New High Seas Treaty Gives Oceans a ‘Fighting Chance’ 20/06/2023 Kerry Cullinan Two-thirds of the world’s oceans are unregulated and subject to overfishing and pollution. After almost 20 years of negotiations, the United Nations has adopted a legally binding treaty to protect the marine biodiversity of sea outside national borders known as the high seas, which cover two-thirds of the world’s oceans. The High Seas Treaty was adopted by consensus at the Intergovernmental Conference on Marine Biodiversity of Areas Beyond National Jurisdiction on Monday. It will come into force once ratified by 60 of the 193 UN member states. “The ocean is the lifeblood of our planet, and today, you have pumped new life and hope to give the ocean a fighting chance,” the UN Secretary-General António Guterres told delegates. “A win for all life on this planet.” #ProtectTheOceans https://t.co/VFEIR5kNgJ — Greenpeace International (@Greenpeace) June 20, 2023 The treaty, an international legally binding instrument under the 1982 United Nations Convention on the Law of the Sea, aims to “ensure the conservation and sustainable use of marine biological diversity of areas beyond national jurisdiction, for the present and in the long term”. However, after its adoption Venezuela’s delegate pointed out that his country is not a party to the convention, so is not bound by the treaty. Meanwhile, Russia also distanced itself from the consensus, claiming that it feared the agreement would be politicised. The new agreement contains 75 articles to protect and ensure the responsible use of the marine environment including provisions based on the polluter-pays principle. This is particularly important to contain toxic chemicals and plastic waste. More than 17 million tons of plastic entered the world’s oceans in 2021, and this is expected to double or triple each year by 2040, according to the latest Sustainable Development Goals (SDG) report. 👏 We applaud governments at @UN for formally adopting the long-awaited #HighSeasTreaty today. Now, we urge countries to ratify the Treaty ASAP: once the 60th country does so, the global ocean Agreement will become international law. https://t.co/KQrHJycHld #OceanTreatyNow pic.twitter.com/tRaNgopOF1 — High Seas Alliance (@HighSeasAllianc) June 19, 2023 The treaty intends to establish new marine protected areas, to conserve and sustainably manage vital habitats and species in the high seas and the international seabed area. The treaty also considers the special circumstances facing small-island and landlocked developing nations. The treaty also underlines the importance of capacity building, including collaboration among regional seas organisations and regional fisheries management organisations to regulate the high seas. The treaty also offers guidance on tackling the adverse effects of climate change and ocean acidification, and maintains and restores ecosystem integrity, including carbon cycling services. “We have a new tool,” UN General Assembly President Csaba Kőrösi told the Intergovernmental Conference delegates on Monday. “This landmark achievement bears witness to your collective commitment to the conservation and sustainable use of marine biological diversity in areas beyond national jurisdiction. Together, you laid the foundation for a better stewardship of our seas, ensuring their survival for generations to come. Image Credits: Julia Goralski/ Unsplash. Lives Are At Risk as Anti-Abortion Groups Attack HIV Programme PEPFAR 20/06/2023 Kerry Cullinan A child with HIV takes a paediatric dose of antiretroviral medication. One of the most successful US aid programmes, the US President’s Emergency Plan for AIDS Relief (PEPFAR) – which has saved 25 million lives in its 20 years of existence – is facing a right-wing backlash based on misinformation. PEPFAR’s five-year budget is due for re-funding by the US Senate and Congress by 30 September, but there has been unprecedented right-wing mobilisation against it over the past few months by both US and African groups. Twenty million people living with HIV are currently on antiretroviral medication thanks to PEPFAR, which also channels the US contribution to the Global Fund for AIDS, Tuberculosis and Malaria. PEPFAR’s key achievements in 2022 PEPFAR was started by Republican president George W Bush in 2003 and has enjoyed bipartisan support from both Republicans and Democrats. But a group of US right-wing groups claimed in a recent letter sent to Senate and Congress leaders that PEPFAR grantees “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. Signatories include the Center for Family and Human Rights (C-FAM), Heritage Foundation and the Dr James Dobson Family Institute. A similar letter was sent on 6 June to the same US Senate and Congress leaders by African politicians and religious leaders claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”. US Representative Chris Smith, who co-sponsored PEPFAR’s refinancing in 2018, has also joined its critics by recently claiming that the programme is being used to “promote abortion on demand”. Illegal for PEPFAR to fund abortion However, it is illegal for PEPFAR to fund or support abortion, and abortion is illegal in most of the African countries where it operates. “PEPFAR has never, will not ever, use that platform in supporting abortion,” said Dr John Nkengasong, who heads PEPAR as the US Global AIDS Co-ordinator, as reported by Devex. One of the PEPFAR grantees that have been singled out is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which targets teenage girls in 16 African countries. Girls and young women are up to five times more likely to contract HIV than boys and men their age, and DREAMS offered HIV prevention services to 2.9 million adolescent girls and young women in 2022. However, a C-FAM report claims that “in Malawi the program focused on young girls 12-14 years providing access to sexual and reproductive health services, which according to the Biden administration includes abortion”. Abortion is illegal in Malawi so this simply isn’t possible. The group also singles out the Anova Health Institute, a respected South African organisation that works largely with government departments on HIV prevention, treatment and care and health systems strengthening. It claims that Anova “promotes abortions to teens as young as 14” and had condemned ”laws enacted in US states that designate bathroom use based on biological sex”. However, Anova CEO Dr Helen Struthers, told Health Policy Watch that her organisation “has always worked within the South African legal framework and within the terms and conditions of our grant agreements”. “We have abided by the United States Government’s Various Codes of Federal Regulation and other restraints placed on the use of PEPFAR funds. Anova has never performed any abortions, nor has it actively promoted abortion as a method of family planning with PEPFAR or any other funds,” Struthers stressed, adding that Anova had supporting the South African government to put 400,000 more people on antiretroviral treatment in the past four years. “These people are all playing with fire, and they’re playing with people’s lives, and there can only be one reason: political motivation to kill PEPFAR,” Mark Dybul, former US global AIDS coordinator, told Devex. Monica Geingos, co-chair of the Global Council on Inequality. Meanwhile, Namibian First Lady Monica Geingos, co-chair of the newly formed UNAIDS Global Council on Inequality, said that “PEPFAR has been an incredibly effective partner for Namibia, and has really contributed to some of our remarkable gains” against HIV. The government of Namibia is close to reaching the @UNAIDS HIV treatment targets and has the leadership and commitment to end HIV/AIDS as a public health threat in Namibia. @USAmbPEPFAR is attending a @MhssNamibia Exec Dir Benetus Nangombe-hosted technical discussion about… pic.twitter.com/UglQJLFa5C — PEPFAR (@PEPFAR) June 19, 2023 “Unfortunately, as the US moves into a political season, and as many countries move to political seasons, things like this tend to happen. And it’s a reminder again, for many countries to become more self-reliant when it comes to health financing,” Geingkos said in response to a Health Policy Watch question at a webinar on Tuesday organised by UNAIDS and the Financial Times. However, Geingos added that misinformation “is not something that the Global Council can ignore” as it “can exacerbate and prolong pandemics when people don’t believe in science, when politicians behave and speak irresponsibly and when this starts to impact where money flows to.” * Story updated to include Anova comment. Image Credits: Paul Kamau/ DNDi. 30 Countries Sign Political Declaration to Include Refugees in National Health Systems 19/06/2023 Stefan Anderson & Elaine Ruth Fletcher A doctor providing essential health services to children in a refugee camp in northwest Syria during the COVID-19 pandemic. Thirty countries signed a political declaration at an international meeting in Morocco last week calling for the health of refugees and migrants to be included in national health systems and universal health coverage. A total of 50 UN member and observer states attended the talks. The Rabat Declaration, signed on Friday, is the first official outcome document on the health of refugees to emerge from a series of Global Consultations on the Health of Refugees and Migrants that began in Istanbul in March last year. “Universal health coverage is only truly universal if it includes refugees and migrants,” the declaration states. The World Health Organization (WHO), UN High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM) and UN Refugee Agency called the declaration “groundbreaking”. “Member States today have pledged that no one will be left behind when addressing the health needs of those forcibly displaced,” said Raouf Mazou, Assistant High Commissioner for Operations at UNHCR, in a joint press release. “Their commitment to not only include refugees, migrants and their hosting communities in national health policies and plans, but to also include them meaningfully in policy health discussions is a significant momentum towards universal health coverage and worthy of global support,” he said. The declaration also calls for increased international efforts for “the protection of refugees, stateless persons, asylum-seekers and other forcibly displaced persons”, recognizes the “positive role and contributions of migrants and refugees for inclusive growth and sustainable development”, and emphasises the need for regional and national health strategies that “include measures to reach refugees and migrants … with the aim of leaving no one behind”. “Refugees and migrants face significant threats to health, and significant barriers to accessing the health services they need,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Protecting the health and dignity of refugees and migrants during their often-dangerous journeys, and in the countries hosting them, is a matter of human rights, and human decency.” Two previous rounds of international meetings on “migrant health” — concluded in Madrid in 2010 and Colombo in 2017 — did not include “refugees” in their official scope. The Colombo statement, signed by 19 countries at the conclusion of the 2017 round of talks, makes no reference to refugees in its guiding principles. WHO spotlights refugee health challenges People receiving food assistance at the Oruchinga refugee settlement in Uganda. A WHO spokesperson described the declaration as the latest in a series of WHO and international actions to recognize refugees’ unique health challenges: “The declaration comes at a crucial moment after the adoption of the Global Compact for Safe, Orderly and Regular Migration (GCM) and the Global Compact on Refugees (GCR) in 2018, the adoption of the WHO Global Action Plan on Promoting the Health of Refugees and Migrants in 2019 and its extension until 2030 just adopted by the World Health Assembly in May this year, the International Migration Review Forum in 2022 and prior to the Global Refugee Forum in December 2023,” the spokesperson said. “In the declaration Member States commit to stronger global coordination and collaboration for better health outcomes of refugees and migrants, as well as actions that improve the health of these populations, such as sustainable Universal Health Coverage (UHC) financing mechanisms or health system strengthening; the development of high-quality global research on the health of refugees and migrants; investments in data to develop a monitoring framework; the participation of refugees and migrants in health policy discussions; and cooperation and financial mechanisms to assist the efforts of host countries at the national and local levels.” Lack of broader country support Countries hosting large numbers of refugees were among the leading signatories of the new statement. These include Turkey, Jordan, Morocco, Lebanon and Iran in the Middle East; Libya, Chad, Somalia, and Algeria and Ethiopia in Africa; Guatemala, Honduras and Mexico in Latin America; and India, the Philippines and Thailand in Asia. Notably, the USA, Italy, Greece, Romania, Slovakia, and Portugal also supported the declaration. Canada, the United Kingdom, Germany, Norway, Sweden and other countries in Europe that play host to large numbers of refugees were not among the signatories. IOM and UNHCR could not be reached for further comment on the implications of the declaration or its political supporters, in time for publication. In response to the relatively low number of signatories, WHO said that the increased attendance, which has more than doubled since the second consultation in 2017, reflects increased “interest in commitment to improving the health of refugees and migrants and addressing the root causes of poor health outcomes”. “This positive trend is very much aligned with the adoption of a resolution to extend the WHO Global Action Plan on Promoting the Health of Refugees and Migrants until 2030, which was put forward by almost 30 governmental co-sponsors,” WHO said. “With the resolution, Member States have seven more years to continue to address the health needs of refugees and migrants, integrate refugee and migrant health in global, regional, and national initiatives, and identify and share challenges, lessons learned, and best practices related to implementing the global action plan.” WHO’s European Region is currently negotiating a new regional action plan on the health of refugees and migrants, with the participation of the countries of the region, the spokesperson added. In a landmark WHO report in 2022, the agency noted that migrants and refugees face big hurdles in accessing health services in two-thirds of their host countries. The report called for more active integration of migrants and refugees into the national health system schemes of their host countries – saying that their inclusion is critical to meeting 2030 Universal Health Coverage goals. A United Nations High Level Meeting on Universal Health Coverage, is scheduled for September. Algeria opposes registration of refugees in health system Tens of thousands of Sahrawi refugees have been stranded in the aftermath of the conflict between Morocco and the Polisario Front over the former Spanish colony of Western Sahara following Spain’s withdrawal in 1975. During three days of negotiations over the statement in Rabat, Morocco last week (13-15 May), Algeria stirred up controversy when its delegation came out in opposition to a key section of the declaration, which notes the international legal obligation of host countries to register refugees in order for them to access national health systems. Algeria is home to an estimated 111,500 refugees from Sub-Saharan Africa and Syria. Around 90,000 of these are Sahrawi refugees who live in five camps near the Saharan desert town of Tindouf, which borders the disputed region of the Western Sahara, Morocco and Mauritania. The Sahrawi are considered by UNHCR to be the “most vulnerable” of the region’s refugees. The Saharawi region is claimed by Morocco. It is recognized as an independent state known as the Sahrawi Arab Democratic Republic by the Africa Union but not by the United Nations. While Algeria did not publicly provide a rationale for its opposition to registration, this is typically seen by many host countries as a step towards the granting of legal refugee asylum status, which they want to discourage. Even so, refugees and asylum seekers in Algiers are allowed free access to the national health system, with around 86% of such people in the capital being treated primarily by its public health system, according to UNHCR. In the harsh deserts of Tindouf, however, Saharawi refugees rely almost entirely on humanitarian assistance. In 2022, UNHCR provided 70% of required medical equipment and supplies in addition to funding training programmes for doctors, nurses and midwives within the camp. The World Food Programme is also responsible for providing essential food supplies across the five camps. The UNHCR describes the predicament of Sahrawi refugees as “one of the most protracted refugee situations in the world”, with many Sahrawi having lived in Tindouf for over 45 years. Over 150,000 Sahrawi were displaced in a 16-year war with Morocco and Mauritania following Spain’s retreat from its colonial territories in the Western Sahara in 1975 – some of which was the Sahrawi homeland. Sahrawi claims are supported by a 1975 International Court of Justice ruling recognizing their claims to self-determination, and a ceasefire agreement negotiated by the UN in 1991 on the condition that a referendum on Sahrawi independence be held. However, the referendum has never been held and the conflict remains unresolved. See also the WHO Global Health Matters series: How can we ensure that health is a reality for migrants and refugees Image Credits: International Rescue Committee, Flickr – USAID, Leiv Meir Clancy, European Commission. Pandemic Accord Negotiations: ‘It’s Not Easy’ 16/06/2023 Kerry Cullinan INB co-chairs Roland Driece and Precious Matsoso At the end of this week’s negotiation on the pandemic accord, Roland Driece, co-chair of the Intergovernmental Negotiating Body (INB) charged with drafting a pandemic accord, told the final plenary on Friday that “it’s not easy” – a phrase that he repeated four times in the space of minutes. To ease difficulties, the INB piloted a new approach involving informal sessions to “bridge gaps” on the sidelines of the formal drafting session, Driece said. Two informal sessions were held on one of the trickiest aspects of the negotiations: Article 9 (Chapter Two) of the current pandemic accord draft, dealing with the research and development (R&D) of pandemic products. Mexico and Norway facilitated the sessions, while experts were on hand to respond to technical questions. Meanwhile, in the formal drafting committee, member states “exchanged views” on Articles 9 (R&D), 10 (liability risk management), 11 (technology transfer), 12 (access and benefit-sharing of pathogen), 13 (supply chain) and 14 (regulatory strengthening). However, before the next set of negotiations from 17-21 July, the INB intends to host three inter-sessional meetings – on articles 9, 12, and 14. Members support pilot informal sessions The pilot informal sessions appeared to have the support of member states, with the African region, Latin America, the cross-cutting 20-country Group of Equity, and the European Union (EU) expressing appreciation in the final plenary. Earlier this week, EU Health Commissioner Stella Kyriakides warned a meeting of European health ministers that there is a risk the negotiations “may be derailed by current dynamics”, according to Politico. 💥Explosive remarks on pandemic treaty from Health Commissioner Stella Kyriakides at EPSCO. Treaty negotiations “may be derailed by current dynamics." "I am not going to hide that I am quite concerned important parts of the EU proposals are not reflected in this latest draft."🧵 — Ashleigh Furlong (@ashleighfurlong) June 13, 2023 Kyriakides added that she was “quite concerned” as “important parts of the EU proposals are not reflected in this latest draft”. However, Sweden, on behalf of the EU said it had been “a very, very useful week” with “very significant progress”. Driece singled out a discussion on access, benefit sharing and equitable access to counter-measures for helping to “increase the understanding of each other’s perspective, objectives, and proposals and the rationale behind them”. The EU also supported the informal sessions as a “significant positive development”, while Colombia, for Latin America, said that these have “allowed us to make progress”. “Although we have not been able to engage in textual negotiations this week, our discussions have allowed us to have a fuller understanding of one another’s proposals and perspectives on the articles taken up,” said India for the Equity Group. Ethiopia at INB5 The African region, via Ethiopia, also welcomed both the informal meetings alongside formal negotiations and the proposed inter-sessional meetings to “enhance mutual understanding”. However, for the sake of smaller delegates, Ethiopia appealed for hybrid meetings that were well-spaced. Ethiopia also stressed Africa’s position that the accord needs “concrete obligations on equity and pandemic prevention, preparedness, response and recovery”. “It’s not that we have big news to share with you all but it’s the only news that we work very hard like I said to get where we want to be,” said Driece. Meanwhile, co-chair Precious Matsoso encouraged INB members to meet informally whenever they could to exchange views and build friendship and trust. At the start of the week, Matsoso used various dance analogies to encourage relations between member states. Driece concluded the meeting by saying that he and Matsoso would tango if the pandemic accord was read by April next year. UniteHealth Announces Social Media Awards Winners 16/06/2023 Maayan Hoffman UniteHealth Social Media Awards 2023 Eight social media influencers were selected earlier this week as winners of the UniteHealth Social Media Awards, showcasing individuals and organisations who used social media to strengthen collective understanding of the COVID-19 pandemic and evidence-based responses. The winners represent eight countries – nominees were recommended from more than 60 countries – and cover six categories and a “Young Leader” category that recognizes the contributions of social media users and influencers under 30. UniteHealth Social Media Awards 2023 Health Policy Watch was one of eight non-profit organizations engaged in public health and health-related media work that co-sponsored the awards alongside UniteHealth. The winners were: Pandemic Policy & Practice: Cinthia Reyes, Mexico Staying Safe: Trisha Greenhalgh, United Kingdom Understanding the Virus: Dr. Vinod Balasubramaniam, Malaysia COVID-19 Care and Support: Benjamin Djoudalbaye, Chad Vaccines: Hector L Frisbie, Mexico and Benjamin Djoudalbaye, Chad Long COVID: Padma Priya DVL, India Young Leader: Shiven Taneja, Canada Watch the ceremony: Unite Health Social Media Awards Live Event https://t.co/llTXdl0tew — #UniteHealth Social Media Awards (@socmed4good) June 13, 2023 The awards aimed to say “thank you” to those who gave their time and expertise to create a positive influence on social media platforms, said Prof Jeffrey Lazarus, a health researcher at the Barcelona Institute of Global Health and co-founder of the awards. Nominations for award candidates were solicited from around the world. Thousands of votes were cast for government officials, NGO workers, scientists, community activists, doctors, nurses and journalists. Image Credits: Screenshot. Obesity, Climate, Reliance on Imported Foods: Small Islands’ Declaration Spells Out a Litany of Challenges 16/06/2023 Kerry Cullinan One of the 340 islands that make up Palau in the Western Pacific Overburdened by non-communicable diseases (NCDs) and threatened by climate change, health ministers of Small Islands Developing States (SIDS) met in Barbados over the past few days and adopted the Bridgetown Declaration on NCDs and Mental Health. The declaration commits the SIDS to a number of actions including implementing the World Health Organization’s (WHO) recommended “Best Buys”, a menu of policy options to prevent and control of NCDs and mental health. These include regulation and taxation of harmful products such as tobacco, alcohol and junk food. The SIDS comprise 39 countries and 18 associate members of the UN situated in the Caribbean, the Pacific, and the Atlantic, Indian Ocean and South China Sea (AIS), and have a combined population of around 65 million. A new WHO report shows that eight of the 15 countries with more than a 30% risk of premature death from cardiovascular disease, cancer, diabetes, or chronic respiratory disease are SIDS. The 10 countries with the highest obesity rates globally are all SIDS in the Pacific, where over 45% of adults live with obesity. Cry for help Small Island Developing States face unique problems While the Bridgetown Declaration is a call to action, it is also a cry for help as it lays bare the problems facing these small nations – one percent of the world – that rely primarily on tourism and workers’ remittances for survival. Over half of the deaths in SIDS are premature and from NCDs, including cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, and mental health conditions, according to the declaration. Nauru, Cook Islands and Palau have the highest rates of obesity in the world, while childhood obesity in all SIDS is increasing exponentially. The highest prevalence of adult diabetes is also projected to be in SIDS, with prevalence in the Caribbean double the global average. Meanwhile, over 30% of adults have hypertension. In Guyana, premature mortality from cardiovascular disease is the highest in the region of the Americas. Rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. The SIDS attribute the drivers of these problems to “disproportionate commercial influence and trade-related challenges. Negative commercial influences are driving high rates of smoking, obesity and sedentary behaviour across these countries.” The islands are a captive audience for these commercial forces. They’re reliant on imported food, which is often ultra-processed and high in sugar, salt and fat – and comes wrapped in plastic that pollutes the environment. With climate change negatively affecting local fishing and agriculture, this dependence is likely to increase. The declaration also speaks of “the disproportionate and repetitive impact of disasters, whose frequency and intensity are further exacerbated by climate change”. This causes economic losses and drives people away from the islands. Funding to mitigate challenges One of the reasons for the meeting, which was hosted by the World Health Organization (WHO), its regional counterpart, the Pan-American Health Organization (PAHO) and the Barbados government, is to prepare for the UN General Assembly high-level meeting on universal health coverage in September. The intention is to engage governments, international agencies and donors to assist SIDS to address their unique problems. “Bold action for our climate, good health, and wellbeing relies on redressing and reorganising global financing to unlock billions in investment while making it less punishing for developing countries to pay their debts,” said Mia Mottley, Prime Minister of Barbados, at a media briefing on Thursday. “Funding for climate change adaptation and mitigation in the most vulnerable countries is also key, with noncommunicable diseases and mental health accounted for.” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the SIDS for showing “remarkable resilience, despite their limited resources and geographical constraints”. He pledged that WHO would work to mobilize financial resources to develop climate-resilient, environmentally sustainable healthcare facilities in the SIDS. WHO will also continue to advocate for “loss and damage” funding for climate change adaptation and mitigation investments in lower-income countries. Image Credits: Rick Bajornas/ UN Photo. Preventative Seasonal Malaria Treatment is Saving Thousands of Children 16/06/2023 Jean Louis Ndiaye & Andre Marie Tchouatieu A doctor examines a child with malaria. For years, malaria has ruled mercilessly in certain regions of the world. Especially in Africa. Yet over the past decade, despite the absence of a malaria vaccine, one anti-malarial strategy sought to make a difference: more than 700 million doses of Seasonal Malaria Chemoprevention (SMC) were distributed to young children, globally. The evidence is now clear: SMC has helped to save hundreds of thousands of their lives. So much so, that more countries have now begun to implement SMC, which involves the intermittent administration of a curative dose of antimalarial medicine to children at high risk of severe malaria living in areas with seasonal transmission, regardless of whether they are infected with malaria. As we mark the International Day of the African Child on 16 June, it’s important to recall how far we’ve come. At the dawn of the new millennium, malaria was infecting several hundred million people every year – and killing almost 900,000, annually. Although gains have been made to rein in its lethal impact, malaria continues to kill at an alarming rate: it took 619,000 lives in 2021, according to the World Health Organization (WHO) and its World Malaria Report 2022. Tragically, it’s children under the age of five who constitute the vast majority of malaria-related deaths; therefore, they are most in need of protection from this deadly disease. Their immune systems are not fully developed to fight off malaria parasites, which makes them easy prey. Averting millions of cases So how did this SMC intervention avert millions of malaria cases and so many needless deaths? The idea behind it was simple: Let’s protect children with existing drugs during the malaria season, commencing just before cases start to climb. The implementation was more complicated, though, as it required strong technical and financial partnerships – which continue to deliver, up through today. The intervention started out slowly. National health authorities had to be convinced of SMC effectiveness. A considerable, consistent supply had to be acquired of Sulfadoxine-Pyrimethamine Amodiaquine (popularly known as SPAQ), which is the antimalarial combination therapy administered in SMC campaigns. A child-friendly formulation also had to be developed, with the drugs then distributed. Healthcare workers had to be trained in its administration. Parents had to be persuaded that three, four even five doses of the drug would protect their children for the entire malaria season. In response, African researchers played a pivotal leadership role in the rapid SMC policy adoption, then its large-scale implementation. From 2002-2008, researchers in Senegal, Gambia, Mali and Ghana ensured that the results of landmark SMC studies were widely disseminated, and then they designed and implemented new research that provided additional evidence of SMC effectiveness. Their efforts led to the initial WHO recommendation, in 2012. As for partnerships, together with Roll Back Malaria, an SMC working group was created to help countries fast-track policy adoption. This working group eventually became the SMC Alliance. Meanwhile, Unitaid has also been a key player: it funded the ACCESS SMC project, which demonstrated the feasibility of scaling up and dramatically expanding SMC, by evaluating its effectiveness and cost. Effective and inexpensive Children under the age of five are most at risk from malaria. As supportive evidence mounted, SMC uptake rapidly increased. Today, 15 countries in the Sahel region of Western Africa are on board, implementing regular SMC campaigns during malaria season. In 2021 alone, despite Covid-related delivery challenges, 45 million children received SMC. Then in 2022, 48 million kids received it. This protected them during the rainy season, when deadly female Anopheles mosquitoes lurk in the shadows, ready to pounce on their next blood meal. As if saving lives were not enough, SMC has also proved to be highly cost-effective. A 2021 analysis revealed that SMC had so far saved participating health systems as much as $66 million. An additional tool to protect young children appeared in 2021 with the arrival of the RTS, S/AS01 malaria vaccine, Mosquirix, which also received a WHO recommendation. A study last year showed that SMC, when combined with this vaccine, provided significantly greater protection than either intervention alone. SMC has shown such remarkable efficacy in the Sahel region of West Africa, other parts of the continent are now beginning adopt it: This year, Mozambique became the first country in southern Africa to pilot SMC; while in East Africa, Uganda, Tanzania and South Sudan are engaged in early SMC efforts. And it doesn’t stop there. From 2009 onwards, researchers in Senegal began to explore whether SMC could benefit older children; they confirmed it could also protect children aged 5 to 10 years old. This led the WHO to review the guidelines in June 2022 to allow SMC to extend beyond the Sahel and reach children older than 5. This potentially protects millions more. All this is excellent news for the donors who have invested in SMC. It is equally welcome news for those national health systems in Africa that experience seasonal malaria transmission, as they are keen to save the lives of future citizens and are attracted to SMC’s cost-effectiveness. However, despite its rapid rise in popularity, SMC brings challenges of its own: mainly, how to secure uninterrupted supplies of SPAQ and develop new drugs to respond to resistance. African manufacturing boost Indeed, reaching older children requires more supplies of WHO-approved SPAQ. To resolve this problem, international partners, including MMV, are supporting the local African production of SPAQ. By the end of 2023, SPAQ will be manufactured for the first time in Africa to WHO-quality standards – another landmark worth celebrating. Meanwhile, as more countries outside the Sahel region are keen to roll out SMC, unfortunately, in parts of eastern Africa, there are signs of drug resistance to Sulfadoxine Pyrimethamine. Undeterred, researchers and national malaria teams in these countries are exploring alternative drug combinations for SMC regimens, in case resistance renders SPAQ completely ineffective. The spectre of drug resistance always looms. So far, though, given the determination of countries’ malaria programs and the malaria community, no problem has been insurmountable. Yet a major barrier remains: sustainable funding. Stagnant funding for malaria, especially malaria-drug research, might not only slow the development of new antimalarials but place millions of young lives at risk. We cannot allow this to happen. We, in the malaria community, are confident that these 10 years of success in protecting and saving countless young African children is all the evidence we need to continue supporting SMC until no child or family ever suffers from this disease. Prof Jean Louis Ndiaye is a Professor of Parasitology and Head of the Research and Innovation Division at the University Iba Der Thiam of Thiès, in Senegal. He is co-chair of the SMC Alliance research sub-group. Dr André Marie Tchouatieu is the Director of Chemoprevention Access and Product Management at MMV and General Secretary of the SMC Alliance. Image Credits: UNICEF USA , Damien Schumann / MMV. Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Lives Are At Risk as Anti-Abortion Groups Attack HIV Programme PEPFAR 20/06/2023 Kerry Cullinan A child with HIV takes a paediatric dose of antiretroviral medication. One of the most successful US aid programmes, the US President’s Emergency Plan for AIDS Relief (PEPFAR) – which has saved 25 million lives in its 20 years of existence – is facing a right-wing backlash based on misinformation. PEPFAR’s five-year budget is due for re-funding by the US Senate and Congress by 30 September, but there has been unprecedented right-wing mobilisation against it over the past few months by both US and African groups. Twenty million people living with HIV are currently on antiretroviral medication thanks to PEPFAR, which also channels the US contribution to the Global Fund for AIDS, Tuberculosis and Malaria. PEPFAR’s key achievements in 2022 PEPFAR was started by Republican president George W Bush in 2003 and has enjoyed bipartisan support from both Republicans and Democrats. But a group of US right-wing groups claimed in a recent letter sent to Senate and Congress leaders that PEPFAR grantees “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. Signatories include the Center for Family and Human Rights (C-FAM), Heritage Foundation and the Dr James Dobson Family Institute. A similar letter was sent on 6 June to the same US Senate and Congress leaders by African politicians and religious leaders claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”. US Representative Chris Smith, who co-sponsored PEPFAR’s refinancing in 2018, has also joined its critics by recently claiming that the programme is being used to “promote abortion on demand”. Illegal for PEPFAR to fund abortion However, it is illegal for PEPFAR to fund or support abortion, and abortion is illegal in most of the African countries where it operates. “PEPFAR has never, will not ever, use that platform in supporting abortion,” said Dr John Nkengasong, who heads PEPAR as the US Global AIDS Co-ordinator, as reported by Devex. One of the PEPFAR grantees that have been singled out is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which targets teenage girls in 16 African countries. Girls and young women are up to five times more likely to contract HIV than boys and men their age, and DREAMS offered HIV prevention services to 2.9 million adolescent girls and young women in 2022. However, a C-FAM report claims that “in Malawi the program focused on young girls 12-14 years providing access to sexual and reproductive health services, which according to the Biden administration includes abortion”. Abortion is illegal in Malawi so this simply isn’t possible. The group also singles out the Anova Health Institute, a respected South African organisation that works largely with government departments on HIV prevention, treatment and care and health systems strengthening. It claims that Anova “promotes abortions to teens as young as 14” and had condemned ”laws enacted in US states that designate bathroom use based on biological sex”. However, Anova CEO Dr Helen Struthers, told Health Policy Watch that her organisation “has always worked within the South African legal framework and within the terms and conditions of our grant agreements”. “We have abided by the United States Government’s Various Codes of Federal Regulation and other restraints placed on the use of PEPFAR funds. Anova has never performed any abortions, nor has it actively promoted abortion as a method of family planning with PEPFAR or any other funds,” Struthers stressed, adding that Anova had supporting the South African government to put 400,000 more people on antiretroviral treatment in the past four years. “These people are all playing with fire, and they’re playing with people’s lives, and there can only be one reason: political motivation to kill PEPFAR,” Mark Dybul, former US global AIDS coordinator, told Devex. Monica Geingos, co-chair of the Global Council on Inequality. Meanwhile, Namibian First Lady Monica Geingos, co-chair of the newly formed UNAIDS Global Council on Inequality, said that “PEPFAR has been an incredibly effective partner for Namibia, and has really contributed to some of our remarkable gains” against HIV. The government of Namibia is close to reaching the @UNAIDS HIV treatment targets and has the leadership and commitment to end HIV/AIDS as a public health threat in Namibia. @USAmbPEPFAR is attending a @MhssNamibia Exec Dir Benetus Nangombe-hosted technical discussion about… pic.twitter.com/UglQJLFa5C — PEPFAR (@PEPFAR) June 19, 2023 “Unfortunately, as the US moves into a political season, and as many countries move to political seasons, things like this tend to happen. And it’s a reminder again, for many countries to become more self-reliant when it comes to health financing,” Geingkos said in response to a Health Policy Watch question at a webinar on Tuesday organised by UNAIDS and the Financial Times. However, Geingos added that misinformation “is not something that the Global Council can ignore” as it “can exacerbate and prolong pandemics when people don’t believe in science, when politicians behave and speak irresponsibly and when this starts to impact where money flows to.” * Story updated to include Anova comment. Image Credits: Paul Kamau/ DNDi. 30 Countries Sign Political Declaration to Include Refugees in National Health Systems 19/06/2023 Stefan Anderson & Elaine Ruth Fletcher A doctor providing essential health services to children in a refugee camp in northwest Syria during the COVID-19 pandemic. Thirty countries signed a political declaration at an international meeting in Morocco last week calling for the health of refugees and migrants to be included in national health systems and universal health coverage. A total of 50 UN member and observer states attended the talks. The Rabat Declaration, signed on Friday, is the first official outcome document on the health of refugees to emerge from a series of Global Consultations on the Health of Refugees and Migrants that began in Istanbul in March last year. “Universal health coverage is only truly universal if it includes refugees and migrants,” the declaration states. The World Health Organization (WHO), UN High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM) and UN Refugee Agency called the declaration “groundbreaking”. “Member States today have pledged that no one will be left behind when addressing the health needs of those forcibly displaced,” said Raouf Mazou, Assistant High Commissioner for Operations at UNHCR, in a joint press release. “Their commitment to not only include refugees, migrants and their hosting communities in national health policies and plans, but to also include them meaningfully in policy health discussions is a significant momentum towards universal health coverage and worthy of global support,” he said. The declaration also calls for increased international efforts for “the protection of refugees, stateless persons, asylum-seekers and other forcibly displaced persons”, recognizes the “positive role and contributions of migrants and refugees for inclusive growth and sustainable development”, and emphasises the need for regional and national health strategies that “include measures to reach refugees and migrants … with the aim of leaving no one behind”. “Refugees and migrants face significant threats to health, and significant barriers to accessing the health services they need,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Protecting the health and dignity of refugees and migrants during their often-dangerous journeys, and in the countries hosting them, is a matter of human rights, and human decency.” Two previous rounds of international meetings on “migrant health” — concluded in Madrid in 2010 and Colombo in 2017 — did not include “refugees” in their official scope. The Colombo statement, signed by 19 countries at the conclusion of the 2017 round of talks, makes no reference to refugees in its guiding principles. WHO spotlights refugee health challenges People receiving food assistance at the Oruchinga refugee settlement in Uganda. A WHO spokesperson described the declaration as the latest in a series of WHO and international actions to recognize refugees’ unique health challenges: “The declaration comes at a crucial moment after the adoption of the Global Compact for Safe, Orderly and Regular Migration (GCM) and the Global Compact on Refugees (GCR) in 2018, the adoption of the WHO Global Action Plan on Promoting the Health of Refugees and Migrants in 2019 and its extension until 2030 just adopted by the World Health Assembly in May this year, the International Migration Review Forum in 2022 and prior to the Global Refugee Forum in December 2023,” the spokesperson said. “In the declaration Member States commit to stronger global coordination and collaboration for better health outcomes of refugees and migrants, as well as actions that improve the health of these populations, such as sustainable Universal Health Coverage (UHC) financing mechanisms or health system strengthening; the development of high-quality global research on the health of refugees and migrants; investments in data to develop a monitoring framework; the participation of refugees and migrants in health policy discussions; and cooperation and financial mechanisms to assist the efforts of host countries at the national and local levels.” Lack of broader country support Countries hosting large numbers of refugees were among the leading signatories of the new statement. These include Turkey, Jordan, Morocco, Lebanon and Iran in the Middle East; Libya, Chad, Somalia, and Algeria and Ethiopia in Africa; Guatemala, Honduras and Mexico in Latin America; and India, the Philippines and Thailand in Asia. Notably, the USA, Italy, Greece, Romania, Slovakia, and Portugal also supported the declaration. Canada, the United Kingdom, Germany, Norway, Sweden and other countries in Europe that play host to large numbers of refugees were not among the signatories. IOM and UNHCR could not be reached for further comment on the implications of the declaration or its political supporters, in time for publication. In response to the relatively low number of signatories, WHO said that the increased attendance, which has more than doubled since the second consultation in 2017, reflects increased “interest in commitment to improving the health of refugees and migrants and addressing the root causes of poor health outcomes”. “This positive trend is very much aligned with the adoption of a resolution to extend the WHO Global Action Plan on Promoting the Health of Refugees and Migrants until 2030, which was put forward by almost 30 governmental co-sponsors,” WHO said. “With the resolution, Member States have seven more years to continue to address the health needs of refugees and migrants, integrate refugee and migrant health in global, regional, and national initiatives, and identify and share challenges, lessons learned, and best practices related to implementing the global action plan.” WHO’s European Region is currently negotiating a new regional action plan on the health of refugees and migrants, with the participation of the countries of the region, the spokesperson added. In a landmark WHO report in 2022, the agency noted that migrants and refugees face big hurdles in accessing health services in two-thirds of their host countries. The report called for more active integration of migrants and refugees into the national health system schemes of their host countries – saying that their inclusion is critical to meeting 2030 Universal Health Coverage goals. A United Nations High Level Meeting on Universal Health Coverage, is scheduled for September. Algeria opposes registration of refugees in health system Tens of thousands of Sahrawi refugees have been stranded in the aftermath of the conflict between Morocco and the Polisario Front over the former Spanish colony of Western Sahara following Spain’s withdrawal in 1975. During three days of negotiations over the statement in Rabat, Morocco last week (13-15 May), Algeria stirred up controversy when its delegation came out in opposition to a key section of the declaration, which notes the international legal obligation of host countries to register refugees in order for them to access national health systems. Algeria is home to an estimated 111,500 refugees from Sub-Saharan Africa and Syria. Around 90,000 of these are Sahrawi refugees who live in five camps near the Saharan desert town of Tindouf, which borders the disputed region of the Western Sahara, Morocco and Mauritania. The Sahrawi are considered by UNHCR to be the “most vulnerable” of the region’s refugees. The Saharawi region is claimed by Morocco. It is recognized as an independent state known as the Sahrawi Arab Democratic Republic by the Africa Union but not by the United Nations. While Algeria did not publicly provide a rationale for its opposition to registration, this is typically seen by many host countries as a step towards the granting of legal refugee asylum status, which they want to discourage. Even so, refugees and asylum seekers in Algiers are allowed free access to the national health system, with around 86% of such people in the capital being treated primarily by its public health system, according to UNHCR. In the harsh deserts of Tindouf, however, Saharawi refugees rely almost entirely on humanitarian assistance. In 2022, UNHCR provided 70% of required medical equipment and supplies in addition to funding training programmes for doctors, nurses and midwives within the camp. The World Food Programme is also responsible for providing essential food supplies across the five camps. The UNHCR describes the predicament of Sahrawi refugees as “one of the most protracted refugee situations in the world”, with many Sahrawi having lived in Tindouf for over 45 years. Over 150,000 Sahrawi were displaced in a 16-year war with Morocco and Mauritania following Spain’s retreat from its colonial territories in the Western Sahara in 1975 – some of which was the Sahrawi homeland. Sahrawi claims are supported by a 1975 International Court of Justice ruling recognizing their claims to self-determination, and a ceasefire agreement negotiated by the UN in 1991 on the condition that a referendum on Sahrawi independence be held. However, the referendum has never been held and the conflict remains unresolved. See also the WHO Global Health Matters series: How can we ensure that health is a reality for migrants and refugees Image Credits: International Rescue Committee, Flickr – USAID, Leiv Meir Clancy, European Commission. Pandemic Accord Negotiations: ‘It’s Not Easy’ 16/06/2023 Kerry Cullinan INB co-chairs Roland Driece and Precious Matsoso At the end of this week’s negotiation on the pandemic accord, Roland Driece, co-chair of the Intergovernmental Negotiating Body (INB) charged with drafting a pandemic accord, told the final plenary on Friday that “it’s not easy” – a phrase that he repeated four times in the space of minutes. To ease difficulties, the INB piloted a new approach involving informal sessions to “bridge gaps” on the sidelines of the formal drafting session, Driece said. Two informal sessions were held on one of the trickiest aspects of the negotiations: Article 9 (Chapter Two) of the current pandemic accord draft, dealing with the research and development (R&D) of pandemic products. Mexico and Norway facilitated the sessions, while experts were on hand to respond to technical questions. Meanwhile, in the formal drafting committee, member states “exchanged views” on Articles 9 (R&D), 10 (liability risk management), 11 (technology transfer), 12 (access and benefit-sharing of pathogen), 13 (supply chain) and 14 (regulatory strengthening). However, before the next set of negotiations from 17-21 July, the INB intends to host three inter-sessional meetings – on articles 9, 12, and 14. Members support pilot informal sessions The pilot informal sessions appeared to have the support of member states, with the African region, Latin America, the cross-cutting 20-country Group of Equity, and the European Union (EU) expressing appreciation in the final plenary. Earlier this week, EU Health Commissioner Stella Kyriakides warned a meeting of European health ministers that there is a risk the negotiations “may be derailed by current dynamics”, according to Politico. 💥Explosive remarks on pandemic treaty from Health Commissioner Stella Kyriakides at EPSCO. Treaty negotiations “may be derailed by current dynamics." "I am not going to hide that I am quite concerned important parts of the EU proposals are not reflected in this latest draft."🧵 — Ashleigh Furlong (@ashleighfurlong) June 13, 2023 Kyriakides added that she was “quite concerned” as “important parts of the EU proposals are not reflected in this latest draft”. However, Sweden, on behalf of the EU said it had been “a very, very useful week” with “very significant progress”. Driece singled out a discussion on access, benefit sharing and equitable access to counter-measures for helping to “increase the understanding of each other’s perspective, objectives, and proposals and the rationale behind them”. The EU also supported the informal sessions as a “significant positive development”, while Colombia, for Latin America, said that these have “allowed us to make progress”. “Although we have not been able to engage in textual negotiations this week, our discussions have allowed us to have a fuller understanding of one another’s proposals and perspectives on the articles taken up,” said India for the Equity Group. Ethiopia at INB5 The African region, via Ethiopia, also welcomed both the informal meetings alongside formal negotiations and the proposed inter-sessional meetings to “enhance mutual understanding”. However, for the sake of smaller delegates, Ethiopia appealed for hybrid meetings that were well-spaced. Ethiopia also stressed Africa’s position that the accord needs “concrete obligations on equity and pandemic prevention, preparedness, response and recovery”. “It’s not that we have big news to share with you all but it’s the only news that we work very hard like I said to get where we want to be,” said Driece. Meanwhile, co-chair Precious Matsoso encouraged INB members to meet informally whenever they could to exchange views and build friendship and trust. At the start of the week, Matsoso used various dance analogies to encourage relations between member states. Driece concluded the meeting by saying that he and Matsoso would tango if the pandemic accord was read by April next year. UniteHealth Announces Social Media Awards Winners 16/06/2023 Maayan Hoffman UniteHealth Social Media Awards 2023 Eight social media influencers were selected earlier this week as winners of the UniteHealth Social Media Awards, showcasing individuals and organisations who used social media to strengthen collective understanding of the COVID-19 pandemic and evidence-based responses. The winners represent eight countries – nominees were recommended from more than 60 countries – and cover six categories and a “Young Leader” category that recognizes the contributions of social media users and influencers under 30. UniteHealth Social Media Awards 2023 Health Policy Watch was one of eight non-profit organizations engaged in public health and health-related media work that co-sponsored the awards alongside UniteHealth. The winners were: Pandemic Policy & Practice: Cinthia Reyes, Mexico Staying Safe: Trisha Greenhalgh, United Kingdom Understanding the Virus: Dr. Vinod Balasubramaniam, Malaysia COVID-19 Care and Support: Benjamin Djoudalbaye, Chad Vaccines: Hector L Frisbie, Mexico and Benjamin Djoudalbaye, Chad Long COVID: Padma Priya DVL, India Young Leader: Shiven Taneja, Canada Watch the ceremony: Unite Health Social Media Awards Live Event https://t.co/llTXdl0tew — #UniteHealth Social Media Awards (@socmed4good) June 13, 2023 The awards aimed to say “thank you” to those who gave their time and expertise to create a positive influence on social media platforms, said Prof Jeffrey Lazarus, a health researcher at the Barcelona Institute of Global Health and co-founder of the awards. Nominations for award candidates were solicited from around the world. Thousands of votes were cast for government officials, NGO workers, scientists, community activists, doctors, nurses and journalists. Image Credits: Screenshot. Obesity, Climate, Reliance on Imported Foods: Small Islands’ Declaration Spells Out a Litany of Challenges 16/06/2023 Kerry Cullinan One of the 340 islands that make up Palau in the Western Pacific Overburdened by non-communicable diseases (NCDs) and threatened by climate change, health ministers of Small Islands Developing States (SIDS) met in Barbados over the past few days and adopted the Bridgetown Declaration on NCDs and Mental Health. The declaration commits the SIDS to a number of actions including implementing the World Health Organization’s (WHO) recommended “Best Buys”, a menu of policy options to prevent and control of NCDs and mental health. These include regulation and taxation of harmful products such as tobacco, alcohol and junk food. The SIDS comprise 39 countries and 18 associate members of the UN situated in the Caribbean, the Pacific, and the Atlantic, Indian Ocean and South China Sea (AIS), and have a combined population of around 65 million. A new WHO report shows that eight of the 15 countries with more than a 30% risk of premature death from cardiovascular disease, cancer, diabetes, or chronic respiratory disease are SIDS. The 10 countries with the highest obesity rates globally are all SIDS in the Pacific, where over 45% of adults live with obesity. Cry for help Small Island Developing States face unique problems While the Bridgetown Declaration is a call to action, it is also a cry for help as it lays bare the problems facing these small nations – one percent of the world – that rely primarily on tourism and workers’ remittances for survival. Over half of the deaths in SIDS are premature and from NCDs, including cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, and mental health conditions, according to the declaration. Nauru, Cook Islands and Palau have the highest rates of obesity in the world, while childhood obesity in all SIDS is increasing exponentially. The highest prevalence of adult diabetes is also projected to be in SIDS, with prevalence in the Caribbean double the global average. Meanwhile, over 30% of adults have hypertension. In Guyana, premature mortality from cardiovascular disease is the highest in the region of the Americas. Rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. The SIDS attribute the drivers of these problems to “disproportionate commercial influence and trade-related challenges. Negative commercial influences are driving high rates of smoking, obesity and sedentary behaviour across these countries.” The islands are a captive audience for these commercial forces. They’re reliant on imported food, which is often ultra-processed and high in sugar, salt and fat – and comes wrapped in plastic that pollutes the environment. With climate change negatively affecting local fishing and agriculture, this dependence is likely to increase. The declaration also speaks of “the disproportionate and repetitive impact of disasters, whose frequency and intensity are further exacerbated by climate change”. This causes economic losses and drives people away from the islands. Funding to mitigate challenges One of the reasons for the meeting, which was hosted by the World Health Organization (WHO), its regional counterpart, the Pan-American Health Organization (PAHO) and the Barbados government, is to prepare for the UN General Assembly high-level meeting on universal health coverage in September. The intention is to engage governments, international agencies and donors to assist SIDS to address their unique problems. “Bold action for our climate, good health, and wellbeing relies on redressing and reorganising global financing to unlock billions in investment while making it less punishing for developing countries to pay their debts,” said Mia Mottley, Prime Minister of Barbados, at a media briefing on Thursday. “Funding for climate change adaptation and mitigation in the most vulnerable countries is also key, with noncommunicable diseases and mental health accounted for.” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the SIDS for showing “remarkable resilience, despite their limited resources and geographical constraints”. He pledged that WHO would work to mobilize financial resources to develop climate-resilient, environmentally sustainable healthcare facilities in the SIDS. WHO will also continue to advocate for “loss and damage” funding for climate change adaptation and mitigation investments in lower-income countries. Image Credits: Rick Bajornas/ UN Photo. Preventative Seasonal Malaria Treatment is Saving Thousands of Children 16/06/2023 Jean Louis Ndiaye & Andre Marie Tchouatieu A doctor examines a child with malaria. For years, malaria has ruled mercilessly in certain regions of the world. Especially in Africa. Yet over the past decade, despite the absence of a malaria vaccine, one anti-malarial strategy sought to make a difference: more than 700 million doses of Seasonal Malaria Chemoprevention (SMC) were distributed to young children, globally. The evidence is now clear: SMC has helped to save hundreds of thousands of their lives. So much so, that more countries have now begun to implement SMC, which involves the intermittent administration of a curative dose of antimalarial medicine to children at high risk of severe malaria living in areas with seasonal transmission, regardless of whether they are infected with malaria. As we mark the International Day of the African Child on 16 June, it’s important to recall how far we’ve come. At the dawn of the new millennium, malaria was infecting several hundred million people every year – and killing almost 900,000, annually. Although gains have been made to rein in its lethal impact, malaria continues to kill at an alarming rate: it took 619,000 lives in 2021, according to the World Health Organization (WHO) and its World Malaria Report 2022. Tragically, it’s children under the age of five who constitute the vast majority of malaria-related deaths; therefore, they are most in need of protection from this deadly disease. Their immune systems are not fully developed to fight off malaria parasites, which makes them easy prey. Averting millions of cases So how did this SMC intervention avert millions of malaria cases and so many needless deaths? The idea behind it was simple: Let’s protect children with existing drugs during the malaria season, commencing just before cases start to climb. The implementation was more complicated, though, as it required strong technical and financial partnerships – which continue to deliver, up through today. The intervention started out slowly. National health authorities had to be convinced of SMC effectiveness. A considerable, consistent supply had to be acquired of Sulfadoxine-Pyrimethamine Amodiaquine (popularly known as SPAQ), which is the antimalarial combination therapy administered in SMC campaigns. A child-friendly formulation also had to be developed, with the drugs then distributed. Healthcare workers had to be trained in its administration. Parents had to be persuaded that three, four even five doses of the drug would protect their children for the entire malaria season. In response, African researchers played a pivotal leadership role in the rapid SMC policy adoption, then its large-scale implementation. From 2002-2008, researchers in Senegal, Gambia, Mali and Ghana ensured that the results of landmark SMC studies were widely disseminated, and then they designed and implemented new research that provided additional evidence of SMC effectiveness. Their efforts led to the initial WHO recommendation, in 2012. As for partnerships, together with Roll Back Malaria, an SMC working group was created to help countries fast-track policy adoption. This working group eventually became the SMC Alliance. Meanwhile, Unitaid has also been a key player: it funded the ACCESS SMC project, which demonstrated the feasibility of scaling up and dramatically expanding SMC, by evaluating its effectiveness and cost. Effective and inexpensive Children under the age of five are most at risk from malaria. As supportive evidence mounted, SMC uptake rapidly increased. Today, 15 countries in the Sahel region of Western Africa are on board, implementing regular SMC campaigns during malaria season. In 2021 alone, despite Covid-related delivery challenges, 45 million children received SMC. Then in 2022, 48 million kids received it. This protected them during the rainy season, when deadly female Anopheles mosquitoes lurk in the shadows, ready to pounce on their next blood meal. As if saving lives were not enough, SMC has also proved to be highly cost-effective. A 2021 analysis revealed that SMC had so far saved participating health systems as much as $66 million. An additional tool to protect young children appeared in 2021 with the arrival of the RTS, S/AS01 malaria vaccine, Mosquirix, which also received a WHO recommendation. A study last year showed that SMC, when combined with this vaccine, provided significantly greater protection than either intervention alone. SMC has shown such remarkable efficacy in the Sahel region of West Africa, other parts of the continent are now beginning adopt it: This year, Mozambique became the first country in southern Africa to pilot SMC; while in East Africa, Uganda, Tanzania and South Sudan are engaged in early SMC efforts. And it doesn’t stop there. From 2009 onwards, researchers in Senegal began to explore whether SMC could benefit older children; they confirmed it could also protect children aged 5 to 10 years old. This led the WHO to review the guidelines in June 2022 to allow SMC to extend beyond the Sahel and reach children older than 5. This potentially protects millions more. All this is excellent news for the donors who have invested in SMC. It is equally welcome news for those national health systems in Africa that experience seasonal malaria transmission, as they are keen to save the lives of future citizens and are attracted to SMC’s cost-effectiveness. However, despite its rapid rise in popularity, SMC brings challenges of its own: mainly, how to secure uninterrupted supplies of SPAQ and develop new drugs to respond to resistance. African manufacturing boost Indeed, reaching older children requires more supplies of WHO-approved SPAQ. To resolve this problem, international partners, including MMV, are supporting the local African production of SPAQ. By the end of 2023, SPAQ will be manufactured for the first time in Africa to WHO-quality standards – another landmark worth celebrating. Meanwhile, as more countries outside the Sahel region are keen to roll out SMC, unfortunately, in parts of eastern Africa, there are signs of drug resistance to Sulfadoxine Pyrimethamine. Undeterred, researchers and national malaria teams in these countries are exploring alternative drug combinations for SMC regimens, in case resistance renders SPAQ completely ineffective. The spectre of drug resistance always looms. So far, though, given the determination of countries’ malaria programs and the malaria community, no problem has been insurmountable. Yet a major barrier remains: sustainable funding. Stagnant funding for malaria, especially malaria-drug research, might not only slow the development of new antimalarials but place millions of young lives at risk. We cannot allow this to happen. We, in the malaria community, are confident that these 10 years of success in protecting and saving countless young African children is all the evidence we need to continue supporting SMC until no child or family ever suffers from this disease. Prof Jean Louis Ndiaye is a Professor of Parasitology and Head of the Research and Innovation Division at the University Iba Der Thiam of Thiès, in Senegal. He is co-chair of the SMC Alliance research sub-group. Dr André Marie Tchouatieu is the Director of Chemoprevention Access and Product Management at MMV and General Secretary of the SMC Alliance. Image Credits: UNICEF USA , Damien Schumann / MMV. Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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30 Countries Sign Political Declaration to Include Refugees in National Health Systems 19/06/2023 Stefan Anderson & Elaine Ruth Fletcher A doctor providing essential health services to children in a refugee camp in northwest Syria during the COVID-19 pandemic. Thirty countries signed a political declaration at an international meeting in Morocco last week calling for the health of refugees and migrants to be included in national health systems and universal health coverage. A total of 50 UN member and observer states attended the talks. The Rabat Declaration, signed on Friday, is the first official outcome document on the health of refugees to emerge from a series of Global Consultations on the Health of Refugees and Migrants that began in Istanbul in March last year. “Universal health coverage is only truly universal if it includes refugees and migrants,” the declaration states. The World Health Organization (WHO), UN High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM) and UN Refugee Agency called the declaration “groundbreaking”. “Member States today have pledged that no one will be left behind when addressing the health needs of those forcibly displaced,” said Raouf Mazou, Assistant High Commissioner for Operations at UNHCR, in a joint press release. “Their commitment to not only include refugees, migrants and their hosting communities in national health policies and plans, but to also include them meaningfully in policy health discussions is a significant momentum towards universal health coverage and worthy of global support,” he said. The declaration also calls for increased international efforts for “the protection of refugees, stateless persons, asylum-seekers and other forcibly displaced persons”, recognizes the “positive role and contributions of migrants and refugees for inclusive growth and sustainable development”, and emphasises the need for regional and national health strategies that “include measures to reach refugees and migrants … with the aim of leaving no one behind”. “Refugees and migrants face significant threats to health, and significant barriers to accessing the health services they need,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Protecting the health and dignity of refugees and migrants during their often-dangerous journeys, and in the countries hosting them, is a matter of human rights, and human decency.” Two previous rounds of international meetings on “migrant health” — concluded in Madrid in 2010 and Colombo in 2017 — did not include “refugees” in their official scope. The Colombo statement, signed by 19 countries at the conclusion of the 2017 round of talks, makes no reference to refugees in its guiding principles. WHO spotlights refugee health challenges People receiving food assistance at the Oruchinga refugee settlement in Uganda. A WHO spokesperson described the declaration as the latest in a series of WHO and international actions to recognize refugees’ unique health challenges: “The declaration comes at a crucial moment after the adoption of the Global Compact for Safe, Orderly and Regular Migration (GCM) and the Global Compact on Refugees (GCR) in 2018, the adoption of the WHO Global Action Plan on Promoting the Health of Refugees and Migrants in 2019 and its extension until 2030 just adopted by the World Health Assembly in May this year, the International Migration Review Forum in 2022 and prior to the Global Refugee Forum in December 2023,” the spokesperson said. “In the declaration Member States commit to stronger global coordination and collaboration for better health outcomes of refugees and migrants, as well as actions that improve the health of these populations, such as sustainable Universal Health Coverage (UHC) financing mechanisms or health system strengthening; the development of high-quality global research on the health of refugees and migrants; investments in data to develop a monitoring framework; the participation of refugees and migrants in health policy discussions; and cooperation and financial mechanisms to assist the efforts of host countries at the national and local levels.” Lack of broader country support Countries hosting large numbers of refugees were among the leading signatories of the new statement. These include Turkey, Jordan, Morocco, Lebanon and Iran in the Middle East; Libya, Chad, Somalia, and Algeria and Ethiopia in Africa; Guatemala, Honduras and Mexico in Latin America; and India, the Philippines and Thailand in Asia. Notably, the USA, Italy, Greece, Romania, Slovakia, and Portugal also supported the declaration. Canada, the United Kingdom, Germany, Norway, Sweden and other countries in Europe that play host to large numbers of refugees were not among the signatories. IOM and UNHCR could not be reached for further comment on the implications of the declaration or its political supporters, in time for publication. In response to the relatively low number of signatories, WHO said that the increased attendance, which has more than doubled since the second consultation in 2017, reflects increased “interest in commitment to improving the health of refugees and migrants and addressing the root causes of poor health outcomes”. “This positive trend is very much aligned with the adoption of a resolution to extend the WHO Global Action Plan on Promoting the Health of Refugees and Migrants until 2030, which was put forward by almost 30 governmental co-sponsors,” WHO said. “With the resolution, Member States have seven more years to continue to address the health needs of refugees and migrants, integrate refugee and migrant health in global, regional, and national initiatives, and identify and share challenges, lessons learned, and best practices related to implementing the global action plan.” WHO’s European Region is currently negotiating a new regional action plan on the health of refugees and migrants, with the participation of the countries of the region, the spokesperson added. In a landmark WHO report in 2022, the agency noted that migrants and refugees face big hurdles in accessing health services in two-thirds of their host countries. The report called for more active integration of migrants and refugees into the national health system schemes of their host countries – saying that their inclusion is critical to meeting 2030 Universal Health Coverage goals. A United Nations High Level Meeting on Universal Health Coverage, is scheduled for September. Algeria opposes registration of refugees in health system Tens of thousands of Sahrawi refugees have been stranded in the aftermath of the conflict between Morocco and the Polisario Front over the former Spanish colony of Western Sahara following Spain’s withdrawal in 1975. During three days of negotiations over the statement in Rabat, Morocco last week (13-15 May), Algeria stirred up controversy when its delegation came out in opposition to a key section of the declaration, which notes the international legal obligation of host countries to register refugees in order for them to access national health systems. Algeria is home to an estimated 111,500 refugees from Sub-Saharan Africa and Syria. Around 90,000 of these are Sahrawi refugees who live in five camps near the Saharan desert town of Tindouf, which borders the disputed region of the Western Sahara, Morocco and Mauritania. The Sahrawi are considered by UNHCR to be the “most vulnerable” of the region’s refugees. The Saharawi region is claimed by Morocco. It is recognized as an independent state known as the Sahrawi Arab Democratic Republic by the Africa Union but not by the United Nations. While Algeria did not publicly provide a rationale for its opposition to registration, this is typically seen by many host countries as a step towards the granting of legal refugee asylum status, which they want to discourage. Even so, refugees and asylum seekers in Algiers are allowed free access to the national health system, with around 86% of such people in the capital being treated primarily by its public health system, according to UNHCR. In the harsh deserts of Tindouf, however, Saharawi refugees rely almost entirely on humanitarian assistance. In 2022, UNHCR provided 70% of required medical equipment and supplies in addition to funding training programmes for doctors, nurses and midwives within the camp. The World Food Programme is also responsible for providing essential food supplies across the five camps. The UNHCR describes the predicament of Sahrawi refugees as “one of the most protracted refugee situations in the world”, with many Sahrawi having lived in Tindouf for over 45 years. Over 150,000 Sahrawi were displaced in a 16-year war with Morocco and Mauritania following Spain’s retreat from its colonial territories in the Western Sahara in 1975 – some of which was the Sahrawi homeland. Sahrawi claims are supported by a 1975 International Court of Justice ruling recognizing their claims to self-determination, and a ceasefire agreement negotiated by the UN in 1991 on the condition that a referendum on Sahrawi independence be held. However, the referendum has never been held and the conflict remains unresolved. See also the WHO Global Health Matters series: How can we ensure that health is a reality for migrants and refugees Image Credits: International Rescue Committee, Flickr – USAID, Leiv Meir Clancy, European Commission. Pandemic Accord Negotiations: ‘It’s Not Easy’ 16/06/2023 Kerry Cullinan INB co-chairs Roland Driece and Precious Matsoso At the end of this week’s negotiation on the pandemic accord, Roland Driece, co-chair of the Intergovernmental Negotiating Body (INB) charged with drafting a pandemic accord, told the final plenary on Friday that “it’s not easy” – a phrase that he repeated four times in the space of minutes. To ease difficulties, the INB piloted a new approach involving informal sessions to “bridge gaps” on the sidelines of the formal drafting session, Driece said. Two informal sessions were held on one of the trickiest aspects of the negotiations: Article 9 (Chapter Two) of the current pandemic accord draft, dealing with the research and development (R&D) of pandemic products. Mexico and Norway facilitated the sessions, while experts were on hand to respond to technical questions. Meanwhile, in the formal drafting committee, member states “exchanged views” on Articles 9 (R&D), 10 (liability risk management), 11 (technology transfer), 12 (access and benefit-sharing of pathogen), 13 (supply chain) and 14 (regulatory strengthening). However, before the next set of negotiations from 17-21 July, the INB intends to host three inter-sessional meetings – on articles 9, 12, and 14. Members support pilot informal sessions The pilot informal sessions appeared to have the support of member states, with the African region, Latin America, the cross-cutting 20-country Group of Equity, and the European Union (EU) expressing appreciation in the final plenary. Earlier this week, EU Health Commissioner Stella Kyriakides warned a meeting of European health ministers that there is a risk the negotiations “may be derailed by current dynamics”, according to Politico. 💥Explosive remarks on pandemic treaty from Health Commissioner Stella Kyriakides at EPSCO. Treaty negotiations “may be derailed by current dynamics." "I am not going to hide that I am quite concerned important parts of the EU proposals are not reflected in this latest draft."🧵 — Ashleigh Furlong (@ashleighfurlong) June 13, 2023 Kyriakides added that she was “quite concerned” as “important parts of the EU proposals are not reflected in this latest draft”. However, Sweden, on behalf of the EU said it had been “a very, very useful week” with “very significant progress”. Driece singled out a discussion on access, benefit sharing and equitable access to counter-measures for helping to “increase the understanding of each other’s perspective, objectives, and proposals and the rationale behind them”. The EU also supported the informal sessions as a “significant positive development”, while Colombia, for Latin America, said that these have “allowed us to make progress”. “Although we have not been able to engage in textual negotiations this week, our discussions have allowed us to have a fuller understanding of one another’s proposals and perspectives on the articles taken up,” said India for the Equity Group. Ethiopia at INB5 The African region, via Ethiopia, also welcomed both the informal meetings alongside formal negotiations and the proposed inter-sessional meetings to “enhance mutual understanding”. However, for the sake of smaller delegates, Ethiopia appealed for hybrid meetings that were well-spaced. Ethiopia also stressed Africa’s position that the accord needs “concrete obligations on equity and pandemic prevention, preparedness, response and recovery”. “It’s not that we have big news to share with you all but it’s the only news that we work very hard like I said to get where we want to be,” said Driece. Meanwhile, co-chair Precious Matsoso encouraged INB members to meet informally whenever they could to exchange views and build friendship and trust. At the start of the week, Matsoso used various dance analogies to encourage relations between member states. Driece concluded the meeting by saying that he and Matsoso would tango if the pandemic accord was read by April next year. UniteHealth Announces Social Media Awards Winners 16/06/2023 Maayan Hoffman UniteHealth Social Media Awards 2023 Eight social media influencers were selected earlier this week as winners of the UniteHealth Social Media Awards, showcasing individuals and organisations who used social media to strengthen collective understanding of the COVID-19 pandemic and evidence-based responses. The winners represent eight countries – nominees were recommended from more than 60 countries – and cover six categories and a “Young Leader” category that recognizes the contributions of social media users and influencers under 30. UniteHealth Social Media Awards 2023 Health Policy Watch was one of eight non-profit organizations engaged in public health and health-related media work that co-sponsored the awards alongside UniteHealth. The winners were: Pandemic Policy & Practice: Cinthia Reyes, Mexico Staying Safe: Trisha Greenhalgh, United Kingdom Understanding the Virus: Dr. Vinod Balasubramaniam, Malaysia COVID-19 Care and Support: Benjamin Djoudalbaye, Chad Vaccines: Hector L Frisbie, Mexico and Benjamin Djoudalbaye, Chad Long COVID: Padma Priya DVL, India Young Leader: Shiven Taneja, Canada Watch the ceremony: Unite Health Social Media Awards Live Event https://t.co/llTXdl0tew — #UniteHealth Social Media Awards (@socmed4good) June 13, 2023 The awards aimed to say “thank you” to those who gave their time and expertise to create a positive influence on social media platforms, said Prof Jeffrey Lazarus, a health researcher at the Barcelona Institute of Global Health and co-founder of the awards. Nominations for award candidates were solicited from around the world. Thousands of votes were cast for government officials, NGO workers, scientists, community activists, doctors, nurses and journalists. Image Credits: Screenshot. Obesity, Climate, Reliance on Imported Foods: Small Islands’ Declaration Spells Out a Litany of Challenges 16/06/2023 Kerry Cullinan One of the 340 islands that make up Palau in the Western Pacific Overburdened by non-communicable diseases (NCDs) and threatened by climate change, health ministers of Small Islands Developing States (SIDS) met in Barbados over the past few days and adopted the Bridgetown Declaration on NCDs and Mental Health. The declaration commits the SIDS to a number of actions including implementing the World Health Organization’s (WHO) recommended “Best Buys”, a menu of policy options to prevent and control of NCDs and mental health. These include regulation and taxation of harmful products such as tobacco, alcohol and junk food. The SIDS comprise 39 countries and 18 associate members of the UN situated in the Caribbean, the Pacific, and the Atlantic, Indian Ocean and South China Sea (AIS), and have a combined population of around 65 million. A new WHO report shows that eight of the 15 countries with more than a 30% risk of premature death from cardiovascular disease, cancer, diabetes, or chronic respiratory disease are SIDS. The 10 countries with the highest obesity rates globally are all SIDS in the Pacific, where over 45% of adults live with obesity. Cry for help Small Island Developing States face unique problems While the Bridgetown Declaration is a call to action, it is also a cry for help as it lays bare the problems facing these small nations – one percent of the world – that rely primarily on tourism and workers’ remittances for survival. Over half of the deaths in SIDS are premature and from NCDs, including cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, and mental health conditions, according to the declaration. Nauru, Cook Islands and Palau have the highest rates of obesity in the world, while childhood obesity in all SIDS is increasing exponentially. The highest prevalence of adult diabetes is also projected to be in SIDS, with prevalence in the Caribbean double the global average. Meanwhile, over 30% of adults have hypertension. In Guyana, premature mortality from cardiovascular disease is the highest in the region of the Americas. Rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. The SIDS attribute the drivers of these problems to “disproportionate commercial influence and trade-related challenges. Negative commercial influences are driving high rates of smoking, obesity and sedentary behaviour across these countries.” The islands are a captive audience for these commercial forces. They’re reliant on imported food, which is often ultra-processed and high in sugar, salt and fat – and comes wrapped in plastic that pollutes the environment. With climate change negatively affecting local fishing and agriculture, this dependence is likely to increase. The declaration also speaks of “the disproportionate and repetitive impact of disasters, whose frequency and intensity are further exacerbated by climate change”. This causes economic losses and drives people away from the islands. Funding to mitigate challenges One of the reasons for the meeting, which was hosted by the World Health Organization (WHO), its regional counterpart, the Pan-American Health Organization (PAHO) and the Barbados government, is to prepare for the UN General Assembly high-level meeting on universal health coverage in September. The intention is to engage governments, international agencies and donors to assist SIDS to address their unique problems. “Bold action for our climate, good health, and wellbeing relies on redressing and reorganising global financing to unlock billions in investment while making it less punishing for developing countries to pay their debts,” said Mia Mottley, Prime Minister of Barbados, at a media briefing on Thursday. “Funding for climate change adaptation and mitigation in the most vulnerable countries is also key, with noncommunicable diseases and mental health accounted for.” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the SIDS for showing “remarkable resilience, despite their limited resources and geographical constraints”. He pledged that WHO would work to mobilize financial resources to develop climate-resilient, environmentally sustainable healthcare facilities in the SIDS. WHO will also continue to advocate for “loss and damage” funding for climate change adaptation and mitigation investments in lower-income countries. Image Credits: Rick Bajornas/ UN Photo. Preventative Seasonal Malaria Treatment is Saving Thousands of Children 16/06/2023 Jean Louis Ndiaye & Andre Marie Tchouatieu A doctor examines a child with malaria. For years, malaria has ruled mercilessly in certain regions of the world. Especially in Africa. Yet over the past decade, despite the absence of a malaria vaccine, one anti-malarial strategy sought to make a difference: more than 700 million doses of Seasonal Malaria Chemoprevention (SMC) were distributed to young children, globally. The evidence is now clear: SMC has helped to save hundreds of thousands of their lives. So much so, that more countries have now begun to implement SMC, which involves the intermittent administration of a curative dose of antimalarial medicine to children at high risk of severe malaria living in areas with seasonal transmission, regardless of whether they are infected with malaria. As we mark the International Day of the African Child on 16 June, it’s important to recall how far we’ve come. At the dawn of the new millennium, malaria was infecting several hundred million people every year – and killing almost 900,000, annually. Although gains have been made to rein in its lethal impact, malaria continues to kill at an alarming rate: it took 619,000 lives in 2021, according to the World Health Organization (WHO) and its World Malaria Report 2022. Tragically, it’s children under the age of five who constitute the vast majority of malaria-related deaths; therefore, they are most in need of protection from this deadly disease. Their immune systems are not fully developed to fight off malaria parasites, which makes them easy prey. Averting millions of cases So how did this SMC intervention avert millions of malaria cases and so many needless deaths? The idea behind it was simple: Let’s protect children with existing drugs during the malaria season, commencing just before cases start to climb. The implementation was more complicated, though, as it required strong technical and financial partnerships – which continue to deliver, up through today. The intervention started out slowly. National health authorities had to be convinced of SMC effectiveness. A considerable, consistent supply had to be acquired of Sulfadoxine-Pyrimethamine Amodiaquine (popularly known as SPAQ), which is the antimalarial combination therapy administered in SMC campaigns. A child-friendly formulation also had to be developed, with the drugs then distributed. Healthcare workers had to be trained in its administration. Parents had to be persuaded that three, four even five doses of the drug would protect their children for the entire malaria season. In response, African researchers played a pivotal leadership role in the rapid SMC policy adoption, then its large-scale implementation. From 2002-2008, researchers in Senegal, Gambia, Mali and Ghana ensured that the results of landmark SMC studies were widely disseminated, and then they designed and implemented new research that provided additional evidence of SMC effectiveness. Their efforts led to the initial WHO recommendation, in 2012. As for partnerships, together with Roll Back Malaria, an SMC working group was created to help countries fast-track policy adoption. This working group eventually became the SMC Alliance. Meanwhile, Unitaid has also been a key player: it funded the ACCESS SMC project, which demonstrated the feasibility of scaling up and dramatically expanding SMC, by evaluating its effectiveness and cost. Effective and inexpensive Children under the age of five are most at risk from malaria. As supportive evidence mounted, SMC uptake rapidly increased. Today, 15 countries in the Sahel region of Western Africa are on board, implementing regular SMC campaigns during malaria season. In 2021 alone, despite Covid-related delivery challenges, 45 million children received SMC. Then in 2022, 48 million kids received it. This protected them during the rainy season, when deadly female Anopheles mosquitoes lurk in the shadows, ready to pounce on their next blood meal. As if saving lives were not enough, SMC has also proved to be highly cost-effective. A 2021 analysis revealed that SMC had so far saved participating health systems as much as $66 million. An additional tool to protect young children appeared in 2021 with the arrival of the RTS, S/AS01 malaria vaccine, Mosquirix, which also received a WHO recommendation. A study last year showed that SMC, when combined with this vaccine, provided significantly greater protection than either intervention alone. SMC has shown such remarkable efficacy in the Sahel region of West Africa, other parts of the continent are now beginning adopt it: This year, Mozambique became the first country in southern Africa to pilot SMC; while in East Africa, Uganda, Tanzania and South Sudan are engaged in early SMC efforts. And it doesn’t stop there. From 2009 onwards, researchers in Senegal began to explore whether SMC could benefit older children; they confirmed it could also protect children aged 5 to 10 years old. This led the WHO to review the guidelines in June 2022 to allow SMC to extend beyond the Sahel and reach children older than 5. This potentially protects millions more. All this is excellent news for the donors who have invested in SMC. It is equally welcome news for those national health systems in Africa that experience seasonal malaria transmission, as they are keen to save the lives of future citizens and are attracted to SMC’s cost-effectiveness. However, despite its rapid rise in popularity, SMC brings challenges of its own: mainly, how to secure uninterrupted supplies of SPAQ and develop new drugs to respond to resistance. African manufacturing boost Indeed, reaching older children requires more supplies of WHO-approved SPAQ. To resolve this problem, international partners, including MMV, are supporting the local African production of SPAQ. By the end of 2023, SPAQ will be manufactured for the first time in Africa to WHO-quality standards – another landmark worth celebrating. Meanwhile, as more countries outside the Sahel region are keen to roll out SMC, unfortunately, in parts of eastern Africa, there are signs of drug resistance to Sulfadoxine Pyrimethamine. Undeterred, researchers and national malaria teams in these countries are exploring alternative drug combinations for SMC regimens, in case resistance renders SPAQ completely ineffective. The spectre of drug resistance always looms. So far, though, given the determination of countries’ malaria programs and the malaria community, no problem has been insurmountable. Yet a major barrier remains: sustainable funding. Stagnant funding for malaria, especially malaria-drug research, might not only slow the development of new antimalarials but place millions of young lives at risk. We cannot allow this to happen. We, in the malaria community, are confident that these 10 years of success in protecting and saving countless young African children is all the evidence we need to continue supporting SMC until no child or family ever suffers from this disease. Prof Jean Louis Ndiaye is a Professor of Parasitology and Head of the Research and Innovation Division at the University Iba Der Thiam of Thiès, in Senegal. He is co-chair of the SMC Alliance research sub-group. Dr André Marie Tchouatieu is the Director of Chemoprevention Access and Product Management at MMV and General Secretary of the SMC Alliance. Image Credits: UNICEF USA , Damien Schumann / MMV. Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Pandemic Accord Negotiations: ‘It’s Not Easy’ 16/06/2023 Kerry Cullinan INB co-chairs Roland Driece and Precious Matsoso At the end of this week’s negotiation on the pandemic accord, Roland Driece, co-chair of the Intergovernmental Negotiating Body (INB) charged with drafting a pandemic accord, told the final plenary on Friday that “it’s not easy” – a phrase that he repeated four times in the space of minutes. To ease difficulties, the INB piloted a new approach involving informal sessions to “bridge gaps” on the sidelines of the formal drafting session, Driece said. Two informal sessions were held on one of the trickiest aspects of the negotiations: Article 9 (Chapter Two) of the current pandemic accord draft, dealing with the research and development (R&D) of pandemic products. Mexico and Norway facilitated the sessions, while experts were on hand to respond to technical questions. Meanwhile, in the formal drafting committee, member states “exchanged views” on Articles 9 (R&D), 10 (liability risk management), 11 (technology transfer), 12 (access and benefit-sharing of pathogen), 13 (supply chain) and 14 (regulatory strengthening). However, before the next set of negotiations from 17-21 July, the INB intends to host three inter-sessional meetings – on articles 9, 12, and 14. Members support pilot informal sessions The pilot informal sessions appeared to have the support of member states, with the African region, Latin America, the cross-cutting 20-country Group of Equity, and the European Union (EU) expressing appreciation in the final plenary. Earlier this week, EU Health Commissioner Stella Kyriakides warned a meeting of European health ministers that there is a risk the negotiations “may be derailed by current dynamics”, according to Politico. 💥Explosive remarks on pandemic treaty from Health Commissioner Stella Kyriakides at EPSCO. Treaty negotiations “may be derailed by current dynamics." "I am not going to hide that I am quite concerned important parts of the EU proposals are not reflected in this latest draft."🧵 — Ashleigh Furlong (@ashleighfurlong) June 13, 2023 Kyriakides added that she was “quite concerned” as “important parts of the EU proposals are not reflected in this latest draft”. However, Sweden, on behalf of the EU said it had been “a very, very useful week” with “very significant progress”. Driece singled out a discussion on access, benefit sharing and equitable access to counter-measures for helping to “increase the understanding of each other’s perspective, objectives, and proposals and the rationale behind them”. The EU also supported the informal sessions as a “significant positive development”, while Colombia, for Latin America, said that these have “allowed us to make progress”. “Although we have not been able to engage in textual negotiations this week, our discussions have allowed us to have a fuller understanding of one another’s proposals and perspectives on the articles taken up,” said India for the Equity Group. Ethiopia at INB5 The African region, via Ethiopia, also welcomed both the informal meetings alongside formal negotiations and the proposed inter-sessional meetings to “enhance mutual understanding”. However, for the sake of smaller delegates, Ethiopia appealed for hybrid meetings that were well-spaced. Ethiopia also stressed Africa’s position that the accord needs “concrete obligations on equity and pandemic prevention, preparedness, response and recovery”. “It’s not that we have big news to share with you all but it’s the only news that we work very hard like I said to get where we want to be,” said Driece. Meanwhile, co-chair Precious Matsoso encouraged INB members to meet informally whenever they could to exchange views and build friendship and trust. At the start of the week, Matsoso used various dance analogies to encourage relations between member states. Driece concluded the meeting by saying that he and Matsoso would tango if the pandemic accord was read by April next year. UniteHealth Announces Social Media Awards Winners 16/06/2023 Maayan Hoffman UniteHealth Social Media Awards 2023 Eight social media influencers were selected earlier this week as winners of the UniteHealth Social Media Awards, showcasing individuals and organisations who used social media to strengthen collective understanding of the COVID-19 pandemic and evidence-based responses. The winners represent eight countries – nominees were recommended from more than 60 countries – and cover six categories and a “Young Leader” category that recognizes the contributions of social media users and influencers under 30. UniteHealth Social Media Awards 2023 Health Policy Watch was one of eight non-profit organizations engaged in public health and health-related media work that co-sponsored the awards alongside UniteHealth. The winners were: Pandemic Policy & Practice: Cinthia Reyes, Mexico Staying Safe: Trisha Greenhalgh, United Kingdom Understanding the Virus: Dr. Vinod Balasubramaniam, Malaysia COVID-19 Care and Support: Benjamin Djoudalbaye, Chad Vaccines: Hector L Frisbie, Mexico and Benjamin Djoudalbaye, Chad Long COVID: Padma Priya DVL, India Young Leader: Shiven Taneja, Canada Watch the ceremony: Unite Health Social Media Awards Live Event https://t.co/llTXdl0tew — #UniteHealth Social Media Awards (@socmed4good) June 13, 2023 The awards aimed to say “thank you” to those who gave their time and expertise to create a positive influence on social media platforms, said Prof Jeffrey Lazarus, a health researcher at the Barcelona Institute of Global Health and co-founder of the awards. Nominations for award candidates were solicited from around the world. Thousands of votes were cast for government officials, NGO workers, scientists, community activists, doctors, nurses and journalists. Image Credits: Screenshot. Obesity, Climate, Reliance on Imported Foods: Small Islands’ Declaration Spells Out a Litany of Challenges 16/06/2023 Kerry Cullinan One of the 340 islands that make up Palau in the Western Pacific Overburdened by non-communicable diseases (NCDs) and threatened by climate change, health ministers of Small Islands Developing States (SIDS) met in Barbados over the past few days and adopted the Bridgetown Declaration on NCDs and Mental Health. The declaration commits the SIDS to a number of actions including implementing the World Health Organization’s (WHO) recommended “Best Buys”, a menu of policy options to prevent and control of NCDs and mental health. These include regulation and taxation of harmful products such as tobacco, alcohol and junk food. The SIDS comprise 39 countries and 18 associate members of the UN situated in the Caribbean, the Pacific, and the Atlantic, Indian Ocean and South China Sea (AIS), and have a combined population of around 65 million. A new WHO report shows that eight of the 15 countries with more than a 30% risk of premature death from cardiovascular disease, cancer, diabetes, or chronic respiratory disease are SIDS. The 10 countries with the highest obesity rates globally are all SIDS in the Pacific, where over 45% of adults live with obesity. Cry for help Small Island Developing States face unique problems While the Bridgetown Declaration is a call to action, it is also a cry for help as it lays bare the problems facing these small nations – one percent of the world – that rely primarily on tourism and workers’ remittances for survival. Over half of the deaths in SIDS are premature and from NCDs, including cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, and mental health conditions, according to the declaration. Nauru, Cook Islands and Palau have the highest rates of obesity in the world, while childhood obesity in all SIDS is increasing exponentially. The highest prevalence of adult diabetes is also projected to be in SIDS, with prevalence in the Caribbean double the global average. Meanwhile, over 30% of adults have hypertension. In Guyana, premature mortality from cardiovascular disease is the highest in the region of the Americas. Rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. The SIDS attribute the drivers of these problems to “disproportionate commercial influence and trade-related challenges. Negative commercial influences are driving high rates of smoking, obesity and sedentary behaviour across these countries.” The islands are a captive audience for these commercial forces. They’re reliant on imported food, which is often ultra-processed and high in sugar, salt and fat – and comes wrapped in plastic that pollutes the environment. With climate change negatively affecting local fishing and agriculture, this dependence is likely to increase. The declaration also speaks of “the disproportionate and repetitive impact of disasters, whose frequency and intensity are further exacerbated by climate change”. This causes economic losses and drives people away from the islands. Funding to mitigate challenges One of the reasons for the meeting, which was hosted by the World Health Organization (WHO), its regional counterpart, the Pan-American Health Organization (PAHO) and the Barbados government, is to prepare for the UN General Assembly high-level meeting on universal health coverage in September. The intention is to engage governments, international agencies and donors to assist SIDS to address their unique problems. “Bold action for our climate, good health, and wellbeing relies on redressing and reorganising global financing to unlock billions in investment while making it less punishing for developing countries to pay their debts,” said Mia Mottley, Prime Minister of Barbados, at a media briefing on Thursday. “Funding for climate change adaptation and mitigation in the most vulnerable countries is also key, with noncommunicable diseases and mental health accounted for.” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the SIDS for showing “remarkable resilience, despite their limited resources and geographical constraints”. He pledged that WHO would work to mobilize financial resources to develop climate-resilient, environmentally sustainable healthcare facilities in the SIDS. WHO will also continue to advocate for “loss and damage” funding for climate change adaptation and mitigation investments in lower-income countries. Image Credits: Rick Bajornas/ UN Photo. Preventative Seasonal Malaria Treatment is Saving Thousands of Children 16/06/2023 Jean Louis Ndiaye & Andre Marie Tchouatieu A doctor examines a child with malaria. For years, malaria has ruled mercilessly in certain regions of the world. Especially in Africa. Yet over the past decade, despite the absence of a malaria vaccine, one anti-malarial strategy sought to make a difference: more than 700 million doses of Seasonal Malaria Chemoprevention (SMC) were distributed to young children, globally. The evidence is now clear: SMC has helped to save hundreds of thousands of their lives. So much so, that more countries have now begun to implement SMC, which involves the intermittent administration of a curative dose of antimalarial medicine to children at high risk of severe malaria living in areas with seasonal transmission, regardless of whether they are infected with malaria. As we mark the International Day of the African Child on 16 June, it’s important to recall how far we’ve come. At the dawn of the new millennium, malaria was infecting several hundred million people every year – and killing almost 900,000, annually. Although gains have been made to rein in its lethal impact, malaria continues to kill at an alarming rate: it took 619,000 lives in 2021, according to the World Health Organization (WHO) and its World Malaria Report 2022. Tragically, it’s children under the age of five who constitute the vast majority of malaria-related deaths; therefore, they are most in need of protection from this deadly disease. Their immune systems are not fully developed to fight off malaria parasites, which makes them easy prey. Averting millions of cases So how did this SMC intervention avert millions of malaria cases and so many needless deaths? The idea behind it was simple: Let’s protect children with existing drugs during the malaria season, commencing just before cases start to climb. The implementation was more complicated, though, as it required strong technical and financial partnerships – which continue to deliver, up through today. The intervention started out slowly. National health authorities had to be convinced of SMC effectiveness. A considerable, consistent supply had to be acquired of Sulfadoxine-Pyrimethamine Amodiaquine (popularly known as SPAQ), which is the antimalarial combination therapy administered in SMC campaigns. A child-friendly formulation also had to be developed, with the drugs then distributed. Healthcare workers had to be trained in its administration. Parents had to be persuaded that three, four even five doses of the drug would protect their children for the entire malaria season. In response, African researchers played a pivotal leadership role in the rapid SMC policy adoption, then its large-scale implementation. From 2002-2008, researchers in Senegal, Gambia, Mali and Ghana ensured that the results of landmark SMC studies were widely disseminated, and then they designed and implemented new research that provided additional evidence of SMC effectiveness. Their efforts led to the initial WHO recommendation, in 2012. As for partnerships, together with Roll Back Malaria, an SMC working group was created to help countries fast-track policy adoption. This working group eventually became the SMC Alliance. Meanwhile, Unitaid has also been a key player: it funded the ACCESS SMC project, which demonstrated the feasibility of scaling up and dramatically expanding SMC, by evaluating its effectiveness and cost. Effective and inexpensive Children under the age of five are most at risk from malaria. As supportive evidence mounted, SMC uptake rapidly increased. Today, 15 countries in the Sahel region of Western Africa are on board, implementing regular SMC campaigns during malaria season. In 2021 alone, despite Covid-related delivery challenges, 45 million children received SMC. Then in 2022, 48 million kids received it. This protected them during the rainy season, when deadly female Anopheles mosquitoes lurk in the shadows, ready to pounce on their next blood meal. As if saving lives were not enough, SMC has also proved to be highly cost-effective. A 2021 analysis revealed that SMC had so far saved participating health systems as much as $66 million. An additional tool to protect young children appeared in 2021 with the arrival of the RTS, S/AS01 malaria vaccine, Mosquirix, which also received a WHO recommendation. A study last year showed that SMC, when combined with this vaccine, provided significantly greater protection than either intervention alone. SMC has shown such remarkable efficacy in the Sahel region of West Africa, other parts of the continent are now beginning adopt it: This year, Mozambique became the first country in southern Africa to pilot SMC; while in East Africa, Uganda, Tanzania and South Sudan are engaged in early SMC efforts. And it doesn’t stop there. From 2009 onwards, researchers in Senegal began to explore whether SMC could benefit older children; they confirmed it could also protect children aged 5 to 10 years old. This led the WHO to review the guidelines in June 2022 to allow SMC to extend beyond the Sahel and reach children older than 5. This potentially protects millions more. All this is excellent news for the donors who have invested in SMC. It is equally welcome news for those national health systems in Africa that experience seasonal malaria transmission, as they are keen to save the lives of future citizens and are attracted to SMC’s cost-effectiveness. However, despite its rapid rise in popularity, SMC brings challenges of its own: mainly, how to secure uninterrupted supplies of SPAQ and develop new drugs to respond to resistance. African manufacturing boost Indeed, reaching older children requires more supplies of WHO-approved SPAQ. To resolve this problem, international partners, including MMV, are supporting the local African production of SPAQ. By the end of 2023, SPAQ will be manufactured for the first time in Africa to WHO-quality standards – another landmark worth celebrating. Meanwhile, as more countries outside the Sahel region are keen to roll out SMC, unfortunately, in parts of eastern Africa, there are signs of drug resistance to Sulfadoxine Pyrimethamine. Undeterred, researchers and national malaria teams in these countries are exploring alternative drug combinations for SMC regimens, in case resistance renders SPAQ completely ineffective. The spectre of drug resistance always looms. So far, though, given the determination of countries’ malaria programs and the malaria community, no problem has been insurmountable. Yet a major barrier remains: sustainable funding. Stagnant funding for malaria, especially malaria-drug research, might not only slow the development of new antimalarials but place millions of young lives at risk. We cannot allow this to happen. We, in the malaria community, are confident that these 10 years of success in protecting and saving countless young African children is all the evidence we need to continue supporting SMC until no child or family ever suffers from this disease. Prof Jean Louis Ndiaye is a Professor of Parasitology and Head of the Research and Innovation Division at the University Iba Der Thiam of Thiès, in Senegal. He is co-chair of the SMC Alliance research sub-group. Dr André Marie Tchouatieu is the Director of Chemoprevention Access and Product Management at MMV and General Secretary of the SMC Alliance. Image Credits: UNICEF USA , Damien Schumann / MMV. Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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UniteHealth Announces Social Media Awards Winners 16/06/2023 Maayan Hoffman UniteHealth Social Media Awards 2023 Eight social media influencers were selected earlier this week as winners of the UniteHealth Social Media Awards, showcasing individuals and organisations who used social media to strengthen collective understanding of the COVID-19 pandemic and evidence-based responses. The winners represent eight countries – nominees were recommended from more than 60 countries – and cover six categories and a “Young Leader” category that recognizes the contributions of social media users and influencers under 30. UniteHealth Social Media Awards 2023 Health Policy Watch was one of eight non-profit organizations engaged in public health and health-related media work that co-sponsored the awards alongside UniteHealth. The winners were: Pandemic Policy & Practice: Cinthia Reyes, Mexico Staying Safe: Trisha Greenhalgh, United Kingdom Understanding the Virus: Dr. Vinod Balasubramaniam, Malaysia COVID-19 Care and Support: Benjamin Djoudalbaye, Chad Vaccines: Hector L Frisbie, Mexico and Benjamin Djoudalbaye, Chad Long COVID: Padma Priya DVL, India Young Leader: Shiven Taneja, Canada Watch the ceremony: Unite Health Social Media Awards Live Event https://t.co/llTXdl0tew — #UniteHealth Social Media Awards (@socmed4good) June 13, 2023 The awards aimed to say “thank you” to those who gave their time and expertise to create a positive influence on social media platforms, said Prof Jeffrey Lazarus, a health researcher at the Barcelona Institute of Global Health and co-founder of the awards. Nominations for award candidates were solicited from around the world. Thousands of votes were cast for government officials, NGO workers, scientists, community activists, doctors, nurses and journalists. Image Credits: Screenshot. Obesity, Climate, Reliance on Imported Foods: Small Islands’ Declaration Spells Out a Litany of Challenges 16/06/2023 Kerry Cullinan One of the 340 islands that make up Palau in the Western Pacific Overburdened by non-communicable diseases (NCDs) and threatened by climate change, health ministers of Small Islands Developing States (SIDS) met in Barbados over the past few days and adopted the Bridgetown Declaration on NCDs and Mental Health. The declaration commits the SIDS to a number of actions including implementing the World Health Organization’s (WHO) recommended “Best Buys”, a menu of policy options to prevent and control of NCDs and mental health. These include regulation and taxation of harmful products such as tobacco, alcohol and junk food. The SIDS comprise 39 countries and 18 associate members of the UN situated in the Caribbean, the Pacific, and the Atlantic, Indian Ocean and South China Sea (AIS), and have a combined population of around 65 million. A new WHO report shows that eight of the 15 countries with more than a 30% risk of premature death from cardiovascular disease, cancer, diabetes, or chronic respiratory disease are SIDS. The 10 countries with the highest obesity rates globally are all SIDS in the Pacific, where over 45% of adults live with obesity. Cry for help Small Island Developing States face unique problems While the Bridgetown Declaration is a call to action, it is also a cry for help as it lays bare the problems facing these small nations – one percent of the world – that rely primarily on tourism and workers’ remittances for survival. Over half of the deaths in SIDS are premature and from NCDs, including cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, and mental health conditions, according to the declaration. Nauru, Cook Islands and Palau have the highest rates of obesity in the world, while childhood obesity in all SIDS is increasing exponentially. The highest prevalence of adult diabetes is also projected to be in SIDS, with prevalence in the Caribbean double the global average. Meanwhile, over 30% of adults have hypertension. In Guyana, premature mortality from cardiovascular disease is the highest in the region of the Americas. Rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. The SIDS attribute the drivers of these problems to “disproportionate commercial influence and trade-related challenges. Negative commercial influences are driving high rates of smoking, obesity and sedentary behaviour across these countries.” The islands are a captive audience for these commercial forces. They’re reliant on imported food, which is often ultra-processed and high in sugar, salt and fat – and comes wrapped in plastic that pollutes the environment. With climate change negatively affecting local fishing and agriculture, this dependence is likely to increase. The declaration also speaks of “the disproportionate and repetitive impact of disasters, whose frequency and intensity are further exacerbated by climate change”. This causes economic losses and drives people away from the islands. Funding to mitigate challenges One of the reasons for the meeting, which was hosted by the World Health Organization (WHO), its regional counterpart, the Pan-American Health Organization (PAHO) and the Barbados government, is to prepare for the UN General Assembly high-level meeting on universal health coverage in September. The intention is to engage governments, international agencies and donors to assist SIDS to address their unique problems. “Bold action for our climate, good health, and wellbeing relies on redressing and reorganising global financing to unlock billions in investment while making it less punishing for developing countries to pay their debts,” said Mia Mottley, Prime Minister of Barbados, at a media briefing on Thursday. “Funding for climate change adaptation and mitigation in the most vulnerable countries is also key, with noncommunicable diseases and mental health accounted for.” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the SIDS for showing “remarkable resilience, despite their limited resources and geographical constraints”. He pledged that WHO would work to mobilize financial resources to develop climate-resilient, environmentally sustainable healthcare facilities in the SIDS. WHO will also continue to advocate for “loss and damage” funding for climate change adaptation and mitigation investments in lower-income countries. Image Credits: Rick Bajornas/ UN Photo. Preventative Seasonal Malaria Treatment is Saving Thousands of Children 16/06/2023 Jean Louis Ndiaye & Andre Marie Tchouatieu A doctor examines a child with malaria. For years, malaria has ruled mercilessly in certain regions of the world. Especially in Africa. Yet over the past decade, despite the absence of a malaria vaccine, one anti-malarial strategy sought to make a difference: more than 700 million doses of Seasonal Malaria Chemoprevention (SMC) were distributed to young children, globally. The evidence is now clear: SMC has helped to save hundreds of thousands of their lives. So much so, that more countries have now begun to implement SMC, which involves the intermittent administration of a curative dose of antimalarial medicine to children at high risk of severe malaria living in areas with seasonal transmission, regardless of whether they are infected with malaria. As we mark the International Day of the African Child on 16 June, it’s important to recall how far we’ve come. At the dawn of the new millennium, malaria was infecting several hundred million people every year – and killing almost 900,000, annually. Although gains have been made to rein in its lethal impact, malaria continues to kill at an alarming rate: it took 619,000 lives in 2021, according to the World Health Organization (WHO) and its World Malaria Report 2022. Tragically, it’s children under the age of five who constitute the vast majority of malaria-related deaths; therefore, they are most in need of protection from this deadly disease. Their immune systems are not fully developed to fight off malaria parasites, which makes them easy prey. Averting millions of cases So how did this SMC intervention avert millions of malaria cases and so many needless deaths? The idea behind it was simple: Let’s protect children with existing drugs during the malaria season, commencing just before cases start to climb. The implementation was more complicated, though, as it required strong technical and financial partnerships – which continue to deliver, up through today. The intervention started out slowly. National health authorities had to be convinced of SMC effectiveness. A considerable, consistent supply had to be acquired of Sulfadoxine-Pyrimethamine Amodiaquine (popularly known as SPAQ), which is the antimalarial combination therapy administered in SMC campaigns. A child-friendly formulation also had to be developed, with the drugs then distributed. Healthcare workers had to be trained in its administration. Parents had to be persuaded that three, four even five doses of the drug would protect their children for the entire malaria season. In response, African researchers played a pivotal leadership role in the rapid SMC policy adoption, then its large-scale implementation. From 2002-2008, researchers in Senegal, Gambia, Mali and Ghana ensured that the results of landmark SMC studies were widely disseminated, and then they designed and implemented new research that provided additional evidence of SMC effectiveness. Their efforts led to the initial WHO recommendation, in 2012. As for partnerships, together with Roll Back Malaria, an SMC working group was created to help countries fast-track policy adoption. This working group eventually became the SMC Alliance. Meanwhile, Unitaid has also been a key player: it funded the ACCESS SMC project, which demonstrated the feasibility of scaling up and dramatically expanding SMC, by evaluating its effectiveness and cost. Effective and inexpensive Children under the age of five are most at risk from malaria. As supportive evidence mounted, SMC uptake rapidly increased. Today, 15 countries in the Sahel region of Western Africa are on board, implementing regular SMC campaigns during malaria season. In 2021 alone, despite Covid-related delivery challenges, 45 million children received SMC. Then in 2022, 48 million kids received it. This protected them during the rainy season, when deadly female Anopheles mosquitoes lurk in the shadows, ready to pounce on their next blood meal. As if saving lives were not enough, SMC has also proved to be highly cost-effective. A 2021 analysis revealed that SMC had so far saved participating health systems as much as $66 million. An additional tool to protect young children appeared in 2021 with the arrival of the RTS, S/AS01 malaria vaccine, Mosquirix, which also received a WHO recommendation. A study last year showed that SMC, when combined with this vaccine, provided significantly greater protection than either intervention alone. SMC has shown such remarkable efficacy in the Sahel region of West Africa, other parts of the continent are now beginning adopt it: This year, Mozambique became the first country in southern Africa to pilot SMC; while in East Africa, Uganda, Tanzania and South Sudan are engaged in early SMC efforts. And it doesn’t stop there. From 2009 onwards, researchers in Senegal began to explore whether SMC could benefit older children; they confirmed it could also protect children aged 5 to 10 years old. This led the WHO to review the guidelines in June 2022 to allow SMC to extend beyond the Sahel and reach children older than 5. This potentially protects millions more. All this is excellent news for the donors who have invested in SMC. It is equally welcome news for those national health systems in Africa that experience seasonal malaria transmission, as they are keen to save the lives of future citizens and are attracted to SMC’s cost-effectiveness. However, despite its rapid rise in popularity, SMC brings challenges of its own: mainly, how to secure uninterrupted supplies of SPAQ and develop new drugs to respond to resistance. African manufacturing boost Indeed, reaching older children requires more supplies of WHO-approved SPAQ. To resolve this problem, international partners, including MMV, are supporting the local African production of SPAQ. By the end of 2023, SPAQ will be manufactured for the first time in Africa to WHO-quality standards – another landmark worth celebrating. Meanwhile, as more countries outside the Sahel region are keen to roll out SMC, unfortunately, in parts of eastern Africa, there are signs of drug resistance to Sulfadoxine Pyrimethamine. Undeterred, researchers and national malaria teams in these countries are exploring alternative drug combinations for SMC regimens, in case resistance renders SPAQ completely ineffective. The spectre of drug resistance always looms. So far, though, given the determination of countries’ malaria programs and the malaria community, no problem has been insurmountable. Yet a major barrier remains: sustainable funding. Stagnant funding for malaria, especially malaria-drug research, might not only slow the development of new antimalarials but place millions of young lives at risk. We cannot allow this to happen. We, in the malaria community, are confident that these 10 years of success in protecting and saving countless young African children is all the evidence we need to continue supporting SMC until no child or family ever suffers from this disease. Prof Jean Louis Ndiaye is a Professor of Parasitology and Head of the Research and Innovation Division at the University Iba Der Thiam of Thiès, in Senegal. He is co-chair of the SMC Alliance research sub-group. Dr André Marie Tchouatieu is the Director of Chemoprevention Access and Product Management at MMV and General Secretary of the SMC Alliance. Image Credits: UNICEF USA , Damien Schumann / MMV. Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Obesity, Climate, Reliance on Imported Foods: Small Islands’ Declaration Spells Out a Litany of Challenges 16/06/2023 Kerry Cullinan One of the 340 islands that make up Palau in the Western Pacific Overburdened by non-communicable diseases (NCDs) and threatened by climate change, health ministers of Small Islands Developing States (SIDS) met in Barbados over the past few days and adopted the Bridgetown Declaration on NCDs and Mental Health. The declaration commits the SIDS to a number of actions including implementing the World Health Organization’s (WHO) recommended “Best Buys”, a menu of policy options to prevent and control of NCDs and mental health. These include regulation and taxation of harmful products such as tobacco, alcohol and junk food. The SIDS comprise 39 countries and 18 associate members of the UN situated in the Caribbean, the Pacific, and the Atlantic, Indian Ocean and South China Sea (AIS), and have a combined population of around 65 million. A new WHO report shows that eight of the 15 countries with more than a 30% risk of premature death from cardiovascular disease, cancer, diabetes, or chronic respiratory disease are SIDS. The 10 countries with the highest obesity rates globally are all SIDS in the Pacific, where over 45% of adults live with obesity. Cry for help Small Island Developing States face unique problems While the Bridgetown Declaration is a call to action, it is also a cry for help as it lays bare the problems facing these small nations – one percent of the world – that rely primarily on tourism and workers’ remittances for survival. Over half of the deaths in SIDS are premature and from NCDs, including cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, and mental health conditions, according to the declaration. Nauru, Cook Islands and Palau have the highest rates of obesity in the world, while childhood obesity in all SIDS is increasing exponentially. The highest prevalence of adult diabetes is also projected to be in SIDS, with prevalence in the Caribbean double the global average. Meanwhile, over 30% of adults have hypertension. In Guyana, premature mortality from cardiovascular disease is the highest in the region of the Americas. Rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. The SIDS attribute the drivers of these problems to “disproportionate commercial influence and trade-related challenges. Negative commercial influences are driving high rates of smoking, obesity and sedentary behaviour across these countries.” The islands are a captive audience for these commercial forces. They’re reliant on imported food, which is often ultra-processed and high in sugar, salt and fat – and comes wrapped in plastic that pollutes the environment. With climate change negatively affecting local fishing and agriculture, this dependence is likely to increase. The declaration also speaks of “the disproportionate and repetitive impact of disasters, whose frequency and intensity are further exacerbated by climate change”. This causes economic losses and drives people away from the islands. Funding to mitigate challenges One of the reasons for the meeting, which was hosted by the World Health Organization (WHO), its regional counterpart, the Pan-American Health Organization (PAHO) and the Barbados government, is to prepare for the UN General Assembly high-level meeting on universal health coverage in September. The intention is to engage governments, international agencies and donors to assist SIDS to address their unique problems. “Bold action for our climate, good health, and wellbeing relies on redressing and reorganising global financing to unlock billions in investment while making it less punishing for developing countries to pay their debts,” said Mia Mottley, Prime Minister of Barbados, at a media briefing on Thursday. “Funding for climate change adaptation and mitigation in the most vulnerable countries is also key, with noncommunicable diseases and mental health accounted for.” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the SIDS for showing “remarkable resilience, despite their limited resources and geographical constraints”. He pledged that WHO would work to mobilize financial resources to develop climate-resilient, environmentally sustainable healthcare facilities in the SIDS. WHO will also continue to advocate for “loss and damage” funding for climate change adaptation and mitigation investments in lower-income countries. Image Credits: Rick Bajornas/ UN Photo. Preventative Seasonal Malaria Treatment is Saving Thousands of Children 16/06/2023 Jean Louis Ndiaye & Andre Marie Tchouatieu A doctor examines a child with malaria. For years, malaria has ruled mercilessly in certain regions of the world. Especially in Africa. Yet over the past decade, despite the absence of a malaria vaccine, one anti-malarial strategy sought to make a difference: more than 700 million doses of Seasonal Malaria Chemoprevention (SMC) were distributed to young children, globally. The evidence is now clear: SMC has helped to save hundreds of thousands of their lives. So much so, that more countries have now begun to implement SMC, which involves the intermittent administration of a curative dose of antimalarial medicine to children at high risk of severe malaria living in areas with seasonal transmission, regardless of whether they are infected with malaria. As we mark the International Day of the African Child on 16 June, it’s important to recall how far we’ve come. At the dawn of the new millennium, malaria was infecting several hundred million people every year – and killing almost 900,000, annually. Although gains have been made to rein in its lethal impact, malaria continues to kill at an alarming rate: it took 619,000 lives in 2021, according to the World Health Organization (WHO) and its World Malaria Report 2022. Tragically, it’s children under the age of five who constitute the vast majority of malaria-related deaths; therefore, they are most in need of protection from this deadly disease. Their immune systems are not fully developed to fight off malaria parasites, which makes them easy prey. Averting millions of cases So how did this SMC intervention avert millions of malaria cases and so many needless deaths? The idea behind it was simple: Let’s protect children with existing drugs during the malaria season, commencing just before cases start to climb. The implementation was more complicated, though, as it required strong technical and financial partnerships – which continue to deliver, up through today. The intervention started out slowly. National health authorities had to be convinced of SMC effectiveness. A considerable, consistent supply had to be acquired of Sulfadoxine-Pyrimethamine Amodiaquine (popularly known as SPAQ), which is the antimalarial combination therapy administered in SMC campaigns. A child-friendly formulation also had to be developed, with the drugs then distributed. Healthcare workers had to be trained in its administration. Parents had to be persuaded that three, four even five doses of the drug would protect their children for the entire malaria season. In response, African researchers played a pivotal leadership role in the rapid SMC policy adoption, then its large-scale implementation. From 2002-2008, researchers in Senegal, Gambia, Mali and Ghana ensured that the results of landmark SMC studies were widely disseminated, and then they designed and implemented new research that provided additional evidence of SMC effectiveness. Their efforts led to the initial WHO recommendation, in 2012. As for partnerships, together with Roll Back Malaria, an SMC working group was created to help countries fast-track policy adoption. This working group eventually became the SMC Alliance. Meanwhile, Unitaid has also been a key player: it funded the ACCESS SMC project, which demonstrated the feasibility of scaling up and dramatically expanding SMC, by evaluating its effectiveness and cost. Effective and inexpensive Children under the age of five are most at risk from malaria. As supportive evidence mounted, SMC uptake rapidly increased. Today, 15 countries in the Sahel region of Western Africa are on board, implementing regular SMC campaigns during malaria season. In 2021 alone, despite Covid-related delivery challenges, 45 million children received SMC. Then in 2022, 48 million kids received it. This protected them during the rainy season, when deadly female Anopheles mosquitoes lurk in the shadows, ready to pounce on their next blood meal. As if saving lives were not enough, SMC has also proved to be highly cost-effective. A 2021 analysis revealed that SMC had so far saved participating health systems as much as $66 million. An additional tool to protect young children appeared in 2021 with the arrival of the RTS, S/AS01 malaria vaccine, Mosquirix, which also received a WHO recommendation. A study last year showed that SMC, when combined with this vaccine, provided significantly greater protection than either intervention alone. SMC has shown such remarkable efficacy in the Sahel region of West Africa, other parts of the continent are now beginning adopt it: This year, Mozambique became the first country in southern Africa to pilot SMC; while in East Africa, Uganda, Tanzania and South Sudan are engaged in early SMC efforts. And it doesn’t stop there. From 2009 onwards, researchers in Senegal began to explore whether SMC could benefit older children; they confirmed it could also protect children aged 5 to 10 years old. This led the WHO to review the guidelines in June 2022 to allow SMC to extend beyond the Sahel and reach children older than 5. This potentially protects millions more. All this is excellent news for the donors who have invested in SMC. It is equally welcome news for those national health systems in Africa that experience seasonal malaria transmission, as they are keen to save the lives of future citizens and are attracted to SMC’s cost-effectiveness. However, despite its rapid rise in popularity, SMC brings challenges of its own: mainly, how to secure uninterrupted supplies of SPAQ and develop new drugs to respond to resistance. African manufacturing boost Indeed, reaching older children requires more supplies of WHO-approved SPAQ. To resolve this problem, international partners, including MMV, are supporting the local African production of SPAQ. By the end of 2023, SPAQ will be manufactured for the first time in Africa to WHO-quality standards – another landmark worth celebrating. Meanwhile, as more countries outside the Sahel region are keen to roll out SMC, unfortunately, in parts of eastern Africa, there are signs of drug resistance to Sulfadoxine Pyrimethamine. Undeterred, researchers and national malaria teams in these countries are exploring alternative drug combinations for SMC regimens, in case resistance renders SPAQ completely ineffective. The spectre of drug resistance always looms. So far, though, given the determination of countries’ malaria programs and the malaria community, no problem has been insurmountable. Yet a major barrier remains: sustainable funding. Stagnant funding for malaria, especially malaria-drug research, might not only slow the development of new antimalarials but place millions of young lives at risk. We cannot allow this to happen. We, in the malaria community, are confident that these 10 years of success in protecting and saving countless young African children is all the evidence we need to continue supporting SMC until no child or family ever suffers from this disease. Prof Jean Louis Ndiaye is a Professor of Parasitology and Head of the Research and Innovation Division at the University Iba Der Thiam of Thiès, in Senegal. He is co-chair of the SMC Alliance research sub-group. Dr André Marie Tchouatieu is the Director of Chemoprevention Access and Product Management at MMV and General Secretary of the SMC Alliance. Image Credits: UNICEF USA , Damien Schumann / MMV. Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Preventative Seasonal Malaria Treatment is Saving Thousands of Children 16/06/2023 Jean Louis Ndiaye & Andre Marie Tchouatieu A doctor examines a child with malaria. For years, malaria has ruled mercilessly in certain regions of the world. Especially in Africa. Yet over the past decade, despite the absence of a malaria vaccine, one anti-malarial strategy sought to make a difference: more than 700 million doses of Seasonal Malaria Chemoprevention (SMC) were distributed to young children, globally. The evidence is now clear: SMC has helped to save hundreds of thousands of their lives. So much so, that more countries have now begun to implement SMC, which involves the intermittent administration of a curative dose of antimalarial medicine to children at high risk of severe malaria living in areas with seasonal transmission, regardless of whether they are infected with malaria. As we mark the International Day of the African Child on 16 June, it’s important to recall how far we’ve come. At the dawn of the new millennium, malaria was infecting several hundred million people every year – and killing almost 900,000, annually. Although gains have been made to rein in its lethal impact, malaria continues to kill at an alarming rate: it took 619,000 lives in 2021, according to the World Health Organization (WHO) and its World Malaria Report 2022. Tragically, it’s children under the age of five who constitute the vast majority of malaria-related deaths; therefore, they are most in need of protection from this deadly disease. Their immune systems are not fully developed to fight off malaria parasites, which makes them easy prey. Averting millions of cases So how did this SMC intervention avert millions of malaria cases and so many needless deaths? The idea behind it was simple: Let’s protect children with existing drugs during the malaria season, commencing just before cases start to climb. The implementation was more complicated, though, as it required strong technical and financial partnerships – which continue to deliver, up through today. The intervention started out slowly. National health authorities had to be convinced of SMC effectiveness. A considerable, consistent supply had to be acquired of Sulfadoxine-Pyrimethamine Amodiaquine (popularly known as SPAQ), which is the antimalarial combination therapy administered in SMC campaigns. A child-friendly formulation also had to be developed, with the drugs then distributed. Healthcare workers had to be trained in its administration. Parents had to be persuaded that three, four even five doses of the drug would protect their children for the entire malaria season. In response, African researchers played a pivotal leadership role in the rapid SMC policy adoption, then its large-scale implementation. From 2002-2008, researchers in Senegal, Gambia, Mali and Ghana ensured that the results of landmark SMC studies were widely disseminated, and then they designed and implemented new research that provided additional evidence of SMC effectiveness. Their efforts led to the initial WHO recommendation, in 2012. As for partnerships, together with Roll Back Malaria, an SMC working group was created to help countries fast-track policy adoption. This working group eventually became the SMC Alliance. Meanwhile, Unitaid has also been a key player: it funded the ACCESS SMC project, which demonstrated the feasibility of scaling up and dramatically expanding SMC, by evaluating its effectiveness and cost. Effective and inexpensive Children under the age of five are most at risk from malaria. As supportive evidence mounted, SMC uptake rapidly increased. Today, 15 countries in the Sahel region of Western Africa are on board, implementing regular SMC campaigns during malaria season. In 2021 alone, despite Covid-related delivery challenges, 45 million children received SMC. Then in 2022, 48 million kids received it. This protected them during the rainy season, when deadly female Anopheles mosquitoes lurk in the shadows, ready to pounce on their next blood meal. As if saving lives were not enough, SMC has also proved to be highly cost-effective. A 2021 analysis revealed that SMC had so far saved participating health systems as much as $66 million. An additional tool to protect young children appeared in 2021 with the arrival of the RTS, S/AS01 malaria vaccine, Mosquirix, which also received a WHO recommendation. A study last year showed that SMC, when combined with this vaccine, provided significantly greater protection than either intervention alone. SMC has shown such remarkable efficacy in the Sahel region of West Africa, other parts of the continent are now beginning adopt it: This year, Mozambique became the first country in southern Africa to pilot SMC; while in East Africa, Uganda, Tanzania and South Sudan are engaged in early SMC efforts. And it doesn’t stop there. From 2009 onwards, researchers in Senegal began to explore whether SMC could benefit older children; they confirmed it could also protect children aged 5 to 10 years old. This led the WHO to review the guidelines in June 2022 to allow SMC to extend beyond the Sahel and reach children older than 5. This potentially protects millions more. All this is excellent news for the donors who have invested in SMC. It is equally welcome news for those national health systems in Africa that experience seasonal malaria transmission, as they are keen to save the lives of future citizens and are attracted to SMC’s cost-effectiveness. However, despite its rapid rise in popularity, SMC brings challenges of its own: mainly, how to secure uninterrupted supplies of SPAQ and develop new drugs to respond to resistance. African manufacturing boost Indeed, reaching older children requires more supplies of WHO-approved SPAQ. To resolve this problem, international partners, including MMV, are supporting the local African production of SPAQ. By the end of 2023, SPAQ will be manufactured for the first time in Africa to WHO-quality standards – another landmark worth celebrating. Meanwhile, as more countries outside the Sahel region are keen to roll out SMC, unfortunately, in parts of eastern Africa, there are signs of drug resistance to Sulfadoxine Pyrimethamine. Undeterred, researchers and national malaria teams in these countries are exploring alternative drug combinations for SMC regimens, in case resistance renders SPAQ completely ineffective. The spectre of drug resistance always looms. So far, though, given the determination of countries’ malaria programs and the malaria community, no problem has been insurmountable. Yet a major barrier remains: sustainable funding. Stagnant funding for malaria, especially malaria-drug research, might not only slow the development of new antimalarials but place millions of young lives at risk. We cannot allow this to happen. We, in the malaria community, are confident that these 10 years of success in protecting and saving countless young African children is all the evidence we need to continue supporting SMC until no child or family ever suffers from this disease. Prof Jean Louis Ndiaye is a Professor of Parasitology and Head of the Research and Innovation Division at the University Iba Der Thiam of Thiès, in Senegal. He is co-chair of the SMC Alliance research sub-group. Dr André Marie Tchouatieu is the Director of Chemoprevention Access and Product Management at MMV and General Secretary of the SMC Alliance. Image Credits: UNICEF USA , Damien Schumann / MMV. Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Extraordinary ‘Culture War’ Clash at ILO over LGBTQ Rights 15/06/2023 Kerry Cullinan Late-night screaming matches and days of delays dogged the adoption of the budget of the International Labour Organization (ILO) this week after some Arab and African member states objected to a clause related to LGBTQ rights. The single offending clause committed the body to support those “affected by discrimination and exclusion, including on the grounds of race, sexual orientation and gender identity” and to “implementing measures conducive to promoting equality of opportunity and treatment”. While the clause was retained in the budget that was finally passed this week at the body’s plenary, the compromise involved the insertion of a note that recorded the differences on some issues, according to AFP, which also reported on the late-night drama and yelling matches. The 2024/25 budget and programme of work was finally overwhelmingly passed by 477 votes, with 11 against and seven abstentions. The hold-out ‘no’ votes included Bahrain, Belarus, Egypt, Gabon, Maldives, Niger and Oman. Pakistan and Morocco had led the initial objections, but Pakistan voted in favour of the compromise while Morocco abstained. Speaking after the adoption of the budget, Sweden’s Thomas Janson on behalf of the European Union, pointed out that LGBTI reference had been in the ILO’s programme of work and budget since 2018/19. “The EU and its member states to reiterate our commitment to equality and non-discrimination and to the entitlement of all persons to enjoy the full range of human rights and fundamental freedoms,” said Janson. Canada’s Leslie Norton at the ILO Canada’s Leslie Norton, speaking on behalf of 37 countries largely from Europe, Latin America and North America, said that the programme and budget document provides the framework for ILO staff to advance its work, and that “groups in the most vulnerable situations must be recognised and named”. “This includes those discriminated on the grounds of their sexual orientation and gender identity,” added Norton. “LGBTI persons disproportionately experience violence, harassment, discrimination, and exclusion throughout the employment cycle, from education to access to the labour market, conditions of work and security of employment,” she noted. “The ILO is a UN organisation with social justice and rights at its centre, including the universally accepted fundamental principle on the Elimination of Discrimination in Employment, particularly for those who are historically or disproportionately discriminated against.” The 37 countries would not accede to the removal of references to LGBTI people as this would be a “regression” that would “compromise on the key mandate of the ILO to promote the elimination of discrimination on any grounds, including on the grounds of sexual orientation and gender identity”, she added. US representative Bathsheba Crocker noted that the ILO’s requested budget increase – the total ask is almost $885m – was “high in nominal terms and we appreciate the office’s efforts to identify additional budgetary efficiencies”. Crocker also expressed the US government’s “unequivocal support for the ILO’s uncontested and universally agreed mandate to promote the elimination of discrimination in employment for all workers as a fundamental right and principle at work”, and that this mandate “is inclusive of any grounds for discrimination, including on the basis of sexual orientation, gender identity and expression and sex characteristics”. The ILO’s Director-General, Gilbert Houngbo from Togo, the first African to hold this position, thanked delegates for passing the budget, noting that despite “intense discussions”, delegates “did come together”. Ironically, the budget was passed shortly before the start of the ILO’s World of Work Summit that is themed “social justice for all”. Heightening global tension over LGBTQ rights Many UN agencies have experienced deadlocked over LGBTQ issues in recent years. For example, at last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. The standoff resulted in an unprecedented vote on the guide. Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Pharma Shares COVID-19 Voluntary Licensing Lessons Amid Debate Over Best Path to Access Pandemic Products 15/06/2023 Megha Kaveri Business leaders and experts from pharmaceutical companies across the world shared their experiences in voluntary licensing during the COVID-19 pandemic. One of the most intense debates in the pandemic accord negotiations is over how to fast-track the development and equitable rollout of vaccines and medicines, with pharmaceutical companies insisting that any infringement on intellectual property (IP) rights will stifle innovation and that voluntary arrangements are the way forward. A recent event to showcase voluntary licensing arrangements during the COVID-19 pandemic was organised by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). It brought a range of pharma companies and their licensees, including MSD and licensee Dr Reddy’s Laboratories, Gilead and Ferozsons Laboratories, Pfizer and Biovac, and Johnson & Johnson and its licensee, Aspen Pharmacare. The panellists expanded on how they voluntarily collaborated with each other and with governments across the world despite lockdowns and supply chain breakages – in an evident rebuttal to their critics who have cast IP rights as a key barrier to more equitable medicines access, saying that IP sharing must be mandatory, not voluntary, in future crises. Expedited innovation – in difficult conditions Since the beginning of the COVID pandemic, a total of 59 vaccines and 44 therapeutics have been approved, said Rasmus Hansen, CEO and founder of the global health analytics firm Airfinity. In addition, 177 collaborations were created to manufacture and commercialise COVID-19 treatments, including 93 voluntary licensing agreements for COVID-19 treatments. Of the 93 voluntary licensing agreements, 84 are currently active, including 80 in developing countries. Manufacturing agreements for therapeutics and vaccines were signed in parallel during the COVID-19 pandemic. (Source: Airfinity) “What we are finding here is pretty much all of the manufacturing announcements involved some kind of collaboration,” Hansen remarked. “I remember we looked at the numbers week on week, and were really astonished to see the output coming from the manufacturers at that point.” Voluntary licensing facilitated swift action The COVID-19 pandemic laid the existing inequity in access to vaccines and therapeutics threadbare. While high-income countries were able to enter into advance purchase agreements with big pharma companies long before the vaccines were ready, low and middle-income countries were forced to navigate arrangements for the local production of new vaccines and medicines that had been developed by the large pharma innovators. South Africa’s Aspen Pharmacare collaborated with Johnson & Johnson to manufacture its COVID-19 vaccine under the name “Aspenovax”, for instance, while Biovac partnered with Pfizer to manufacture mRNA vaccines. “The J&J vaccine was the one that was demonstrating the best prospects for Africa, given Africa’s idiosyncrasies, geographic supply chain and otherwise. We got into discussions with J&J and we were able to move very swiftly to concluding an agreement,” explained Stavros Nicolaou, Aspen’s group senior executive for strategic trade. Aspen was attractive to established companies, said Nicolaou, because of its “strong track record and also a blueprint in the form of voluntary licensing and technology transfers that existed already” as well as two decades of experience. The technology transfer was completed five and a half months after the agreement was signed in December 2021, which was “not an easy task given the severe lockdowns” at that stage. “It’s not like J&J colleagues could jump on a plane and, and travel down south and inspect facilities and do audits,” Nicolaou pointed out, adding that Aspen staff worked 24/7 doing on-camera audits “to give certainty and assurance around quality, safety and efficacy of our manufacturing”. Political complications However, due to a lack of demand for COVID-19 vaccines as the pandemic evolved and the company getting caught in the middle of a political crossfire between Africa and Europe that delayed production, Aspen Pharmacare did not sell a single vial of the vaccine, as reported previously by Health Policy Watch. The political storm revolved around millions of J&J vaccines being produced in Aspen that were due for export to Europe at a time when only 7% of South Africans were vaccinated. South Africa’s President Cyril Ramaphosa intervened, appealing to the Europe Commission head Ursula von der Leyen to prevent this and by September, European countries had agreed to return the J&J vaccines produced by Aspen for distribution in Africa. “There was a standoff between Europe and the African Union in terms of where these vaccines would finally land,” Nicolaou explained at a previous webinar organised by Brown University. “And it took quite significant negotiating and eventually, an agreement was settled between the EU and Africa for some of these vaccines, initially 60% and eventually 90%, to be retained on the African continent.” Therapeutics partnerships Later in the pandemic, as therapeutics also came online, Indian firm Dr Reddy’s Laboratories entered into a licensing agreement with the US-based MSD for the production of the antiviral drug molnupiravir, in January 2022. A Pakistani company, Ferozsons Laboratories Limited, also partnered with the US-based Gilead Sciences to manufacture Remdesivir. Both agreements were signed as voluntary licenses and as part of a long-term collaboration between these companies. Vignesh Shivnath, director of business development alliance management at Dr Reddy’s Laboratories. Despite bitter criticism that developing country markets still got access to such drugs much later and in far more limited quantities, the voluntary partnerships helped to build the capacity of firms in the global south to produce new forms of treatment, panelists said. For instance, early engagement and a bilateral partnership with MSD helped Dr Reddy’s Laboratories mobilise the materials needed to manufacture molnupiravir swiftly, said Vignesh Shivnath, the company’s director of business development alliance management. Dr Reddy’s Laboratories was one of eight generic manufacturers chosen by MSD for establishing bilateral manufacturing agreements. “The direct agreements with Gilead helped us to ramp up technology transfers, quality control and manufacturing roll-out at breakneck speed,” said Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited, about his company’s partnership for the production of remdesivir in Pakistan. Osman Khalid Waheed, CEO of Ferozsons Laboratories Limited (left) and Hemal Shah, Director for Public Policy at Gilead. “I think it was 6 May 2020, when Gilead first reached out to us, and within a week, we had an agreement. Within 12 weeks of that, we were able to start rolling out the product, and sharing information on production and quality control with our partners around the world,” said Waheed. Under the looming shadow of the pandemic accord Referring to the latest draft text of the pandemic accord, Thomas Cueni, IFPMA Director-General, said that he is concerned that, should IP protections for innovative drugs and vaccines be weakened, there is a risk that more “unlicensed, substandard, low quality and counterfeit” drugs and vaccines might be produced in the next pandemic. The risk that new drugs and vaccines might enjoy weakened IP protections could also stymie investments in health tools that would be needed to confront the next pandemic, he warned. “In terms of the pandemic treaty, I have to admit, I’m deeply concerned that the zero-draft is potentially undermining innovation,” Cueni said. Member states of the World Health Organization (WHO) are currently in the process of negotiating a binding instrument for pandemic preparedness, prevention and response. At the Intergovernmental Negotiating Body’s (INB) sessions this week in Geneva, African countries criticised the latest draft text, produced by a guiding body of six member states called the “Bureau”. They called it “weak”, especially in matters concerning equity. “The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table… “However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realization of equity,” Ethiopia said, on behalf of the 47 countries in Africa. Additional reporting by Kerry Cullinan. Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Eight Killed and 18 Injured in Attacks on Sudan’s Healthcare System 15/06/2023 Megha Kaveri Violence erupted between a paramilitary group and the armed forces in Khartoum on 15 April 2023. There have been 46 attacks on Sudan’s healthcare infrastructure during which eight people have been killed and 18 injured, and two-thirds of the hospitals in affected areas are closed as a result of the heightened attacks, the World Health Organization (WHO) said. Clashes erupted in mid-April in Khartoum between the country’s armed forces and a paramilitary group, Rapid Support Forces (RSF), headed by General Mohamed Hamdan Dagalo, currently deputy leader of the country’s Sovereign Council. The RSF appeared to attempt to stage a coup following conflict over the planned integration of the RSF into the Sudanese army. “Overall, the greatest public health risks remain the ongoing violence resulting in trauma injuries, major disruptions to health care and repeated attacks on the health system, and poor access to clean water, sanitation and food, increasing the risk of malnutrition and water- and vector-borne diseases,” said the WHO in its first situation report on the conflict. “According to the Preliminary Committee of Sudan Doctor’s Trade Union, 67% (60 out of 89) of all main hospitals in affected areas were out of service as of 31 May,” the report pointed out. “The 29 hospitals operating fully or partially (some providing emergency medical services only) are at risk of closure due to shortage of medical staff, supplies, water, and electricity.” Among the healthcare assets compromised in the violence are the National Public Health Laboratory, and the Federal Ministry of Health’s National Medical Supply Funds Warehouse. Condemning the continued attacks on healthcare facilities, workers and assets, the WHO urged the parties in the conflict to uphold ceasefire agreements, in order to “guarantee the safety of humanitarians and safe passage of humanitarian aid in the country as well as protection of health workers and health facilities to ensure health facilities remain functional and accessible, and supplies are delivered without impediment so the population can receive the health care they need and deserve”. Since 15 April, 866 people have been killed across the country, and over 6000 people have been injured. At least a million people had fled, including over 250,000 people who have taken refuge in neighboring countries. The WHO had earlier flagged the occupation of the National Public Health Laboratory, which housed a wide variety of chemical and biological materials, and disease pathogens, and added that it was conducting risk assessment around the situation. The agency added that the revised Sudan Humanitarian Response Plan (HRP) needs $2.6 billion to help the people in Sudan and that 24.7 million people were in need of humanitarian aid. WHO’s Contingency Fund for Emergencies (CFE) has released $3.6 million towards emergency response in the region, days after violence erupted. On 21 May, the RSF and the Sudanese military agreed to a seven-day ceasefire agreement in Jeddah to allow delivery of humanitarian aid to the affected people in Khartoum and regions torn by violence. Although the warring parties agreed to extend the ceasefire by another five days, intense clashes were reported in Khartoum a day after the extension was agreed upon. Image Credits: UN Human Rights. Posts navigation Older postsNewer posts