Contraception Use Soars Despite Cuts in Donor Funds 25/01/2023 Kerry Cullinan Dr Samukeliso Dube, FP2030 executive director. In the past year alone, women’s use of contraception in 82 low- and lower-middle-income countries has averted more than 141 million unintended pregnancies, 29 million unsafe abortions and almost 150,000 maternal deaths. This is according to the global family planning partnership, FP2030, which released its 2022 Measurement Report on Wednesday. Today, 371 million women of reproductive age are using modern contraception – an increase of 87 million over the past decade, according to the report. The biggest increase in contraceptive use is in sub-Saharan Africa, where there has been an increase of over 6% in the past decade, to cover 23% of women and girls of reproductive age. “The past ten years have been full of obstacles for country health systems – wars, political upheavals, natural disasters, deadly disease outbreaks, and lately the COVID-19 pandemic – yet through it all, women everywhere have continued to seek out and use modern contraception in ever-growing numbers,” said Dr Samukeliso Dube, FP2030 executive director. “What our latest report shows is just how unstoppable the demand for modern contraception is,” she added. “Women want to control whether and when to have children, and how many children to have.” in sub-Saharan Africa, young married women aged 15-24 relied on methods such as injections and pills obtained from government facilities, while most unmarried sexually active women in the same age group relied on condoms from private health sources. Globally, there has been “a steady shift towards long-acting and reversible contraception”, according to FP2030’s Jason Bremner. Today, implants are the most common method in 10 sub-Saharan African countries and the second most common method in another 14. Between 2012 and 2018, the use of implants in Benin, Guinea, and Mali more than doubled among unmarried sexually active women aged 15-24, and today more than one in five unmarried sexually active contraceptive users in these countries are using implants. Funding flatlining However, the report shows that donor funding for family planning is not keeping up with the growing demand for modern contraception. In 2021, donor government funding totalled approximately US$1.4 billion, which was substantially lower US$1.52 billion received in 2019. The US remains by far the biggest funder of family planning, making up over 41% of the $1.39 billion in bilateral disbursements in 2021. The UK has reduced its contribution the most, and now contributions little over 11%. The Netehrlands is now the second biggest donor, contributing 13,7%. “Failing to adequately fund family planning efforts would be a missed opportunity for millions of women,” said Dr Dube. “We need not only to hold the line but also to secure new funding to accommodate the surge in demand for family planning. The hard-won gains of the last 10 years could slip away if we don’t act now.” “There are still 50 million women who report using a traditional method, such as rhythm and withdrawal,” according to Bremner, adding that they should be offered the opportunity to use a more modern and reliable form of contraception. Tanzanian Scientists Study Mosquitoes’ Mating Behaviour to Control Malaria 25/01/2023 Kizito Makoye A resident of Ifakara tucked into a mosquito net. IFAKARA, Tanzania – When you think of malaria, a swarm of mosquitoes flying against an orange sunset is a dangerous sight. As part of their mating ritual, the dreaded bloodsuckers brazenly hover for 30 minutes, males adroitly flapping their slender wings to produce a sound that lures female partners to join them. The mosquito proliferation that results from this harmonic mating song ensures a grim reality for farmers in Tanzania’s Mchombe Village, who struggle with bouts of malaria. Locals in this impoverished village use all the ammunition at their disposal to fight the deadly insects, whose population keep rising. At dusk, they routinely shut down windows, burn piles of fresh eucalyptus leaves to produce scented smoke to chase away the mosquitoes and, most importantly, get under their bed nets to sleep. “Malaria is a big problem here. The mosquitoes reproduce themselves in large numbers,” said Amina Jaka, a paddy farmer at Mchombe Village. The 28-year-old mother of four children, says mosquitoes are ubiquitous due to the presence of stagnant ponds of water, and her children struggle to sleep through the night because of them. Clever insects Jaka, who has witnessed two malaria deaths in the village in the past few weeks, is increasingly worried about her children and makes sure they are tucked under mosquito nets even they sleep in the afternoon. “Mosquitoes are very clever insects. You simply don’t know when they will bite you,” she said. Msombwa villagers, who had considered themselves exempt from malaria after a mammoth government-led anti-malaria campaign in the village two years ago, are baffled by the rising number of mosquitoes in recent months. Nestled on the lower echelons of the Kilombero River, the village is a hotspot for the Anopheles mosquito, which transmits the plasmodium parasite that causes malaria. Although malaria infections have declined in most parts of Tanzania since 2000 thanks to multiple vector control interventions, including insecticide-treated bed nets, residual spraying and improved diagnostics, the struggle is far from over. Constant innovation Scientists in Tanzania are constantly devising new ways to control the mosquito population. At a research institute run by the Ifakara Health Institute dubbed ‘Mosquito City’ as it’s home to the world’s largest captive colony of mosquitoes, researchers are studying the mating behaviour of mosquitos. Fedros Okumu, a senior entomologist and director of science at the centre, said his team uses cutting-edge approaches to trap, repel and kill mosquitoes when mating. “One of the most interesting experiments we have done is to study the mating behaviour of malaria mosquitoes,” he told Health Policy Watch. “Male mosquitoes usually fly to their favourite mating places to begin a ritualistic flight dance [at sunset], drawing in females,” Okumu said, adding that a male would then identify and pursue a flying female by detecting her flight sound. “If the male can’t properly hear the female then the chase fails and they don’t mate,” he said. Although mosquitoes’ romances sound like a trivial matter, researchers say it is a rare opportunity to kill the malaria-causing insects. A doctor at Ifakara district hospital treating a malaria patient In 2021 there were approximately 247 million cases of malaria worldwide with about 619,000 deaths, according to World Health Organisation (WHO). The WHO Africa region carries the heaviest global malaria burden. In 2021 the continent was home to 95% of malaria cases and 96% of deaths, with children under five accounting for about 80% of the deaths. At Mosquito City, scientists are studying the Anopheles funestus mosquito, which is responsible for 90% of malaria cases in the region. “This is a least understood species of mosquitoes because it is extremely difficult to raise in a laboratory environment,” Okumu said. There are 3500 known species of mosquitoes of which 400 belong to Anopheles family, and only 50 to 70 of them can transmit malaria to humans, he said. In Africa, malaria parasites are transmitted by the Anopheles gambiae, funestus, arabiensis and colluzzi species. “Effective malaria control can be achieved when we identify, understand and target just one or two anopheles species instead of trying to kill all mosquitoes,” he said. Recent gains in the fight against malaria have been attributed particularly to the use of insecticide-treated bed nets . Since 2000, over two billion insecticide-treated nets have been delivered to malaria-endemic countries including Tanzania. This rapid scale-up has been by far the largest contributor to the impressive drops seen in malaria incidence since the turn of the century, according to WHO. But in the last two decades, analysts say their effectiveness is increasingly being compromised by the emergence and spread of insecticide resistance and increasing outside exposure to mosquito bites. Genetically modified mosquitos Scientists globally are now working to better understand the overall ecology of mosquitoes as the malaria vector and how the changing landscape will affect the mosquito population in the future. One such innovation is to create genetically modified mosquitoes under lab conditions, which, upon mating with wild mosquitoes, produce offspring that are incapable of further reproduction or transmitting malaria to humans. However, malaria researcher Zul Premji said past efforts to ensure the genetic control of mosquitoes using the sterile-insect technique have been less successful than expected due to low competitiveness between sterile and wild males. “Many mosquito species can be cultured in large numbers under controlled conditions, but due to genetic selection and loss of natural traits, such insects may behave differently from their wild siblings,” Premji told Health Policy Watch. However, the seasoned researcher is confident that laboratory cultures and subsequent genetic transformation of target mosquito species may result in insects with widely different mating behaviours compared to their wild siblings. But Jaka and fellow villagers are sceptical about whether a genetically modified species will make any difference. To them, what matters to prevent malaria is the provision of free insecticide bed nets, and repellents, quality diagnostics at local hospitals and the availability of antimalarial drugs. Image Credits: Peter Mgongo. Too Early to Decide on Annual COVID-19 Boosters as Virus Has No Seasonal Pattern Yet 24/01/2023 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus While the World Health Organization’s (WHO) emergency committee on COVID-19 will decide this week whether the virus still constitutes a global health emergency, the body’s Director-General, Dr Tedros Adhanom Ghebreyesus, is “very concerned” about the pandemic. “While I will not pre-empt the advice of the emergency committee, I remain very concerned by the situation in many countries and the rising number of deaths,” Tedros told a media briefing on Tuesday. He described the global COVID-19 response as being “under strain” with too few vulnerable people adequately vaccinated, too many people behind on their boosters, antivirals remaining too expensive, fragile health systems struggling with COVID-19 and other diseases, alongside a “torrent of pseudoscience and misinformation”. “My message is clear. Do not underestimate this virus. It has and will continue to surprise us,” Tedros warned. Dr Joachim Hombach, executive secretary of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) agreed: “For the time being, COVID hasn’t really come down to the usual seasonal seasonality that we see for other viruses. The virus is still fairly unstable so it is a bit of anticipation if we end up in a seasonal pattern as we have it for instance for influenza.” “It is conceivable that annual vaccination would be suitable. You basically have to find the sweet spot between waning immunity and the benefit and the effort of providing an additional vaccination,” said Hombach. Dr Joachim Hombach, executive secretary of the WHO Strategic Advisory Group of Experts on Immunization (SAGE). Meanwhile, Dr Maria van Kerkhove, WHO’s lead on COVID-19, said that there were “a lot of uncertainties in terms of what is circulating in our ability to assess them”, given that surveillance of the virus had dropped substantially. Funding appeal for emergencies Tedros also appeal for an additional $2.5 billion to assist the WHO to address 54 health crises around the world, 11 of which are classified as Grade 3, WHO’s highest level of emergency. “The number of people in need of humanitarian relief has increased by almost 25% compared with last year, to 339 million people, and 85% of humanitarian needs globally are driven by conflict.,” said Tedros. “The world cannot look away and hope these crises resolve themselves.” WHO Executive Board focus on resources The key issues to be discussed at next week’s WHO’s executive board meeting, involve money and resources, according to Dr Tim Armstrong, WHO’s director of the department of governing bodies. Armstrong’s top three issues from over 40 agenda items are the new programme budget for 2024/25, sustainable financing and an enhanced central role for the WHO in the global health architecture, particularly to support member states during health emergencies. The board meeting starts next Monday, 30 January. Better surveillance of contaminated medicines Dr Hanan Balkhy Tedros called on governments to ensure better surveillance of medicines following “incidents of contaminated cough syrups for children”. While the WHO had issued medical alerts focused on the Gambia (last October), Indonesia (last November) and Uzbekistan this month, “at least seven countries have been affected”, said Tedros. “Most of the [over 300] deceased have been children under the age of five. These contaminants are toxic chemicals used as industrial solvents, and antifreeze agents that can be fatal even in small amounts,” he said. This week, the WHO issued an “urgent call for countries manufacturers and suppliers to do more to prevent detect, and respond quickly to contaminated medicines,” said Tedros. “Governments must increase surveillance so they can detect and remove from circulation any substandard medicines identified in the WHO medical alerts. They must also enforce illegal measures to help stop the manufacture, distribution and use of substandard and falsified medicines. “Manufacturers must purchase pharmaceutical grade ingredients from qualified suppliers and conduct comprehensive testing before using them.” Meanwhile, Assistant Director-General Dr Hanan Balkhy, said the WHO was appealing to governments and specifically the regulatory authorities to ensure that they “have proactive surveillance mechanisms to be able to detect the presence of these medications”. Balkhy, who oversees Antimicrobial Resistance and is Acting interim Assistant Director-General for Medicines and Health Products, said that while contamination would always be an issue in the production of medicine, the WHO’s “ask” was that member states strengthen the capacity of their regulatory authorities’ oversight capacity. Brazil to Call for Protection of Indigenous People’s Health After Bolsonaro ‘Abandonment’ During COVID-19 24/01/2023 Kerry Cullinan The new Brazilian government under President Lula da Silva intends to propose that the World Health Organization (WHO) addresses the health of indigenous people systematically, including by training indigenous health workers. Santiago Alcazar, the former head of WHO in Brazil, told a discussion convened by the Geneva Global Health Hub (G2H2) on Monday that Brazil would propose that the WHO establish a project on indigenous people’s health at the body’s executive board meeting, which starts this weekend. Alcazar was addressing a G2H2 discussion on authoritarianism in a pandemic, which focused on the judgement of the Permanent People’s Tribunal (PPT) that former Brazilian president Jair Bolsonaro was “liable for crimes against humanity” during the COVID-19 pandemic. Indigenous peoples, Black people, and quilombola (descendants of escaped slaves) were worst affected by the Bolsanaro administration’s “rejection of isolation, social distancing, [COVID] prevention, and vaccination”, according to the PPT, which was set in 1979 up to expose human rights violations of ordinary people worldwide. “Contrary to the unanimous position of scientists around the world and WHO recommendations, Bolsonaro not only ensured that the Brazilian population did not adopt the planned measures to limit the infection but repeatedly created various obstacles to them, frustrating his own government’s attempts to protect the population from the virus,” according to the PPT judgement. Bolsonaro is infamous for declaring during the pandemic: “Everyone has to die one day. We have to stop being a country of sissies.” During the height of the pandemic, there were reports of people being buried in mass graves in the Mannaus in the Amazon as graveyards struggled to cope with the death toll. In June 2020, as the death toll soared, Bolsonaro’s government simply stopped publishing statistics on COVID-19 infections and deaths. You will find more infographics at Statista ‘Genocidal weaponisation of COVID’ G2H2 co-chair Nicoletta Dentico, who was part of the PPT jury that heard evidence against Bolsonaro, said that the tribunal had drawn global attention to Bolsonaro’s “genocidal weaponization of COVID”. Dentico indicated that having public hearings was one of the few tools that civil society could use against authoritarian governments during a pandemic. PPT secretary Gianni Tognoni told the meeting that the Commission for the Defense of Human Rights Dom Paulo Evaristo Arns, the Articulation of Indigenous Peoples of Brazil (Apib), the Black Coalition for Rights, and Public Services International (PSI) has requested the hearing. They argued that Bolsonaro and his government “intentionally spread COVID-19”, causing an estimated 480,000 unnecessary deaths that “mainly affected the indigenous population, people of colour, and health workers”. Brazilian human rights lawyer Eloisa Machado said that the Bolsonaro government had a “deliberate project to disseminate COVID-19”, yet the country’s general prosecutor, aligned with the former president, had not been interested in investigating any criminal activity. “There was an explicit recommendation to follow recommendations that were not medically endorsed, there was a resistance to adopting measures to reduce the circulation of people and there was also an explicit ruling against using masks,” said Machado. Outrageous claims “States and municipalities also did not have the financial resources to fight against COVID-19, there was negligence in the purchase of vaccines and there was a lack of vaccination campaign,” said Machado. While a parliamentary commission found that Bolsonaro was propagating the pandemic by failing to implement preventive measures, the conditions in the country were not conducive to openly challenging the “democratically elected dictator”, added Machado. There was court action against some of Bolsonaro’s more outrageous claims – such as that a person could get AIDS from the COVID-19 vaccine – but nothing to expose the systemic way in which he pursued a deliberate policy of mass COVID-19 infection instead of trying to protect people. As a result, civil society organisations opted to approach the PPT for a hearing to show that there had been a systemic policy that had particularly affected the country’s most vulnerable people. “We’re confident that the judicial interpretation of the PPT ruling will be able to be used to bring justice, aside from this occurring in a symbolic realm,” said Machado, stressing that civil society is adamant that there should be no amnesty for the crimes against indigenous populations committed during the pandemic. State of emergency in Yanomami Alcazar, who now works for the Fiocruz Foundation, said that indigenous communities had been abandoned during COVID-19. Last week, the government declared a state of emergency in Yanomami territory, Brazil’s largest indigenous territory, in reaction to severe malnutrition. During Bolsanaro’s reign, illegal gold miners have been operating freely in the area, often clashing violently with local people, and the health system has been neglected. “Brazil has 2.7% of the world’s population but it has 11% of deaths due to COVID,” said Alcazar, adding that this was not just a result of incompetence but “evil intent”. Image Credits: Aljazeera. Five Billion People Exposed to Industrially Produced Trans Fats 23/01/2023 Stefan Anderson Policies to eliminate industrially produced trans fats are relatively simple to implement, and can save lives and economies. Five billion people around the world have no protection against industrially produced trans fats (ITFAs), putting them at risk of heart disease and death, the World Health Organization said. ITFAs are responsible for over 500,000 premature deaths from coronary heart disease every year. Commonly found in baked goods, cooking oils, and packaged foods, ITFAs are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. “Take any liquid oil and bubble hydrogen through it, and that makes it more solid,” Dr Tom Frieden, CEO of Resolve to Save Lives said at a WHO press conference announcing the launch of the report. “That’s pretty good for baking. Unfortunately, it’s also solid in your coronary arteries.” The WHO first called for the worldwide elimination of ITFAs in 2018. Best-practice policies have gained significant traction since, protecting 2.8 billion people globally – a six-fold increase – but the WHO target for the total elimination of trans fats by 2023 is “unattainable,” the report said. Momentum for banning ITFAs has grown, but the world still has “a long way to go,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. Most legislation policing ITFAs has been implemented by high-income nations, with the Americas and Europe taking the lead. The European Union successfully banned all ITFAs from its food supply in 2021, and nearly 80% of people living in high-income countries are protected by what the WHO considers best-practice policies. Four countries – Bangladesh, India, the Philippines and Ukraine – account for all 51% of people covered by best-practice policies in lower-middle income countries, with India representing 41% of that total. While 62 countries have implemented laws to ban ITFAs, covering 46% of the global population, no one living in low-income countries enjoys any legislative protections. “Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.” The tobacco of the food industry No one living in low-income countries is protected from trans fats, putting them at risk of its devastating health effects. Unlike sugar, sodium, or saturated fats, ITFAs are not naturally occurring in any food group. While sugar and sodium can pose serious health risks, their omnipresence in foods people around the world rely on every day makes a ban both impossible and impractical. A ban on nutrients like sugar and sodium is also unnecessary, as their adverse health effects can be managed through light-touch regulation paired with dietary guidelines and recommendations. But ITFAs are produced industrially and injected into the food supply, and can be easily replaced by healthier alternatives like vegetable oils. Experts say this makes their total elimination an easy decision for governments. “It’s very rare for us in the nutrition space to be able to say it’s just so bad,” said Dr Rain Yamamoto, a scientist at the WHO’s department of nutrition and food safety. “There are no health benefits whatsoever.” While significant progress has been made in the fight against ITFAs in recent years, nine of the 16 countries facing the highest estimated burden of trans fat-induced coronary heart disease deaths do not have best-practice policies in place. These include Australia, Egypt, Pakistan, Iran, and South Korea. WHO also emphasized the cost of falling behind the regulatory wave for countries not currently facing a high burden from ITFAs. As more economies become off-limits to industrial producers of trans fats, countries unprotected by legislation policing ITFAs face the prospect of companies dumping products into their food supplies. This is particularly concerning given the lack of any legislation in low-income nations regulating ITFAs. “If it’s not present, then there’s no harm in banning it and preventing other countries from dumping products into your country,” Frieden said. “Think of artificial trans fats as the tobacco of nutrition. It has no valid use.” Today, 62 countries have implemented bans on ITFAs. Denmark leads the way Studies suggesting that trans fats could be a cause of the large increase in coronary artery disease were penned as early as 1956, but it would take until the early 1990s for renewed scientific scrutiny to confirm their negative health impacts. The findings spurred Denmark to begin enacting policies to cut ITFAs out of the country’s food supply in 1991. What began as mandatory labelling and nutritional education policies evolved into a political and social pressure on companies to phase out ITFAs from their products in the decades that followed. By the time Denmark became the first country in the world to pass a total ban on ITFAs in 2007, consumption had already been cut by some 90% since 1991. A 2022 study found the policies substantially reduced coronary heart disease mortality, preventing an estimated 1,200 deaths by 2007. The 11% reduction in mortality observed over that period is similar to the contribution from decreases in smoking rates. National legislative bans on ITFAs following Denmark’s lead by Iceland, Austria, and Switzerland, have also proven to be extremely effective. “There’s really no alternative to governmental action,” Frieden said, adding that proper enforcement mechanisms are critical to ensuring industry takes action to eliminate trans fats. Globally, legislation to remove ITFAs from foods is seen as one of the most potent public health measures for reducing non-communicable disease burdens emphasized by WHO in the Sustainable Development Goals to reduce premature deaths from NCDs by 30% by 2030. In the absence of legislation, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on companies to pull their weight. “I call on the food industry to help us make up for lost time by replacing industrially produced trans-fatty acids with healthier oils,” Tedros said. “If they so choose, these companies could have an almost unparalleled impact on global health.” China Downplays COVID Threat from Lunar New Year Travel 23/01/2023 Kerry Cullinan Although some experts predict that the past weekend’s celebrations of China’s lunar new year will hasten the spread of COVID-19 to rural parts of the country, one of the country’s top scientists has disputed this. Wu Zunyou, China Centre for Disease Control and Prevention’s chief epidemiologist, downplayed the risk on the Chinese social media platform, Weibo, claiming that 80% of Chinese people had already been infected before the week-long celebrations. Chinese rejoice in first holiday after COVID response change Festivities, which were curtailed by the COVID-19 epidemic, are back in full force after a downgrade in #China's COVID-19 management strategy earlier this month. #COVID19 #chinesenewyear2023https://t.co/tCqVVnuhRe pic.twitter.com/JpNeLD2PHs — China.org.cn (@chinaorgcn) January 22, 2023 On this past Sunday, international travel restrictions in and out of China were lifted, while lockdowns and other measures to curb domestic travel have also been lifted in past weeks, enabling many people to travel to see their families in rural areas for the first time in three years. A direct flight from China landed at Indonesia’s resort island of Bali on January 22, 2023, the first time since the route was suspended due to Covid-19. pic.twitter.com/xLp94zZm42 — South China Morning Post (@SCMPNews) January 23, 2023 Global health analytics company Airfinity said last week that it had “updated its cases and deaths forecast for China’s COVID-19 outbreak as the lunar new year holiday hastens the spread of the virus”. It had initially predicted two COVID waves, but Airfinity’s analytics director Dr Matt Linley said that it “now expects to see one larger and more prolonged wave with infections reaching a higher peak”. Airfinity’s new model predicts that, between 1 December 2022 when restrictions were lifted, and 17 January 2023, 99.5 million people were infected (up from its December prediction of 72.9 million). This squares with Wu Zunyou’s assertion about mass infections happening before the new year celebrations. Airfinity COVID-19 predictions for China, 1 December 2022 – 1 April 2023 Linley warned that provinces such as Hubei and Henan “could see patient demand for intensive care beds being six times hospital capacity”, and that there would be .”a significant burden on China’s healthcare system for the next fortnight”. However, unlike China’s very low official mortality data, Airfinity’s new model estimates daily deaths to have been 32,200 by 17 January with cumulative deaths from 1 December 2022 to 17 January to be 608,000. “Deaths are forecast to peak at 36,000 a day on 26 January during the lunar new year festival. This is up from our previous estimate of deaths peaking at 25,000 a day,” said Aifinity. It warned that one larger wave as opposed to two smaller ones meant “increased pressure on hospitals and crematoriums and therefore also potentially a higher case fatality ratio”. Meanwhile, the full extent of COVID-19’s impact is unlikely to surface after Chinese authorities announced an internet crackdown on people spreading “false information” and “gloomy sentiments” about COVID-19 for a month around the new year festivities, according to The Guardian. Previously, social media has been filled with stories about families reporting on relatives’ infections and their struggles to get Pfizer’s anti-viral medicine, Paxlovid, the black marker price of which has soared. Paxlovid is not covered by Chinese medical insurance because of its high price. A Kickstart Towards Health Care ‘Ecosystems’ 20/01/2023 John Heilprin Participants in a private Davos panel discussion on building better health ‘ecosystems’ to solve the health challenges of tomorrow Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond. DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed. The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background. “I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States. “Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.” Dhivya Venkat, left, and Seema Kumar, right, listen as Dr Victor Dzau speaks at a private Davos panel discussion on building better health “ecosystems” Building access and equity from the start into health care ‘ecosystems’ Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed. “We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson. “We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.” Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company. Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach. “We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate. Beth Thompson participates in a private Davos panel discussion on building better health “ecosystems” Health care ‘ecosystems’ puzzle needs diversity of data Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further. “Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.” DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services. “You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach. “We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.” But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data. “That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza. “And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.” Rick Bright, Daniella Foster, and Francis deSouza, left to right, participate in a private Davos panel discussion on building better health ‘ecosystems’ Post-pandemic health care ‘ecosystems’ approaches More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020. “We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing. “We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation. “And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?” Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care. “What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?” During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines. Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week. “We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked. Image Credits: John Heilprin. Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
Tanzanian Scientists Study Mosquitoes’ Mating Behaviour to Control Malaria 25/01/2023 Kizito Makoye A resident of Ifakara tucked into a mosquito net. IFAKARA, Tanzania – When you think of malaria, a swarm of mosquitoes flying against an orange sunset is a dangerous sight. As part of their mating ritual, the dreaded bloodsuckers brazenly hover for 30 minutes, males adroitly flapping their slender wings to produce a sound that lures female partners to join them. The mosquito proliferation that results from this harmonic mating song ensures a grim reality for farmers in Tanzania’s Mchombe Village, who struggle with bouts of malaria. Locals in this impoverished village use all the ammunition at their disposal to fight the deadly insects, whose population keep rising. At dusk, they routinely shut down windows, burn piles of fresh eucalyptus leaves to produce scented smoke to chase away the mosquitoes and, most importantly, get under their bed nets to sleep. “Malaria is a big problem here. The mosquitoes reproduce themselves in large numbers,” said Amina Jaka, a paddy farmer at Mchombe Village. The 28-year-old mother of four children, says mosquitoes are ubiquitous due to the presence of stagnant ponds of water, and her children struggle to sleep through the night because of them. Clever insects Jaka, who has witnessed two malaria deaths in the village in the past few weeks, is increasingly worried about her children and makes sure they are tucked under mosquito nets even they sleep in the afternoon. “Mosquitoes are very clever insects. You simply don’t know when they will bite you,” she said. Msombwa villagers, who had considered themselves exempt from malaria after a mammoth government-led anti-malaria campaign in the village two years ago, are baffled by the rising number of mosquitoes in recent months. Nestled on the lower echelons of the Kilombero River, the village is a hotspot for the Anopheles mosquito, which transmits the plasmodium parasite that causes malaria. Although malaria infections have declined in most parts of Tanzania since 2000 thanks to multiple vector control interventions, including insecticide-treated bed nets, residual spraying and improved diagnostics, the struggle is far from over. Constant innovation Scientists in Tanzania are constantly devising new ways to control the mosquito population. At a research institute run by the Ifakara Health Institute dubbed ‘Mosquito City’ as it’s home to the world’s largest captive colony of mosquitoes, researchers are studying the mating behaviour of mosquitos. Fedros Okumu, a senior entomologist and director of science at the centre, said his team uses cutting-edge approaches to trap, repel and kill mosquitoes when mating. “One of the most interesting experiments we have done is to study the mating behaviour of malaria mosquitoes,” he told Health Policy Watch. “Male mosquitoes usually fly to their favourite mating places to begin a ritualistic flight dance [at sunset], drawing in females,” Okumu said, adding that a male would then identify and pursue a flying female by detecting her flight sound. “If the male can’t properly hear the female then the chase fails and they don’t mate,” he said. Although mosquitoes’ romances sound like a trivial matter, researchers say it is a rare opportunity to kill the malaria-causing insects. A doctor at Ifakara district hospital treating a malaria patient In 2021 there were approximately 247 million cases of malaria worldwide with about 619,000 deaths, according to World Health Organisation (WHO). The WHO Africa region carries the heaviest global malaria burden. In 2021 the continent was home to 95% of malaria cases and 96% of deaths, with children under five accounting for about 80% of the deaths. At Mosquito City, scientists are studying the Anopheles funestus mosquito, which is responsible for 90% of malaria cases in the region. “This is a least understood species of mosquitoes because it is extremely difficult to raise in a laboratory environment,” Okumu said. There are 3500 known species of mosquitoes of which 400 belong to Anopheles family, and only 50 to 70 of them can transmit malaria to humans, he said. In Africa, malaria parasites are transmitted by the Anopheles gambiae, funestus, arabiensis and colluzzi species. “Effective malaria control can be achieved when we identify, understand and target just one or two anopheles species instead of trying to kill all mosquitoes,” he said. Recent gains in the fight against malaria have been attributed particularly to the use of insecticide-treated bed nets . Since 2000, over two billion insecticide-treated nets have been delivered to malaria-endemic countries including Tanzania. This rapid scale-up has been by far the largest contributor to the impressive drops seen in malaria incidence since the turn of the century, according to WHO. But in the last two decades, analysts say their effectiveness is increasingly being compromised by the emergence and spread of insecticide resistance and increasing outside exposure to mosquito bites. Genetically modified mosquitos Scientists globally are now working to better understand the overall ecology of mosquitoes as the malaria vector and how the changing landscape will affect the mosquito population in the future. One such innovation is to create genetically modified mosquitoes under lab conditions, which, upon mating with wild mosquitoes, produce offspring that are incapable of further reproduction or transmitting malaria to humans. However, malaria researcher Zul Premji said past efforts to ensure the genetic control of mosquitoes using the sterile-insect technique have been less successful than expected due to low competitiveness between sterile and wild males. “Many mosquito species can be cultured in large numbers under controlled conditions, but due to genetic selection and loss of natural traits, such insects may behave differently from their wild siblings,” Premji told Health Policy Watch. However, the seasoned researcher is confident that laboratory cultures and subsequent genetic transformation of target mosquito species may result in insects with widely different mating behaviours compared to their wild siblings. But Jaka and fellow villagers are sceptical about whether a genetically modified species will make any difference. To them, what matters to prevent malaria is the provision of free insecticide bed nets, and repellents, quality diagnostics at local hospitals and the availability of antimalarial drugs. Image Credits: Peter Mgongo. Too Early to Decide on Annual COVID-19 Boosters as Virus Has No Seasonal Pattern Yet 24/01/2023 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus While the World Health Organization’s (WHO) emergency committee on COVID-19 will decide this week whether the virus still constitutes a global health emergency, the body’s Director-General, Dr Tedros Adhanom Ghebreyesus, is “very concerned” about the pandemic. “While I will not pre-empt the advice of the emergency committee, I remain very concerned by the situation in many countries and the rising number of deaths,” Tedros told a media briefing on Tuesday. He described the global COVID-19 response as being “under strain” with too few vulnerable people adequately vaccinated, too many people behind on their boosters, antivirals remaining too expensive, fragile health systems struggling with COVID-19 and other diseases, alongside a “torrent of pseudoscience and misinformation”. “My message is clear. Do not underestimate this virus. It has and will continue to surprise us,” Tedros warned. Dr Joachim Hombach, executive secretary of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) agreed: “For the time being, COVID hasn’t really come down to the usual seasonal seasonality that we see for other viruses. The virus is still fairly unstable so it is a bit of anticipation if we end up in a seasonal pattern as we have it for instance for influenza.” “It is conceivable that annual vaccination would be suitable. You basically have to find the sweet spot between waning immunity and the benefit and the effort of providing an additional vaccination,” said Hombach. Dr Joachim Hombach, executive secretary of the WHO Strategic Advisory Group of Experts on Immunization (SAGE). Meanwhile, Dr Maria van Kerkhove, WHO’s lead on COVID-19, said that there were “a lot of uncertainties in terms of what is circulating in our ability to assess them”, given that surveillance of the virus had dropped substantially. Funding appeal for emergencies Tedros also appeal for an additional $2.5 billion to assist the WHO to address 54 health crises around the world, 11 of which are classified as Grade 3, WHO’s highest level of emergency. “The number of people in need of humanitarian relief has increased by almost 25% compared with last year, to 339 million people, and 85% of humanitarian needs globally are driven by conflict.,” said Tedros. “The world cannot look away and hope these crises resolve themselves.” WHO Executive Board focus on resources The key issues to be discussed at next week’s WHO’s executive board meeting, involve money and resources, according to Dr Tim Armstrong, WHO’s director of the department of governing bodies. Armstrong’s top three issues from over 40 agenda items are the new programme budget for 2024/25, sustainable financing and an enhanced central role for the WHO in the global health architecture, particularly to support member states during health emergencies. The board meeting starts next Monday, 30 January. Better surveillance of contaminated medicines Dr Hanan Balkhy Tedros called on governments to ensure better surveillance of medicines following “incidents of contaminated cough syrups for children”. While the WHO had issued medical alerts focused on the Gambia (last October), Indonesia (last November) and Uzbekistan this month, “at least seven countries have been affected”, said Tedros. “Most of the [over 300] deceased have been children under the age of five. These contaminants are toxic chemicals used as industrial solvents, and antifreeze agents that can be fatal even in small amounts,” he said. This week, the WHO issued an “urgent call for countries manufacturers and suppliers to do more to prevent detect, and respond quickly to contaminated medicines,” said Tedros. “Governments must increase surveillance so they can detect and remove from circulation any substandard medicines identified in the WHO medical alerts. They must also enforce illegal measures to help stop the manufacture, distribution and use of substandard and falsified medicines. “Manufacturers must purchase pharmaceutical grade ingredients from qualified suppliers and conduct comprehensive testing before using them.” Meanwhile, Assistant Director-General Dr Hanan Balkhy, said the WHO was appealing to governments and specifically the regulatory authorities to ensure that they “have proactive surveillance mechanisms to be able to detect the presence of these medications”. Balkhy, who oversees Antimicrobial Resistance and is Acting interim Assistant Director-General for Medicines and Health Products, said that while contamination would always be an issue in the production of medicine, the WHO’s “ask” was that member states strengthen the capacity of their regulatory authorities’ oversight capacity. Brazil to Call for Protection of Indigenous People’s Health After Bolsonaro ‘Abandonment’ During COVID-19 24/01/2023 Kerry Cullinan The new Brazilian government under President Lula da Silva intends to propose that the World Health Organization (WHO) addresses the health of indigenous people systematically, including by training indigenous health workers. Santiago Alcazar, the former head of WHO in Brazil, told a discussion convened by the Geneva Global Health Hub (G2H2) on Monday that Brazil would propose that the WHO establish a project on indigenous people’s health at the body’s executive board meeting, which starts this weekend. Alcazar was addressing a G2H2 discussion on authoritarianism in a pandemic, which focused on the judgement of the Permanent People’s Tribunal (PPT) that former Brazilian president Jair Bolsonaro was “liable for crimes against humanity” during the COVID-19 pandemic. Indigenous peoples, Black people, and quilombola (descendants of escaped slaves) were worst affected by the Bolsanaro administration’s “rejection of isolation, social distancing, [COVID] prevention, and vaccination”, according to the PPT, which was set in 1979 up to expose human rights violations of ordinary people worldwide. “Contrary to the unanimous position of scientists around the world and WHO recommendations, Bolsonaro not only ensured that the Brazilian population did not adopt the planned measures to limit the infection but repeatedly created various obstacles to them, frustrating his own government’s attempts to protect the population from the virus,” according to the PPT judgement. Bolsonaro is infamous for declaring during the pandemic: “Everyone has to die one day. We have to stop being a country of sissies.” During the height of the pandemic, there were reports of people being buried in mass graves in the Mannaus in the Amazon as graveyards struggled to cope with the death toll. In June 2020, as the death toll soared, Bolsonaro’s government simply stopped publishing statistics on COVID-19 infections and deaths. You will find more infographics at Statista ‘Genocidal weaponisation of COVID’ G2H2 co-chair Nicoletta Dentico, who was part of the PPT jury that heard evidence against Bolsonaro, said that the tribunal had drawn global attention to Bolsonaro’s “genocidal weaponization of COVID”. Dentico indicated that having public hearings was one of the few tools that civil society could use against authoritarian governments during a pandemic. PPT secretary Gianni Tognoni told the meeting that the Commission for the Defense of Human Rights Dom Paulo Evaristo Arns, the Articulation of Indigenous Peoples of Brazil (Apib), the Black Coalition for Rights, and Public Services International (PSI) has requested the hearing. They argued that Bolsonaro and his government “intentionally spread COVID-19”, causing an estimated 480,000 unnecessary deaths that “mainly affected the indigenous population, people of colour, and health workers”. Brazilian human rights lawyer Eloisa Machado said that the Bolsonaro government had a “deliberate project to disseminate COVID-19”, yet the country’s general prosecutor, aligned with the former president, had not been interested in investigating any criminal activity. “There was an explicit recommendation to follow recommendations that were not medically endorsed, there was a resistance to adopting measures to reduce the circulation of people and there was also an explicit ruling against using masks,” said Machado. Outrageous claims “States and municipalities also did not have the financial resources to fight against COVID-19, there was negligence in the purchase of vaccines and there was a lack of vaccination campaign,” said Machado. While a parliamentary commission found that Bolsonaro was propagating the pandemic by failing to implement preventive measures, the conditions in the country were not conducive to openly challenging the “democratically elected dictator”, added Machado. There was court action against some of Bolsonaro’s more outrageous claims – such as that a person could get AIDS from the COVID-19 vaccine – but nothing to expose the systemic way in which he pursued a deliberate policy of mass COVID-19 infection instead of trying to protect people. As a result, civil society organisations opted to approach the PPT for a hearing to show that there had been a systemic policy that had particularly affected the country’s most vulnerable people. “We’re confident that the judicial interpretation of the PPT ruling will be able to be used to bring justice, aside from this occurring in a symbolic realm,” said Machado, stressing that civil society is adamant that there should be no amnesty for the crimes against indigenous populations committed during the pandemic. State of emergency in Yanomami Alcazar, who now works for the Fiocruz Foundation, said that indigenous communities had been abandoned during COVID-19. Last week, the government declared a state of emergency in Yanomami territory, Brazil’s largest indigenous territory, in reaction to severe malnutrition. During Bolsanaro’s reign, illegal gold miners have been operating freely in the area, often clashing violently with local people, and the health system has been neglected. “Brazil has 2.7% of the world’s population but it has 11% of deaths due to COVID,” said Alcazar, adding that this was not just a result of incompetence but “evil intent”. Image Credits: Aljazeera. Five Billion People Exposed to Industrially Produced Trans Fats 23/01/2023 Stefan Anderson Policies to eliminate industrially produced trans fats are relatively simple to implement, and can save lives and economies. Five billion people around the world have no protection against industrially produced trans fats (ITFAs), putting them at risk of heart disease and death, the World Health Organization said. ITFAs are responsible for over 500,000 premature deaths from coronary heart disease every year. Commonly found in baked goods, cooking oils, and packaged foods, ITFAs are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. “Take any liquid oil and bubble hydrogen through it, and that makes it more solid,” Dr Tom Frieden, CEO of Resolve to Save Lives said at a WHO press conference announcing the launch of the report. “That’s pretty good for baking. Unfortunately, it’s also solid in your coronary arteries.” The WHO first called for the worldwide elimination of ITFAs in 2018. Best-practice policies have gained significant traction since, protecting 2.8 billion people globally – a six-fold increase – but the WHO target for the total elimination of trans fats by 2023 is “unattainable,” the report said. Momentum for banning ITFAs has grown, but the world still has “a long way to go,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. Most legislation policing ITFAs has been implemented by high-income nations, with the Americas and Europe taking the lead. The European Union successfully banned all ITFAs from its food supply in 2021, and nearly 80% of people living in high-income countries are protected by what the WHO considers best-practice policies. Four countries – Bangladesh, India, the Philippines and Ukraine – account for all 51% of people covered by best-practice policies in lower-middle income countries, with India representing 41% of that total. While 62 countries have implemented laws to ban ITFAs, covering 46% of the global population, no one living in low-income countries enjoys any legislative protections. “Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.” The tobacco of the food industry No one living in low-income countries is protected from trans fats, putting them at risk of its devastating health effects. Unlike sugar, sodium, or saturated fats, ITFAs are not naturally occurring in any food group. While sugar and sodium can pose serious health risks, their omnipresence in foods people around the world rely on every day makes a ban both impossible and impractical. A ban on nutrients like sugar and sodium is also unnecessary, as their adverse health effects can be managed through light-touch regulation paired with dietary guidelines and recommendations. But ITFAs are produced industrially and injected into the food supply, and can be easily replaced by healthier alternatives like vegetable oils. Experts say this makes their total elimination an easy decision for governments. “It’s very rare for us in the nutrition space to be able to say it’s just so bad,” said Dr Rain Yamamoto, a scientist at the WHO’s department of nutrition and food safety. “There are no health benefits whatsoever.” While significant progress has been made in the fight against ITFAs in recent years, nine of the 16 countries facing the highest estimated burden of trans fat-induced coronary heart disease deaths do not have best-practice policies in place. These include Australia, Egypt, Pakistan, Iran, and South Korea. WHO also emphasized the cost of falling behind the regulatory wave for countries not currently facing a high burden from ITFAs. As more economies become off-limits to industrial producers of trans fats, countries unprotected by legislation policing ITFAs face the prospect of companies dumping products into their food supplies. This is particularly concerning given the lack of any legislation in low-income nations regulating ITFAs. “If it’s not present, then there’s no harm in banning it and preventing other countries from dumping products into your country,” Frieden said. “Think of artificial trans fats as the tobacco of nutrition. It has no valid use.” Today, 62 countries have implemented bans on ITFAs. Denmark leads the way Studies suggesting that trans fats could be a cause of the large increase in coronary artery disease were penned as early as 1956, but it would take until the early 1990s for renewed scientific scrutiny to confirm their negative health impacts. The findings spurred Denmark to begin enacting policies to cut ITFAs out of the country’s food supply in 1991. What began as mandatory labelling and nutritional education policies evolved into a political and social pressure on companies to phase out ITFAs from their products in the decades that followed. By the time Denmark became the first country in the world to pass a total ban on ITFAs in 2007, consumption had already been cut by some 90% since 1991. A 2022 study found the policies substantially reduced coronary heart disease mortality, preventing an estimated 1,200 deaths by 2007. The 11% reduction in mortality observed over that period is similar to the contribution from decreases in smoking rates. National legislative bans on ITFAs following Denmark’s lead by Iceland, Austria, and Switzerland, have also proven to be extremely effective. “There’s really no alternative to governmental action,” Frieden said, adding that proper enforcement mechanisms are critical to ensuring industry takes action to eliminate trans fats. Globally, legislation to remove ITFAs from foods is seen as one of the most potent public health measures for reducing non-communicable disease burdens emphasized by WHO in the Sustainable Development Goals to reduce premature deaths from NCDs by 30% by 2030. In the absence of legislation, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on companies to pull their weight. “I call on the food industry to help us make up for lost time by replacing industrially produced trans-fatty acids with healthier oils,” Tedros said. “If they so choose, these companies could have an almost unparalleled impact on global health.” China Downplays COVID Threat from Lunar New Year Travel 23/01/2023 Kerry Cullinan Although some experts predict that the past weekend’s celebrations of China’s lunar new year will hasten the spread of COVID-19 to rural parts of the country, one of the country’s top scientists has disputed this. Wu Zunyou, China Centre for Disease Control and Prevention’s chief epidemiologist, downplayed the risk on the Chinese social media platform, Weibo, claiming that 80% of Chinese people had already been infected before the week-long celebrations. Chinese rejoice in first holiday after COVID response change Festivities, which were curtailed by the COVID-19 epidemic, are back in full force after a downgrade in #China's COVID-19 management strategy earlier this month. #COVID19 #chinesenewyear2023https://t.co/tCqVVnuhRe pic.twitter.com/JpNeLD2PHs — China.org.cn (@chinaorgcn) January 22, 2023 On this past Sunday, international travel restrictions in and out of China were lifted, while lockdowns and other measures to curb domestic travel have also been lifted in past weeks, enabling many people to travel to see their families in rural areas for the first time in three years. A direct flight from China landed at Indonesia’s resort island of Bali on January 22, 2023, the first time since the route was suspended due to Covid-19. pic.twitter.com/xLp94zZm42 — South China Morning Post (@SCMPNews) January 23, 2023 Global health analytics company Airfinity said last week that it had “updated its cases and deaths forecast for China’s COVID-19 outbreak as the lunar new year holiday hastens the spread of the virus”. It had initially predicted two COVID waves, but Airfinity’s analytics director Dr Matt Linley said that it “now expects to see one larger and more prolonged wave with infections reaching a higher peak”. Airfinity’s new model predicts that, between 1 December 2022 when restrictions were lifted, and 17 January 2023, 99.5 million people were infected (up from its December prediction of 72.9 million). This squares with Wu Zunyou’s assertion about mass infections happening before the new year celebrations. Airfinity COVID-19 predictions for China, 1 December 2022 – 1 April 2023 Linley warned that provinces such as Hubei and Henan “could see patient demand for intensive care beds being six times hospital capacity”, and that there would be .”a significant burden on China’s healthcare system for the next fortnight”. However, unlike China’s very low official mortality data, Airfinity’s new model estimates daily deaths to have been 32,200 by 17 January with cumulative deaths from 1 December 2022 to 17 January to be 608,000. “Deaths are forecast to peak at 36,000 a day on 26 January during the lunar new year festival. This is up from our previous estimate of deaths peaking at 25,000 a day,” said Aifinity. It warned that one larger wave as opposed to two smaller ones meant “increased pressure on hospitals and crematoriums and therefore also potentially a higher case fatality ratio”. Meanwhile, the full extent of COVID-19’s impact is unlikely to surface after Chinese authorities announced an internet crackdown on people spreading “false information” and “gloomy sentiments” about COVID-19 for a month around the new year festivities, according to The Guardian. Previously, social media has been filled with stories about families reporting on relatives’ infections and their struggles to get Pfizer’s anti-viral medicine, Paxlovid, the black marker price of which has soared. Paxlovid is not covered by Chinese medical insurance because of its high price. A Kickstart Towards Health Care ‘Ecosystems’ 20/01/2023 John Heilprin Participants in a private Davos panel discussion on building better health ‘ecosystems’ to solve the health challenges of tomorrow Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond. DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed. The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background. “I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States. “Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.” Dhivya Venkat, left, and Seema Kumar, right, listen as Dr Victor Dzau speaks at a private Davos panel discussion on building better health “ecosystems” Building access and equity from the start into health care ‘ecosystems’ Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed. “We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson. “We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.” Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company. Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach. “We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate. Beth Thompson participates in a private Davos panel discussion on building better health “ecosystems” Health care ‘ecosystems’ puzzle needs diversity of data Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further. “Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.” DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services. “You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach. “We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.” But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data. “That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza. “And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.” Rick Bright, Daniella Foster, and Francis deSouza, left to right, participate in a private Davos panel discussion on building better health ‘ecosystems’ Post-pandemic health care ‘ecosystems’ approaches More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020. “We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing. “We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation. “And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?” Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care. “What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?” During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines. Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week. “We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked. Image Credits: John Heilprin. Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
Too Early to Decide on Annual COVID-19 Boosters as Virus Has No Seasonal Pattern Yet 24/01/2023 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus While the World Health Organization’s (WHO) emergency committee on COVID-19 will decide this week whether the virus still constitutes a global health emergency, the body’s Director-General, Dr Tedros Adhanom Ghebreyesus, is “very concerned” about the pandemic. “While I will not pre-empt the advice of the emergency committee, I remain very concerned by the situation in many countries and the rising number of deaths,” Tedros told a media briefing on Tuesday. He described the global COVID-19 response as being “under strain” with too few vulnerable people adequately vaccinated, too many people behind on their boosters, antivirals remaining too expensive, fragile health systems struggling with COVID-19 and other diseases, alongside a “torrent of pseudoscience and misinformation”. “My message is clear. Do not underestimate this virus. It has and will continue to surprise us,” Tedros warned. Dr Joachim Hombach, executive secretary of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) agreed: “For the time being, COVID hasn’t really come down to the usual seasonal seasonality that we see for other viruses. The virus is still fairly unstable so it is a bit of anticipation if we end up in a seasonal pattern as we have it for instance for influenza.” “It is conceivable that annual vaccination would be suitable. You basically have to find the sweet spot between waning immunity and the benefit and the effort of providing an additional vaccination,” said Hombach. Dr Joachim Hombach, executive secretary of the WHO Strategic Advisory Group of Experts on Immunization (SAGE). Meanwhile, Dr Maria van Kerkhove, WHO’s lead on COVID-19, said that there were “a lot of uncertainties in terms of what is circulating in our ability to assess them”, given that surveillance of the virus had dropped substantially. Funding appeal for emergencies Tedros also appeal for an additional $2.5 billion to assist the WHO to address 54 health crises around the world, 11 of which are classified as Grade 3, WHO’s highest level of emergency. “The number of people in need of humanitarian relief has increased by almost 25% compared with last year, to 339 million people, and 85% of humanitarian needs globally are driven by conflict.,” said Tedros. “The world cannot look away and hope these crises resolve themselves.” WHO Executive Board focus on resources The key issues to be discussed at next week’s WHO’s executive board meeting, involve money and resources, according to Dr Tim Armstrong, WHO’s director of the department of governing bodies. Armstrong’s top three issues from over 40 agenda items are the new programme budget for 2024/25, sustainable financing and an enhanced central role for the WHO in the global health architecture, particularly to support member states during health emergencies. The board meeting starts next Monday, 30 January. Better surveillance of contaminated medicines Dr Hanan Balkhy Tedros called on governments to ensure better surveillance of medicines following “incidents of contaminated cough syrups for children”. While the WHO had issued medical alerts focused on the Gambia (last October), Indonesia (last November) and Uzbekistan this month, “at least seven countries have been affected”, said Tedros. “Most of the [over 300] deceased have been children under the age of five. These contaminants are toxic chemicals used as industrial solvents, and antifreeze agents that can be fatal even in small amounts,” he said. This week, the WHO issued an “urgent call for countries manufacturers and suppliers to do more to prevent detect, and respond quickly to contaminated medicines,” said Tedros. “Governments must increase surveillance so they can detect and remove from circulation any substandard medicines identified in the WHO medical alerts. They must also enforce illegal measures to help stop the manufacture, distribution and use of substandard and falsified medicines. “Manufacturers must purchase pharmaceutical grade ingredients from qualified suppliers and conduct comprehensive testing before using them.” Meanwhile, Assistant Director-General Dr Hanan Balkhy, said the WHO was appealing to governments and specifically the regulatory authorities to ensure that they “have proactive surveillance mechanisms to be able to detect the presence of these medications”. Balkhy, who oversees Antimicrobial Resistance and is Acting interim Assistant Director-General for Medicines and Health Products, said that while contamination would always be an issue in the production of medicine, the WHO’s “ask” was that member states strengthen the capacity of their regulatory authorities’ oversight capacity. Brazil to Call for Protection of Indigenous People’s Health After Bolsonaro ‘Abandonment’ During COVID-19 24/01/2023 Kerry Cullinan The new Brazilian government under President Lula da Silva intends to propose that the World Health Organization (WHO) addresses the health of indigenous people systematically, including by training indigenous health workers. Santiago Alcazar, the former head of WHO in Brazil, told a discussion convened by the Geneva Global Health Hub (G2H2) on Monday that Brazil would propose that the WHO establish a project on indigenous people’s health at the body’s executive board meeting, which starts this weekend. Alcazar was addressing a G2H2 discussion on authoritarianism in a pandemic, which focused on the judgement of the Permanent People’s Tribunal (PPT) that former Brazilian president Jair Bolsonaro was “liable for crimes against humanity” during the COVID-19 pandemic. Indigenous peoples, Black people, and quilombola (descendants of escaped slaves) were worst affected by the Bolsanaro administration’s “rejection of isolation, social distancing, [COVID] prevention, and vaccination”, according to the PPT, which was set in 1979 up to expose human rights violations of ordinary people worldwide. “Contrary to the unanimous position of scientists around the world and WHO recommendations, Bolsonaro not only ensured that the Brazilian population did not adopt the planned measures to limit the infection but repeatedly created various obstacles to them, frustrating his own government’s attempts to protect the population from the virus,” according to the PPT judgement. Bolsonaro is infamous for declaring during the pandemic: “Everyone has to die one day. We have to stop being a country of sissies.” During the height of the pandemic, there were reports of people being buried in mass graves in the Mannaus in the Amazon as graveyards struggled to cope with the death toll. In June 2020, as the death toll soared, Bolsonaro’s government simply stopped publishing statistics on COVID-19 infections and deaths. You will find more infographics at Statista ‘Genocidal weaponisation of COVID’ G2H2 co-chair Nicoletta Dentico, who was part of the PPT jury that heard evidence against Bolsonaro, said that the tribunal had drawn global attention to Bolsonaro’s “genocidal weaponization of COVID”. Dentico indicated that having public hearings was one of the few tools that civil society could use against authoritarian governments during a pandemic. PPT secretary Gianni Tognoni told the meeting that the Commission for the Defense of Human Rights Dom Paulo Evaristo Arns, the Articulation of Indigenous Peoples of Brazil (Apib), the Black Coalition for Rights, and Public Services International (PSI) has requested the hearing. They argued that Bolsonaro and his government “intentionally spread COVID-19”, causing an estimated 480,000 unnecessary deaths that “mainly affected the indigenous population, people of colour, and health workers”. Brazilian human rights lawyer Eloisa Machado said that the Bolsonaro government had a “deliberate project to disseminate COVID-19”, yet the country’s general prosecutor, aligned with the former president, had not been interested in investigating any criminal activity. “There was an explicit recommendation to follow recommendations that were not medically endorsed, there was a resistance to adopting measures to reduce the circulation of people and there was also an explicit ruling against using masks,” said Machado. Outrageous claims “States and municipalities also did not have the financial resources to fight against COVID-19, there was negligence in the purchase of vaccines and there was a lack of vaccination campaign,” said Machado. While a parliamentary commission found that Bolsonaro was propagating the pandemic by failing to implement preventive measures, the conditions in the country were not conducive to openly challenging the “democratically elected dictator”, added Machado. There was court action against some of Bolsonaro’s more outrageous claims – such as that a person could get AIDS from the COVID-19 vaccine – but nothing to expose the systemic way in which he pursued a deliberate policy of mass COVID-19 infection instead of trying to protect people. As a result, civil society organisations opted to approach the PPT for a hearing to show that there had been a systemic policy that had particularly affected the country’s most vulnerable people. “We’re confident that the judicial interpretation of the PPT ruling will be able to be used to bring justice, aside from this occurring in a symbolic realm,” said Machado, stressing that civil society is adamant that there should be no amnesty for the crimes against indigenous populations committed during the pandemic. State of emergency in Yanomami Alcazar, who now works for the Fiocruz Foundation, said that indigenous communities had been abandoned during COVID-19. Last week, the government declared a state of emergency in Yanomami territory, Brazil’s largest indigenous territory, in reaction to severe malnutrition. During Bolsanaro’s reign, illegal gold miners have been operating freely in the area, often clashing violently with local people, and the health system has been neglected. “Brazil has 2.7% of the world’s population but it has 11% of deaths due to COVID,” said Alcazar, adding that this was not just a result of incompetence but “evil intent”. Image Credits: Aljazeera. Five Billion People Exposed to Industrially Produced Trans Fats 23/01/2023 Stefan Anderson Policies to eliminate industrially produced trans fats are relatively simple to implement, and can save lives and economies. Five billion people around the world have no protection against industrially produced trans fats (ITFAs), putting them at risk of heart disease and death, the World Health Organization said. ITFAs are responsible for over 500,000 premature deaths from coronary heart disease every year. Commonly found in baked goods, cooking oils, and packaged foods, ITFAs are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. “Take any liquid oil and bubble hydrogen through it, and that makes it more solid,” Dr Tom Frieden, CEO of Resolve to Save Lives said at a WHO press conference announcing the launch of the report. “That’s pretty good for baking. Unfortunately, it’s also solid in your coronary arteries.” The WHO first called for the worldwide elimination of ITFAs in 2018. Best-practice policies have gained significant traction since, protecting 2.8 billion people globally – a six-fold increase – but the WHO target for the total elimination of trans fats by 2023 is “unattainable,” the report said. Momentum for banning ITFAs has grown, but the world still has “a long way to go,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. Most legislation policing ITFAs has been implemented by high-income nations, with the Americas and Europe taking the lead. The European Union successfully banned all ITFAs from its food supply in 2021, and nearly 80% of people living in high-income countries are protected by what the WHO considers best-practice policies. Four countries – Bangladesh, India, the Philippines and Ukraine – account for all 51% of people covered by best-practice policies in lower-middle income countries, with India representing 41% of that total. While 62 countries have implemented laws to ban ITFAs, covering 46% of the global population, no one living in low-income countries enjoys any legislative protections. “Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.” The tobacco of the food industry No one living in low-income countries is protected from trans fats, putting them at risk of its devastating health effects. Unlike sugar, sodium, or saturated fats, ITFAs are not naturally occurring in any food group. While sugar and sodium can pose serious health risks, their omnipresence in foods people around the world rely on every day makes a ban both impossible and impractical. A ban on nutrients like sugar and sodium is also unnecessary, as their adverse health effects can be managed through light-touch regulation paired with dietary guidelines and recommendations. But ITFAs are produced industrially and injected into the food supply, and can be easily replaced by healthier alternatives like vegetable oils. Experts say this makes their total elimination an easy decision for governments. “It’s very rare for us in the nutrition space to be able to say it’s just so bad,” said Dr Rain Yamamoto, a scientist at the WHO’s department of nutrition and food safety. “There are no health benefits whatsoever.” While significant progress has been made in the fight against ITFAs in recent years, nine of the 16 countries facing the highest estimated burden of trans fat-induced coronary heart disease deaths do not have best-practice policies in place. These include Australia, Egypt, Pakistan, Iran, and South Korea. WHO also emphasized the cost of falling behind the regulatory wave for countries not currently facing a high burden from ITFAs. As more economies become off-limits to industrial producers of trans fats, countries unprotected by legislation policing ITFAs face the prospect of companies dumping products into their food supplies. This is particularly concerning given the lack of any legislation in low-income nations regulating ITFAs. “If it’s not present, then there’s no harm in banning it and preventing other countries from dumping products into your country,” Frieden said. “Think of artificial trans fats as the tobacco of nutrition. It has no valid use.” Today, 62 countries have implemented bans on ITFAs. Denmark leads the way Studies suggesting that trans fats could be a cause of the large increase in coronary artery disease were penned as early as 1956, but it would take until the early 1990s for renewed scientific scrutiny to confirm their negative health impacts. The findings spurred Denmark to begin enacting policies to cut ITFAs out of the country’s food supply in 1991. What began as mandatory labelling and nutritional education policies evolved into a political and social pressure on companies to phase out ITFAs from their products in the decades that followed. By the time Denmark became the first country in the world to pass a total ban on ITFAs in 2007, consumption had already been cut by some 90% since 1991. A 2022 study found the policies substantially reduced coronary heart disease mortality, preventing an estimated 1,200 deaths by 2007. The 11% reduction in mortality observed over that period is similar to the contribution from decreases in smoking rates. National legislative bans on ITFAs following Denmark’s lead by Iceland, Austria, and Switzerland, have also proven to be extremely effective. “There’s really no alternative to governmental action,” Frieden said, adding that proper enforcement mechanisms are critical to ensuring industry takes action to eliminate trans fats. Globally, legislation to remove ITFAs from foods is seen as one of the most potent public health measures for reducing non-communicable disease burdens emphasized by WHO in the Sustainable Development Goals to reduce premature deaths from NCDs by 30% by 2030. In the absence of legislation, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on companies to pull their weight. “I call on the food industry to help us make up for lost time by replacing industrially produced trans-fatty acids with healthier oils,” Tedros said. “If they so choose, these companies could have an almost unparalleled impact on global health.” China Downplays COVID Threat from Lunar New Year Travel 23/01/2023 Kerry Cullinan Although some experts predict that the past weekend’s celebrations of China’s lunar new year will hasten the spread of COVID-19 to rural parts of the country, one of the country’s top scientists has disputed this. Wu Zunyou, China Centre for Disease Control and Prevention’s chief epidemiologist, downplayed the risk on the Chinese social media platform, Weibo, claiming that 80% of Chinese people had already been infected before the week-long celebrations. Chinese rejoice in first holiday after COVID response change Festivities, which were curtailed by the COVID-19 epidemic, are back in full force after a downgrade in #China's COVID-19 management strategy earlier this month. #COVID19 #chinesenewyear2023https://t.co/tCqVVnuhRe pic.twitter.com/JpNeLD2PHs — China.org.cn (@chinaorgcn) January 22, 2023 On this past Sunday, international travel restrictions in and out of China were lifted, while lockdowns and other measures to curb domestic travel have also been lifted in past weeks, enabling many people to travel to see their families in rural areas for the first time in three years. A direct flight from China landed at Indonesia’s resort island of Bali on January 22, 2023, the first time since the route was suspended due to Covid-19. pic.twitter.com/xLp94zZm42 — South China Morning Post (@SCMPNews) January 23, 2023 Global health analytics company Airfinity said last week that it had “updated its cases and deaths forecast for China’s COVID-19 outbreak as the lunar new year holiday hastens the spread of the virus”. It had initially predicted two COVID waves, but Airfinity’s analytics director Dr Matt Linley said that it “now expects to see one larger and more prolonged wave with infections reaching a higher peak”. Airfinity’s new model predicts that, between 1 December 2022 when restrictions were lifted, and 17 January 2023, 99.5 million people were infected (up from its December prediction of 72.9 million). This squares with Wu Zunyou’s assertion about mass infections happening before the new year celebrations. Airfinity COVID-19 predictions for China, 1 December 2022 – 1 April 2023 Linley warned that provinces such as Hubei and Henan “could see patient demand for intensive care beds being six times hospital capacity”, and that there would be .”a significant burden on China’s healthcare system for the next fortnight”. However, unlike China’s very low official mortality data, Airfinity’s new model estimates daily deaths to have been 32,200 by 17 January with cumulative deaths from 1 December 2022 to 17 January to be 608,000. “Deaths are forecast to peak at 36,000 a day on 26 January during the lunar new year festival. This is up from our previous estimate of deaths peaking at 25,000 a day,” said Aifinity. It warned that one larger wave as opposed to two smaller ones meant “increased pressure on hospitals and crematoriums and therefore also potentially a higher case fatality ratio”. Meanwhile, the full extent of COVID-19’s impact is unlikely to surface after Chinese authorities announced an internet crackdown on people spreading “false information” and “gloomy sentiments” about COVID-19 for a month around the new year festivities, according to The Guardian. Previously, social media has been filled with stories about families reporting on relatives’ infections and their struggles to get Pfizer’s anti-viral medicine, Paxlovid, the black marker price of which has soared. Paxlovid is not covered by Chinese medical insurance because of its high price. A Kickstart Towards Health Care ‘Ecosystems’ 20/01/2023 John Heilprin Participants in a private Davos panel discussion on building better health ‘ecosystems’ to solve the health challenges of tomorrow Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond. DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed. The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background. “I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States. “Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.” Dhivya Venkat, left, and Seema Kumar, right, listen as Dr Victor Dzau speaks at a private Davos panel discussion on building better health “ecosystems” Building access and equity from the start into health care ‘ecosystems’ Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed. “We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson. “We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.” Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company. Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach. “We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate. Beth Thompson participates in a private Davos panel discussion on building better health “ecosystems” Health care ‘ecosystems’ puzzle needs diversity of data Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further. “Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.” DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services. “You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach. “We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.” But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data. “That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza. “And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.” Rick Bright, Daniella Foster, and Francis deSouza, left to right, participate in a private Davos panel discussion on building better health ‘ecosystems’ Post-pandemic health care ‘ecosystems’ approaches More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020. “We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing. “We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation. “And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?” Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care. “What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?” During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines. Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week. “We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked. Image Credits: John Heilprin. Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
Brazil to Call for Protection of Indigenous People’s Health After Bolsonaro ‘Abandonment’ During COVID-19 24/01/2023 Kerry Cullinan The new Brazilian government under President Lula da Silva intends to propose that the World Health Organization (WHO) addresses the health of indigenous people systematically, including by training indigenous health workers. Santiago Alcazar, the former head of WHO in Brazil, told a discussion convened by the Geneva Global Health Hub (G2H2) on Monday that Brazil would propose that the WHO establish a project on indigenous people’s health at the body’s executive board meeting, which starts this weekend. Alcazar was addressing a G2H2 discussion on authoritarianism in a pandemic, which focused on the judgement of the Permanent People’s Tribunal (PPT) that former Brazilian president Jair Bolsonaro was “liable for crimes against humanity” during the COVID-19 pandemic. Indigenous peoples, Black people, and quilombola (descendants of escaped slaves) were worst affected by the Bolsanaro administration’s “rejection of isolation, social distancing, [COVID] prevention, and vaccination”, according to the PPT, which was set in 1979 up to expose human rights violations of ordinary people worldwide. “Contrary to the unanimous position of scientists around the world and WHO recommendations, Bolsonaro not only ensured that the Brazilian population did not adopt the planned measures to limit the infection but repeatedly created various obstacles to them, frustrating his own government’s attempts to protect the population from the virus,” according to the PPT judgement. Bolsonaro is infamous for declaring during the pandemic: “Everyone has to die one day. We have to stop being a country of sissies.” During the height of the pandemic, there were reports of people being buried in mass graves in the Mannaus in the Amazon as graveyards struggled to cope with the death toll. In June 2020, as the death toll soared, Bolsonaro’s government simply stopped publishing statistics on COVID-19 infections and deaths. You will find more infographics at Statista ‘Genocidal weaponisation of COVID’ G2H2 co-chair Nicoletta Dentico, who was part of the PPT jury that heard evidence against Bolsonaro, said that the tribunal had drawn global attention to Bolsonaro’s “genocidal weaponization of COVID”. Dentico indicated that having public hearings was one of the few tools that civil society could use against authoritarian governments during a pandemic. PPT secretary Gianni Tognoni told the meeting that the Commission for the Defense of Human Rights Dom Paulo Evaristo Arns, the Articulation of Indigenous Peoples of Brazil (Apib), the Black Coalition for Rights, and Public Services International (PSI) has requested the hearing. They argued that Bolsonaro and his government “intentionally spread COVID-19”, causing an estimated 480,000 unnecessary deaths that “mainly affected the indigenous population, people of colour, and health workers”. Brazilian human rights lawyer Eloisa Machado said that the Bolsonaro government had a “deliberate project to disseminate COVID-19”, yet the country’s general prosecutor, aligned with the former president, had not been interested in investigating any criminal activity. “There was an explicit recommendation to follow recommendations that were not medically endorsed, there was a resistance to adopting measures to reduce the circulation of people and there was also an explicit ruling against using masks,” said Machado. Outrageous claims “States and municipalities also did not have the financial resources to fight against COVID-19, there was negligence in the purchase of vaccines and there was a lack of vaccination campaign,” said Machado. While a parliamentary commission found that Bolsonaro was propagating the pandemic by failing to implement preventive measures, the conditions in the country were not conducive to openly challenging the “democratically elected dictator”, added Machado. There was court action against some of Bolsonaro’s more outrageous claims – such as that a person could get AIDS from the COVID-19 vaccine – but nothing to expose the systemic way in which he pursued a deliberate policy of mass COVID-19 infection instead of trying to protect people. As a result, civil society organisations opted to approach the PPT for a hearing to show that there had been a systemic policy that had particularly affected the country’s most vulnerable people. “We’re confident that the judicial interpretation of the PPT ruling will be able to be used to bring justice, aside from this occurring in a symbolic realm,” said Machado, stressing that civil society is adamant that there should be no amnesty for the crimes against indigenous populations committed during the pandemic. State of emergency in Yanomami Alcazar, who now works for the Fiocruz Foundation, said that indigenous communities had been abandoned during COVID-19. Last week, the government declared a state of emergency in Yanomami territory, Brazil’s largest indigenous territory, in reaction to severe malnutrition. During Bolsanaro’s reign, illegal gold miners have been operating freely in the area, often clashing violently with local people, and the health system has been neglected. “Brazil has 2.7% of the world’s population but it has 11% of deaths due to COVID,” said Alcazar, adding that this was not just a result of incompetence but “evil intent”. Image Credits: Aljazeera. Five Billion People Exposed to Industrially Produced Trans Fats 23/01/2023 Stefan Anderson Policies to eliminate industrially produced trans fats are relatively simple to implement, and can save lives and economies. Five billion people around the world have no protection against industrially produced trans fats (ITFAs), putting them at risk of heart disease and death, the World Health Organization said. ITFAs are responsible for over 500,000 premature deaths from coronary heart disease every year. Commonly found in baked goods, cooking oils, and packaged foods, ITFAs are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. “Take any liquid oil and bubble hydrogen through it, and that makes it more solid,” Dr Tom Frieden, CEO of Resolve to Save Lives said at a WHO press conference announcing the launch of the report. “That’s pretty good for baking. Unfortunately, it’s also solid in your coronary arteries.” The WHO first called for the worldwide elimination of ITFAs in 2018. Best-practice policies have gained significant traction since, protecting 2.8 billion people globally – a six-fold increase – but the WHO target for the total elimination of trans fats by 2023 is “unattainable,” the report said. Momentum for banning ITFAs has grown, but the world still has “a long way to go,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. Most legislation policing ITFAs has been implemented by high-income nations, with the Americas and Europe taking the lead. The European Union successfully banned all ITFAs from its food supply in 2021, and nearly 80% of people living in high-income countries are protected by what the WHO considers best-practice policies. Four countries – Bangladesh, India, the Philippines and Ukraine – account for all 51% of people covered by best-practice policies in lower-middle income countries, with India representing 41% of that total. While 62 countries have implemented laws to ban ITFAs, covering 46% of the global population, no one living in low-income countries enjoys any legislative protections. “Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.” The tobacco of the food industry No one living in low-income countries is protected from trans fats, putting them at risk of its devastating health effects. Unlike sugar, sodium, or saturated fats, ITFAs are not naturally occurring in any food group. While sugar and sodium can pose serious health risks, their omnipresence in foods people around the world rely on every day makes a ban both impossible and impractical. A ban on nutrients like sugar and sodium is also unnecessary, as their adverse health effects can be managed through light-touch regulation paired with dietary guidelines and recommendations. But ITFAs are produced industrially and injected into the food supply, and can be easily replaced by healthier alternatives like vegetable oils. Experts say this makes their total elimination an easy decision for governments. “It’s very rare for us in the nutrition space to be able to say it’s just so bad,” said Dr Rain Yamamoto, a scientist at the WHO’s department of nutrition and food safety. “There are no health benefits whatsoever.” While significant progress has been made in the fight against ITFAs in recent years, nine of the 16 countries facing the highest estimated burden of trans fat-induced coronary heart disease deaths do not have best-practice policies in place. These include Australia, Egypt, Pakistan, Iran, and South Korea. WHO also emphasized the cost of falling behind the regulatory wave for countries not currently facing a high burden from ITFAs. As more economies become off-limits to industrial producers of trans fats, countries unprotected by legislation policing ITFAs face the prospect of companies dumping products into their food supplies. This is particularly concerning given the lack of any legislation in low-income nations regulating ITFAs. “If it’s not present, then there’s no harm in banning it and preventing other countries from dumping products into your country,” Frieden said. “Think of artificial trans fats as the tobacco of nutrition. It has no valid use.” Today, 62 countries have implemented bans on ITFAs. Denmark leads the way Studies suggesting that trans fats could be a cause of the large increase in coronary artery disease were penned as early as 1956, but it would take until the early 1990s for renewed scientific scrutiny to confirm their negative health impacts. The findings spurred Denmark to begin enacting policies to cut ITFAs out of the country’s food supply in 1991. What began as mandatory labelling and nutritional education policies evolved into a political and social pressure on companies to phase out ITFAs from their products in the decades that followed. By the time Denmark became the first country in the world to pass a total ban on ITFAs in 2007, consumption had already been cut by some 90% since 1991. A 2022 study found the policies substantially reduced coronary heart disease mortality, preventing an estimated 1,200 deaths by 2007. The 11% reduction in mortality observed over that period is similar to the contribution from decreases in smoking rates. National legislative bans on ITFAs following Denmark’s lead by Iceland, Austria, and Switzerland, have also proven to be extremely effective. “There’s really no alternative to governmental action,” Frieden said, adding that proper enforcement mechanisms are critical to ensuring industry takes action to eliminate trans fats. Globally, legislation to remove ITFAs from foods is seen as one of the most potent public health measures for reducing non-communicable disease burdens emphasized by WHO in the Sustainable Development Goals to reduce premature deaths from NCDs by 30% by 2030. In the absence of legislation, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on companies to pull their weight. “I call on the food industry to help us make up for lost time by replacing industrially produced trans-fatty acids with healthier oils,” Tedros said. “If they so choose, these companies could have an almost unparalleled impact on global health.” China Downplays COVID Threat from Lunar New Year Travel 23/01/2023 Kerry Cullinan Although some experts predict that the past weekend’s celebrations of China’s lunar new year will hasten the spread of COVID-19 to rural parts of the country, one of the country’s top scientists has disputed this. Wu Zunyou, China Centre for Disease Control and Prevention’s chief epidemiologist, downplayed the risk on the Chinese social media platform, Weibo, claiming that 80% of Chinese people had already been infected before the week-long celebrations. Chinese rejoice in first holiday after COVID response change Festivities, which were curtailed by the COVID-19 epidemic, are back in full force after a downgrade in #China's COVID-19 management strategy earlier this month. #COVID19 #chinesenewyear2023https://t.co/tCqVVnuhRe pic.twitter.com/JpNeLD2PHs — China.org.cn (@chinaorgcn) January 22, 2023 On this past Sunday, international travel restrictions in and out of China were lifted, while lockdowns and other measures to curb domestic travel have also been lifted in past weeks, enabling many people to travel to see their families in rural areas for the first time in three years. A direct flight from China landed at Indonesia’s resort island of Bali on January 22, 2023, the first time since the route was suspended due to Covid-19. pic.twitter.com/xLp94zZm42 — South China Morning Post (@SCMPNews) January 23, 2023 Global health analytics company Airfinity said last week that it had “updated its cases and deaths forecast for China’s COVID-19 outbreak as the lunar new year holiday hastens the spread of the virus”. It had initially predicted two COVID waves, but Airfinity’s analytics director Dr Matt Linley said that it “now expects to see one larger and more prolonged wave with infections reaching a higher peak”. Airfinity’s new model predicts that, between 1 December 2022 when restrictions were lifted, and 17 January 2023, 99.5 million people were infected (up from its December prediction of 72.9 million). This squares with Wu Zunyou’s assertion about mass infections happening before the new year celebrations. Airfinity COVID-19 predictions for China, 1 December 2022 – 1 April 2023 Linley warned that provinces such as Hubei and Henan “could see patient demand for intensive care beds being six times hospital capacity”, and that there would be .”a significant burden on China’s healthcare system for the next fortnight”. However, unlike China’s very low official mortality data, Airfinity’s new model estimates daily deaths to have been 32,200 by 17 January with cumulative deaths from 1 December 2022 to 17 January to be 608,000. “Deaths are forecast to peak at 36,000 a day on 26 January during the lunar new year festival. This is up from our previous estimate of deaths peaking at 25,000 a day,” said Aifinity. It warned that one larger wave as opposed to two smaller ones meant “increased pressure on hospitals and crematoriums and therefore also potentially a higher case fatality ratio”. Meanwhile, the full extent of COVID-19’s impact is unlikely to surface after Chinese authorities announced an internet crackdown on people spreading “false information” and “gloomy sentiments” about COVID-19 for a month around the new year festivities, according to The Guardian. Previously, social media has been filled with stories about families reporting on relatives’ infections and their struggles to get Pfizer’s anti-viral medicine, Paxlovid, the black marker price of which has soared. Paxlovid is not covered by Chinese medical insurance because of its high price. A Kickstart Towards Health Care ‘Ecosystems’ 20/01/2023 John Heilprin Participants in a private Davos panel discussion on building better health ‘ecosystems’ to solve the health challenges of tomorrow Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond. DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed. The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background. “I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States. “Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.” Dhivya Venkat, left, and Seema Kumar, right, listen as Dr Victor Dzau speaks at a private Davos panel discussion on building better health “ecosystems” Building access and equity from the start into health care ‘ecosystems’ Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed. “We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson. “We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.” Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company. Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach. “We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate. Beth Thompson participates in a private Davos panel discussion on building better health “ecosystems” Health care ‘ecosystems’ puzzle needs diversity of data Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further. “Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.” DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services. “You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach. “We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.” But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data. “That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza. “And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.” Rick Bright, Daniella Foster, and Francis deSouza, left to right, participate in a private Davos panel discussion on building better health ‘ecosystems’ Post-pandemic health care ‘ecosystems’ approaches More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020. “We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing. “We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation. “And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?” Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care. “What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?” During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines. Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week. “We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked. Image Credits: John Heilprin. Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
Five Billion People Exposed to Industrially Produced Trans Fats 23/01/2023 Stefan Anderson Policies to eliminate industrially produced trans fats are relatively simple to implement, and can save lives and economies. Five billion people around the world have no protection against industrially produced trans fats (ITFAs), putting them at risk of heart disease and death, the World Health Organization said. ITFAs are responsible for over 500,000 premature deaths from coronary heart disease every year. Commonly found in baked goods, cooking oils, and packaged foods, ITFAs are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. “Take any liquid oil and bubble hydrogen through it, and that makes it more solid,” Dr Tom Frieden, CEO of Resolve to Save Lives said at a WHO press conference announcing the launch of the report. “That’s pretty good for baking. Unfortunately, it’s also solid in your coronary arteries.” The WHO first called for the worldwide elimination of ITFAs in 2018. Best-practice policies have gained significant traction since, protecting 2.8 billion people globally – a six-fold increase – but the WHO target for the total elimination of trans fats by 2023 is “unattainable,” the report said. Momentum for banning ITFAs has grown, but the world still has “a long way to go,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. Most legislation policing ITFAs has been implemented by high-income nations, with the Americas and Europe taking the lead. The European Union successfully banned all ITFAs from its food supply in 2021, and nearly 80% of people living in high-income countries are protected by what the WHO considers best-practice policies. Four countries – Bangladesh, India, the Philippines and Ukraine – account for all 51% of people covered by best-practice policies in lower-middle income countries, with India representing 41% of that total. While 62 countries have implemented laws to ban ITFAs, covering 46% of the global population, no one living in low-income countries enjoys any legislative protections. “Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.” The tobacco of the food industry No one living in low-income countries is protected from trans fats, putting them at risk of its devastating health effects. Unlike sugar, sodium, or saturated fats, ITFAs are not naturally occurring in any food group. While sugar and sodium can pose serious health risks, their omnipresence in foods people around the world rely on every day makes a ban both impossible and impractical. A ban on nutrients like sugar and sodium is also unnecessary, as their adverse health effects can be managed through light-touch regulation paired with dietary guidelines and recommendations. But ITFAs are produced industrially and injected into the food supply, and can be easily replaced by healthier alternatives like vegetable oils. Experts say this makes their total elimination an easy decision for governments. “It’s very rare for us in the nutrition space to be able to say it’s just so bad,” said Dr Rain Yamamoto, a scientist at the WHO’s department of nutrition and food safety. “There are no health benefits whatsoever.” While significant progress has been made in the fight against ITFAs in recent years, nine of the 16 countries facing the highest estimated burden of trans fat-induced coronary heart disease deaths do not have best-practice policies in place. These include Australia, Egypt, Pakistan, Iran, and South Korea. WHO also emphasized the cost of falling behind the regulatory wave for countries not currently facing a high burden from ITFAs. As more economies become off-limits to industrial producers of trans fats, countries unprotected by legislation policing ITFAs face the prospect of companies dumping products into their food supplies. This is particularly concerning given the lack of any legislation in low-income nations regulating ITFAs. “If it’s not present, then there’s no harm in banning it and preventing other countries from dumping products into your country,” Frieden said. “Think of artificial trans fats as the tobacco of nutrition. It has no valid use.” Today, 62 countries have implemented bans on ITFAs. Denmark leads the way Studies suggesting that trans fats could be a cause of the large increase in coronary artery disease were penned as early as 1956, but it would take until the early 1990s for renewed scientific scrutiny to confirm their negative health impacts. The findings spurred Denmark to begin enacting policies to cut ITFAs out of the country’s food supply in 1991. What began as mandatory labelling and nutritional education policies evolved into a political and social pressure on companies to phase out ITFAs from their products in the decades that followed. By the time Denmark became the first country in the world to pass a total ban on ITFAs in 2007, consumption had already been cut by some 90% since 1991. A 2022 study found the policies substantially reduced coronary heart disease mortality, preventing an estimated 1,200 deaths by 2007. The 11% reduction in mortality observed over that period is similar to the contribution from decreases in smoking rates. National legislative bans on ITFAs following Denmark’s lead by Iceland, Austria, and Switzerland, have also proven to be extremely effective. “There’s really no alternative to governmental action,” Frieden said, adding that proper enforcement mechanisms are critical to ensuring industry takes action to eliminate trans fats. Globally, legislation to remove ITFAs from foods is seen as one of the most potent public health measures for reducing non-communicable disease burdens emphasized by WHO in the Sustainable Development Goals to reduce premature deaths from NCDs by 30% by 2030. In the absence of legislation, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on companies to pull their weight. “I call on the food industry to help us make up for lost time by replacing industrially produced trans-fatty acids with healthier oils,” Tedros said. “If they so choose, these companies could have an almost unparalleled impact on global health.” China Downplays COVID Threat from Lunar New Year Travel 23/01/2023 Kerry Cullinan Although some experts predict that the past weekend’s celebrations of China’s lunar new year will hasten the spread of COVID-19 to rural parts of the country, one of the country’s top scientists has disputed this. Wu Zunyou, China Centre for Disease Control and Prevention’s chief epidemiologist, downplayed the risk on the Chinese social media platform, Weibo, claiming that 80% of Chinese people had already been infected before the week-long celebrations. Chinese rejoice in first holiday after COVID response change Festivities, which were curtailed by the COVID-19 epidemic, are back in full force after a downgrade in #China's COVID-19 management strategy earlier this month. #COVID19 #chinesenewyear2023https://t.co/tCqVVnuhRe pic.twitter.com/JpNeLD2PHs — China.org.cn (@chinaorgcn) January 22, 2023 On this past Sunday, international travel restrictions in and out of China were lifted, while lockdowns and other measures to curb domestic travel have also been lifted in past weeks, enabling many people to travel to see their families in rural areas for the first time in three years. A direct flight from China landed at Indonesia’s resort island of Bali on January 22, 2023, the first time since the route was suspended due to Covid-19. pic.twitter.com/xLp94zZm42 — South China Morning Post (@SCMPNews) January 23, 2023 Global health analytics company Airfinity said last week that it had “updated its cases and deaths forecast for China’s COVID-19 outbreak as the lunar new year holiday hastens the spread of the virus”. It had initially predicted two COVID waves, but Airfinity’s analytics director Dr Matt Linley said that it “now expects to see one larger and more prolonged wave with infections reaching a higher peak”. Airfinity’s new model predicts that, between 1 December 2022 when restrictions were lifted, and 17 January 2023, 99.5 million people were infected (up from its December prediction of 72.9 million). This squares with Wu Zunyou’s assertion about mass infections happening before the new year celebrations. Airfinity COVID-19 predictions for China, 1 December 2022 – 1 April 2023 Linley warned that provinces such as Hubei and Henan “could see patient demand for intensive care beds being six times hospital capacity”, and that there would be .”a significant burden on China’s healthcare system for the next fortnight”. However, unlike China’s very low official mortality data, Airfinity’s new model estimates daily deaths to have been 32,200 by 17 January with cumulative deaths from 1 December 2022 to 17 January to be 608,000. “Deaths are forecast to peak at 36,000 a day on 26 January during the lunar new year festival. This is up from our previous estimate of deaths peaking at 25,000 a day,” said Aifinity. It warned that one larger wave as opposed to two smaller ones meant “increased pressure on hospitals and crematoriums and therefore also potentially a higher case fatality ratio”. Meanwhile, the full extent of COVID-19’s impact is unlikely to surface after Chinese authorities announced an internet crackdown on people spreading “false information” and “gloomy sentiments” about COVID-19 for a month around the new year festivities, according to The Guardian. Previously, social media has been filled with stories about families reporting on relatives’ infections and their struggles to get Pfizer’s anti-viral medicine, Paxlovid, the black marker price of which has soared. Paxlovid is not covered by Chinese medical insurance because of its high price. A Kickstart Towards Health Care ‘Ecosystems’ 20/01/2023 John Heilprin Participants in a private Davos panel discussion on building better health ‘ecosystems’ to solve the health challenges of tomorrow Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond. DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed. The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background. “I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States. “Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.” Dhivya Venkat, left, and Seema Kumar, right, listen as Dr Victor Dzau speaks at a private Davos panel discussion on building better health “ecosystems” Building access and equity from the start into health care ‘ecosystems’ Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed. “We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson. “We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.” Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company. Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach. “We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate. Beth Thompson participates in a private Davos panel discussion on building better health “ecosystems” Health care ‘ecosystems’ puzzle needs diversity of data Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further. “Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.” DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services. “You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach. “We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.” But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data. “That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza. “And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.” Rick Bright, Daniella Foster, and Francis deSouza, left to right, participate in a private Davos panel discussion on building better health ‘ecosystems’ Post-pandemic health care ‘ecosystems’ approaches More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020. “We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing. “We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation. “And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?” Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care. “What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?” During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines. Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week. “We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked. Image Credits: John Heilprin. Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
China Downplays COVID Threat from Lunar New Year Travel 23/01/2023 Kerry Cullinan Although some experts predict that the past weekend’s celebrations of China’s lunar new year will hasten the spread of COVID-19 to rural parts of the country, one of the country’s top scientists has disputed this. Wu Zunyou, China Centre for Disease Control and Prevention’s chief epidemiologist, downplayed the risk on the Chinese social media platform, Weibo, claiming that 80% of Chinese people had already been infected before the week-long celebrations. Chinese rejoice in first holiday after COVID response change Festivities, which were curtailed by the COVID-19 epidemic, are back in full force after a downgrade in #China's COVID-19 management strategy earlier this month. #COVID19 #chinesenewyear2023https://t.co/tCqVVnuhRe pic.twitter.com/JpNeLD2PHs — China.org.cn (@chinaorgcn) January 22, 2023 On this past Sunday, international travel restrictions in and out of China were lifted, while lockdowns and other measures to curb domestic travel have also been lifted in past weeks, enabling many people to travel to see their families in rural areas for the first time in three years. A direct flight from China landed at Indonesia’s resort island of Bali on January 22, 2023, the first time since the route was suspended due to Covid-19. pic.twitter.com/xLp94zZm42 — South China Morning Post (@SCMPNews) January 23, 2023 Global health analytics company Airfinity said last week that it had “updated its cases and deaths forecast for China’s COVID-19 outbreak as the lunar new year holiday hastens the spread of the virus”. It had initially predicted two COVID waves, but Airfinity’s analytics director Dr Matt Linley said that it “now expects to see one larger and more prolonged wave with infections reaching a higher peak”. Airfinity’s new model predicts that, between 1 December 2022 when restrictions were lifted, and 17 January 2023, 99.5 million people were infected (up from its December prediction of 72.9 million). This squares with Wu Zunyou’s assertion about mass infections happening before the new year celebrations. Airfinity COVID-19 predictions for China, 1 December 2022 – 1 April 2023 Linley warned that provinces such as Hubei and Henan “could see patient demand for intensive care beds being six times hospital capacity”, and that there would be .”a significant burden on China’s healthcare system for the next fortnight”. However, unlike China’s very low official mortality data, Airfinity’s new model estimates daily deaths to have been 32,200 by 17 January with cumulative deaths from 1 December 2022 to 17 January to be 608,000. “Deaths are forecast to peak at 36,000 a day on 26 January during the lunar new year festival. This is up from our previous estimate of deaths peaking at 25,000 a day,” said Aifinity. It warned that one larger wave as opposed to two smaller ones meant “increased pressure on hospitals and crematoriums and therefore also potentially a higher case fatality ratio”. Meanwhile, the full extent of COVID-19’s impact is unlikely to surface after Chinese authorities announced an internet crackdown on people spreading “false information” and “gloomy sentiments” about COVID-19 for a month around the new year festivities, according to The Guardian. Previously, social media has been filled with stories about families reporting on relatives’ infections and their struggles to get Pfizer’s anti-viral medicine, Paxlovid, the black marker price of which has soared. Paxlovid is not covered by Chinese medical insurance because of its high price. A Kickstart Towards Health Care ‘Ecosystems’ 20/01/2023 John Heilprin Participants in a private Davos panel discussion on building better health ‘ecosystems’ to solve the health challenges of tomorrow Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond. DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed. The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background. “I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States. “Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.” Dhivya Venkat, left, and Seema Kumar, right, listen as Dr Victor Dzau speaks at a private Davos panel discussion on building better health “ecosystems” Building access and equity from the start into health care ‘ecosystems’ Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed. “We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson. “We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.” Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company. Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach. “We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate. Beth Thompson participates in a private Davos panel discussion on building better health “ecosystems” Health care ‘ecosystems’ puzzle needs diversity of data Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further. “Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.” DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services. “You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach. “We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.” But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data. “That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza. “And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.” Rick Bright, Daniella Foster, and Francis deSouza, left to right, participate in a private Davos panel discussion on building better health ‘ecosystems’ Post-pandemic health care ‘ecosystems’ approaches More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020. “We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing. “We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation. “And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?” Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care. “What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?” During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines. Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week. “We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked. Image Credits: John Heilprin. Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
A Kickstart Towards Health Care ‘Ecosystems’ 20/01/2023 John Heilprin Participants in a private Davos panel discussion on building better health ‘ecosystems’ to solve the health challenges of tomorrow Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond. DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed. The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background. “I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States. “Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.” Dhivya Venkat, left, and Seema Kumar, right, listen as Dr Victor Dzau speaks at a private Davos panel discussion on building better health “ecosystems” Building access and equity from the start into health care ‘ecosystems’ Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed. “We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson. “We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.” Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company. Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach. “We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate. Beth Thompson participates in a private Davos panel discussion on building better health “ecosystems” Health care ‘ecosystems’ puzzle needs diversity of data Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further. “Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.” DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services. “You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach. “We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.” But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data. “That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza. “And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.” Rick Bright, Daniella Foster, and Francis deSouza, left to right, participate in a private Davos panel discussion on building better health ‘ecosystems’ Post-pandemic health care ‘ecosystems’ approaches More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020. “We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing. “We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation. “And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?” Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care. “What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?” During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines. Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week. “We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked. Image Credits: John Heilprin. Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
Small Island States Bear Disproportionate Burden of Non-Communicable Diseases 20/01/2023 Kerry Cullinan Over 85% of Fiji’s residents die of non-communicable diseases (NCDs), primarily strokes, heart disease and diabetes. Almost two-thirds of adults in the south Pacific country are overweight and 30% are obese. Similarly, three-quarters of the residents of Vanuatu, a collection of 80 islands also in the south Pacific, die prematurely of NCDs, primarily strokes and heart disease. Two-thirds of those who die of cardiovascular diseases are under the age of 70. Some 57% of adults are overweight and 40% have hypertension. Both Fiji and Vanuatu are small island developing states (SIDS), where deaths from NCDs are much higher than average, according to the World Health Organisation (WHO) The WHO hosted a meeting this week to discuss NCDs in the states and launched a data portal that profiles the 40 member states classified as SIDS. SIDS are defined as a set of islands and coastal states that share similar sustainable development challenges as a result of their size, geography and vulnerability to climate change. Marginalised communities These countries are disproportionately affected by the four main NCDs – namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Ten of the nations with the highest obesity rates in the world are SIDS, 30% of adults have hypertension, and SIDS also have one of the highest prevalence of adult diabetes in the world. In addition, rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. “The climate crisis and the COVID-19 pandemic, combined with poverty, unemployment, inequality and the marginalization of minority communities, are fuelling an increase in non-communicable diseases and mental health conditions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the SIDS meeting. During the meeting, participants identified key steps to achieve a one-third reduction in premature mortality from NCDs and suicide before 2030. These include early detection, prevention and management; strengthening health systems in the face of the climate crisis and the COVID-19 pandemic; tackling obesity, and providing adequate, sustainable financial and human resources for NCDs and mental health. The promotion of ultra-processed products, cigarettes and alcohol, were also identified as culprits driving premature deaths in the SIDS. Some states have already introduced health taxation, incorporating health into climate change adaptation and mitigation efforts, and maintaining NCD and mental health services during health emergencies. Image Credits: Monika MG/ Unsplash. Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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.
Amendments to International Health Regulations Focus on Accountability, Compliance and Equity 20/01/2023 Kerry Cullinan Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown. Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus. Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday. The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month. So nice to see you my friend @LawrenceGostin! Thank you for your support in the International Health Regulations review process and development of a #PandemicAccord. We also discussed the #COVID19 situation and importance of applying the lessons learnt on health equity. Together! pic.twitter.com/g9sKn4W9PZ — Tedros Adhanom Ghebreyesus (@DrTedros) January 12, 2023 By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies. The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a “public health emergency of international concern”. But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products. Improving pandemic prevention “The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting. “The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added. “In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.” The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly. Africa wants equity The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity. Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material. Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International. The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to “facilitate the manufacture, export and import of the required health products, including their materials and components”. Conspiracy theories In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly. Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty. These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting. Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway. European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. 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
European Union Pushes for Stronger Air Pollution Rules 19/01/2023 Stefan Anderson Air pollution is the 10th leading cause of death in the European Union. At least 300,000 people lose their lives to air pollution each year across the European Union, and the bloc is pushing to tighten air quality regulations as part of its Green New Deal legislative package. The new rules aim to reduce the number of premature deaths and illness caused by air pollution, as well as reducing pressure on ecosystems and biodiversity caused by poor air quality – two criteria the EU said are critical to its ambition of reaching an environment free of harmful pollution by 2050. “Each year, hundreds of thousands of Europeans die prematurely and many more suffer from heart- and lung diseases or pollution-induced cancers,” said Frans Timmermans, executive vice-president for the European Green Deal. “The longer we wait to reduce this pollution, the higher the costs to society.” The new rules aim to limit PM2.5 and NO2, the two deadliest air pollutants, to 10 µg/m3 and 20 µg/m3 respectively, which the EU says will cut premature deaths due to air pollution by at least 55% by 2030, potentially saving over 150,000 lives. The WHO’s air quality guidelines are more stringent, advising targets of 5 µg/m3 for PM2.5 and 10 µg/m3 for NO2, half of the levels under the new proposal. But the EU says its proposed levels will reduce deaths resulting from air pollution above WHO guidelines by 75% in 10 years. Ambient air pollution is a leading cause of strokes, cancer and diabetes in the EU, costing an estimated €300-853 billion per year to public authorities. The new air quality standards will cost less than 0.1% of GDP and provide a return of at least seven times that number, with gross annual benefits estimated between €42 billion and €121 billion in 2030, at an annual cost of less than €6 billion. “The cost in inaction is far greater than the cost of prevention,” EU Commissioner for the Environment Virginijus Sinkevičius said in a statement. The health effects of polluted air affect “the vulnerable most of all,” he added. Most European cities are above new air pollution targets European cities will need to make major advances by 2030 to meet the new limits. An analysis of 2019 data released this week by the Health Effects Institute and State of Global Air found only 22% of European cities met the proposed limits on PM2.5 levels, while 84% met the new target for NO2 concentration. The health effects of air pollution, even if they are not fatal, can be devastating. Pregnant women who are exposed to air with PM2.5 concentrations are at a higher risk of delivering infants with health issues such as premature birth and low birth weight. Additionally, research has shown that air pollution caused by traffic can lead to the development of asthma in both children and adults, as well as increase the risk of acute lower respiratory infections in children and lung cancer-related deaths. For its part, NO2 has been linked to increased vulnerability to severe respiratory infections and asthma, while long-term exposure can cause chronic lung disease. That report also reinforced the stark geographic patterns in air quality noted by previous studies, with countries and cities in Central and Western Europe seeing the highest PM2.5 concentrations. Higher air pollution levels in the region correlate to its elevated reliance on coal and solid fuel in industrial and domestic settings. The Bulgarian capital of Sophia topped the list for most polluted air of European capital cities, while 15 of the top 20 most polluted cities overall were in Poland. NO2 concentrations were observed to be highest in large cities like Paris and Barcelona, likely due to heavy vehicle traffic. Central and Eastern European cities tended to have lower NO2 concentrations. Overall, eight out of 10 urban residents in the EU are exposed to PM2.5 levels above the new target of 10 µg/m3, while 5 out of 10 breathe air above the 20 µg/m target for NO2. While the modelling of NO2’s effects on premature mortality are not yet well-developed, a recent study found PM2.5 to be associated with 90.4% of all air pollutions deaths in Europe between 1990 and 2019. Progress is in the right direction, but danger lingers in the air The average annual population-weighted aPM2.5 concentration in European countries for 1990 (left) and 2019 (right). While it still has a long way to go to meet its goals, Europe has made steady progress in reducing air pollution in recent decades. A 2021 study exploring the impact of air quality on health in 43 European countries – including Russia and Iceland – between 1990 and 2019 found that on average, public exposure to PM2.5 fell by 33.7%. The report also found socioeconomic determinants had a substantial impact on air pollution-related deaths. Countries ranking in the lowest income bracket lost 11 times as many adjusted life years on average to ischemic heart disease attributed to air pollution, and 25 times more adjusted life years to air pollution-induced strokes. Air-pollution deaths per capita were highest in Eastern European countries where PM2.5 concentrations remain unchecked. Bosnia and Herzegovina and North Macedonia had death rates five and seven times higher than the European average, respectively. Their average lost adjusted life years were also the highest in Europe and 32 times higher than Iceland, which had the lowest rate of the countries surveyed. Some 24,917 years of life were lost per 100,000 people in Europe in 2019 from premature deaths from air pollution exposure, which marked a decrease of 63% from 1990. “By 2050, we want our environment to be free of harmful pollutants,” Timmermans said. “That means we need to step up action today.” Image Credits: Tangopaso, Mariordo, State of Global Air, Scientific Reports. Posts navigation Older postsNewer posts