As the impact of drought worsens, there is a growing risk of famine in Somalia. Some 4.5 million Somalis are directly affected by the drought, and about 700,000 people have been displaced.

The worsening drought in Somalia is likely to have caused 43,000 excess deaths in 2022, of which around 21,500 are children under the age of five, according to a new report released on Monday.

“We are racing against time to prevent deaths and save lives that are avoidable. We have seen, deaths and diseases thrive when hunger and food crises prolong. We will see more people dying from disease than from hunger and malnutrition combined if we do not act now,” Dr Mamunur Rahman Malik, the World Health Organization (WHO) representative for Eastern Mediterranean region (EMRO) said. 

“The cost of our inaction will mean that children, women and other vulnerable people will pay with their lives while we hopelessly, helplessly, witness the tragedy unfold”.

The Horn of Africa, particularly southeast Ethiopia, northern Kenya and Somalia, has been experiencing one its worst hunger crisis in 70 years. Along with the

failure of six consecutive monsoon seasons, Somalia is also struggling with the effects of climate change-induced weather events, political instability, ethnic tensions, food insecurity and rising prices. The COVID-19 pandemic only exacerbated an already grim situation.  

The study was commissioned by UNICEF and the WHO and was carried out by the London School of Hygiene and Tropical Medicine and the Imperial College, London. The study involved a statistical mode, which retrospectively estimated that the crude death rate across Somalia increased from 0.33 to 0.38 deaths per 10,000 person-days between January 2022 and December 2022. 

The death rate in children younger than five years was almost double these levels. The researchers used data from 238 mortality surveys carried out by the Food Security and Nutrition Analysis Unit for Somalia to arrive at these estimates. 

“Our findings suggest that tens of thousands of Somalis lost their life in 2022 due to drought conditions, with this toll set to increase in 2023. This is in spite of Somalis’ own resilience, support by Somali civil society within and outside the country and a large-scale international response,” said Dr Francesco Checchi, co-author and professor of epidemiology and international health at the London School of Hygiene and Tropical Medicine. “Far from being scaled back, humanitarian support to Somalia must if anything be increased as the year progresses, and sustained until Somalia exits this latest crisis.”

For the year 2023, the crude death rate is forecasted to increase to 0.42 deaths per 10,000 person-days by June 2023. 

The highest death rates were estimated in south-central Somalia, around the areas of Bay, Bakool and Banadir regions, the center of the current drought. 

“We continue to be concerned about the level and scale of the public health impact of this deepening and protracted food crisis in Somalia,” said Somalia’s Health Minister, Dr Ali Hadji Adam Abubakar.

“At the same time, we are optimistic that if we can sustain our ongoing and scaled-up health and nutrition actions and humanitarian response to save lives and protect the health of our vulnerable, we can push back the risk of famine forever, else those vulnerable and marginalized will pay the price of this crisis with their lives.”

Image Credits: UN-Water/Twitter .

Tanzania’s Health Minister, Ummy Mwalimu, inspects a health facility for its preparedness to handle a disease outbreak in Kagera

BUKOBA, Tanzania – Scientists have identified the mystery disease that has killed five people in the last week in Tanzania’s north-western Kagera region as the highly contagious Marburg virus, which is a filovirus like Ebola.

Health Minister Ummy Mwalimu announced this on Tuesday but said that her government has managed to control the spread of the disease. Three patients are receiving treatment in hospital and 161 contacts are being traced by the authorities, she added.

Health officials said two additional cases were identified in the coastal town of Bukoba, where victims reportedly displayed symptoms like vomiting, high fever and kidney failure.

A team of virologists and epidemiologists was rushed to the affected villages to contain and track the outbreak. 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

Multiple samples from the bodies of victims were analysed by specialists in a government laboratory in the capital Dar es Salaam.

Two people known to be infected are being treated in a local isolation ward and responding well to medication, Nagu said. She urged the public to take additional safety precautions and remain hyper-vigilant around people showing signs of illness.

The health ministry has advised that anyone who shows signs of nausea, weakness, bleeding, diarrhoea, or fever should report to the nearest health centre.

The Tanzanian government has launched a public awareness campaign across the Kagera region where the virus was identified in a bid to mobilize its residents to help contain the outbreak.

“Public education is critical,” Nagu said. “Especially in rural areas where people are usually indifferent to the changing situation during disease outbreaks.”

A reminder of COVID-19 

Nestled between the borders of Uganda, Rwanda and Burundi, Tanzania’s Kagera region has repeatedly experienced outbreaks of unknown diseases.

Its proximity to neighbouring countries has raised suspicion that diseases may have spilt over from neighbours like Uganda, which battled an Ebola outbreak that killed 55 people and infected 142 more in under four months before it was contained in January this year.

At present, Equatorial Guinea is contending with a Marburg outbreak, but a lack of laboratory capacity has hampered its efforts to identify and contain the outbreak.

Traders in Muruku ward in Kagera sell their fruit in the local market.

Issessenda Kaniki, a regional medical officer and virologist, told Health Policy Watch that medical experts deployed in Kagera are exploring every possible avenue to identify and defeat the outbreak.

“Strict personal hygiene rules were observed when handling the bodies to avoid direct contact with infected blood of bodily fluids,” Kaniki said, noting that the government worked with the bereaved families of the victims to safely dispose of the bodies, which were handled by trained officials in personal protective gear.

While the risk of contagion from corpses is rarely a significant factor, Kaniki said great caution was exercised by local authorities.

“A dead body may carry a significant amount of infectious virus for as long as seven days after someone dies,” she said.

Paskalia Mujwahuzi, a relative of one of the victims, said her 43-year-old brother suffered rapid and severe internal and external bleeding before experiencing the kidney complications that took his life.

“I was very frightened not knowing what to do,” she said. “We rushed him to the hospital but [as soon as we arrived] he was pronounced dead.”

Mujwahuzi told Health Policy Watch she noticed an abrupt change in his brother’s condition when he returned from rearing cattle. He suffered vomiting, searing chest pain, and swelling in his legs.

“He was perpetually vomiting and spitting blood,” she said.

Despite her best efforts, nothing she did could alleviate his symptoms and he died shortly afterwards.

Health workers being trained to tackle disease oubreaks

Zoonotic illnesses surging across Africa 

The incidence of new infectious diseases in humans has surged in recent decades. More than 30 new infections – 60% of which have spilt over from animals – have been detected in the past 30 years, according to the World Health Organization (WHO).

Africa has seen a 63% jump in zoonotic diseases in the past decade. The global Mpox outbreak that caused panic across the globe is endemic in parts of the continent and is just one example of the many challenges confronting health authorities.   

The increased frequency of diseases jumping from animals to humans is due in part to Africa’s rapid population growth. With the fastest-growing population in the world, the demand for food derived from animals like meat, poultry and eggs is rising sharply, heightening the risk of zoonotic infections.

Tanzania has been hit particularly hard by this wave of new illnesses. As the country’s population grows, encroachment on wildlife habitats has become increasingly common, experts said.

Cecilia Mville, a virologist at Tanzania’s Kibong’oto Infectious Disease Hospital, said the government needs to urgently enhance its surveillance systems, diagnostic laboratories and health workforce to keep up with emerging threats.

“We need a pool of skilled health workers specially trained to detect, prevent and respond to disease outbreaks,” Mville said.

While COVID-19 underscored the urgency of strengthening national disease surveillance efforts, experts like Mville said these often overlook the rural communities at the highest risk of being infected by zoonotic diseases due to their frequent contact with wild animals and limited access to health facilities.

As Tanzanian authorities race to keep up with the Marburg outbreak, Mville warned that new investments in health systems are required if the country hopes to avoid future crises.

“Delayed detection of infectious disease outbreaks and ineffective responses heighten the risk of pandemics.”

Image Credits: Muhidin Issa Michuzi.

Some of the co-authors confer with IPCC Vice-Chair Ko Barrett (centre) before the adoption of the report over the weekend.

The world will heat up by at least 1.5ºC by the 2030s – and our best hope is that global warming does not “go blasting” way beyond this point, according to scientists from the United Nations Intergovernmental Panel on Climate Change (IPCC).

The IPCC released its sixth synthesis report on climate change in Interlaken in Switzerland on Monday after a two-day extension of its four-day meeting – largely because of disagreements from various UN member states about how to frame the temperature increases.

“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.

But global greenhouse emissions have increased by 54% between 1990 and 2019, and the world is already 1.1ºC warmer now than it was in the pre-industrial era (1850-1900). 

In the past year, the world emitted more carbon dioxide than in any other year on records dating to 1900. One of the reasons was the Russia-Ukraine war, which caused a resurgence in coal use by Western nations to replace Russian gas.

The world’s two biggest polluters, the US and China, show few signs of slowing emissions. The US recently approved a massive new oil drilling project in Alaska called Willow that will produce 260 million tons of carbon dioxide,  equal to the annual output of 66 American coal plants. Meanwhile, China has approved over one hundred new coal plants.

“Keeping warming to 1.5°C above pre-industrial levels requires deep, rapid and sustained greenhouse gas emissions reductions in all sectors,” warned IPCC chair Hoesung Lee.

Political will and public support will determine whether the world reduces global warming, Lee added, but warned that “we are walking when we should be sprinting”.

IPCC chairperson Hoesung Lee

Co-author Dr Peter Thorne said that “almost irrespective of our emissions choices in the near term, we will probably reach I.5ºC in the first half of the next decade”. 

“The real question is whether our will to reduce emissions quickly means we reach 1.5ºC, maybe go a little bit over, but then come back down or whether we go blasting through 1.5ºC, go through even 2ºC and keep on going, so the future really is in our hands,” warned Thorne.

“We will, in all probability, reach around 1.5ºC early next decade, but after that, it really is our choice. This is why this the rest of this decade is key. The rest of this decade is whether we can apply the brakes and stop the warming at that level.”

Wrong direction

Petteri Taalas, Secretary-General of the World Meteorological Organisation, warned that all indicators were “going in the wrong direction” – temperature, ocean warming, melting ice and rising sea level.

Taalas urged countries to invest in early warning services, describing them as “one of the best ways to mitigate climate risk.

Meanwhile, UN Secretary-General Antonio Guterres appealed to countries to stop expanding their coal, oil and gas projects, saying that limiting global warming to 1.5ºC would require a “quantum leap in climate action”. 

Three to six times the current spending on climate adaptation and mitigation is needed to achieve targets, said Indian economist Dr Dipak Dasgupta, one of the report’s co-authors.

“Governments can do more with the public finances,” said Dasgupta. “And the financial system itself – the banks, the central banks or regulators themselves – have to start recognising the urgency and pricing in the risks.”

Another co-author, Dr Aditi Mukherji, also warned that once the world reached a certain temperature, it would be less possible for countries and communities to adapt.

IPCC report co-author, Dr Aditi Mukherji (left).

“Almost half of the world’s population lives in regions that are highly vulnerable to climate change. In the last decade, deaths from floods, droughts and storms were 15 times higher in highly vulnerable regions,“ she stressed.

Inger Andersen, Executive Director of the UN Environment Agency, said that the report tells us “we are very, very close to 1.5 degree limit and that even this limit is not safe for people and for planet”. 

“Climate change is throwing its hardest punches at the most vulnerable communities who  bear the least responsibility, as we just saw with Cyclone Freddy in Malawi, Mozambique and Madagascar, and as we saw with flash floods in Turkey just recently,” said Andersen.

 “We must turn down the heat. We must help vulnerable communities to adapt to those impacts of climate change that are already here.”

Climate-resilient development

The report proposes “climate-resilient development” as the solution, including clean energy,  low-carbon electrification, and walking and cycling as preferred methods of public transport to enhance air quality and improve health.

Lee added that there is “a great deal of room for improvement in the energy efficiencies”, and energy consumption can be reduced by 40 to 70% in some sectors over the next two decades”. 

But “climate-resilient development becomes progressively more challenging with every increment of warming”, warns the report.

“The greatest gains in wellbeing could come from prioritizing climate risk reduction for low-income and marginalised communities, including people living in informal settlements,” said Christopher Trisos, one of the report’s authors. “Accelerated climate action will only come about if there is a many-fold increase in finance. Insufficient and misaligned finance is holding back progress.”

UNEP Executive Director Inger Andersen

Meanwhile, UNEP’s Andersen said that the global community already has the solutions: “Renewable energy instead of fossil fuels, energy efficiency, green transport, green urban infrastructure, halting deforestation, ecosystem restoration, sustainable food systems,  including reduced food loss and waste.”  i

“Investing in these areas will help to stabilise our climate, reduce nature and biodiversity loss and pollution and waste,” she stressed.

Image Credits: Anastasia Rodopoulou IISD/ ENB .

Neurodegenerative

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

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

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

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

Today, that number is in the thousands.

Repeated head trauma

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

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

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

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

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

The “dose relationship”

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

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

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

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

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

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

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

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

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

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

The last was a semi-pro soccer player.

Image Credits: Albinfo.

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

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

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

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

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

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

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

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

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

Awareness growing – but not fast enough

The situation is changing – although not rapidly enough.

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

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

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

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

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

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

We need a reset.

Bringing oral health into the NCDs ‘fold’

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

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

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

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

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

Relationship between oral health and general health

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

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

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

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

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

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

Katie Dain Is the CEO of the NCD Alliance.

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

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

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

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

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

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

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

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

Positive swabs

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

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

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

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

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

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

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

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

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

Molecular evidence

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

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

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

China CDC needs to explain

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

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

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

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

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

Earlier evidence of links to raccoon dogs

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

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

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

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

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

Image Credits: Nature , Arend Kuester/Flickr.

A child getting an oral polio vaccination.

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

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

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

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

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

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

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

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

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

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

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

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

Equatorial Guinea’s Marburg testing conundrum

Dr Ahmed Ouma, acting director of the Africa CDC

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

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

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

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

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

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

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

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

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

Cyclone Freddy linked waterborne disease outbreaks

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

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

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

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

Image Credits: Sanofi Pastuer/Flickr.

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

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

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

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

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

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

Barriers to integration

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

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

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

Financial burden

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

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

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

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

Ethical questions arise

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

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

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

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

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

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

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

Image Credits: Sangharsh Lohakare/ Unsplash.

Professor Anna Gilmore

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

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

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

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

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

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

Montevideo’s Mayor Carolina Cosse

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

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

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

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

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

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

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

Kampala’s Mayor Erias Lukwago

Addressing the big four

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

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

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

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

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

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

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

Stick and carrot

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

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

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

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

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

London Mayor Sadiq Khan

Incentives for healthy canteens

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

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

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

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

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

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

Image Credits: Bloomberg Philanthropies.

Cholera
Floods and cyclones increase the risk of cholera outbreaks.

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

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

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

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

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

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

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

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

African countries are particularly vulnerable

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

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

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

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

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

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

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

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

The vaccine challenge

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

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

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

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

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

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

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