from undue political and commercial influence”, something that NCD advocates lobbied for on the sidelines of the WHA.

No consensus on replenishment fund

However, the same spirit of agreement was absent in Committee B, with a divergence among member states’ opinions on a “replenishment mechanism” proposed by the WHO Director-General to ensure more sustainable financing of the organisation.

Member-states deliberated on different possible models of sustainable funding of the WHO, delaying agreement on a single, unified formula of a “replenishment mechanism”. 

The US made it clear that it did not support the replenishment mechanism – a view that ultimately held sway. It, however, expressed support to have rounds of investments by donors, similar to other global health organizations like The Global Fund. 

“We agreed to support planning for the secretariat’s proposed new initiative for sustainable financing for WHO with the understanding that we’ve moved to a more streamlined approach of innovative fundraising through an investment round, and that we’re not approving a replenishment mechanism for WHO,” stated the US. It is also widely believed that the country pushed for inclusion of “earmarked contributions” in the draft text of the resolution, in exchange for its support to the resolution. 

Switzerland supported the replenishment mechanism for the WHO, saying it had “considerable potential to strengthen the strategic use of funding and to guarantee predictability of financing for WHO’s operations in order to guarantee health for all”.

But, it also underlined that “earmarked contributions will remain vital to the funding of WHO for many member states” but that their use needs to be “traceable, transparent and efficient”. 

A decision on what mechanism should be adopted to bolster WHO’s finances is expected on Friday.

Maria van Kerkhove, Priya Basu, Mary Mahy, Iveth J. González and Benjamin Roche.

 GENEVA – Global health conversations are much deeper at present because everyone has been affected by COVID-19 – and this opens up the possibility of building an “all-of-society” approach before the next pandemic, said Sylvie Brand, the World Health Organization’s (WHO) Director of Epidemic and Pandemic Preparedness and Prevention.

“We have seen during this pandemic that it’s not enough to have doctors and nurses at the frontline. We need to bring on board politicians, academics, the private sector, civil society, faith-based organisations – everybody has a role to play,” said Brand during her keynote address to the Resilience Summit held alongside the World Health Assembly in Geneva.

“But this is not enough. We need also to make sure that we connect people because when the crisis starts, it’s very hard to build things from scratch.”

Her input came after leaders from the public and private sectors had discussed three different areas related to pandemics – prevention, preparedness and response – at the invitation-only summit hosted by the World Climate Foundation and the Geneva Health Forum. 

Stop the zoonotic spark

The pandemic prevention group, which had a strong contingent of One Health actors, felt that primary prevention had to focus on zoonotic spillover from animals to people.

“You have to start with the spark that can cause the fire, addressing the interface between animals and people,” said Jonathan Epstein, Vice-President of EcoHealth Alliance.

The group also called for the integration of climate change and biodiversity and health.

Collaborative surveillance and data-sharing dominated the discussion at the preparedness roundtable, which also stressed the importance of building trust and understanding. 

“We need the foundation – global, regional, national systems – for surveillance that is intentionally collaborative, that goes beyond the health sector,” said Dr Magda Robalo Correia e Silva, the Health Minister of Guinea-Bissau. 

She also said that preparing for an infectious disease outbreak or a pandemic must be rooted in communities and lived experiences of the people.  

The panellists also touched on how preventative measures like surveillance or data sharing don’t work in isolation. 

“It’s an ecosystem. It cannot be the data only or the tools only or the financing of the early warning system or political support. It’s an ecosystem that starts with the doctors, nurses who are in the frontlines. That’s where the [early warning] system gets triggered,” said Dr Nino Kharaishvili, Global Solutions Director of the health systems governance at Jacobs.

The group dealing with the pandemic response grappled with how data could be properly collected and shared to ensure that responses were timely and resources went to areas most in need. 

The World Bank’s Priya Basu, who heads the Pandemic Fund secretariat, said that applications for funding for the first round of the Fund’s disbursements were aimed at strengthening health systems in low and middle-income countries. Collaboration between government departments within countries, and between countries and donors had been a prerequisite for applicants.

The huge and growing shortages of health workers and a lack of trained personnel were also a substantial challenge.

“We need to deal with the global shortage of health workers and the poaching by high-income countries of health workers from low and middle-income countries. There are an estimated six million missing health workers in Africa,” said Philippe Guinot, Chief Technical Officer of IntraHealth.

A sticking point in pandemic accord discussions has been around how to share pathogen sequencing.

IFPMA’s Grega Kumer

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

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

However, Yaunqiong Hu from Médecins sans Frontières appealed for community contributions to the development of vaccines to be valued, pointing out the contributions of residents of Guinea to the development of Ebola vaccines.

Meanwhile, Maria van Kerkhove, WHO’s Technical Lead on COVID-19, said that substantial capacity for surveillance had been built during the pandemic, but that transparency and data sharing were waning.

But “governments don’t want to find the next pandemic because of the disincentives”, she added, citing how South Africa had been slapped with travel bans after sharing the Omicron sequencing.

Misinformation undermining the ‘age of biology’

Chris Perez, head of International Programs at biotech company Concentric by Ginkgo

Chris Perez, head of International Programs at biotech company Concentric by Ginkgo, told the evening plenary how his company’s tracking of aeroplane wastewater had identified COVID-19 variants in the US significantly earlier than any other tracking body.

“We believe that the age of biology and the bio-economy hold the keys to enormous opportunities. across sectors for a more sustainable and resilient future for the world,” said Perez.

Biological risks arise from “humans encroaching on new environments and climate change” as well as the “accidental or intentional misuse of bioengineering”, warned Perez.

However, he also warned of social risks – particularly misinformation that undermined people’s faith in science.

“As most people know, in the United States, the COVID-19 response was very politically charged in a challenging environment and also involved the dangers of misinformation in public health,” said Perez. 

“We need resilient societies and governance structures and today’s information environment can compound biological risks. Trust and the truth must be core organising principles if we are to address this.”

The World Resilience Summit’s steering committee intends to draft recommendations for public-private partnerships in each of the three areas to “add value with public-private partnership solutions in the implementation of the upcoming pandemic treaty drafted by the WHO”.

(With inputs from Megha Kaveri)