Dr Muhammad Ali Pate, incoming Gavi CEO

The global vaccine alliance, Gavi, has appointed former Nigerian health minister, Dr Muhammad Ali Pate, as its new CEO.

Pate was Minister of State for Health in Nigeria between 2011 and 2013, where he led a national campaign to “revive routine immunisation and primary health care, chaired a presidential taskforce to eradicate polio and introduced new vaccines into the country”, according to Gavi.

“It will be my privilege to lead Gavi and continue to support countries to scale up critical routine immunisation programmes, reach more zero-dose children, expand access to new vaccines, transform primary health care systems, and help fight outbreaks and future pandemics,” said Pate in a media release on Monday.

He will join Gavi in August, replacing Dr Seth Berkley who has led the alliance for the past 12 years.

Pate is a medical doctor trained in both internal medicine and infectious diseases who also has an MBA from Duke University in US.

Between 2019 and 2021, he was the World Bank’s Global Director for Health, Nutrition and Population and headed the Global Financing Facility at the World Bank where he led the Bank’s $ 18 billion COVID-19 global health response.

He is currently the Julio Frenk Professor of Public Health Leadership at Harvard Chan School of Public Health and has served on several health-focused boards and expert panels in the public, private and not-for-profit sectors during his career.

Gavi undertook a year-long search for Berley’s replacement which was led by its board chair, Professor José  Manuel Barroso.

“Dr Pate stood out in a field of world-class candidates. With his knowledge and experience of both national immunization programming and international emergency response and global finance, I am confident that Gavi will continue to build on its vision and mission, as well as navigate the many challenges and opportunities we will face,” said Barroso.

Meanwhile, Berkley described “leading Gavi and helping the alliance to continually surpass itself in terms of saving lives, protecting children and supporting countries during global health emergencies” as “the greatest honour of my career”. 

“I am confident in its future under Muhammad’s leadership. Having worked with him during his time as Minister and at the World Bank, I know he understands intimately the landscape we work in and will be uncompromising in his drive for public health equity,” added Berkley.

Berkley has led Gavi since 2011, and during his tenure the alliance estimates that it has averted 11.8 million future deaths (compared to 4.5 million between 2000 and 2010); and has helped immunise more than 676 million children – more than double the 305 million children reached between 2000 and 2010.

During his tenure, the alliance has added a number of new vaccines to its portfolio, including to prevent HPV, polio, cholera and malaria, and in its current strategy cycle is focusing on reaching zero-dose children across marginalised communities. 

“The economic result of Gavi’s expansion of activities during [Berkley’s] tenure has been profound, unlocking over $160 billion of economic benefits compared to $24 billion in its first 10 years.”

 

The world’s biggest multinational companies are failing to meet the bold climate change pledges they have made – and are obfuscating their failures through “ambiguous commitments, offsetting plans that lack credibility and emission scope exclusions”.

This is according to the Corporate Climate Responsibility Monitor 2023, which was released on Monday by Carbon Market Watch and NewClimate Institute.

The report focuses on 24 multinational companies that have endorsed the Paris Agreement to ensure global warming does not exceed 1.5 degrees Celsius. 

Greenhouse gas and carbon emissions need to be cut by 43% and 48% respectively between 2019 and 2030 to limit the global temperature increase to 1.5°C, according to the Intergovernmental Panel on Climate Change (IPCC, 2022). 

But the companies’ targets only amount to a 15% reduction in “full value chain emissions between 2019 and 2030”.

‘Low integrity’ companies

The climate strategies of American Airlines, Samsung Electronics, meat company JBS and retail and grocery multinational Carrefour were described as “very low integrity”.

One rung up were the “low integrity” companies, including Amazon, DHL, Foxconn, Mercedes Benz, Pepsico, Volkswagen and Walmart.

Their poor ratings were the result of “inadequacy or complete lack of explicit emission reduction commitments alongside ambiguous net-zero pledges”, according to the report.

Apple, Arcelor Mittal, Google, H&M and Microsoft were some of the companies described as having “moderate integrity”, while shipping company Maersk was rated “reasonable” – the top rating of the companies. Together the 24 companies account for about 4% of all global greenhouse emissions.

Substantial ‘greenwashing’

Warning of substantial “greenwashing”, the report called on “regulatory oversight at international, national and sectoral levels”.

Speaking at the launch, Carbon Market Watch’s Lindsay Otis said that it had taken a team of accomplished researchers “a number of months” to understand the companies’ pledges and strategies.

“Companies’ climate change commitments do not add up to what their pledges might suggest,” according to the report. 

Their 2030 targets can “rarely be taken at face value”, mainly because they focus on direct emissions or emissions from procured energy but exclude indirect emission categories that account for “over 90% of the greenhouse gas emission footprints for most of the companies we have assessed”.

For others, 2030 targets are misleading due to reliance on offsetting.

“The findings in our report suggest that many companies only plan to reduce a small share of their full emission footprint, relying instead on offsetting their remaining emissions with contentious carbon credits,” according to the report.

“We find that at least three-quarters of the 24 sampled companies rely on forestry and land-use-related offsets. The demand for such carbon dioxide removals would exceed the potential of the world’s natural resource base by around two to four times if these practices would be replicated by other companies,” the report notes.

“Moreover, these plans demonstrate the widespread lack of awareness that the biological storage of carbon is fundamentally unsuitable for offsetting claims due to the non-permanence of the climate impact.”

Regulation

“Companies must play a central role in finding and scaling up solutions for deep decarbonisation, but their efforts need urgent acceleration and appropriate regulatory frameworks,” according to the report.

It cites the European Union’s Corporate Sustainability Reporting Directive, which enters into force this year  2023 and will introduce “tighter requirements for corporate climate strategies”.

However, it calls for close monitored “to ensure a high standard of compliance”.

Alcohol is linked to seven cancers, but public awareness of the links is low.

Alcohol is the second biggest cause of cancer after tobacco, and Movendi is mobilizing communities worldwide to publicize the link

At the WHO’s 152th Executive Board, an updated list of policy “best buys” to prevent and control non-communicable diseases (NCDs) was presented. The EB decided unanimously to adopt the updated list of cost-effective interventions in response to the lack of progress to prevent and reduce NCDs, as Health Policy Watch reported.

Higher taxes and warning labels on unhealthy food, cigarettes and alcohol, and better screening for cancers, are some of the new “best buys” to accelerate action on NCDs, such as cancer, heart disease, diabetes, lung disease, and mental health conditions.

No country is currently on track to achieve the 2030 global targets set by the World Health Assembly back in 2013, and the declaration by the UN General Assembly High-Level Meeting on NCDs in 2018 – including the 10% reduction of population-level alcohol use.

One major public health problem that is worsening due to the lack of implementation of the NCDs best buys is cancer. Cancer kills nearly 10 million people a year, but the risk of dying from cancer varies greatly across the world.

About 70% of these deaths are in low- and middle-income countries – and the disparity is worsening. For example, in Africa, cancer deaths are expected to more than double, reaching roughly 1.4 million deaths annually by 2040.

Make a noise

On World Cancer Day on 4 February, Movendi International launched an ambitious new campaign, “Be Loud For Change”. We are mobilizing communities around the world to make a noise about the direct link between alcohol and cancer, the low public recognition of the fact that alcohol causes seven types of cancer, and the unique opportunity for our governments to bring change through proven solutions.

Since 1988, alcohol – like tobacco and asbestos – has been scientifically proven to be a group one carcinogen. When humans consume ethanol in beer, wine, and liquor, the byproduct attacks the DNA. But the media found it difficult to report properly on the real effects of alcohol and instead helped the alcohol industry to keep people in the dark.

After tobacco, alcohol is the second biggest cause of cancer – before other risk factors such as infections, physical inactivity, or sunlight. Globally, 740,000 people get cancer due to alcohol, each year.

The alcohol industry wants to keep people in the dark about the fact that their products are as carcinogenic as cigarettes and asbestos. Research has shown that awareness of the link between alcohol and cancer is very low internationally.

Alcohol companies are afraid of people becoming aware of the fact that ethanol in beer, wine, and liquor causes at least seven types of cancer. And so they fight tooth and nail against scientific studies, warning labels on alcohol products, and other alcohol policy solutions contained in the recently updated list of NCD best buys.

 The wide support of the WHO Executive Board and growing momentum for addressing cancer risk factors, such as alcohol, mean something significant: The world is experiencing a shift in awareness about alcohol harm, driven by growing awareness that alcohol causes cancer.

And the world is experiencing a shift in perception of alcohol policy solutions. The alcohol policy best buys – raising alcohol taxes, banning alcohol advertising, limiting alcohol availability – help prevent diseases such as cancer and heart disease; they help strengthen health systems; and they boost economic growth.

Alcohol taxes and warning labels

This means, our governments can do a lot to bring about change. They can develop alcohol taxation systems that effectively protect people from alcohol harm, including cancer. For example, reducing total alcohol consumption by 10% would lead to a 9% reduction in alcohol-related cancer deaths. That means ca. 57.000 fewer deaths.

Our governments can also put warning labels on alcoholic products informing about cancer, heart disease, and other alcohol harms. They can fund mass media campaigns to increase public recognition of the real harm due to alcohol. They can ban alcohol advertising, sponsorship, and promotion. And our governments can put in place common sense limits on the presence of alcohol in our communities.

Our governments have proven solutions at their disposal. There has never been a better time for an ambitious approach to protect our societies from cancer caused by alcohol. Such an initiative will protect and improve the health and well-being of people and communities, it will strengthen our health systems as alcohol harms, such as cancer cases and deaths, decline, and will unlock fresh resources for investment in health promotion and disease prevention.

 

Kristina Sperkova is International President of Movendi International

Pubudu Sumanasekara is International Vice President of Movendi International

Image Credits: Taylor Brandon/ Unsplash.

Over eight million Ukrainians have fled the country.

Russia’s war in Ukraine has sparked a global health crisis – from the death, suffering and displacement of people in the country to the global food and fuel insecurity, and diminished donor funds to support other health issues.

“The UN High Commission for Refugees estimated that about 17.6 million Ukrainians, which is about 43% of Ukraine’s population of 41 million, will need humanitarian assistance in the year 2023,” Ulana Suprun, a former Ukrainian health minister, told a webinar organized by the Global Health Center at the Geneva Graduate Institute.

 “Some 45% of those are women, 23% are children and 15% are people with disabilities,” she said. 

While the latest official civilian death toll as recorded by the Office of the UN High Commission on Human Rights, stands at 7,155, the real number could be as high as 100,000, Suprun pointed out. 

“Nearly eight million people have been displaced going into neighbouring countries, and 5.3 million people are internally displaced,” she said.

‘Defend Europe’

Suprun was part of a panel looking at the global health impact of the war In Ukraine, which took place on Wednesday, shortly after Ukraine’s President Voldymyr Zelensky addressed the European Parliament, and appealed for his country to be admitted to the European Union and for more weapons to “defend Europe”.

“A number of the governments that have traditionally been the largest donors to global health initiatives, such as in Europe and the United States, have sent millions of dollars in aid to Ukraine, and this has raised difficult questions in many capitals, about whether they can continue at the same level of funding to other global health initiatives,” said moderator Suerie Moon, co-director of Global Health Centre. 

In spite of the difficulties, including the deliberate targeting of health facilities by the Russian army, with 171 health facilities completely destroyed and at least 1,200 damaged anywhere between 10 and 90%, Suprum said the health system is functioning surprisingly well. This is also thanks to a process of healthcare reforms that the country has been conducting for the past six years to begin implementing universal healthcare.

At the same time, she highlighted how international help has been crucial while the logistics of supplying Ukraine with necessary items such as medicines, electric generators and food remains very challenging.

International food security 

Ukraine food crisis

The war has disrupted food supply chains well beyond Ukraine, said Ahmad Mukhtar, a senior economist at the Food and Agricultural Organization (FAO) for Near East and North Africa.

“Ukraine and the Russian Federation are some of the largest producers of the Black Sea region and a lot of the world depends on the Black Sea for seedlings exports,” said Mukhtar, who is based in Egypt.

The world already had a food security problem on the eve of the COVID-19 pandemic, but until 2019, the absolute number of people suffering from hunger had been declining, he added. The pandemic, followed by the war, had caused an increase in numbers. 

The WHO has been trying to persuade countries to promote healthy and nutritious diets, but many nations are grappling with food security and consider such diets to be luxuries that only rich countries can afford, despite the detrimental long-term effects of unbalanced diets, he added.

While the Black Sea Grain Initiative brokered by the UN last July, has allowed significant volumes of grain to be exported from three key Ukrainian ports in the Black Sea – Odesa, Chornomorsk, Yuzhny – Mukhtar called for a “new and more general approach” to food security to be found.

“We are going to have a global food systems reset, let us recognize, internalize and manage it so that it will be a win-win for everyone, including citizens, governments and the global community,” he said. 

Working on countries’ self-sufficiency in food production can be one of the tools, but at the same time it is necessary to help over 100 nations for which this is not an attainable goal with trade mechanisms “more from a food security and humanitarian perspective, rather than the transactional perspective, that is the state of affairs for now,” he remarked.

The role of international actors 

In light of the crisis in Ukraine, the international actors must continue to guarantee their financial support to Kyiv, otherwise “Ukraine and its healthcare system will not continue to function and people will not receive their salaries,” said Michel Kazatchkine, Special Advisor to WHO Europe, and a Senior Fellow and Course Director at the Global Health Centre. 

Kazatchkine suggested that the international community should also prioritize persuading Russia to give international humanitarian organizations access to the occupied territories to assess their health needs. 

Looking forward, international cooperation is also going to be crucial after the war ends.

“[Ukraine] is working on reforming its systems and looking towards reconstruction,” Kazatchkine said. “And of course, here the international donors will have a key role in terms of budgetary support, but also in terms of helping Ukraine to reconstruct hospitals and other health care facilities not as they were before, but as facilities responding to the best modern standards of care.”

First priority

Jakob Ström, a senior health diplomat at the Swedish Ministry for Foreign Affairs, said Stockholm considers supporting Ukraine one of the highest priorities of its presidency of the EU Council, which began on 1 January.

“Our government has been very clear that Ukraine is the number one priority for our development cooperation during the EU presidency,” he said. “The second priority for the Swedish EU presidency in this field is global health, and the third is corruption.” 

“We can and we will combine the engagement with Ukraine with global solidarity on issues such as food security, climate change and global health,” he pledged.

Both Kazatchkine and Ström agreed that, despite the war, international negotiations in the health field had not been disrupted.

“I don’t think that multilateral negotiations are immune from geopolitics,” said Ström. However, I disagree that the Russian aggression against Ukraine has disrupted negotiations in Geneva on health because we’ve been witnessing an increased interest in matters related to global health.” 

“The Russian Federation keeps sending strong messages that it wants to be part of WHO,” Kazatchkine echoed.

Mental health emergency

People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine.

As Ukraine is working around the clock to provide for the health needs of its people, one of the major emergencies is assisting Ukrainians with mental health challenges.

“One in every four Ukrainians – about 10 million people – are at risk of having mental health issues as time goes on,” said Suprun. “That’s something that we need to face.

Ukrainian First Lady Olena Zelenska is coordinating an initiative partnering with national and international organizations to handle the emergency.”

The efforts involve offering further training to mental health specialists, setting up specialized hotlines and creating a program for primary health physicians to recognize and provide at least first aid in mental health issues.

Suprun highlighted that one of the current mental health emergencies is helping victims of sexual violence perpetrated by Russian soldiers.

“It is currently very difficult to establish the exact number of victims of sexual violence by the Russian occupiers,” she said. 

“Although people don’t want to remember it and relive the horror, documenting it is very important, and we need the information as well as to identify those people so that we can provide help for them.”

“There is one country here that is at fault,” Suprun concluded. “It is very nice to say that health care is not political or global health doesn’t get involved in politics. But we can see today that global health is being impacted by the war that Russia started in Ukraine.”

Image Credits: Sam Mednick/TNH, People in Need, Joseph C. Okechukwu/Twitter .

Cholera flourishes in dirty water.

As Malawi struggles with its biggest-ever cholera outbreak, its response is being hampered by the global shortage of vaccines, warned Dr Patrick Otim Ramadan, World Health Organization (WHO) Africa’s Incident Manager for Regional Cholera Response at a media briefing on Thursday.

By Wednesday, Malawi had recorded 40,284 cases and 1,316 deaths, with a case fatality rate of 3.3%, Dr Charles Mwansambo, Malawi’s Secretary for Health, told the WHO Africa media briefing.

Confirming that his country had run out of vaccines last month, Mwansambo said that while the vaccines were important in preventing transmission, cholera could only be stopped by addressing “water, sanitation and hygiene”.

“What is a bit unusual is that this cholera outbreak started during the dry season,” added Mwansambo. “Last year, we had tropical cyclones and floods that destroyed most of the water and sanitation facilities in the southern region, and this was the start of the current problem of cholera.

“We then had cases in the fishing community in the north, which is a very mobile population, and it has gone out of control. So there are a number of issues, starting with climate and the weather.”

Dr Charles Mwansambo, Malawi’s Secretary for Health,

Horn of Africa drought

Ten countries in the African region have reported cholera cases, with the DRC recording over 3,000 cases, mostly in the north of the country which has been destabilised by M23 insurgents. Many people displaced by the conflict between M23 and government forces are living in close quarters in camps with inadequate water and sanitation – a breeding ground for the rapidly spreading cholera bacteria that breed in dirty water, contaminated food and sewage.

DRC health official Dr Placide Welo Okitayemba said that most people in the camps got their water from water tankers, and many of the children in the camps are malnourished “and cholera progresses faster in children who are malnourished”.

“Some of the camps are in mountainous areas and it is hard to get water to them, so we may have to move some of the camps,” added Okitayemba, who directs the DRC’s cholera control programme.

The drought in the Horn of Africa is driving cholera cases in Kenya, Somalia and Ethiopia.

Case statistics for January alone accounted for 30% of the total cases in 2022, added Ramadan.

“We are concerned that, if this trend continues, we will far exceed the number of cases that we’ve seen in 2022 and it will put significant strain on the health systems in the countries that are affected, but also significant demand on the medical countermeasures that we need to respond to this,” he added.

Acute shortage of vaccines

With 18 countries globally reporting vaccines, there is an “acute shortage of oral cholera vaccines, routinely used to stop transmission in areas where access to safe water cannot be rapidly scaled up”, said Ramadan. 

To alleviate this shortage, the WHO recommended using a single dose of the two-dose vaccine last October, while at a global level, the WHO has been engaging with manufacturers.

As previously reported by Health Policy Watch, only two global suppliers make cholera vaccines available for mass vaccinations. Shanchol is produced by Shanta Biotechnics, a Sanofi subsidiary in India, and Euvichol-Plus, made by EuBiologics in South Korea.

Both companies supply the international cholera vaccine stockpile managed by the International Coordinating Group (ICG), a mechanism that coordinates the provision of emergency vaccines and antibiotics to countries during major outbreaks. 

All countries that need cholera vaccines apply to the ICG, and those that qualify for Gavi financing get free vaccines while the others need to reimburse the stockpile.

But Shanta Biotechnics announced a while back that it will stop making Shanchol this year, while production at EuBiologics is currently constrained as the company is expanding its facilities. The expansion will ultimately enable it to produce 50 million vaccines a year. 

Countries are also short of pre-packed cholera kits containing IV fluids and other measures to address infections, said Ramadan.

Dr Patrick Otim Ramadan, World Health Organization (WHO) Africa’s Incident Manager for Regional Cholera Response

Lessons from COVID-19

Dr Theirno Baldé, WHO Africa’s incident manager for COVID-19, said all countries were better prepared to address pandemics, including cholera, since the start of the COVID-19 pandemic.

“It’s very important to mention that a lot of effort has been done by countries supported by WHO and also the partners to scaling up response capacities in the region, both for detecting new pathogens but also for trying to respond to them,” said Baldé. ‘But we are not there yet. We need to triple our response mechanisms.”

Mwansambo concurred, saying that Malawi is using the same structures that were put in place for COVID-19 to respond to cholera, with the Presidential Task Force coordinating the response and also a budget for pandemic preparedness and response. 

However, Ramadan stressed that, in the context of cholera, all countries also needed to urgently improve their water, sanitation and hygiene (WASH) plans.

Image Credits: L Pezzoli/ WHO.

Pfizer’s Paxlovid, an oral antiviral approved by the US FDA in December, has shown 90% efficacy in preventing mortality among those who take it in the first few days of infection.

After three years of its “Zero COVID” policy, the Chinese government allowed a return to relative normalcy for its citizens in early December 2022. Due to the ongoing transmission of Omicron and its numerous COVID subvariants in China, the sudden policy shift was accompanied by rapid community transmission across the country and high numbers of severe COVID cases. 

The resulting surge contributed to severe shortages of COVID medicines across the country, particularly Pfizer’s WHO-recommended oral antiviral treatment nirmatrelvir/ritonavir – known by its brand name Paxlovid – for high-risk populations.

It is unlikely that Pfizer will voluntarily drop its price, making the Chinese government’s most viable option, should it decide to seize it, the issuance of compulsory licences for the domestic marketing of Paxlovid to companies with available manufacturing capacity.

Five Chinese companies are already positioned to manufacture Paxlovid for export to low- and middle-income countries (LMICs) through the existing voluntary licence agreement.

Scarcity of supply and a failed price negotiation

Paxlovid was added to China’s National Guidelines for Diagnosis and Treatment of COVID-19 in March 2022. Paxlovid was initially covered by a national healthcare reimbursement scheme at CNY 2,300 (US$340) per treatment. This price point was recently updated to CNY 1,890 (US$282).

In early January, Paxlovid was included in the annual price negotiation for medicines in the catalogue of China’s national healthcare reimbursement scheme. After long hours of negotiation between China’s National Health Security Administration (NHSA) and Pfizer, no price agreement was reached.

While the actual terms of the negotiations remain unknown, it was widely reported that the price Pfizer offered was rejected by NHSA. A response from NHSA stated they had negotiated in good faith with Pfizer, but a wide gap in positions on pricing remained. 

NHSA added that negotiations on the inclusion of any particular drug in the catalogue is done only once a year, meaning they will not engage with Pfizer on a separate negotiation on Paxlovid again this year. The current coverage of Paxlovid by the healthcare reimbursement scheme is set to expire at the end of March 2023.

Paxlovid shortages have reportedly driven prices on the black market as high as US$7,200 per treatment. In the absence of any approval for generic versions of nirmatrelvir/ritonavir by China’s drug regulatory authority, people have turned to purchasing more affordable generics produced in India, where companies offer prices as low as US$36 per treatment to some low-income countries. 

Why is China – a middle-income developing country with a well-established pharmaceutical industry of more than 4,000 manufacturers, and a major exporter of active pharmaceutical ingredients (API) for the global market – so restricted in accessing affordable generic Paxlovid for people who need it now? 

To understand the root causes of this access crisis, a breakdown of Pfizer’s IP strategy is necessary.

Paxlovid’s patent status in China

Paxlovid is a co-packaged product containing two separate compounds – nirmatrelvir and ritonavir. Ritonavir has been off-patent since 2020, after AbbVie withdrew its remaining secondary patents on ritonavir worldwide (which were near expiration) following a compulsory license issued by the government of Israel on lopinavir-ritonavir (LPV/RTV) that had been considered as an antiviral treatment against COVID earlier.

Nirmatrelvir is a new compound for which Pfizer has been actively seeking patent protection globally. Pfizer has filed two patent applications on the nirmatrelvir compound in China, both of which remain pending.

In short, Pfizer currently holds no granted patent on nirmatrelvir nor Paxlovid as a whole in China. Yet it remains unclear if generic companies in China can freely produce and supply generic alternative versions of Paxlovid domestically. 

Paxlovid

Restrictive voluntary licensing terms hinder local production

Controlling who has access to Paxlovid even before Pfizer has secured patent protection on the product is central to the company’s IP strategy. In November 2021, Pfizer entered a voluntary license (VL) agreement with the Medicines Patent Pool (MPP) to facilitate generic supply of Paxlovid in 95 low- and middle-income countries (LMICs).

As of March 2022, 36 generic companies from 13 countries had signed the sublicense agreement, including five Chinese companies (Desano, Apeloa, Huahai, Fosun and Jiuzhou), for the production of API and/or finished product.

However, several issues with the terms of the Pfizer/ MPP VL continue to limit the options for access to generic supply in China. First, China is excluded from the territories specified in the terms of the VL agreement, meaning the five Chinese companies that signed the VL cannot supply the local market.

The exclusion of China and other major middle-income countries (MICs) like Brazil and other Latin American countries from the license territory is a long-standing practice of major pharmaceutical companies in VL negotiations with MPP. MSF has criticized this practice for its unethical consequence of blocking supply for local health needs.

Second, the terms of the VL say that exceptions can be made for local supply in excluded territories by licensed companies if their activities do not infringe on Pfizer’s “patents” as defined under the licence (Section 1.24). This includes cases of governments issuing compulsory licences according to their national law.

This means the definition of “patents” under the terms of the VL includes both granted patents and any pending patent applications. In the absence of a valid patent on Paxlovid in China, Pfizer can still prevent the five Chinese generic companies, of which several have completed the development of their generics and are ready to file for regulatory approval, from immediately supplying the Chinese domestic market to meet urgent health needs.

But if the Chinese government decided to issue a compulsory license allowing generic production and supply in the country, this could allow the five licensed companies as well as other generic supplies within China to immediately produce and supply the local market.

Finally, the VL terms require sublicensed companies to pass WHO prequalification (PQ) or stringent regulatory authority (SRA) approval before commercialization in ANY market (Section 3.5). This includes the local market where the generic companies are based.

There is no flexibility in the terms to reflect exceptional circumstances where urgent supply is mandated by national regulatory approval while WHO PQ or SRA approval is not yet complete. It is unclear how this requirement would be met if one of the Chinese generic companies included in the Pfizer/MPP VL licence were to launch a generic product locally under a compulsory licence issued by the Chinese government.

Notably, the other two VLs that MPP has signed on COVID therapeutics with Merck and Shinogi include flexibilities allowing national regulatory approval to be the basis for local supply in emergency situations.

Possible actions to overcome challenges

There are several possible solutions to the present challenges of access to affordable Paxlovid courses in China.  

As Pfizer failed to offer an acceptable price to the Chinese government to support better coverage of the drug under the national healthcare reimbursement scheme, it is not feasible to rely on a price reduction by the company. The unwillingness to negotiate comes in addition to the overall lack of transparency on different prices charged by Pfizer to countries and health agencies around the world.

Generic companies that signed the Pfizer/MPP VL may get the leverage to supply for local health needs if the territory of the licence is revised to include China in its scope. But based on past experience, such an amendment appears unlikely. 

The CEO of Pfizer has reportedly denounced the willingness of the company to facilitate generic supply in China, and would rather resort to its own contracted manufacturing company in China to supply the drug. This means Pfizer will remain in total control of overall production, supply and price. 

Generic companies that signed the Pfizer/MPP VL could supply to the domestic market if the Chinese government issues a compulsory licence for generic production and supply. This is both a fast and optimal solution, particularly in view of the fact that some of these generic companies have finished product development and are ready for regulatory approval.

Generic companies that did not sign the Pfizer/MPP VL may be less restricted and could catch up in seeking regulatory approval and launch their generic versions domestically. However, potential legal risks due to TRIPS-plus provisions, such as data exclusivity, may need to be lifted explicitly by the government. This could be done through a compulsory licence to provide certainty for independent generic suppliers.

China could also emulate the US approach, where the government directly authorized the use of patented health technologies in at least 166 government contracts without the consent of the rights holder to combat the COVID pandemic.

Grey areas under China’s TRIPS-plus provisions 

Beyond the issues outlined with Pfizer’s VL strategy, certain TRIPS-plus provisions create some grey areas for the rapid entry of generic Paxlovid production when Chinese patent law and drug regulatory rules are considered.

Chinese patent law contains several important public health safeguarding provisions. These include provisions on compulsory licensing, including for government use and public health needs, and an exception to facilitate research and development by generic companies in preparation for regulatory approval.

However, recent revisions of Chinese patent law and related regulations introduced stringent rules on data exclusivity, patent linkage and patent term extension that go beyond the obligations under the TRIPS agreement.

These revisions make it possible for a company holding only a pending patent application to threaten potential competitors with future lawsuits. Since Chinese law allows provisional protection based on pending applications, retrospective claims on infringement are valid under its patent laws.

These TRIPS-plus provisions increase the legal risks for rapid generic entry, alongside the restrictive VL terms outlined above.

Broader national and global solutions for the future

China’s current Paxlovid access challenges show once again how relying solely on the voluntary actions and goodwill of pharmaceutical corporations is insufficient to ensure medicines reach people in need. It is also a telling example of how the exercise of IP rights by a dominant company can stand in the way of COVID therapeutics access, despite claims by the pharmaceutical industry that IP is not an issue.

These challenges were anticipated on a global level at the beginning of the COVID pandemic by a decision to allow countries to temporarily waive certain IP protections on COVID medical tools called for at the World Trade Organisation (WHO), known as the TRIPS Waiver.

Unfortunately, the final outcome decision at the 12th Ministerial Conference of WTO  was insufficient and narrow in its scope, applying only to COVID-19 vaccines.

In view of the present IP barriers erected against access to COVID treatments like Paxlovid, it is regrettable that the negotiations to include COVID therapeutics and diagnostics, not just vaccines, remain at a standstill at WTO. 

The frustrating proceedings at WTO are a reminder of the importance of prioritizing national and regional actions that can provide direct and long-lasting impacts on access to medicines for all. 

To address issues and limitations with voluntary licensing practices, governments should establish adequate mechanisms to allow public scrutiny and oversight over terms and conditions requested by the patent holders that restrict access options.

Requirements for full transparency on licensing terms, cost and pricing are crucial to ensure accountability for the private sector concerning the impact its IP protection practices have on public health. Terms restricting local production supply in developing countries and those restricting access to certain populations should be available for scrutiny.

All countries should review and improve national IP law and regulations to ensure implementation of the full range of public health safeguards, and refrain from introducing TRIPS-plus provisions that could have an unfavourable impact on access to medicines for those in need.

Authors

Zhenyan Zhu, is China Advisor of Médecins Sans Frontières (MSF) Access Campaign

Yuanqiong Hu, is Senior Legal and Policy Advisor, MSF Access Campaign

Guangjian Xue, MSF China Representative.

 

Image Credits: Bobbi-Jean MacKinnon, Pfizer .

Earthquake
“We know [casualty] numbers will climb,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Wednesday. “We’re in a race against time to save lives.”
The earthquake that struck Turkey and Syria this week is now the deadliest the world has seen in over a decade. By Wednesday evening, 11,600 people had been confirmed dead. Tens of thousands more are injured.

As deaths continue to mount, search and rescue teams from across the world are in a race against the clock to locate survivors amidst the rubble of thousands of collapsed buildings. Experts warn the window of opportunity for rescue is closing rapidly.

“The first 72 hours are considered to be critical,” Steven Goldby, a natural hazards expert at Nottingham Trent University told the Associated Press. “The survival ratio on average within 24 hours is 74%, after 72 hours it is 22%, and by the fifth day it is 6%.”

Despite massive international efforts, the scale of the devastation means many people are still waiting for help to arrive.

Accessibility to war torn area limited

The intensity of the earthquake which affected Turkey and Syria is shown in darker colours, with the epicentre in orange.

“We continue to be very concerned about areas which are inaccessible,” said World Health Organization (WHO) representative in Syria Dr Iman Shankiti, noting that the damage caused to roads and transport infrastructure has rendered certain regions inaccessible to emergency services. “The health needs are tremendous.”

The affected area straddles the war-torn region of northern Syria where Kurdish forces, Syrian-backed militias, and remnants of Islamic State, all control enclaves of territory.

The quakes shattered roads surrounding Bab al-Hawa crossing, the only UN-designated transit point for aid from Turkey into Syria. As a result, emergency aid and response teams have yet to reach Idlib province. That has left some 4.5 million Syrians – around 60% of whom have already been displaced by the war – without assistance. The United Nations, which is already mounting a massive relief effort in Turkey with WHO and other UN agencies, said it hopes to send the first aid trucks to the Syrian side of the border on Thursday.

Refugees displaced by the Syrian conflict have been hit particularly hard. Turkey hosts more than 3.5 million Syrian refugees, and in the 10 Turkish provinces hit by the quake, more than 1.7 million of the 15 million inhabitants are Syrian refugees.

The UN estimates 10.9 million people inside Syria have been affected by the quakes. The World Food Programme said it has enough food to feed people in Syria for one week. A dozen years of war have critically weakened the country’s healthcare system, leaving just 50% of its hospitals operational.

At a press conference held at WHO headquarters, Executive Director Mick Ryan called on governments to reflect on the compounding effects of war and conflict on health systems, and the lives of ordinary people.

“What’s common in both the [Syrian and Ukraine] wars is the devastating impact of war and conflict on the health system, and the health and wellbeing of ordinary civilians,” he said. “The reality is, it doesn’t matter what takes a building down, 7.9 degrees on the Richter scale or a missile. It’s human bones that are crushed, it’s human children that are killed.

“The situation in Turkey and Syria in terms of the earthquake is largely unavoidable,” Ryan said. “The realities underlying the crisis in Syria and the crisis in Ukraine are entirely avoidable.”

Image Credits: US Geological Service .

HPV vaccine
World’s first peer-reviewed study gives a shot in the arm to Bavarian Nordic’s Mpox vaccine.

Just one shot of the Mpox vaccine reduces the risk of infection by 86% compared to those who are unvaccinated, according to a new study published recently in Nature Medicine.

The real-world study – the first to be published in a peer-reviewed journal since the outbreak began last spring  – tested the effectiveness of a single dose of the live attenuated vaccine, produced by Bavarian Nordic (MVA-BN) in preventing cases of symptomatic infection. 

It comes as WHO’s Mpox Emergency Committee reconvenes again on Thursday to reconsider whether the global public health emergency declared last July may be over, in light of the sharp decline in cases recently – thanks in part to the worldwide response focusing on the vaccination of high-risk groups and other public health measures.

The observational study, conducted by Israel’s largest health fund, Clalit Health Services, followed 2,054 men, who were eligible for the vaccine, 50% of whom were vaccinated during the study recruitment period and completed at least 90 days of follow-up. During the study period, only 5 members of the vaccinated group came down with symptomatic Mpox infection, as compared to 16 cases in the unvaccinated individuals, respectively. 

The health fund conducted a major outreach drive to health fund members determined to be at high risk for contracting the virus, and therefore eligible to receive a vaccine, after Mpox vaccines became available last July.

The study’s analysis also considered risk factors such as age, socioeconomic status and comorbidities. The average age of the patients was 34. The heath fund and national health authorities also ran an awareness campaign focusing on careful sexual behavior among the LGBT population during the study period. It is possible that the information campaign also affected risk-taking behaviour of individuals, and thus study results, the researchers noted. 

Only a handful of other studies have yet produced findings on the vaccine’s real-world efficacy, but they have not yet been published in peer reviewed journals. One retrospective analysis by the US CDC published in October 2022, found unvaccinated men had a 14 times higher risk of becoming infected as vaccinated men, aged 18-48. Smaller studies or less well- controlled studies have reported similar findings in pre-print articles and journal  communications.  

Single dose regime used – with subcutaneous administration

The study is also striking because in light of the global vaccine shortage, it relied upon a single dose of the vaccine – despite the fact that the US CDC recommendation, where the vaccine first received regulatory approval, is for a two dose-regime – administered four weeks apart.  

However in Israel, as elsewhere, public health authorities resorted to single jabs to stretch scarce Mpox vaccine supplies.  The vaccine, however, was administered in the traditional manner with an injection to the subcutaneous layer of skin tissue, which lies just above the muscle.  That as compared to the shallower, intradermal administration of a smaller vaccine dose – which the US Health and Human Services, had authorized in August 2022 – but which many health experts said could be a gamble.   

When vaccination began in Israel, at the end of July, the jab was initially offered only to people deemed to be at maximum risk of contracting and spreading the disease. The criteria for eligibility for vaccination were defined by the Ministry of Health in cooperation with Clalit and based on the findings of a preliminary study by the team of researchers who identified the main risk factors for Mpox morbidity prior to the start of the vaccination campaign.  They then used advanced digital technology to match those criteria with the records of patients deemed to be at high risk. 

WHO Emergencies Committee to meet soon to reconsider Mpox public health emergency

Source: WHO

WHO declared Mpox to be a public health emergency of international concern (PHEIC) on 23 July 2022, after more than 16,000 cases were reported in 75 countries within a matter of weeks. The organization subsequently called for a worldwide vaccination campaign for high-risk populations. 

However, with Mpox cases now in a sharp decline, WHO’s Mpox Emergency Committee is due to meet soon to reconsider the status of the public health emergency, Dr Tedros Adhanom Ghebreyesus said during last week’s WHO Executive Board meeting.

The latest global trends show new case reports declining to just 159 in the week of 30-January to 6 February, roughly compared to the levels reported when the first widespread wave of cases outside Africa began, in May 2022.  This is as compared to about 7,000 new cases a week at the height of the outbreak.

Mpox belongs to the family of viruses that previously caused smallpox, although it is less virulent. People tend to catch the virus from person-to-person contact, mainly via sexual intercourse. Of course, it can also spread from direct contact with the rash or the bodily fluids of an infected person. 

Ultimately, more than 85,000 people worldwide have been verified as infected with the virus as of January 25, 2023. Around 85 people have died so far. 

Image Credits: US National Cancer Institute, Unsplash, National Cancer Institute on Unsplash.

Breastfeeding has been portrayed as outmoded and even ‘unfeminist’ in formula milk marketing.

Infant formula companies have “pathologised” normal baby behaviour to promote their products, and there should be “an international, legal treaty” to prevent their marketing,  according to health experts.

In addition, political lobbying by milk formula companies to influence public policy should be sharply curtailed. 

These are some of the suggestions contained in a three-part series published in The Lancet on Wednesday morning.

Fewer than half of all babies are breastfed as recommended by the World Health Organization (WHO), as formula milk companies “exploit parents’ emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women, and children,” argue the authors.

“The sale of commercial milk formula is a multi-billion-dollar industry which uses political lobbying alongside a sophisticated and highly effective marketing playbook to turn the care and concern of parents and caregivers into a business opportunity. It is time for this to end,” says series co-author, Professor Nigel Rollins from WHO’s Department of Maternal, Newborn, Child and Adolescent Health.

Exploiting mothers’ insecurities

The series exposes how the commercial milk formula (CMF) industry portrays normal baby behaviour –  including crying, fussiness, vomiting and poor night-time sleep – as “pathological” problems. They “exploit mothers’ insecurities about their milk and their ability to satisfy and calm their baby” – and offer CMF as a solution, adds the series.

The damning exposé comes over 40 years after the World Health Assembly adopted the voluntary International Code of Marketing of Breast-milk Substitutes in 1981 to reign in the infant formula industry – which has been powerless to stop marketing manipulation.

In fact, sales of milk formula grew 37-fold between 1978 and 2019 – from $1∙5 billion to $55∙6 billion annually.

Political lobbying

Nestlé (Switzerland), Danone (France), Reckitt (UK), Abbott (US), Friesland Campina (Netherlands), and Feihe (China) dominate today’s global market, and use tactics similar to those of the tobacco, alcohol, and ultra-processed food industries.

“The ability of CMF corporations to expand and sustain their marketing practices worldwide is only possible because of their large investments in corporate political activities aimed at fostering policy, regulatory, and knowledge environments conducive to such marketing,” argues the series.

Between 2007 and 2018, the big six manufacturers spent $184∙2 million on lobbying the US government, which went on to oppose marketing regulations in Hong Kong, Thailand, Malaysia, and Indonesia, and in the World Trade Organization, and through direct bilateral engagements with governments seeking to implement national breastfeeding protection laws.

Unsubstantiated claims

Specialised formula is being sold as “comfort milks” for hungry babies, for colic, allergies, and to enhance sleep –  claims that are scientifically unsubstantiated.

These “comfort milks” can contain prebiotics, hydrolysed proteins, xanthan gum, or low lactose, but there are no clinical trials to back claims that they can provide relief for infant discomfort.

”Hypoallergenic milks” are “increasingly playing a key role in the growth strategy of major manufacturers, fuelled by a rising awareness about allergies and food intolerance among parents”, according to the report.

The companies also make unsubstantiated inferences that milk formula can “enhance brain development and improve intelligence”, using terms such as “brain, neuro, and intelligence quotient” written in large font on their products.

Some marketing of commercial milk formula companies implies that the product can improve intelligence (brand names have been changed).

Undermining breastfeeding

There are huge health advantages to breastfeeding. Mothers transmit elements of their microbiota to their children through breastmilk, and these bacteria live in the babies’ gut and help fight disease, digest food, and regulate the child’s evolving immune system

Breastfeeding also releases oxytocin, prolactin, and other metabolites that “foster mother–child bonding and reduce physiological stress for both”,  while hormones in breastmilk stimulate babies’ appetite and sleep development.  

“Not breastfeeding increases the risk of infant and young child mortality, infections and malocclusion, and potentially obesity and diabetes,” notes the report.

For mothers, it reduces breast cancer and potentially ovarian cancer and type 2 diabetes.

Yet breastfeeding is portrayed in CMF marketing as generic, outmoded, and even “anti-feminist”, while formula milk marketing links it to “upward mobility, modernity, and later with women’s liberation”. 

“The idea that breastfeeding is anti-work and anti-feminist is repeated in popular blogs, media, and academic publications, especially in high-income countries,” argue researchers.

By undermining breastfeeding and fostering dependency on commercial supply chains, CMF marketing undermines infant and young child food security in the context of major disruptions to supply chains (such was seen in the US during COVID-19).

Pitches to health professionals

“Similar to pharmaceutical companies, the CMF industry sponsors professional organisations and their conferences, meetings, and training, and posts adverts and publishes sponsored articles in scientific journals,” the series notes.

Their influence is widespread. A review of paediatric association websites and Facebook accounts, found that 60% documented receiving financial support from CMF companies.

Pitches to health professionals are presented as the sharing of scientific information or professional training, creating an image of the formula milk company as an “objective and respectable adviser”. 

“For the company to provide support materials, sponsor attendance at scientific meetings, and fund conferences and other needs therefore seem natural and acceptable. These activities are presented as professional collaborations rather than inducements,” it notes.

The series also detailed the environmental harms associated with the industry, including “greenhouse gas emissions, water use and pollution, and packaging waste”.

Not enough maternity leave

Co-author Professor Rafael Pérez-Escamilla from Yale University’s School of Public Health points out that “breastfeeding promotes brain development, protects infants against malnutrition, infectious diseases, and death, while also reducing risks of obesity and chronic diseases in later life”. 

“Yet, globally, many women who wish to breastfeed face multiple barriers, including insufficient parental leave and lack of support in healthcare systems and at the workplace, in the context of exploitative marketing tactics of the commercial milk formula industry,” adds  Pérez-Escamilla.

A systematic review of studies spanning the Americas, Asia, Africa, Europe, Oceania, and southeast Asia, found that women with three months’ maternity leave, paid or unpaid, were at least 50% more likely to continue breastfeeding compared with women returning to work before this time, and those with six months or more were 30% more likely to maintain 6 months of breastfeeding. 

The US is the only high-income country that does not have legislated maternity leave.

“There is a pressing need to reverse unfair work burdens placed on women, to make visible the economic value of breastfeeding and other unpaid work within mainstream economics, and to recognise breastfeeding as a globally distributed form of food production within food surveillance systems,” the series notes.

“Data collection on breastfeeding is particularly poor in high-income countries, allowing governments to avoid their responsibilities for progressing the rights of women and infants and young children everywhere.”

Marketing of commercial milk formula using reassuring words such as “gentle” (brand names have been changed).

Ban marketing

Marketing of CMF products should not be permitted, argue the researchers.

“A framework convention, placing the rights of children and women at its heart, is needed to protect parents and communities from the commercial marketing of food products for and to children younger than three years old, including CMF marketing systems. The framework would restrict marketing but not the sale of these products.”

 Such a convention or treaty would obligate governments to fully legislate its provisions into national law. 

“The treaty must protect policymaking from industry influence, with obligations for senior public officials to divulge meetings with lobbyists and requirements for scientific organisations to disclose funding sources and members of expert advisory groups,” adds researcher Professor David McCoy from the United Nations University. 

“This would regulate the commercial milk formula industry while not restricting the sale of the products to those who need or want them. More generally, the global and public health community must also be much more critical about public-private partnerships that enable or tolerate conflicts of interest.”

The researchers also want requirements for research institutions, think tanks, professional organisations, and NGOs to disclose funding sources.

Image Credits: Ana Curcan/ Unsplash.

Antimicrobial resistance
Rivers, lakes and sediment can be transient sources of antimicrobial resistance.

A new UN Environment report calls for more attention to be focused on the environmental factors fostering the development of strains of drug-resistant bacteria immune to all known antibiotics, known as “superbugs”. By 2050, the UN estimates that up to 10 million deaths could be caused by superbugs and associated forms of antimicrobial resistance, matching the annual global death toll of cancer.

WHO has estimated that some 4.9 million deaths annually are associated with antimicrobial resistance (AMR), while a 2022 Lancet study found that in 2019, 1.27 million deaths – including 860,000 in Africa – were the direct result of drug-resistant bacterial infections. That same year, Africa saw 640,000 deaths from HIV. 

While most attention to AMR has been focused on the use of anti-microbial drugs in the health care and animal husbandry sector, the report highlights growing evidence that the environment is a significant factor in AMR’s growth, transmission, and spread. 

Antimicrobials – which include antibiotics, antivirals, antiparasitics and antifungals – are critical to the health of humans and the livestock, aquaculture, and crops the global food chain relies on. Their discovery in 1928 led to a revolution in medicine that brought about a new era of food security and health now taken for granted.

But their overuse in the pharmaceutical, agricultural and healthcare sectors, and resulting spillover into the environment, is threatening to undermine their effectiveness altogether. As human-made antimicrobials spillover into rivers, soil, and other natural reservoirs, bacteria learn to ‘resist’ treatments to which they were previously vulnerable.

“We are confronted by a silent, slow-motion pandemic,” Mia Amor Mottley, President of Barbados, said at a press briefing marking the launch of the report, held on the sidelines of the Sixth Meeting of the Global Leaders Group on Antimicrobial Resistance in Bridgetown, Barbados. “Our greatest fear is that [AMR] may well become the leading cause of death in the world.”

Climate change and pollution are media for superbug spread

Projected global deaths by continent in 2050. Low-Income Countries (LICs) and Lower-Middle-Income Countries (LMICs) bear a significant burden of infectious disease and will be more adversely affected by AMR, according to the report.

The report calls attention to both global warming and the increased pollution of rivers, lakes and other waterways, which provide condusive environments for drug resistant pathogens to breed and spread. 

“The climate crisis and AMR are two of the most complex threats the world currently faces,” the report said. “Both have been worsened by, and can be mitigated by, human action.”

The UNEP report is the first to call for a “One Health” response to AMR, highlighting the relationship between extreme weather events, higher temperatures, and land-use changes and the spread of resistant bacteria. 

As temperatures increase around the globe, the evolution of resistant bacteria accelerates. In addition, extreme weather events, like floods, lead to the mixing of pathogens from diverse sources, exacerbating the spread of resistant bacteria in places where they did not exist previously, the report stated. 

Of special concern is the pollution of waterways by hospital wastewater, run-off from pharmaceutical production, and agricultural treatments, which contribute to the development and spread of resistant microorganisms in the environment. 

Wastewater and other effluents discharged by such industries are often highly contaminated with antibiotics and other chemicals used to protect or treat people, livestock and plants. When the contaminated waste is discharged, without adequate treatment, it creates an ideal medium for drug resistant bacteria and viruses to grow and flourish. 

This is a particularly large problem in burgeoning cities, which lack adequate wastewater management.  Low and middle income countries, particularly in Asia and South East Asia, are expanding their industrial agricultural production of plants and livestock – which often involves heavy drug and chemical applications  – without adequate effluent treatment.

“The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem,” said Inger Andersen, Executive Director of the UN Environment Programme, at a launch of the report on Tuesday. “The impacts of antimicrobial resistance could destroy our health and food systems.”

Reduction of antimicrobial use is possible, but funding and planning are needed 

While a 2020 study estimated that the use of veterinary antimicrobials will increase by 11.5% by 2030, several countries have already undertaken successful national action plans to reduce the use of antimicrobials across the board. 

The Netherlands achieved a 68% decrease in antimicrobial use over a 10-year period after implementing a comprehensive action plan in 2008. The United Kingdom also reported a decrease in antimicrobial use in animals by 39.2% after publishing its “Five-Year Antimicrobial Resistance Strategy” in 2013. 

But as the global population expands, and financial resources to address AMR remain scarce, low- and middle-income countries will require support to ensure their agricultural industries do not follow the industrialized farming path charted by high-income countries now seeking to redress the negative impacts of antimicrobial use. 

“We need to be able to mobilize far more expansive resources globally if small countries are to play their part in ensuring that the planet that we live on remains safe,” Mottley said, adding that middle-income nations vulnerable to climate shocks should also be supported. 

Currently, 150 countries around the world have national action plans relating to AMR, but just 40 have been implemented. If the rest are not implemented, the risk of AMR getting out of control may become an inevitability. 

“It’s a big ask, but it’s a big problem,” said Dr. Haileyesus Getahun, Director Global AMR Coordination at WHO, who spoke at the publication’s launch. “Unless we step up to the plate, we’re going to have problems not just now, but for generations to come.”

AMR death toll may catch up to cancer by 2050

Predicted mortality from AMR compared with common causes of current deaths.

Antimicrobial resistance is listed by the WHO as one of the top 10 threats to global health, and its impacts are already taking a significant toll on the health of humans, animals, plants, and economies. 

If the development and spread of AMR continues at its current rate, modern medicine will struggle to treat even mild infections among humans, animals, and plants, with devastating consequences, scientists predict.

“We are here because antimicrobials are a super weapon,” UNEP’s Andersen said at a press conference accompanying the launch of the report on Tuesday. “But their effectiveness is under threat. Scattergun and careless use of this super weapon is increasing the emergence of antimicrobial resistant superbugs.” 

The report estimates knock-on effects from AMR could result in at least $3.4 trillion in annual economic damage by 2030, pushing 24 million more people into extreme poverty in the next decade.

“In a world profoundly skewed in favour of wealthy nations and communities, AMR will hit the most vulnerable the hardest. Poverty, lack of sanitation and poor hygiene make AMR worse,” Andersen said. “If we are serious about increasing equity and saving lives, we must act now on AMR.”

Image Credits: Balasaheb Pokharkar.