The World Health Organization (WHO) member states are currently negotiating a pandemic treaty to prepare for the next pandemic – but how can representatives of civil society have a seat at the table? What are the rules of civil society participation inside and outside decision-making spaces and what should they be? These questions were discussed during a panel organized by the Global Health Center at the Geneva Graduate Institute recently.

“Today, governments are assisted, influenced and challenged by a variety of civil society organizations, demanding greater transparency, inclusivity and accountability,” said Courtenay Howe, senior advocacy advisor at STOPAIDS and platform coordinator at Platform for ACT-A Civil Society and Community Representatives, who moderated the event.

How it worked in environmental sector

In order to understand what best practices can be implemented in international rulemaking, the panellists shared their experiences about the processes that led to other fundamental treaties in the field of environment, human rights and other sectors, such as the Basel Convention on hazardous waste.

“The Basel Convention is over 30 years old, so I would like to start with what happened at the very beginning,” said Katharina Kummer Peiry, director of Kummer EcoConsult. 

She explained that at the time the field was dominated by one very active NGO: “They were excellent negotiators, better prepared than most governments, and as a result, they almost had more influence than many government negotiators,” she pointed out.

According to Kummer Peiry, the organization focused on protesting outside of the building where the negotiations were happening, as well as “naming and shaming” the negotiators in order to demand change. 

“This has evolved over the lifespan of the convention,” she added. “There are now three categories of observers that are admitted through the process, civil society, which is mostly environmental organizations, but also social development organizations, industry and then academic institutions.”

Today, in the environmental field the goal is to have a variety of organizations involved and encourage them to hold  events and prepare materials for the delegates carrying on the negotiations, she added.

 

A universal right

“Participating in a decision-making process is a universal desire for everyone, but not only that, it is actually a fundamental human right, protected by international human rights framework,” said Saranbaatar Bayarmagnai from the United Nations High Commissioner for Human Rights (OHCHR).

Bayarmagnai recalled the process of negotiating the Convention on the Rights of Persons with Disabilities, which was adopted in 2006. It currently has 164 signatories.

“There was an intergovernmental working group established to develop and negotiate this treaty, and initially the process wasn’t as inclusive as we wanted,” he said. 

“There was a huge outcry by civil society actors in different regions and globally, especially by persons with disabilities saying that no decision would be made about them without them.”

Eventually, member states became more open and accepted to include organizations working on disability rights.

“They had a very meaningful and inclusive seat at the table,” Bayarmagnai noted.  “What happened as a result of that is that 75% of the legal text of the Convention on the Rights of Persons with Disabilities came from those actors who were part of the process.”

Increasing participation in negotiations

In December 2021, the WHO established an Intergovernmental Negotiating Body (INB) in order to negotiate the legal framework for pandemic preparedness. 

Asked about what mechanisms have been put forward to ensure civil participation in the process, INB’s Co-Chair Precious Matsoso said making space for non-state actors was a useful tool.

“We are talking about an organization that was established through a constitution over 70 years ago, and this constitution is designed in such a way that the organization is rule bound, so we have to work within those rules,” she said.

“But I also think that the world has changed, it is more complex, more dynamic and more inclusive, so perhaps we have to look at how best we reform these processes,” she also said, adding that the attempt to involve non-state actors, despite some shortcomings, has resulted in a more open process.

Steven Solomon, WHO’s Principal Legal Officer, also offered his perspective on the ongoing negotiations for the pandemic treaty.

According to Solomon, these innovations were made possible thanks to the mandate of member states that participation should be expanded and deepened as much as possible.

The WHO official said that in his view, this mandate was due “to the level of confidence that member states had in relevant stakeholders in civil society, confidence in their commitment to constructive engagement.”

“It is remarkable to see what can be achieved,” he said.

However, there is still room for improving the mechanisms for guaranteeing civil participation.

Cedric Nininahazwe from the Global Network of People living with HIV (GNP+) suggested allowing more space for feedback and ensuring that information collected by communities reaches the relevant stakeholders in a timely manner.

“I think for the relevance of engagement and the information that people are providing, it will be great to create some feedback mechanisms where we can really engage on different issues,” he said.

During COVID, many community organizations were out in the field and they collected a lot of information.

“However, there is no way that this information can be shared,” he concluded, asking for a way to ensure that the data that has been collected reaches those involved in the negotiation of the pandemic prevention, preparedness and response treaty.

Mia Mottley, Prime Minister of Barbados, addresses COP27’s opening ceremony.

Europe’s attempts to get alternative gas supplies from African countries in the wake of Russia’s war in Ukraine are a “bridge to nowhere”, former US vice-president Al Gore told the UN climate change talks in Egypt, COP27.

“We must see the so-called dash for gas for what it really is: a dash down a bridge to nowhere, leaving the countries of the world facing climate chaos and billions in stranded assets, especially here in Africa,” Gore told the opening ceremony on Monday.

Earlier, civil society activists had also condemned the ‘dash for gas’, describing it as a short-term approach that was undermining Africa’s quest for renewable energy.

Turning Africa into Europe´s gas station

“European countries want to turn Africa into Europe’s gas station. They want to lock Africa on a gas pathway that will leave Africa with stranded assets, and leave the 600 million Africans who currently don’t have access to energy without the opportunity to power their future prosperity using the incredible renewable energy potential that exists,” Mohamed Adow, CEO of PowerShift Africa, told a press conference on Monday.

Gore also decried the short-sightedness of Europe’s approach to gas expansion in Africa, warning that it would “lock in” long-term dependence on fossil fuels. 

“We have to move beyond the era of fossil fuel colonialism. The dash for gas in Africa is a dash for gas to be sent to wealthy countries,” said Gore. He was referring to the recent spate of visits by European leaders to the continent to shop for gas to replace sanctioned Russian supplies – something that has reinforced the political will of some fossil-fuel rich African states to exploit their vast reserves. 

Instead of succumbing to those pressures, Africa should aim to become a ¨renewable energy superpower.¨ Gore added. 

On highway to climate hell

UN Secretary General Antonio Guterres

Meanwhile, United Nations Secretary General Antonio Guterres challenged COP27 to “agree on a clear, time-bound roadmap reflective of the scale and urgency of the challenge” to assist countries suffering loss and damage caused by the climate crisis, including “effective institutional arrangements for financing”.

“Getting concrete results on loss and damage is a litmus test of the commitment of the governments to the success of COP27,” said Guterres, who told the ceremony that the world was “on the highway to climate hell with our foot on the accelerator”.

Mia Mottley the Prime Minister of Barbados, said that it was time to reform the Bretton Woods institutions – the World Bank and the International Monetary Fund (IMF) – so that they could assist countries in the global South.

“The global North borrows with interest rates of between one to 4%, the South at 14% and then we wonder why the just energy partnerships are not working,” said Mottley.

“Similarly, we ask ourselves, if countries that want to finance their way to net zero and want to do the right thing can’t get the critical supplies, will they not have to rely again on natural gases to cross that bridge?”

Commending Denmark, Belgium and Scotland for accepting “the precepts and principles of loss and damage as critical and as morally just”, Mottley said it wasn’t enough for state parties to do the right thing.

“The non-state actors and the stakeholders, oil and gas companies, need to be brought into a special conversation between now and COP28. How do companies that make $200 billion in profits in the last three months not expect to contribute at least 10 cents on every dollar of profit or loss and damage fund?”

Ugandan climate activist Leah Namugerwa

Young Ugandan activist Leah Namugerwa said her ambition was to plant one million trees and bluntly asked the world leaders at COP what they were doing to address the climate crisis.

“If COP27 is to truly deliver, we must face some real truths.  We have had decades of inaction from all leaders, such as that the world is in a state of emergency because of fossil fuels. Africa contributes less than 4% of the carbon emissions while we suffer the most,” said Namugerwa. 

Debt burden hampering sustainable development

At a press conference before the opening ceremony, Tasneem Essop, executive director of the Climate Action Network, called out wealthy countries for failing to honour the commitment made over a decade ago to raise $100 billion per annum by 2020 for climate mitigation. 

“Vulnerable countries and poorer countries are reeling from the debt burden that they have to deal with. Much of the debt burden is also due to loans that they have to take out to actually address climate impacts,” said Essop, whose network represents over 1,900 civil society organisations in 130 countries.

“Developing countries are going through a vicious cycle of debt burden, taking out further loans and not having the fiscal space to actually deal with the developmental needs that they have in their own countries.”

Ahmed El Droubi, Greenpeace MENA campaigns manager, told the press conference that, not only had the $100 billion promised in Copenhagen in 2009 not materialised but that “approximately 70% of this finance comes in the forms of loans and further traps global South economies”.

Climate Action Network executive director Tasneem Essop and Ahmed El Droubi, Greenpeace MENA campaigns manager.

“The biggest issue of COP27 is the establishment of a loss and damage financial facility. This is long overdue, and is the greatest example of climate injustice that we see across the planet,” added Droubi.

Climate of ‘immense repression’ in Egypt

Essop also decried the “immense repression” of human rights defenders and climate activists in Egypt, with at least 60,000 “prisoners of conscience” being held in jails.

“There’s an overall trust deficit because of what I’ve just described – rich nations not fulfilling obligations – and then we also have a context in which, as civil society, we know that our right to protest, our right to assemble, our right have a voice, our right to have the right to dissent and hold power accountable is seriously and severely challenged in this COP being held in Egypt.”

British Egyptian pro-democracy activist Alaa Abd el-Fattah, who was sentenced for five years in prison in 2019 for “spreading false news”, and has been on a months-long hunger strike, announced that he had stopped drinking water as COP27 got underway on Sunday, setting the stage for a showdown over the human rights issue in coming days.

COP27
The line-up of speakers for COP27’s opening ceremony side by side before their keynotes.

As ceremonies opened in Sharm El-Sheik’s grand plenary hall on Monday, only one word came to mind in trying to sum up the scene: surreal.

World leaders paraded into the hall to music seemingly taken from a Star Wars film. The cast of speakers taking the stage consisted of a petro-state monarch, a friendly host cum authoritarian dictator, the UN Secretary General, a few academics, a young student, and the heads of state of Barbados and Senegal, sat side by side on white leather armchairs straight out of a first class airplane cabin. 

Set against the backdrop of an existential cross-roads in the global fight against climate change and the Egyptian government’s efforts to gloss over its human rights record, COP27 is off to a complicated start. 

Appearances a focus for Egyptian government amid human rights criticisms

Sharm El-Sheikh
Egyptian President Abdel Fattah el-Sisi takes the stage to deliver his opening address.

The road to COP27 has not been easy for President Abdel Fattah el-Sisi’s public relations department. Like Qatar’s efforts to use its position as host of the FIFA World Cup this winter to better its image on the international stage, Egypt’s plans have backfired.

The video that opened the ceremony – complete with cheering children, highly saturated shots of beautiful Egyptian coastlines, and a smiling cast of happy-go-lucky characters welcoming delegates to the country – was more a tourism advertisement than a call to action. 

And the sight of President Sisi cheering as the screen faded to black was eerie to any observer aware of the subtext behind the choreography: Egypt is, by any metric, a police state.

Cop27
Scenes from the opening video played before President Sisi’s speech.

Ten years after the revolution in Tahrir Square, Reporters Without Borders (RSF) ranked Egypt 166th out of 180 countries in its World Press Freedom Index. Since Sisi took power in 2013, over 100 journalists have been imprisoned.

“Abdel Fattah el-Sisi’s government has muzzled the country’s journalists and media,” said Sabrina Bennoui, the head of RSF’s Middle East desk. “Journalists can no longer say what they think and have no choice but to repeat the official line or risk being jailed for threatening the state’s stability.”

Sisi’s government moved to release dozens of high-profile political prisoners ahead of COP27 in an attempt to soften its image. But 19 journalists remain behind bars – making Egypt one of the world’s biggest jailers of journalists. And the fate of one activist, the British-Egyptian blogger Alaa Abdel Fattah who on Sunday racheted up his prolonged hunger strike, has focused the international spotlight on the human rights issue.

No word on Alaa, King Charles address mysteriously scrapped

Alaa
Alaa Abd El-Fatah speaking to Al Jazeera in 2011 amid the uprising against the government of Hosni Mubarak.

Abd El Fattah rose to prominence as one of the faces of Egypt’s 2011 uprising. After Sisi came to power, he became a vocal critic of the regime’s use of military trials for civilians taking part in protests or speaking out against the government. Today, military trials for civilians continue to be allowed under Egypt’s 2014 Constitution.

He is currently serving a sentence handed down in 2019 for “joining a terrorist group” and “spreading fake news” in a manner threatening to national security. Human rights lawyer Mohamed al-Baqer, who represented Abd El Fattah, was prosecuted as part of the same case after authorities detained him when he showed up to represent his client. 

“After Sisi came to power, the whole country was forced to shut up,” Sanaa Seif, Abd El Fattah’s younger sister and three time political prisoner told the European Parliament’s sub-committee on Human Rights in the run up to COP27. “As an Egyptian there is no way, not in my wildest dreams, that I could imagine a local climate activist raising concerns at COP27. Not because they wouldn’t want to, but because they can’t.”

Alaa
Alaa’s two sisters, Mona and Sanaa, stage a protest for his release outside the British Foreign Office in London.

Abd El Fattah has been on hunger strike since April and began refusing water on Sunday as the curtains lifted on COP27. Without food or water, he is expected to be able to survive just a few days. 

“The only reason I am able to address these concerns is firstly because we are not having this conversation in Egypt, and secondly because I am already doomed with the label of human rights activist,” Ms. Seif told the Parliament. “I have served three prison sentences and my brother is in jail, I have nothing to lose.”

Given the hunger striker´s British citizenship, the question of whether King Charles, who was slated to speak via video address, would bring up Abd El Fattah’s case loomed large over the opening ceremony.

But despite being listed as one of the key speakers, no speech by the British monarch was screened. Who made the decision to postpone or axe King Charles’s comments – or whether the King or Prime Minister Rishi Sunak might still address the COP27 in tomorrow´s high-level segment – remains unclear. 

Well-aware of the dangers to her own freedom, Ms. Seif arrived in Egypt on Sunday night. “I am here to shed light on my brother’s case and save him,” she told a sea of cameras as she reached the conference grounds. “Today he took his last glass of water, so it’s now a matter of hours.”

Sharm El-Sheikh as a symbol: no room for civil society

Sharm el-Sheikh
Sharm El-Sheikh has long been used by the Egyptian elite to escape public scrutiny due to its isolated location.

The history of Sharm El-Sheikh is emblematic of the contradictions underpinning Egypt’s hosting of COP27. The purpose built resort town is a six-hour drive from the 22 million citizens of Cairo, and its isolated location allows Egyptian authorities to tightly control who can get close to, let alone enter, the site of the conference. 

In the week leading up to the COP27, authorities detained an Indian climate activist walking from the capital to Sharm El-Sheikh for holding a banner that said “March For Our Planet”. He and his lawyer were released some 24-hours later, but the story reflects the value of Sharm el-Sheikh’s fortress-like status in quelling official’s fears over potential civil society demonstrations around the conference. 

“Every Egyptian you will meet in Sharm El-Sheikh will be vetted or intimidated beforehand,” Seif told the European Parliament. “You need to have that in mind while going to COP27.”

When former Egyptian president Hosni Mubarak was forced to flee the uprisings of Tahrir Square in 2011, he came to his residence in Sharm El-Sheikh. When president Sisi announced plans to build “New Cairo”, a gated satellite capital in the desert outside Cairo, he issued the declaration from the very convention center currently packed with climate dignitaries. 

Over 2 millions protesting in Tahrir Square after Mubarak’s speech saying that he would not step down, February 11th, 2001.

“Sharm El-Sheikh is a dream resort where the government can exclude the majority of Egyptians, and invest huge amounts of resources to ensure that everything is under surveillance and their control,” Hussein Baoumi of Amnesty International told the Guardian. “It’s telling how the Egyptian presidency and the leadership view their ideal society, it’s a gated one without the masses.”

In response to international diplomatic pressure, a designated protest area was constructed alongside a highway far from the conference center. Without the presence of civil society, it will be up to heads of state and negotiators to remember what is at stake. 

“You cannot shy away from addressing the human rights crisis with the excuse that you are going to COP27 to talk about climate,” Ms. Seif concluded as she held back tears during her appearance before the European Parliament.

“The climate crisis is not about the planet, the planet will outlive us all. The climate crisis is about life on the planet. And if you are serious about caring for the planet, you need to push for human rights.”

Image Credits: Gigi Ibrahim, Alisdare Hickson, Rutger van der Maar, Jonathan Rashad.

In 1918, when the notorious Spanish flu started to sweep through the world, there was very little physicians could do to help those infected. A century later, things have radically changed.

This is partially due to a network of laboratories in dozens of countries that for the past 70 years have been collaborating to fight influenza.

“After the Second World War, there were efforts to try and build up virological surveillance on the viruses that were out there to see if it was possible to build up a global picture of what the virus is, instead of just counting influenza deaths,” Professor John McCauley says during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan.

McCauley is the director of the Worldwide Influenza Centre at the Francis Crick Institute in the United Kingdom. He joines Aslanyan together with Professor Mahmudur Rahman, former director of the Institute of Epidemiology, Disease Control and Research and the National Influenza Centre in Bangladesh.

The episode was produced in partnership with the World Health Organization’s Global Influenza Surveillance and Response System, also known by its acronym, GISRS, to celebrate its 70th anniversary.

“Annually, around a billion people get seasonal influenza, and the threat of a pandemic is always lurking on the horizon as viruses keep evolving,” says Aslanyan. “To safeguard and protect us from these public health threats, year-round surveillance is being conducted by GISRS.”

In the late 1940s, the network included only 20 to 30 laboratories. Today it has grown to include some 150 labs in 127 countries.

GISRS’ work has also had a deep impact on how individual countries have been carrying out surveillance against the flu.

Rahman shares the experience of Bangladesh.

“We developed our laboratory so that we can also have a look into the circulating influenza virus, and what is happening in the country,” he explains. “After that, we set up 12 centre sites across the country, and we were collecting data on a regular basis to understand what was happening.”

This allowed Bangladesh to appreciate how its influenza season is different from those of other countries.

“Over the years we have developed our capacity with the support of business and CDC,” he adds. “When COVID came in, we could easily and quickly diagnose COVID also in this country very quickly in our laboratory.”

According to McCauley, it is crucial to remember that influenza is a global threat and therefore international collaboration is essential.

“What we are looking at is a global threat, and so what we need to do is build up a global picture,” he says. “It is not isolated events, these events are linked because flu spreads really quickly. And so when you get a flu virus establishing in one place, basically, we’ve seen it time and again, within a year that virus has gone all around the world.”

Listen to previous episodes on the Health Policy website >>
Learn more about “Global Health Matters”>>

Image Credits: TDR.

On right: Sameh Shoukry, COP27 President, center: UN Climate Executive Secretary, Simon Stiell at opening day press conference

¨Loss and damage´ from climate change gains a formal place on the COP27 agenda, as conference gets underway, while the World Health Organization issues urgent appeal to world leaders to negotiate a treaty to phase out fossil fuels altogether. 

Sharm el Sheikh – In a historic first, the issue of ¨loss and damage¨ finance for developing countries suffering from impacts of climate change was added to the formal negotiating agenda, as the 27th UN Climate Conference of Parties (COP27) opened here on Sunday – albeit after a delay of several hours as delegates tussled over the final wording of the agenda item.

Meanwhile, the World Health Organization (WHO) issued a grim warning that the climate crisis is increasing illness and deaths at an increasing pace – with hundreds of millions of people already affected and trillions of dollars in direct and indirect economic losses.

And the World Metereological Organization said the world is on track this year to record it´s eight warmest years ever, between 2015-2022.

The final text of the disputed agenda item calls for delegates to discuss, “matters relating to funding arrangements responding to loss and damage associated with the adverse effects of climate change, including a focus on addressing loss and damage.”

Speaking at a press conference shortly after the agenda was finally approved after a days of late night talks, Egypt´s Foreign Minister and COP 27 President Sameh Shoukry, said it was ¨too soon to speculate on the substantive content¨ of the charged loss and damage issue.

Loss and damage agenda item creates ´space´ for discussion

Climate-related events such as Pakistan´s recent floods displacing 33 million people helped push loss-and-damage onto COP27´s agenda.

But Shoukry said that the mere inclusion of the item in the formal negotiating agenda – after years when it was largely just a  civil society talking point, means that ´´political will has been demonstrated¨ to take the issue seriously.

¨This does open the door for a more in-depth, transparent consultation and negotiation process.¨  He cautioned, however, that the ¨landing zone for whatever conclusions we will have, we will have to arrive at through consensus building, building bridges, through accommodation, through flexibility.¨

Demands to include loss and damage formally on the COP negotiating agenda have escalated particularly as developing nations in the global south experience the fallout of more frequent and extreme weather events – from flooding in Nigeria and Pakistan to droughts in the Horn of Africa and hurricanes in the Caribbean.

There had been fears that increased polarization between rich and poor countries over climate priorities, as well as mounting geopolitical tensions between China, Russia and the United States and its allies, the approval of the COP27 agenda could become an even uglier sticking point. Fortunately, despite Sunday´s last minute stalls, that did not prove to be the case.

Observed Simon Stiell, UN Climate Executive Secretary, ¨The space has been created for the discussion. This is about building trust between the parties, and the fact that the parties can come together and resolve whatever issues there were with regards to the agenda is a very positive and constructive sign.  But the real test will be the quality of the discussion that takes place now over the next two weeks.¨

Stiell also called upon countries to update last year´s climate pledges with more ambitious commitments; something less than three dozen countries have done in line wth pledges made at the close of COP26 in Glasgow.

“Only 29 countries had come forward with tightened national plans since Cop26 – 29 is not 194. So here I am now looking out at 165 countries that are due to be revisiting and strengthening their national pledges this year,” he said.

Health should be at core of negotiations

In a statement issued Sunday, WHO appealed for health to ¨be at the core of these critical negotiations¨ – even though the health topic is not formally represented among the thematics of the COP27 conference, or its formal negotiations.

“Climate change is making millions of people sick or more vulnerable to disease all over the world and the increasing destructiveness of extreme weather events disproportionately affects poor and marginalized communities,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It is crucial that leaders and decision makers come together at COP27 to put health at the heart of the negotiations.”

Jungle burned for agriculture in southern Mexico

¨Our health depends on the health of the ecosystems that surround us, and these ecosystems are now under threat from deforestation, agriculture and other changes in land use and rapid urban development,¨ added the WHO Director-General.

¨The encroachment ever further into animal habitats is increasing opportunities for viruses harmful to humans to make the transition from their animal host. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year from malnutrition, malaria, diarrhea and heat stress.

¨The rise in global temperature that has already occurred is leading to extreme weather events that bring intense heatwaves and droughts, devastating floods and increasingly powerful hurricanes and tropical storms. The combination of these factors means the impact on human health is increasing and is likely to accelerate.¨

World Metereological Organization report cites last eight years as warmest on record

Those statements were bolstered by a new World Metereological Organization report on the State of of the Global Climate, also released Sunday.  According to the report, the years 2015-2022 are on track to be the eight warmest ever on record. Meanwhile, the rate of sea level rise has doubled since 1993, with oceans rising by nearly 10 mm since January 2020 to a new record high this year, the report stated.

Global mean temperature increase in the 2022 WMO State of the Global Climate report.

¨We have such high levels of carbon dioxide in the atmosphere now that the lower 1.5°C of the Paris Agreement is barely within reach,” said WMO Secretary-General Prof Petteri Taalas of the findings, which confirm those of a spate of other recent reports by the UN Environment Programme and the UN Climat Secretariat on the steady pace of global warming in the face of inadequate mitigation measures.

“It’s already too late for many glaciers, and the melting will continue for hundreds if not thousands of years, with major implications for water security. The rate of sea level rise has doubled in the past 30 years. Although we still measure this in terms of millimetres per year, it adds up to half to one meter per century, and that is a long-term and major threat to many millions of coastal dwellers and low-lying states,” Taalas added.

“All too often, those least responsible for climate change suffer most – as we have seen with the terrible flooding in Pakistan and deadly, long-running drought in the Horn of Africa. But even well-prepared societies this year have been ravaged by extremes – as seen by the protracted heatwaves and drought in large parts of Europe and southern China.”

Direct damage to health in the billions, indirect of trillions

According to WHO estimates, the direct damage costs to health by 2030 (i.e., excluding costs in health-determining sectors such as agriculture and water and sanitation), is estimated to be between US$ 2–4 billion per year.

But indirect damage in sectors such as agriculture, critical to food security and nutrition, already rank in the trillions,  WHO officials told Health Policy Watch on the eve of the conference. And warming projections whereby large swathes of the planet will simply become uninhabitable sometime in this century make quantification of future damages exponentially larger.

Expansion of extremely hot regions in business-as-usual climate scenario. Black and hashed areas represent unliveable hot zones, home to 3.5 billion people in 2070.

Calling for just, equitable and fast phase out of fossil fuels – and non-proliferation treaty

Fossil fuel combustion is a leadng source of global warming as well as of health harmful air pollution emissions.

In its statement, WHO called for a ¨just, equitable and fast phase out of fossil fuels and transition to a clean energy future¨ to head off such scenarios. Its use of the term ¨phase out¨ contrasted sharply with the watered down reference to a ¨phase down¨ of fossil fuel use, which was used in the official outcome statement of last year´s COP26 in Glasgow.

WHO´s COP26 Climate Change and Health Recommendations

But the WHO call for a ¨fossil fuel non-proliferation treaty¨ goes even further.

¨There has also been encouraging progress on commitments to decarbonisation,¨ the agency noted, ¨and WHO is calling for the creation of a fossil fuel non-proliferation treaty that would see coal and other fossil fuels harmful to the atmosphere phased out in a just and equitable way. This would represent one of the most significant contributions to climate change mitigation.”

Beyond the formal negotiations, it called upon government at all levels, with civil society, to rethink the development of cities and rural areas in more sustainable ways.

¨Improvement in human health is something that all citizens can contribute to, whether through the promotion of more urban green spaces, which facilitate climate mitigation and adaptation while decreasing the exposure to air pollution, or campaigning for local traffic restrictions and the enhancement of local transport systems,¨ said the statement.

“Community engagement and participation on climate change is essential to building resilience and strengthening food and health systems, and this is particularly important for vulnerable communities and small island developing states (SIDS), who are bearing the brunt of extreme weather events.”

Scale of climate impacts accelerating visibly

The agency also referred to a warning from its African Regional Office, issued last week, about the acceleration of climate-related droughts and flooding in the conflict ridden Horn of Africa region. See our related story here:

COP 27: War, Inflation and Geopolitical Tensions Reduce Chances of Breakthrough

According to the new report by WHO´s African Regional Office, some 31 million people in the seven countries that make up the greater Horn of Africa are facing acute hunger, and 11 million children are facing acute malnutrition, as the region faces one of the worst droughts in recent decades. Climate change already has an impact on food security and if current trends persist, it will only get worse, the WHO statement said, some estimates put those costs as high as $12-14 trillion.

¨The floods in Pakistan are a result of climate change and have devasted vast swathes of the country. The impact will be felt for years to come. Over 33 million people have been affected and almost 1500 health centres damaged.

¨But even communities and regions less familiar with extreme weather must increase their resilience, as we have seen with flooding and heat waves recently in central Europe.

Investments in clean energy will yield health gains that repay costs twice over­

Hospital in Johannesburg, South Africa decked with solar panels to support clean energy supply in the health sector- the most energy intensive commercial sector after the hotel industry.Climate-friendly policies could also generate health benefits simultaneously, the agency added.

¨Health-focused climate policy would help bring about a planet that has cleaner air, more abundant and safer fresh water and food, more effective and fairer health and social protection systems and, as a result, healthier people.

¨Investment in clean energy will yield health gains that repay those investments twice over,¨ the agency added.

¨There are proven interventions able to reduce emissions of short-lived climate pollutants, for instance applying higher standards for vehicle emissions, which have been calculated to save approximately 2.4 million lives per year, through improved air quality and reduce global warming by about 0.5 °C by 2050.

¨The cost of renewable sources of energy has decreased significantly in the last few years, and solar energy is now cheaper than coal or gas in most major economies.¨

At COP27, a WHO Health Pavilion will offer a 2-week programme of events, showcasing evidence, initiatives and solutions to maximize the health benefits of tackling climate change across regions, sectors and communities. Link here to see the calendar and watch the events on livestream.

Image Credits: Fletcher/Health Policy Watch, Rahul Rajput, Jami Dwyer, World Metereological Organization, PNAS, Chris LeBoutillier, WHO, Health Care Without Harm .

COP 27
On 21 September 2022 people wait in the midday sun for the water troughs to fill with water at Hula Hula Springs in Marsabit County, Kenya. With the ongoing drought in Marsabit, the spring is the only available water source for the whole community.

Sharm El Sheikh, Egypt – Over 120 heads of state are expected to attend this year´s UN Climate Conference (COP 27), which begins Sunday, raising hopes that global leaders will at least give a nod to the most existential crisis facing humanity by bothering to attend in person.

But in a world paralyzed by the Ukraine war, inflation and deep North-South divides, the chances of bold climate action continue to be appear grim – even as the warnings of climate catastrophe and real life damages incurred in human lives, livelihoods and health continue to increase exponentially.

The hard decisions on the COP27 table include demands from developing countries for formal recognition of the rising toll of “loss and damage” sustained by their economies due to climate events fueled by decades emissions they had little to do with.

Rich countries will also face calls from low- and middle-income countries to commit trillions more dollars in climate finance – a sentiment echoed by multiple recent UN reports – to assure their green transition. But they are yet to even reach the $100 billion annually in support for the green climate fund goal agreed to in the 2015 Paris Climate Agreement.

Only 26 countries have made new climate mitigation commitments since the 2021 Glasgow Climate Conference (COP26), a testimony to the lack of ambition displayed by the international community at a time when experts warn the possibility of keeping warming to 1.5 C is increasingly distant –  or perhaps impossible.

Neither China´s President, Xi Jinping, head of the state of the world´s second largest emitter, nor Indian Prime Minister Narendra Modi – who forced a last minute change to the language of the Glasgow COP26 outcome statement from a “phase out” to “phase down” of fossil fuels – are expected to attend, admitted Egyptian Ambassador Wael Aboulmagd, special advisor to the incoming COP presidency in a press briefing Friday morning.

Russia´s Vladimir Putin, whose war in Ukraine has exacerbated the climate impacts of a global food crisis, is preoccupied. Besides, his country is perhaps the only one that stands to win the climate crisis.

Agenda on opening day could be first point of dispute 

Cop 27
Wael Aboulmagd, Special Advisor to the incoming COP presidency speaking at a press briefing Friday.

The deep discord could already surface in opening day talks on Sunday, when an agenda for the 12 days-long meeting will need to be approved. This will require broad agreement with developing country demands to at least convene formal negotiating sessions on provisions for loss-and-damage compensation, as well as negotiations over a ¨just energy transition¨ – code words for continued fossil fuel development in the global South.

Speaking at a press briefing Friday, Aboulmagd said he hoped the agenda be quickly finalized thanks to the ongoing intensive talks between COP parties this weekend.

He urged rivals like the United States and China to put aside their bilateral tensions, and countries more generally to ¨rise to the occasion¨ by aligning technical negotiating positions with public statements.

¨The threat is real, none of this is about getting a few gains out of a negotiated text, it is about real lives that are being lost,¨ said Aboulmagd. “We cannot continue on a path where pledges are made in front of cameras and then in the negotiating groups, we are back to an adversarial approach.”

The world is at a tipping point, and Egypt hopes to be the unlikely hero to mediate conversations between world leaders to set the world on track to a climate recovery.

“The urgency, the gravity of the challenge necessitates that we all show a spirit of compromise, show a little more empathy and understanding of the predicament of the other,” Aboulmagd said. ¨Only when we do that and rise literally to the occasion that is before us, will we be able to meet the climate challenge.¨

In an appeal to COP members issued Sunday morning, WHO called for quick action on phase out on fossil fuels, including a “fossil fuel nonproliferation treaty.”

Egypt poised to play its role

COp27
COP27 will be held from 6 to 18 November 2022 in Sharm El Sheikh, Egypt.

If Egypt is facing criticism of its human rights record, it also has the unenviable task of bringing the very disparate and, in some cases, warring parties together.

But as the third most populous country in Africa and the biggest country in the Arab world, Cairo also has the potential to play a pivotal role in the talks, based on its record as an able player in regional and global diplomacy.

Official statements in the lead up to this year´s COP have underlined that Egypt wants to push ¨win-win¨ achievements and practical implementation plans.

Aboulmagd stressed Cairo´s support for developing countries´ demands, as expressed recently by the G-7, to finally tackle the mounting losses that poor countries are facing due to climate-related weather extremes.

He also reiterated a point made by the United Nation’s Environmental Agency (UNEP)  ‘Adaptation Gap’ report released yesterday: climate finance needs increase from billions to ¨trillions¨ if developing countries are to afford the shift to more sustainable energy sources.

¨100 billion is not going to even come close to address actual needs,¨ Aboulmagd said. ¨The overall finance landscape has to be revisited.”

Stinging series of UN reports set the stage for COP 27 

UNEP
Inadequate progress on climate action makes rapid transformation of societies only option, the UNEP’s Emissions Gap report found.

The start of the conference follows the release of a series of gloomy reports about the world´s current warming trajectory. The UNEP ‘Emissions Gap’ report found that the world has both “no credible pathway to 1.5 C”, and is on track for warming of 2.8 C if current policies persist.

And Egyptian officials have concurred with UN assessments that the aim of keeping warming to 1.5 C is ´more fragile than ever.´

Without a ¨historic pact¨ between rich and poor countries, the planet is ¨doomed¨ to experience the worst of the climate crisis,¨ warned UN Secretary General Antonio Guterres on Friday. His remarks were the latest in a string of stark warnings on the crisis, which world leaders have so far largely ignored.

“There is no way we can avoid a catastrophic situation, if the two [the developed and developing world] are not able to establish a historic pact,” he told the Guardian in an interview. “Because at the present level, we will be doomed.”

Historic levels of climate-related crises in Horn of Africa in 2022

The Secretary General´s warnings were echoed by WHO officials in a series of statements this week.

In the Greater Horn of Africa, disease outbreaks and climate-related health emergencies are at their highest-ever level this century, WHO´s African Regional Office warned on Thursday.

Most of the region is battling its worst droughts in at least 40 years, with an unprecedented fifth rainy season failure now anticipated. And countries spared from drought face flooding and conflict, and 47 million people already facing acute hunger.

“Climate change is having an impact here and now on the health of Africans in the greater Horn of Africa. The failure of four consecutive rainy seasons has scorched the earth and pushed people out of their homes in search of food and water,” said Matshidiso Moeti, Regional Director for Africa of the situation of the seven countries that make-up the greater Horn of Africa region.

“It is critical that world leaders reach agreement on stemming the rise in temperatures at the 27th United Nations Climate Change conference (COP27) which is very appropriately taking place in Africa,” she said. “As a continent we are the least responsible for global warming, but among the first to experience its tragic impact.”

The WHO analysis of the seven countries – Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda – recorded 39 disease outbreaks. These included anthrax, measles, cholera, yellow fever, chikungunya, meningitis, and other infectious diseases, compounding the toll exacted by the droughts, flooding and other disasters that have struck this year.

Millions of children under the age of five in the region are estimated to be facing acute malnutrition, increasing their risk of not only starvation, but also of more severe outcomes from common childhood diseases, the WHO analysis reported.

Horn of Africa is just a taste of what is happening globally

June floods in Pakistan killed 1,717. The health impacts of the devastation are still unfolding.

And these figures are just a glimpse of the global situation, WHO´s Maria Neira and Diarmid Campbell-Lendrum noted at a Thursday Geneva press conference focused on health and climate.

“In Pakistan the floods affected about 33 million people, but also impacted about 1500 health centers,” Campbell-Lendrum said. “Climate change and extreme weather are actually destroying our capacity to protect people from their impacts.”

Policymakers have yet to pay serious attention to the slower-moving increases in extreme heat exposures for older people and outdoor workers. Heat extremes are changing patterns of vector-borne diseases, impacting mental health, and providing fertile ground for noncommunicable disease conditions triggered and exacerbated by air pollution from fossil fuel emissions to develop. The air pollution question is one that WHO as well as climate and health experts around the world have documented over and again.

Climate change also is affecting water access and food security. As the important natural water reservoirs for countries from the Himalayas to Europe contained in glaciers melt, and once fertile ground across Latin America and Africa becomes unlivable, the health consequences project to be as extreme as the climates that catalyze them.

“A few years ago, WHO estimated that we would be experiencing a minimum of 250,000 additional deaths from climate change by the 2030s,” Campbell-Lendrum said. “Everything that we’re now observing in the real world suggest that those impacts we will either hit that number, or exceed it.”

Health consequences grabbing more attention – but not enough in core negotiations  

Cop 27
With 11 thematic days on the schedule, none are reserved to discuss the impacts of climate on health.

While the health impacts of climate extremes have started to grab more headlines, it has not been enough to place health at the center of COP27 talks. The WHO has its own pavilion, but as in previous years, official talks will continue to be dominated by climate conversations driven by energy, environment and foreign ministers, as well as heads of state.

This year´s COP conference will feature the most extensive centering of health in its discussions, but the bar was low: the word ´health´´ was not even mentioned in the final outcome document of Glasgow. And with no dedicated thematic day, health continues to rank outside of the key issues of finance, youth, science, agriculture and other topics.

“Governments still sometimes think that climate action competes with saving money and other priorities”, Campbell-Lendrum said. “In many cases, I don’t think it is that government’s don’t care, but that they don’t realise health does not compete with these priories, it reinforces them.”

The case of fossil fuels, renewable energy and air pollution

Cop 27
Dr Diarmid Campbell-Lendrum, Head of the Climate Change and Health Unit at WHO, speaking at a press conference on Thursday.

As one case in point, the war in Ukraine has led to a renewed push for more fossil fuel development, particularly in Africa, as energy ministers in rich countries scramble to make up for shortfalls left by sanctions on Russian oil and gas.

At the same time, the lack of metrics to quantify the health impacts of fossil fuel use in climate and carbon accountancy means that the real costs of fossil fuels, including some $5.9 trillion annually on fossil fuel subsidies and dependency continue to be drastically undercounted.

Those costs include not only 7 million lives lost to air pollution every year, but also related healthcare costs and loss of economic productivity.

¨The most common objection to taking climate action up until now is the idea that it costs us money, that it’s too expensive to protect the global climate,¨ Campbell-Lendrum pointed out. ¨That never made much sense. And it makes even less sense now as we’ve seen the prices of fossil fuel energy spike around the world to the extent that in Europe, at least gas is about nine times more expensive than renewable energy.

Solar energy, now the cheapest energy in history, Campbell-Lendrum remarked, is a quintessential example of how progress on health can go hand-in-hand with financial savings.

“Solar is the healthiest form of energy because it doesn’t produce the air pollution that currently causes about one death every five seconds,” he explained. “This has started to raise awareness around the world that there are many reasons why we should get off our addiction to fossil fuels: they are killing us through air pollution, killing the planet, and draining our financial resources.”

Costs of investments to transition nothing compared to benefits

WHO
Dr Maria Neira, Director of Environment, Climate Change and Health at WHO providing closing remarks to Thursday’s press conference.

¨If we are able to transition to renewable sources of energy, the cost of the investment you need at the beginning will be nothing compared with the benefit that we will obtain in terms of health and the cost for the health system,” Dr Maria Neira, director of WHO´s Department of Environment, Climate and Health said in concluding Thursday’s press conference.

“Reducing the reliance on fossil fuels will decrease the mortality and morbidities caused by air pollution. That means reducing asthma, lung cancer and other chronic pulmonary disease cases. It means reducing strokes. These are directly linked to exposure to the pollution resulting from the combustion of fossil fuels,¨ she pointed out.

Cutting carbon emissions will also provide benefits in tackling food insecurity, water- and vector-borne disease spread, and reducing health care costs, Neira continued. For every $1 invested in renewables, they generate four times more than fossil fuels in terms of jobs. 

“There are so many wins we can obtain by doing just one thing: cutting carbon emissions,” Neira concluded. “The question is why we are not doing more.”

Image Credits: WHO Africa, OXFAM.

Ebola
Health workers at the Madudu Health Center meet with Mohamed Fall, UNICEF Regional Director for Eastern & Southern Africa.

On Friday, the Ebola taskforce of Kassanda district in Uganda delivered the remains of four people that succumbed to the the virus for burial to their home village of Kitongo.

Three of the bodies belong to family members who died from exposure to the virus after they exhumed a loved one they had lost to Ebola the week before so they could rebury the body based on local religious traditions.

Authorities insist the outbreak is under control. But despite its relatively limited spread, the deadly Sudan strain of Ebola continues to take a tragic toll on villages and families around the country – because there is currently no authorized vaccine against that particular Ebola virus strain.

However, the World Health Organization (WHO), Uganda and a number of other international partners have announced plans to launch clinical trials of several promising vaccine candidates, in an effort to halt the deadly outbreak. 

The trials will be conducted with the support of Uganda´s Makarere University, as well as with Coalition for Epidemic Preparedness Innovation (CEPI) and the Vaccine Alliance (GAVI), the partners said in a joint statement.

Embedding research into outbreak response

¨By embedding research at heart of the outbreak response, we can achieve two goals: to evaluate potentially efficacious candidate vaccines, and to potentially contribute to end this outbreak, and protect populations at risk in the future,¨ the statement said.

¨The Ministry of Health has designated the Makerere University Lung Institute to conduct vaccine and therapeutics clinical trials. A Principal investigator from Makerere University Lung Institute will lead the vaccine trial.¨

WHO, CEPI and Gavi are providing support to ensure that sufficient doses of candidate vaccines are available for the trial and beyond, the statemend added. ¨The aim of the vaccine trial would be to establish how effective the candidate vaccines are in diverse populations.¨

The vaccine candidates are being made available through the University of Oxford and the Serum Institute of India, the Sabin Vaccine Institute and the US government institutions Biomedical Advanced Research and Development Authority (BARDA) and National Institutes of Health (NIH), as well as International AIDS Vaccine Initiative (IAVI) and MSD, the statement added.

Outbreak has spread to the capital

Following the declaration of the outbreak in the country on 20 September, the virus has spread to seven districts, including the Ugandan capital of Kampala, thereby increasing the risks of further spread within the country and across borders. The Ministry of Health has confirmed 131 cases, 56 recoveries, and 48 deaths to date.

There is currently no known vaccine for the Sudan strain of Ebola – and thus the outbreak represents a window of opportunity to bridge that gap.  A similar strategy was tested in the deadly outbreaks of the Zaire strain of Ebola that ripped through West Africa in 2014-2016, followed by an outbreak in the Democratic Republic of Congo in 2018-2020.  In both cases, the deployment of vaccine candidates, which ultimately were approved by regulatory agencies, eventually helped squash the outbreaks.  

“We are doing what we can with experimental options, and there are vaccines in clinical trials that we hope to deploy soon,” Dr Henry Kyobe Bosa, national incident manager for Ebola for Uganda’s Ministry of Health wrote in the New York Times on Thursday. “This outbreak is a test of how much faster we can secure vaccine access this time around [compared to the early days of COVID-19], and groups like CEPI and the WHO are helping us get that early access.”

Goals of intervention: immediate impact with an eye on the future 

Ebola
Ugandan Health Minister Dr. Jane Ruth Aceng visits a proposed site to construct an isolation facility in Kassanda District.

Ebola has a fatality rate of up to 90%, making immediate support in areas like contact tracing key to limiting the damage caused by the virus.

WHO has already helped the Ministry of Health train and deploy over 300 contact tracers, who have contributed to a rise in the success rate of contact tracing from 25% at the start of the outbreak, to nearly 94% in recent days, WHO said.

“Today there is an outbreak in Uganda. Tomorrow it could be somewhere else,” Bosa said. “After the last major Ebola outbreak in West Africa, the world began to undertake changes to ensure it wouldn’t happen again, but then moved on. We need to finish the job this time.”

Image Credits: UNICEF, Uganda Ministry of Health .

Monkeypox
Researchers have published data showing an increase in transmissibility of the deadly Clade-1 variant of monkeypox.

A report presented at the Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH) on Thursday found the potential for larger, deadlier outbreaks of monkeypox outbreaks in Central Africa and internationally – as the more dangerous Clade 1 of the virus become more transmissible.

“Many people in the US CDC (Centers for Disease Control), the World Health Organization and in health ministries and research institutions across sub-Saharan Africa were calling attention to the rising danger of monkeypox long before we started seeing infections outside of Africa,” said ASTMH President Daniel Bausch. “This study provides important new insights that point to the urgent need to provide additional resources that can help Africans fight this disease.”

There are two “clades” of monkeypox virus. The one that has long been endemic in the Democratic Republic of Congo (DRC) – known as Clade 1 – has a fatality rate of up to 10%, and can include severe complications such as blindness. Clade 2, the source of recent outbreaks outside of the west and central African countries where it is endemic, is fatal less than 3% of the time.

The concern now, the report relates, is that Clade 1 is evolving to become more transmissible, at an increasing rate.

The deadlier variant has increased its rate of transmission 

Monkeypox
Tshuapa Province (noted in red), where the study took place, is situated in the remote reaches of the country’s north-west.

Data from DRC´s Tshuapa province collected between 2013 and 2017 showed an increase in the transmissibility of the Clade 1 variant. The effective reproduction rate – a closely watched metric for any infectious disease denoting its capacity to infect new hosts – has increased to 0.81 from a baseline of 0.3 to 0.5 seen throughout the 1980s.  When the reproduction rate reaches or exceeds 1, that is a tipping point where the number of new cases increases even faster than the numbers of people recovered or dying, creating the potential for transmission across much larger areas and populations.

“Our data show that monkeypox transmission in the area we studied was notably higher than previous estimates and was getting close to the point where it can cause large and sustained local outbreaks,” said Dr Kelly Charniga, a Prevention Effectiveness Fellow at the CDC and first author of the study. “This research puts the global health community on alert that there may be the opportunity for larger outbreaks in DRC on the horizon.”

The disease’s increased transmissibility has already led to longer outbreaks, increasing the opportunities for the virus to evolve to be able to sustain more person to person spread. Researchers also found evidence of more regular “spillovers” of monkeypox infections from rodents – thought to be the virus’s natural reservoir – to people.

“With today’s interconnected world, outbreaks don’t necessarily stay at their source,” Charniga said. “The best way to prevent monkeypox from causing more outbreaks in DRC and from becoming a bigger global problem is to devote more attention to areas where it is clearly causing the most suffering today.”

Monkeypox burden increasing in endemic countries

Tshuapa River, Democratic Republic of the Congo

Monkeypox cases in endemic African countries have been increasing for several years. The fall in cross-reactive immunity from the smallpox vaccination campaign ended after victory over the smallpox virus in 1982 led to the cessation of smallpox vaccination, which is protective against monkeypox too. That, in turn, has contributed to a rise in infections of both clades across Africa. The current global outbreak of Clade 2 Monkeypox virus began in the United Kingom in May, after a traveler returning  to the UK from Nigeria was reported to have been infected. Since then, some 78,000 monkeypox cases have been reported globally, with the areas of most intensive transmission in Europe and the Americas.  Although the number of new cases reported has declined sharply in the past two months, transmission remains a concern in many countries. 

Improving surveillance in endemic rural areas is the key to stemming the evolution of the disease, but is easier said than done. The regions of the DRC where the strongest monkeypox reservoirs can be found – like Tshuapa province where the study was carried out – are hard to access, researchers noted.

This complicates the distribution of vaccines and antivirals already in limited supply, and many clinics still rely on paper forms to report suspected cases. Despite these difficulties, Charniga emphasized that pro-active health system measures will lead to the most favorable outcomes for everyone.

“The best way to prevent monkeypox from causing more outbreaks in DRC and from becoming a bigger global problem is to devote more attention to areas where it is clearly causing the most suffering today,” she said.

Image Credits: WikiCommons, United Nations.

Africa only produces 1% of the vaccines it uses.

Gavi, the global vaccine alliance, has undertaken to adapt its approach to procuring vaccines in order to support African vaccine manufacturing.

In a plan released on Thursday, Gavi has committed to placing “a higher value on the benefits of diversification to supply security, with a focus on Africa”.

The 10-point plan, developed in consultation with the African Union and other key partners, also allocates responsibilities to other key players – G7 Development Ministers, African countries, international partners including development financial institutions, and the private sector – to support sustainable African manufacturing capacity.

However, Gavi will drive and coordinate the plan, given its enormous clout as the world’s biggest buyer of vaccines.

“For 22 years, as the largest buyer of vaccines in the world, Gavi has worked closely with African countries and manufacturers to favourably shape the market for essential routine and outbreak vaccines,” said Gavi CEO Dr Seth Berkley. 

“Gavi is committed to contributing to the AU’s vision. The plan published today provides a pathway to ensuring vaccine supply security for Africa during pandemics and expanding access to other life-saving vaccines at sustainable, affordable prices.”

The COVID-19 pandemic exposed Africa’s vulnerability when the entire continent was unable to get vaccines for months as wealthy countries had bought up all the doses made by Pfizer and Moderna and India stopped the export of generic vaccines made by the Serum Institute of India destined for the continent.

Stung by the COVID-19 experience, the AU has set a target to produce and supply more than 60% of its vaccine doses on the continent by 2040 – it currently supplies 1%. 

Although Africa consumes vaccines valued at over $1 billion every year, the cost of much of this is carried by Gavi, UNICEF and donors.

At present, Gavi chooses vaccine suppliers on price, and “does not systematically permit the accommodation of higher prices in the name of geographical diversity and supply security”, it acknowledged. 

“New accommodations in the way Gavi assesses products against supply security as a new market health objective, could have a substantial impact,” it acknowledges. 

The risk of supporting more expensive African-made vaccines could be mitigated by countries committing upfront to vaccines which would enable “predictable pooled procurement volumes”. 

African countries themselves also need to “send clear demand signals to the market on willingness to select and procure from African suppliers”.

“In the last 18 months alone, more than 30 new African manufacturing projects have been announced and estimates indicate that the African vaccine market across all existing and projected novel products could range between US$ 2.8 billion and US$ 5.6 billion by 2040, demonstrating the potential for a thriving regional industry to emerge,” according to Gavi.

However, the report also acknowledges that “a disorderly expansion risks unhealthy competition, potentially undermining the impact of market-shaping initiatives that have delivered low vaccine prices to lower-income nations, while also failing to realise Africa’s manufacturing aspirations”. 

It calls for a  “business model” that “actively shapes markets in support of the AU’s vision: meeting the mutually reinforcing objectives of continued global market health, and a sustainable regional manufacturing sector”.

Nonetheless, the price of setting up new manufacturing facilities in Africa may mean that their products are way too expensive to be viable.

“Modelling indicates that price differentials for new entrants may be in excess of levels that could be accommodated during standard Gavi/UNICEF competitive tenders, without impact on programme coverage,” Gavi warns.

“Ways must be found to support new entrants, whilst at the same time, avoiding a situation in which incumbent manufacturers increase their prices for vaccines due to lost volumes. This carries a potential risk of increasing the costs of immunisation worldwide.”

To address the high cost for new entrants, the plan proposes “a time-limited financial instrument that can help mitigate the high cost of vaccine production at market entry”. 

It also advocates that this financial instrument supports African manufacturers to make the most commercially viable antigen-based vaccines – starting with cholera and Ebola.

For their part, African countries are tasked with accelerating investment in the enabling environment, including “strong regulatory authorities, robust supply chains, skilled human capital, reduced trade barriers and empowered regional coordination”.

Image Credits: Gavi/Karel Prinsloo 2017.

Roast chicken vendors prepare their meals in Dar es Salaam                                                             

DAR ES SALAAM, Tanzania—At a smoky kitchen in the port city of Dar es Salaam, none of the customers jostling to place their orders knows that the irresistibly tasty roast chicken may be harbouring bacteria that could make them sick.

“I don’t think poultry farmers would do anything likely to cause harm,” said 34-year-old Lilian Kiswale a regular customer at this popular fast-food joint.

However, what is not clear to Kiswale, is that strains of bacteria that are resistant to antibiotics have repeatedly been found in chickens at farms where city’s street kitchens source their poultry products.

“None of our customers has ever complained about the smell of antibiotics in the food we have prepared,” said Kelvin Massawe who works as a chef at the chicken restaurant that is a culinary delight in the neighbourhood. 

But it’s not about antibiotics ruining the taste of roast chicken. The antibiotic-laced food that poultry farmers in Tanzania give to their birds, ostensibly to increase muscle weight quickly and keep infections at bay, poses a threat to humans as well.

According to a recent study by Tanzania’s Muhimbili University of Health and Allied Sciences (MUHAS), excessive amounts of antibiotic residue had been found in broiler chicken tissues – a perfect condition for antimicrobial resistance (AMR).

Using the liver samples of 84 commercial broiler chickens, the researchers found that 100% had the antibiotic tetracycline – and 90% at levels that exceeded acceptable daily limits. In addition, 21.4% of the samples also had sulphonamide, although this was within the maximum limit, according to the study, which was published in the journal, Antibiotics.

Worse still, researchers say that poultry farmers have unrestricted access to prescription-only antibiotics including tetracycline, sulphonamides, penicillin, aminoglycosides and macrolides.

Shop owner Jesca Anthony confirms that she sells antibiotics to farmers without prescription

This was confirmed by shop owner Jesca Anthony, who said that she sells antibiotics, without prescriptions to farmers.

“Random use of antibiotics in animal feeds heighten the risk of drug resistance not just to animals but in humans as well,” Professor Mecky Matee, head of microbiology at MUHAS and the study’s lead author, told Health Policy Watch.

“The use of antibiotics as growth promoters for chicken should be banned,” Matee stressed.

Antibiotics are losing their power

When an antibiotic is used, it wipes out susceptible bacteria, leaving behind resistant ones. These resistant bacteria can grow and become dominant, and pass from chicken products to humans who eat or handle the meat. Once inside a person, these resistant bacteria can take over the colon, which is then unable to fight infections.

Antibiotics are increasingly losing their efficacy due to indiscriminate use in humans and for stimulating animal and birds’ growth.

The rise in drug-resistant bacteria has the potential to inflict a devastating human and economic toll globally, according to the United Nations.

According to the most comprehensive estimate of the global impact of antimicrobial resistance (AMR), published in The Lancet in January 2022, an estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections – more deaths than those from HIV/AIDS or malaria.

“Many types of common antibiotics are no longer effective enough to treat bacteria, in many cases patients need hospitalisation,” said Hellen Sabuka, a senior epidemiologist at Shree Hindul Mandal Hospital in Dar es Salaam.

Sabuka urged Tanzania’s health authorities to adopt strict regulations and control on the use of antibiotics in animal production.

A customer at the Tegeta slaughter house

Although Tanzania has policies and guidelines for the use of antibiotics in animal feed, such policies are poorly enforced due to weak systems for food and agricultural productions.

In Dar es Salaam, one of Africa’s fastest-growing cities and home to 5.8 million inhabitants, poultry farmers routinely mix an array of human antibiotics into chicken feed to try to ensure they grow faster and don’t get sick.

It is a humid Sunday evening at Kibamba, a suburb in the western part of Dar es Salaam, and Salma Libuhi is busy mixing a concoction of medicines into rice husks to feed her caged chickens.

Amid smouldering heat, she methodically mixes in a cocktail of three antibiotics— oxytetracycline, doxycycline and enrofloxacin – and sets the food in cans.

“When they eat this food, they grow faster,” she told Health Policy Watch. For the 38-year-old mother of four, poultry farming is her livelihood. In 2017, quit her job as a teacher and ventured into entrepreneurship.

“Raising chicken is very profitable,” she said.

To educate herself about animal husbandry, Libuhi joined a whatsapp groups where she gets all the information about diseases and antibiotics.

“I never consulted a vet. The information I get from the group is enough,” she said.

 At Libuhi’s farm, broiler chickens usually take six weeks to reach market weight. Once they’ve reached the proper size and weight she catches each chicken by hand and transfers them to holding cages ready to be sold.

Unlike wild chickens that traverse a range of habitats as they forage for seeds, insects and fresh leaves, broiler chicken are often kept in overcrowded, poorly ventilated and unhygienic shacks.

Lack of controls in Africa

Across Africa, antibiotics are heavily in the farming of cows, pigs and chickens to fight infections and promote growth. With the indiscriminate use of antibiotics, particularly in agriculture for stimulating animal and birds’ growth, these essential medicines are losing their efficacy.

“Many types of common antibiotics are no longer effective enough to treat bacteria, in many cases patients need hospitalisation,” said Hellen Sabuka, a senior epidemiologist at Shree Hindul Mandal Hospital in Dar es Salaam.

Sabuka urged Tanzania’s health authorities to adopt strict regulations and control on the use of antibiotics in animal production.

While over-use of antibiotics as growth promoters is not a new phenomenon, global experts think preventing drug-resistant bacteria that kill millions of people every year, requires a coordinated approach.

Mohan P. Joshi, technical lead for antimicrobial resistance and global health security at the non-profit, Management Sciences for Health, said the overuse of antimicrobials in animals, especially as growth-promoters in food-producing animals, is common in many countries.

 “In some countries, the proportion [of antibiotics] used in the animal sector is as high as 80% of the total antimicrobials consumed. Alternatives such as good animal husbandry, vaccinations, and biosecurity measures including hygienic practices are critical farming approaches that can help reduce antimicrobial use in animals raised for food,” he said.

While 144 countries have national plans to combat AMR, according to a 2021 World Health Organization (WHO)  report, Joshi says sectors differ in the amount of progress they’ve made, with the human health sector generally making the most progress and the animal sector lagging.

“We need collaborative, multisectoral coordination to address public health threats at the intersection of humans, animals, and the environment. A One Health-focused approach is the only way to effectively address this widespread issue,” Joshi said.

According to him, the fight against AMR needs coordinating bodies with adequate funding, political support and authority to act.

“Countries need to establish functional multi-sectoral task forces to contain AMR that include high-level government officials and stakeholders from both human and animal health, along with the agricultural, environmental and food sectors, and ensure that such bodies are effectively facilitating One Health coordination, helping build capacities of local stakeholders, and mobilising diversified funding,” he said

In 2019, five million human infections were associated with bacterial antimicrobial resistance worldwide, including more than 1.2 million human deaths attributable to bacterial AMR. The burden was highest in sub-Saharan Africa and South Asia, with children below five years of age the most affected.

Pushed by the rising demand for cheap poultry products, the broiler value chain in Tanzania, is a big user of antibiotics. Most poultry farmers in Tanzania treat chicken with a concoction of antibiotics often without consulting veterinary doctors.

Despite the growing adversity, global experts are cautiously optimistic about prescription-only system where veterinarians will have the upper hand in dispensing drugs used in animal production.

Chicken dealers waiting for customers at Tegeta slaughter house.

Thomas Van Boeckel, from the public research university, Zurich ETH, said the best way to curb antibiotic use in animals is to move to a prescription only –system where only trained veterinarian would be authorized to sell the antibiotics rather than retail shop owners.

“However, even in Switzerland where such a system is in place, this does not resolve all problems because vets may still have a financial conflict of interest in prescribing for profit,” Boeckel said.

He says that a better solution would be to “remove the profit margin from vets on drug prescription,” as is the case in Sweden.

Meanwhile, Emma Berntman, senior engagement specialist at FAIRR initiative, said low and middle-income countries, including Tanzania have the largest share of global antimicrobial consumption in animals and agriculture, due to the routine use of antimicrobials in farming for growth promotion and prophylaxis.

She blamed the countries’ lack of checks and balances and low awareness on overuse of antibiotics.

“Tanzania is no exception to this. The country lacks regulation that is sufficient to adequately address the issue of excessive antimicrobial use and antibiotic are cheap and widely available,” said Berntman. FAIRR is an investor-run initiative to address threats to the global food supply.

According to her, even when regulation exists in the emerging market, it can be hard to enforce when there is a lack of access to veterinarians and poor awareness of the impacts of overusing antibiotics.

“On-the-ground initiatives are needed to help support farmers to reduce their dependence on these drugs,” she stressed.

Growing appeal of organic products

Although Switzerland launched an AMR strategy in 2015, FAIRR experts say the highest priority critically important antibiotics (HPCIAs) including fluoroquinolones, are still excessively used in farms, notably in broiler production, with authorities warning of high levels of resistance.

“These antibiotics are deemed ‘the last line of defence’ in human medicine and are the only antibiotics available to treat certain bacterial infection. If they become ineffective, it poses a significant threat to human health,” Berntman said.

“Resistant bacteria developed in broilers can spread to humans through direct contact with the birds, eating chicken or via the environment. There is also a risk to flock health due to the reduced efficacy of antimicrobials used to treat them.”

Despite the growing threat, experts see glimmer of hope in reducing the use of antibiotics in broiler farms and other antibiotics used in human medicines.

“The government can support reductions by further restricting the use of antibiotics in animals in line with the latest EU regulations, so that antibiotics can only be used to treat infections and routine use is prevented,” Berntman said.

Moreover, Berntman said the government can facilitate antibiotic stewardship activities to support the adoption of alternatives to antimicrobials including vaccination programmes and improved nutrition.

According to Berntman the rising awareness of the risk of AMR in Europe and North America has triggered a surge in demand for products associated with or lower antibiotic use.

“Many consumers are willing to pay a price premium to purchase organic chicken or chicken raised without antibiotics,” she said.

Approximately 60% of broilers in the US are now raised without antibiotics, according to Berntman. Moreover, the number of broiler chicks receiving antibiotics in the hatchery has dropped by 90% to nearly zero.

 “It is important that poultry producers improve animal welfare, vaccinate their flocks, and implement routine health monitoring programmes to meet consumer demand for broilers raised with less or no antibiotics while simultaneously creating environments where healthy flocks can be raised no antimicrobials required without impacting animal welfare,” Berntman said.

But for chicken lovers in Dar es Salaam, antibiotic-free roast chicken meat is probably a distant dream.

Image Credits: Peter Mgongo.