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

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

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

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

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

Tackling fragmentation

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

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

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

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

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

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

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

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

Timely access to medicines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WHO Internal Justice System Under Scrutiny  

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

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

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

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

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

Election campaign for new WPRO RD to begin in April

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

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

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

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

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

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

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

Image Credits: WHO.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: Kelly Sikkema/ Unsplash.

Ukrainian couple Anatasiia and Oleksii were severely injured in the war and are now wheelchair-bound.

Spinal cord injuries, brain damage, burns, limb amputations and complex limb trauma are some of the new rehabilitation challenges caused by the war in Ukraine, Dr Volodymyr Golyk, a World Health Organization (WHO) officer dealing with disability and rehabilitation in Ukraine, told a WHO Europe media briefing on Tuesday.

Prior to the war, Ukrainians already had significant rehabilitation needs because of the country’s high burden of non-communicable diseases (NCDs).

However, WHO’s Dr Satish Mishra said that “thousands of people in Ukraine have sustained complex war-related injuries that need rehabilitation services and assistive technology”, including wheelchairs and walkers.

“Injuries resulting from war can cause devastating and long-lasting physical and psychological impact, requiring early and specialised rehabilitation interventions from multidisciplinary rehabilitation team and long-term follow-up to reduce complications and to optimise independence and quality of life,” added Mishra, WHO Europe’s Technical Officer for Disability and Rehabilitation.

 

Pre-existing conditions

Ukrainians often had pre-existing health conditions alongside “multiple complex injuries that require rehabilitation”, added Mishra. 

But the rehabilitation needs of the Ukrainian population are increasing in the face of complex barriers to accessing health care during the war, including “targeted attacks on healthcare facilities, fewer health care workers due to displacement, reduced public transportation, interrupted supply chains and power shortages”.

“Providing coordinated ongoing care and rehabilitation for those affected by war is one of the greatest challenges faced in many health emergencies. There can be significant and life-changing consequences for those whose rehabilitation needs are unmet or delayed, leaving a legacy of deprivation and exclusion from society for years to come,” he stressed.

Iuliia Sokolovska, deputy head of the Office of the President of Ukraine

However, Iuliia Sokolovska, deputy head of the Office of the President of Ukraine, said that her country had started to create “a modern effective rehabilitation system built on evidence-based medicine” before the war.

“Notwithstanding the invasion of the Russian Federation, the development of the new rehabilitation system was not stopped. We accelerated our efforts and took into account the new challenges that we have faced now.”

Sokolovska added that improved organisation meant that injured citizens and military personnel “start to receive rehabilitation assistance in the hospital immediately after surgery or medical intervention” with the involvement of multidisciplinary teams.

Ukraine was also developing its capacity to manufacture prosthetic limbs and other assistive technology.

Amputations

“Due to the war, the complexity of cases and amputations is enormous,” she added. “This stimulates the acquisition of unique skills by both doctors and other specialists, while WHO and other international partners supply assistive technologies and rehabilitation equipment to Ukraine.”

But, stressed Sokolovska, “Ukrainians also suffer from psychological stress and trauma on a daily basis. This is why psychological health should be as accessible as medical help.”

Dr Jarno Habicht, Head of WHO Country Office in Ukraine, described the health system as “resilient, even after more than 800 attacks on health facilities”.

“As a WHO, we have supported more than 4000 people in more than 25 facilities with rehabilitative services. This is related to the services, and the equipment and supplies needed to provide those services.”

Image Credits: WHO Europe.

WHO Foundation Chief Impact Investment Officer ​Geetha Tharmaratnam at OurCrowd Investor Summit.

A company that is using AI-powered technologies to help rehabilitate people with severe brain injuries, including those caused by strokes, has caught the eye of the World Health Organization (WHO) Foundation.

The foundation’s Global Health Equity Fund (GHEF), formed in September will soon be ready to make its first round of investments.  The WHO Foundation was launched by WHO Director General Dr Tedros Adhanom Ghebreyesus in 2020, with mission of supporting the goals of the global public health agency.  However, as a legally independent body, it also has a broader mandate to recruit funds from corporate donors, high-net worth individuals, and the broad public – which are not part of WHO’s traditional funding pool due to strict legal and conflict-of-interest rules. 

The new equity fund is a $200 million impact venture capital investment fund that focuses on breakthrough technologies that could improve health worldwide, especially in low- and middle-income countries. It has been formed with OurCrowd, a global venture investing platform that encourages investment in emerging technology companies at an early stage while still privately held

The fund is nearing a preliminary funding round of $20 million, and BrainQ’s device may well benefit soon.

One in four adults over the age of 25 will have a stroke in their lifetime, often resulting in damage to neural networks in the brain that cause impaired motor function.

The Israeli tech company, BrainQ, has developed a wearable device that “uses non-invasive, frequency-tuned extremely low frequency and low-intensity electromagnetic fields with the aim of promoting neurological recovery in the central nervous system”. 

The Israeli company has already received accelerator funding from the  European Innovation Council (EIC) in 2019, and its device is undergoing clinical trials.

“A growing body of evidence indicates that neural oscillations at specific frequencies are linked to opening neuroplasticity periods, suggesting that using non-invasive brain stimulation techniques to neuromodulate at specific frequencies can influence these oscillations and aid in neuro recovery,” according to BrainQ.

The oscillatory patterns of people who have had strokes are “measurably different from those of healthy individuals”, according to the company, which “operates on the premise that exposing such unhealthy individuals to specific EMF frequencies associated with healthy functioning may improve network plasticity and functional ability”.

Science fiction

WHO Foundation’s Chief Impact Investment Officer, Geetha Tharmaratnam, described the device as “science fiction” and said that it was significantly cheaper than existing therapies. 

“It replaces a combination of physical, occupational and speech therapy,” said Tharmaratnam.

“Being a wearable device, you can bring it into your home so your family members can become part of your caregivers. And the final thing is that the time in which recovery happens is a fraction compared to the time at which recovery happens right now for stroke,” she added,

Tharmaratnam attended the OurCrowd Global Investment Summit in Israel last month, and was on the lookout for potential investments for the GHEF. 

“The number of stroke victims worldwide is enormous,” she said. “This is not just an issue in North America or Europe; it is everywhere. So BrainQ is an example of a company which, when we start investing, we would be interested in.”

GHEF is aligned with WHO Foundation’s Access Pledge, which ensures that the portfolio companies will make their solutions for people and countries experiencing inequity. Each company is expected to develop an “access plan”. 

Tharmaratnam is supporting the fund from WHO Foundation, while OurCrowd CEO Jon Medved and OurCrowd Managing Partner Dr Morris Laster lead it. The WHO Foundation and OurCrowd will create an advisory board to assist. 

‘Technology a big part of the answer’

GHEF was conceived due to the COVID-19 pandemic, highlighting the inequitable access to health technology solutions and vaccines in low- and middle-income countries.

“COVID-19 was a wake-up call for me as an investor,” Medved said in September when GHEF was announced. “The pandemic opened my eyes to health inequity worldwide and reinforced the potential of innovative technology to save lives.”

Tharmaratnam joined WHO Foundation a year ago, and GHEF is one of her first projects. Currently, the program only runs with OurCrowd, but she hopes to develop several other partners worldwide centered on similar concepts. 

“No country or health system was ready for COVID,” Tharmaratnam said. “My mandate is to align investors with WHO’s mission and the understanding that insufficient healthcare funding is available across the board.”

She told Health Policy Watch that the first step is evaluating how healthcare is administered, and “technology is a big part of the answer.”

“Technology is the magic of our generation, but used badly, it can amplify exclusion,” Tharmaratnam said. “If you are building a diagnostic tool, it needs to be able to work in Brazil. It needs to be able to work in Nigeria. I need to be able to work in Indonesia.”

She said the foundation’s role is to spearhead a sea change in the investment space by building awareness among private companies of the value of financial and health return on investment. 

“The fund can really coalesce around the companies to help them go into markets they may not have otherwise considered by recognizing that they are huge opportunities and have huge needs,” Tharmaratnam added.

Checks and balances

The WHO Foundation has come under fire in the past for accepting funds from companies not aligning with global health standards. In 2021, for example, it was accused of receiving $2.1 million from the multinational food and beverage company Nestlé, which had been accused of violating infant milk formula’s international marketing codes.

But the foundation has said that receipt of funds does not imply endorsement of a company’s activities. 

Tharmaratnam insisted that the foundation has “the same checks and balances” as the WHO “regarding who we can take money from. If we raise funds from you to support the activities of WHO, then you need to be in alignment with that.”

Image Credits: World Health Organization Foundation.

Anti-war protest in Germany

As Russia’s war against Ukraine intensifies around Bakhmut, a new report estimates that the invading army has had between 200,000 to 250,000 casualties – dead and wounded – in the past year.

The Center for Strategic and International Studies (CSIS) calculates that the average rate of Russian soldiers killed in Ukraine every month is “at least 25 times the number killed per month in Chechnya and 35 times the number killed in Afghanistan”.

Coming on the heels of one of the worst COVID-19 mortality rates in the world and a mass exodus of young men and their families fleeing from conscription, Russia may have lost two million people in the past three years, according to The Economist.

The life expectancy of Russian males aged 15 is currently at the same level as those in Haiti.

The country’s birth rates have been in decline since 1994 when Russia was estimated to have 149 million citizens. By the start of 2022, its population was estimated to be 145,6 million, with 3,358 births a day being more than cancelled out by a daily death rate of 3,663, according to Statistica.

Statistic: Natural population increase in Russia from 1990 to 2021 (in 1,000s) | Statista

Between 1 January 2022 and 1 January this year, the Russian population was estimated to have decreased by approximately 560,000.

Aside from deaths, estimates of people immigrating range from 500,000 to a million people in the past year alone.

Excess deaths during COVID

Using a statistical method based on changes in the population age structure, there were 351,158 excess deaths in 2020 and 678,022 in 2021 in the Russian Federation, according to an article published in the journal, PlosOne last November.

There was significant regional variation, with men and urban residents suffering the greatest mortality.

Meanwhile in 2021, there were approximately 1.04 million more deaths than births recorded in Russia, according to Statistica. 

Russia recorded one of the biggest excess mortality gaps globally, with  580,000 more deaths than expected between April 2020 and June 2021, although its official COVID-19 toll was only 130,000, according to The Economist.

In one year, the mortality rate leapt from 14.6 deaths per 1000 people (2020) to 16.7 per 1000 in 2021.

Statistic: Mortality rate in Russia from 1950 to 2021 (per 1,000 population) | Statista
Find more statistics at Statista

In 2021, the most common cause of death in Russia was circulatory system diseases (particularly, heart attacks, strokes and aneurysms), causing an estimated 640 deaths per 100,000 people. COVID-19 was the second-highest cause of death, with 319 deaths per 100,000. Neoplasms, predominantly cancers, caused over 194 deaths per 100,000 and were the third biggest cause of death.

War cancels out government solutions 

Patriarch Kirill, the head of the Russian Orthodox Church in Moscow, called for a ban on abortions to reverse the demographic trend.

Meanwhile, in 2020, Russian President Vladimir Putin’s government announced a package of tax breaks and welfare benefits aimed at stimulating the country’s birth rate. This follows the lead of Hungary, which has a wide range of tax incentive aimed at stimulating that country’s declining birth rate.

However, the war on Ukraine has effectively cancelled out whatever positive effects this stimulus package had on the country’s birth rate.

Image Credits: Dea Andreea/ Unsplash.

INB co-chair Precious Matsoso and WHO Director-General Tedros at the start of INB 4.

After spending the past week negotiating a proposed future pandemic accord in the intergovernmental negotiating body (INB) set up by the World Health Organization (WHO), member states will pick up discussions from 3 to 6 April.

Last week’s discussions were based on the zero draft developed by the INB’s Bureau after a series of meetings and public hearings during 2022 about the contents of the document aimed to guide and protect the world in the next pandemic.

During the closing session of Friday’s meeting, a number of delegates expressed the hope that it would be possible for the INB Bureau to develop a first draft of the accord after the April meeting, but the INB ultimately chose not to commit to this.

“The start of discussions of concrete language for the WHO pandemic accord sends a clear signal that countries of the world want to work together for a safer, healthier future where we are better prepared for, and able to prevent future pandemic threats, and respond to them effectively and equitably,” said Roland Driece, co-chair of the INB Bureau.

He noted at the start of last week’s fourth INB meeting that the April meeting would be taken as a continuation of the current meeting, the bulk of which was held in private.

Co-chair Precious Matsoso described the meeting, which ended last Friday, as “a critical step in ensuring we do not repeat the mistakes of the COVID-19 pandemic response, including in sharing life-saving vaccines, provision of information and development of local capacities”.

“That we have been able to move forward so decisively is testimony to the global consensus that exists on the need to work together and to strengthen WHO’s and the international community’s ability to protect the world from pandemic threats,’ Matsoso added.

The INB Bureau is to convene informal intercessional meetings between meetings to help facilitate agreements, but Matsoso urged delegates to have their own informal meetings before April to “iron out the wrinkles”.

A progress report on the accord will be given to the World Health Assembly in May, with the final draft due to be considered by the 77th World Health Assembly in 2024.

Also present at the INB meeting were the co-facilitators of the United Nations General Assembly High-Level Meeting on Pandemic Prevention, Preparedness, and Response, set for 20 September.

The co-facilitators, Morocco and Israel’s ambassadors to the UN in New York, told INB members that they wanted to ensure that the INB process and the high-level meeting were in sync.

The co-facilitators also meet with the World Intellectual Property Organization (WIPO) and the World Trade Organization (WTO).

Syria
WHO Director-General Tedros Adhanom Ghebreyesus (centre) is the first top UN official to visit Syria since the start of its civil war.

World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus is the first senior United Nations (UN) official to visit northwest Syria since the war began 12 years ago.

The visit was a bid to underline the organization’s commitment to the region, which has provided around a third of all medicines to arrive in northwest Syria in the past decade. Since the earthquake, that number has risen to two-thirds.

According to the UN, the devastating earthquakes have killed at least 50,000 people across Turkey and Syria. Tens of thousands more are still missing, hundreds of thousands have been left homeless, and thousands of families are yet to be reunited.

“The suffering is impossible to describe in words or even in pictures,” Tedros said at a Friday press briefing. “The destruction is immense.”

While NGOs and local authorities expressed gratitude for the WHO chief’s visit, they also voiced deep “disappointment” in the UN’s high-level team for avoiding setting foot in the region since the beginning of the war.

The scale of devastation in Turkey has been extreme, counting at least 44,000 deaths and $34.2 billion in infrastructural damage. A World Bank report published on Monday estimated the costs of reconstruction and economic disruption will likely cost twice that amount.

In Syria, about 6,000 people have been confirmed dead, mostly in the rebel-held northwest. But while the challenges and trauma faced on both sides of the Turkish-Syrian border are similar, the Syrians are working with far fewer resources.

“Twelve years of war has destroyed infrastructure, homes and hope,” Tedros said, “Drought, economic collapse, the COVID-19 pandemic, and the ongoing cholera outbreak have heaped misery upon misery. The risks now being faced by people on the Syrian side are far higher than those living just a few kilometers away.”

Before the earthquakes, 15.3 million Syrians – 70% of the country’s population – needed of humanitarian assistance. Price increases of more than 800% in the past two years had driven another 90% below the poverty line and led to food insecurity for 12.4 million people.

In an address to the UN Security Council on Tuesday, UN Emergency Relief Coordinator Martin Griffiths called the situation in Syria an “almost unbelievable tragedy.”

“Amid the harsh winter season, the earthquake has destroyed entire neighborhoods, rendering them uninhabitable … In many areas, four to five families are packed into tents,” Griffiths said. “The risk of disease is growing amid pre-existing cholera outbreaks. Women and children face increased harassment, violence, and risk of exploitation.”

UN efforts to mobilize international relief funding are underway, but underfunded. The emergency appeal for $397.6 million in aid for Syrian quake victims has raised just 42% of its target. Meanwhile, the 2023 Syria Humanitarian Response Plan – the largest humanitarian appeal in the world – needs $4.8 billion to address needs pre-dating the earthquake.

Children have also been caught in the crossfire, with thousands separated from their parents, without access to education, or displaced from their homes.

“I met a 15-year-old boy who broke his arms when he jumped out of a window during the earthquake,” Tedros said. “He hasn’t been to school since he was nine years old.”

With world leaders set to gather for a donor conference in Brussels next week on the 12th anniversary of the Syrian war, Tedros called on the international community to confront the humanitarian crisis.

“The Syrian people have suffered more than most people ever will, or ever could,” he said. “Their needs, dreams and hopes are the same as all people; for health, food, water, shelter, and peace for a better future for their children.”

Image Credits: WHO.

WHO Assistant Director General, Ranieri Guerra

Italian prosecutors in Bergamo have indicted Ranieri Guerra, a former World Health Organization (WHO) Assistant Director General, for making false statements before a public prosecutor about his role in the suppression of a major WHO report on Italy’s response to the pandemic. 

The WHO report had criticized the Italian government for failing to update a pandemic preparedness plan prior to the COVID outbreak – and at a time when Guerra was in fact in charge of updating the plan as the Italian Ministry of Health’s General Director for Prevention. 

Published on WHO’s website on May 13, 2020, and deleted a day later, the 102-page report “An Unprecedented Challenge”, revealed that the country’s pandemic preparedness plan had not been updated since 2006 – despite European Union instructions to countries to update their plans in 2013-2014 – when Guerra was in charge.

“Just one word: Finally,” tweeted Francesco Zambon, the whistleblower who left WHO in protest over the suppression of the report, in response to news of the indictments.  

Speaking to Health Policy Watch, Zambon added that “after three years no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which concerned some of the most senior officials in the organization.” 

Guerra, a WHO ADG for special initiatives, was dispatched exceptionally by WHO’s Director General Dr Tedros Adhanom Ghebreyesus to Italy in early 2020 to support the initial phase of the country’s pandemic response – as one of the first and hardest hit countries in the world initially. 

A few months later, WHO’s Venice Office, under the direction of Francesco Zambon prepared an independent WHO report on Italy’s pandemic response, that frankly addressed Italy’s lack of an updated preparedness plan, in just a few phrases. 

After seeing a draft of the report, Guerra demanded that the language referring to the lack of preparedness, be redacted.  When Zambon refused, the report was deleted from WHO’s website – only a day after its publication. 

At the time, Guerra publicly denied that he had had a role in suppressing the report – which had sought to highlight both the successes as well as the weaknesses in Italy’s pandemic response. 

However a series of publications in both the Italian media and abroad, including in Health Policy Watch, revealed a trail of emails that reflected the pressure Guerra had applied on Zambon and his superiors in WHO’s European Office to have the report redacted and then suppressed. 

Following that, other revelations in the Italian media suggested that Guerra had even bragged to Italian officials about his role in convincing WHO’s Regional Director for Europe, Hans Kluge and others to delete the report.

It was on the basis of those communications that Guerra was finally indicted by Bergamo legal authorities.  WHO, meanwhile, staunchly stood by Guerra, refusing to answer questions about his role – citing UN immunity. 

Zambon ultimately resigned in protest after being frozen out of his management role at the Venice office. 

Speaking to Health Policy Watch on Friday, Zambon said of the indictment: “Yes, it is quite a big thing actually. It would be worth noting that, after three years, no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which was about the highest officials in the organization. 

“Nor was any apology provided to me for being a whistleblower who tried to protect WHO from scandals. To the very contrary, WHO continues stating I am not a whistleblower as – in their opinion – there was no retaliation. Even Transparency International and 40plus organizations wrote to Tedros about this untenable position. They never got a reply.

“WHO lost a huge opportunity of being a credible and transparent agency towards national authorities. Also not being compliant with the same privileges that it benefits from, which unequivocally states that immunity MUST be waived when interfering with a national investigation. This certainly was the case.

“I wonder and I ask citizens of the world: where is WHO’S accountability? How much should the world wait for having a ground-shaking reform permitting WHO to be at the ethical standard it should be?”

Reportedly Guerra is also under investigation for “neglect of official duties” in relation to his failure to update the 2006 pandemic preparedness plan during the time in which he served as head of prevention. 

World AIDS day Report UNAIDS
UNAIDS Executive Director Winnie Byanyima (left), has warned that laws criminalising same-sex relationships are exacerbating HIV.

Over the past week, there has been a steep rise in anti-LGBTQ activity organised by  prominent politicians and religious leaders in Kenya and Uganda, which has sparked condemnation by health and human rights activists and fears that this will result in violence.

On Thursday, Kenya’s newly elected evangelical president, William Ruto, said he would not allow “homosexual acts or same-sex marriage” during his term. 

His remarks came after an outcry led by conservative Christian and Muslim groups after last week’s Supreme Court judgement confirming that LGBTQ people had the right of association and that the NGO Board’s decision to bar LGBTQ people from forming recognised groups is discriminatory.

Meanwhile, Ugandan opposition Member of Parliament Asuman Basalirwa tabled a private Member’s Bill in that country’s parliament on Tuesday seeking life in prison for homosexuality.

That same day, Anitah Among, Uganda’s Speaker of Parliament and a prominent member of the ruling party, told religious leaders that “a Bill will be introduced as soon as possible to deal with homosexuality and lesbianism”, and that voting on it would be “by show of hands” not secret ballot.

This followed a national anti-homosexuality protest on 24 February called by the Uganda Muslim Supreme Council.

The Uganda Muslim Supreme Council held a national protest against homosexuality on 24 February.

Fuelling HIV

Ironically, the anti-LGBTQ frenzy coincided with Zero Discrimination Day on 1 March, when UNAIDS highlighted the need to remove laws that criminalise people living with HIV and “key populations”, its term for those most vulnerable to HIV, including LGBTQ people.

“Criminalizing laws chase people away from life-saving treatment. Those need to be removed,” said Winnie Byanyima, Executive Director of UNAIDS.

Byanyima added that “at the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.”

Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalise same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions.

‘Homo-hysteria’

“The current wave of homo-hysteria in Kenya began earlier this year with the death of [gay activist and fashion designer] Edwin Chiloba,” human rights lawyer and Amnesty International Kenya Board member Tabitha Saoyo told Health Policy Watch.

“This was exacerbated by the Supreme Court judgement favouring LGBTQ groups. What we are now currently witnessing is an attack on the judiciary, massive disinformation on the contents of the judgement coupled with intentional fear, hate and panic from religious groups, politicians and public influencers.

“This wave of hate is manifesting through formation of anti-LGBTQ WhatsApp groups, public protests, online threats of rape, death and myriad of other harmful attacks in grassroots communities,” she added.

Thirteen Kenyan human rights organisations and LGBTQ organisations including the Kenya Human Rights Commission and the International Commission of Jurists (Kenya Section) issued a statement on Thursday expressing alarm at the misinformation and disinformation that has followed the Supreme Court ruling.

Noting that the Kenyan Constitution “expressly prohibits incitement to violence, discrimination and vilification of others or incitement to cause harm”, they said that there have been “increasing incidents of malicious online and offline comments, profiling and public demonstrations against persons who identify as intersex, gay, lesbian or non-binary, and the personal details of LGBTQ+ citizens and their family members are being openly shared and intimidated online, violating the right to privacy and human dignity”. 

Evacuation requests

“Citizens are reporting confrontations with landlords and employers. They are increasing requests for evacuation, relocation and psychotherapy, while legal and health services and officers are having to close due to safety concerns, organisations have been responding to no less than 117 homophobic cases in the last month,” they noted. 

Meanwhile, the United Nations Human Rights Office urged the Ugandan parliament to refrain from passing an anti-homosexuality bill, adding that “the  State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity”.

HIV targets far off track

In 2021, the UN adopted a Polical Declaration on HIV and AIDS that committed member states to “ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services” by 2025.

However, this goal is far form being realised with 67 of the 134 reporting countries still criminalizing consensual same-sex sexual activity and 20 criminalizing and/or prosecuting  transgender people.

“Criminalisation drives discrimination and structural inequalities. It robs people of the prospect of healthy and fulfilling lives. And it holds back the end of AIDS,” said UNAIDS.

Image Credits: Twitter.