Causa Justa activists outside Colombia’s Constitutional Court

In February, Colombia introduced one of the most liberal abortion laws in the world after activists took to the courts – but now their challenge lies in ensuring the health system is in a position to offer terminations

Not long ago, abortion in Colombia was a taboo topic that could not be mentioned during dinners or family gatherings, according to Florence Thomas, one of Colombia’s feminism most influential voices.

“It was considered such a difficult subject that people would stand up and leave my lectures when I touched upon it,” Thomas told Health Policy Watch.

 Some 16 years ago, in 2006, Colombian lawyer Mónica Roa challenged the country’s complete ban on abortion in the Constitutional Court and achieved the decriminalization of abortion on three grounds: when the pregnancy was the result of rape or incest; when there was a severe malformation of the fetus; and when the pregnancy constituted a risk to the woman’s health. 

“That ruling changed the course of history,” Thomas explains because it made it evident that the legal way to fight for safe abortions was not the Congress, but the Constitutional Court, the highest court in Colombia.

Since then, feminist movements and pro-choice lawyers like Roa have fought to extend the decriminalization of abortion in Colombia.

Lawsuit against barriers

In 2020, Causa Justa (“Just Cause”), a movement made up of over 100 organisations and 140 activists united to legalise abortion, filed a lawsuit against the criminalization of the early termination of pregnancy. 

Instead of proposing a whole new scheme of laws that would have to go through Congress, they sought a regulate abortion within the rules that were already in place and thus would not rely on politicians. 

Causa Justa showed that, despite the 2006 reforms, abortion remained a crime in the Penal Code, putting it out of reach for most women.  Causa Justa’s lawsuit, supported by more than 100 national and international experts, also showed that almost 400 women were convicted every year for having or seeking an abortion, with sentences ranging from 16 to 54 months in prison. Between 2006 and 2019, more than 5,700 women were charged for abortion.

Causa Justa’s lawyers also showed the judges that criminalization forced women to seek unsanitary and dangerous underground abortion clinics. According to Colombia’s Public Health and Epidemiology Observatory, one of the main causes of  the deaths of over 400 women from haemorrhaging in 2020 was unsafe, illegal abortions.

Between 59% and 70% of the complaints laid against the women seeking abortions had come from health workers, explains Mariana Ardila, a lawyer with Women’s Link, one of the organizations that are part of Causa Justa. 

Abortion providers could also face charges, which made most health professionals refuse to perform abortions.

Nail-bitingly close judgement

That sad reality changed with the new ruling in February this year, which established that abortion will only be an offence after the 24th week of pregnancy. 

“Women won,” said the plaintiffs after learning of the decision, surrounded by chants claiming: “It is a law! It is a law! It is a law.”

The ruling is historic because successive Colombian governments have never legislated on an issue that they consider neither a priority nor find beneficial because of the controversy it generates in the street. 

Colombia is a secular but deeply religious country. A 2017 survey revealed that 97% of citizens believe in God and the different churches, predominantly Catholic and Evangelical, have enormous power over believers, pushing them into an all-out fight against abortion.

In its final stage, the Constitutional Court judges voted on the lawsuit, and the vote was nail-bitingly close: five judges were in favor, and four against. With this final say, the court proved that Colombia is changing. Today, only 20% of the population approves that women go to jail if they get an abortion.

Health services not prepared

The Court also ruled that the government would have to implement a comprehensive public policy regarding access to safe and legal abortions in the “shortest possible time.” However, to date, such a policy hasn’t been fully defined and executed.

 Colombia’s Ministry of Health recognizes that barriers to abortion persist and are mainly associated with the denial of services – mainly due to ignorance of the changed legal framework and improper exercise of conscientious objection by medical personnel. 

On 28 September, it issued a document with instructions about how to strengthen sexual and reproductive health care, including abortion, that was addressed to all entities that are part of the health system.

Colombia is part of a “green wave” of countries in the region that have decided to expand their abortion freedoms, but it allows abortion much later than its regional counterparts.

 

Mexico’s Supreme Court ruled late last year that was unconstitutional to criminalize abortion. However, each state has to regulate the decision of the Supreme Court. 

In Argentina, Congress approved abortion’s legality up to 14 weeks, and, as in Colombia, lifted the restrictions that only allowed for abortion in cases of rape or where the mother’s health is at risk.

On the other hand, Ecuador’s National Assembly approved a bill that allows abortions if they result from rape up to the 12th week, but President Guillermo Lasso vetoed it, saying that he respects “life from conception.”

Colombia’s ruling, however, is a historic victory for the Colombian women’s movement that has fought for decades for their rights to be recognized in a traditional and ultra-catholic country. The next step is for the public policy to be fully deployed across the country and to serve as a model for the region.

Mesa por la Vida y la Salud de las Mujeres, a feminist collective that defends women’s sexual and reproductive rights, stated that during the first few months of 2022, they helped more than 90 women to overcome barriers while seeking an abortion within the new law’s parameters.

Alejandra* (not her real name) is one example. She asked for an abortion in her sixth week of pregnancy but only finally got one in her 11th week. She states that the procedure was slow and painful and that the doctors did not provide clear information about the process.

The numbers show that the path is still long for women in Colombia and that the famous feminist march slogan, “we want sex education to decide, contraceptives to avoid abortion, and legal abortion not to die,” will still echo in the streets, the mountains, the buildings, and law-making entities until Colombian women can feel free to decide, unchallenged, about their bodies.

The Rosa Luxemburg Foundation provided support for this article.

Image Credits: Causa Justa.

Alcohol is related to more than 60 different conditions, including cancers, heart and liver disease.

A $15 million initiative to address the harms of alcohol consumption through policy change was launched Tuesday, roughly doubling the total global spending on mitigating the effects of alcohol.

Alcohol is one of the top-ten drivers of death, illness and injury, with wide-ranging social and economic harms, many disproportionately affecting young adults, according to Vital Strategies, which heads the RESET Alcohol consortium.

“RESET Alcohol is an initiative that brings together national governments, civil society, research organizations, and global leaders in public health and alcohol policy to develop and implement evidence-based alcohol policies from the World Health Organization’s WHO) SAFER technical package,” according to Vital Strategies. 

The initiative will focus on Latin America, Africa and Asia, with partners Movendi International; the University of Illinois Chicago; the Global Alcohol Policy Alliance (GAPA); the Non-Communicable Disease (NCD) Alliance; and the WHO, with GiveWell as the donor.

RESET’s primary policy focus will be on increasing alcohol taxation and other pricing policies which it describes as being “among the most effective interventions for reducing consumption”. It also aims to regulate the availability of alcohol, and restrict its marketing.

Over three years, the initiative will support 15 or more countries to develop policies including raising the price of alcohol via taxation, regulating availability, and restricting alcohol marketing.

Policies to protect kids

“Every year, alcohol use cuts millions of lives short and causes even more widespread suffering,” said Adam Karpati, senior vice president at Vital Strategies. 

“The onus can’t be on individuals. We must reset from an environment where the alcohol industry is empowered to push alcohol into nearly every aspect of our lives, including schools, sports, and media. We need policies that protect kids, make healthy choices, the easy choices, and check the industry’s influence. RESET Alcohol will do just that through strong partnerships with government and civil society leaders who are committed to action.” 

Alcohol consumption has increased in nearly all regions of the world consistently since 2005, and accelerated during the COVID-19 pandemic. It is related to more than 60 different conditions, including cancers, heart disease, liver disease, tuberculosis and HIV/AIDS; injuries and trauma including suicide, homicide, assault, falls, intimate partner violence, and vehicle crashes. Alcohol consumption is also associated with adverse economic impacts, from medical care costs to lost productivity.

RESET Alcohol’s approach builds on its partners’ successes in similar consortiums that have addressed tobacco and other harmful commodities, including contributing to 18.5% reduction in tobacco use in Bangladesh between 2009 and 2017 and a 17% reduction in India between 2010 and 2017.

“Failure to act has led to millions of preventable deaths and suffering from alcohol,” said Jacqui Drope, the new director of RESET Alcohol. “It’s time governments treat it like the public health crisis that it is. When governments take up policies proven to reduce alcohol-related harms, population health and economies will benefit.”

 RESET Alcohol will provide technical support to governments, improve national research and data collection, resource advocacy for policy change, and mount communications campaigns.

 “For governments, tax increases on alcohol are a win-win, especially given the sluggish global economy,” said Jeffrey Drope, Research Professor at UIC.

“Effective alcohol taxation reduces affordability, consumption and alcohol-related disease and premature death. This means lower healthcare costs and increased productivity from a healthier population. Taxes also create revenue for governments to fund health programs or other social priorities.

Image Credits: U.S. Air Force/Samuel King Jr. .

The World Health Organization (WHO) and World Meteorological Organization (WMO) launched the first global knowledge platform dedicated to climate and health on Monday called climahealth.info.

The global open-access platform is envisaged as being the “go-to technical reference point for users of interdisciplinary health, environmental, and climate science”, according to the WHO in a media release. 

“The use of tailored climate and environmental science and tools for public health, such as disease forecasting and heat health early warning systems, have enormous life-saving potential. These tools and resources can enhance our understanding of the connections between climate and health, help us reach at-risk populations, and anticipate and reduce impacts,” according to the media release.

“Climate change is killing people right now,” said Diarmid Campbell-Lendrum, coordinator of WHO’s climate change and health programme. “It is affecting the basics we need to survive – clean air, safe water, food and shelter – with the worst impacts being felt by the most vulnerable. Unmitigated climate change has the potential to undermine decades of progress in global health. Reducing its impacts requires evidence-based policy backed by the best available science and tools.”

Joy Shumake-Guillemot, who leads the WMO-WHO Climate and Health Joint Office, said that public health practitioners who are concerned about the environmental impacts on health “lack access to training and tailored climate information needed to address these growing issues” while  “climate experts (are) sitting on troves of research and resources that could be applied to support public health goals, but just aren’t reaching the right people”.

The initiative is supported by the Wellcome Trust.

“Collaboration between climate, health and technical specialists is crucial for helping us understand and tackle the health effects of climate change,” said Madeleine Thomson, Head of Climate Impacts and Adaptation for the Wellcome Trust. “But right now, experts can’t always partner and share information as effectively as we know they’d like to. We hope this portal will help fulfill the potential of different disciplines to work together on research and gain new insights into how climate change is affecting health around the world.”

Cities’ Malaria Framework launched

On the occasion of World Cities Day 2022 on Monday, the WHO and UN Habitat launched the Global framework for the response to malaria in urban areas, which provides guidance to city government officials, health professionals and urban planners on how to develop a  comprehensive malaria response specifically in urban areas, “where the dynamics of transmission and burden of vector-borne diseases can be different from that of rural areas”.

By 2050, nearly 70% of people globally will live in cities and other urban settings and the WHO predicts that unplanned urbanization is likely to result in a malaria disease burden that is “disproportionately high among the urban poor”.

Speakers at the launch also anticipated that climate change will see malaria in places that were previously too cold for the disease that is carried by mosquitos.

The framework provides guidance for city leaders, health programmes and urban planners to respond to the challenges of rapid urbanization in a targeted way that helps to build resilience against the threat of malaria and other vector-borne diseases.

Omicron
Experts have described the array of subvariants as a “swarm”.

The SARS-CoV2 virus just won’t give up. As the northern hemisphere heads into its third pandemic winter, experts say the continued evolution of Omicron’s sub-variants indicates a fresh wave is coming, but no one knows which variant will fuel it.

Scientists have catalogued 390 Omicron lineages and 48 recombinants of the virus – which occur when at least two variants co-infect the same person, allowing them to ‘exchange notes’ and evolve. The sheer number of Omicron strains circulating makes predictions complicated.

“We’re having trouble isolating which of the omicron sub-variants will have a growth advantage and will take over in dominating the spread,” WHO Senior Emergency Officer Dr Catherine Smallwood explained at a press conference last week. “Some variants like BQ.1 have been noted as potentially accelerated, but we’re not sure yet how this is going to pan out in the longer term.”

The variety of offshoots also creates the possibility of a ‘double wave’ in some places if two successive variants with different immune-dodging characteristics succeed each other.

“Looking at all the data, it seems a sizable new infection wave is certain to come,” Tom Wenseleers, an evolutionary biologist at the Catholic University of Leuven told Nature.

Subvariant surges not causing hospitalization spikes – for now

Omicron
Ranking of the immune evasion for the new variants

There is some good news: early signs show that though the BA.4, BA.5, BQ.1.1 and XBB subvariants are able to break through immune protections and resist certain treatments, they do not appear to be causing increases in hospitalizations.

“An encouraging sign for one of – if not the most – immune evasive new variants XBB: it is dominant in India and Bangladesh without a rise in cases or deaths to date,” said Eric Topol, founder and director of Scripps Research.

Despite the dominance of the highly infectious XBB variant, deaths and cases in India and Bengladesh have remained stable.

Similar findings have come out of South Africa, where the Africa Health Research Institute in Durban conducted studies on the BA.4 and BA.5 sub-lineages. The team, led by virologist Alex Sigal, found that while these Omicron families possess strong enough immune-dodging mechanisms to lead to an infection wave, they are “not likely to cause much more severe disease than the previous waves, especially in vaccinated people.”

The World Health Organization’s (WHO) Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE), which released a statement singling out BQ.1 and XBB as key variants of concern on Thursday, issued a similar analysis.

“While we are looking at a vast genetic diversity of Omicron sublineages, they currently display similar clinical outcomes, but with differences in immune escape potential,” TAG-VE’s expert panel found. “So far there is no epidemiological evidence that these sublineages will be of substantially greater risk compared to other Omicron sublineages.”

World trending in the right direction – but surprises could be around the corner

WHO
WHO data as of the October 26 SARS-CoV2 weekly situation report.

The question lingering on the mind of many experts is whether the varying properties of subvariants mean infection by one will provide immunity from others – a key determinant of whether double waves will hit.

A team at Peking University in Beijing, led by Yunglong Richard Cao, has been studying the variants’ immune-evading capacities. “I have a feeling that if you’re infected with BQ.1, you might have some protection against XBB,” he told Nature. “We don’t have data yet.”

Experts warn not to rule out more surprises from the virus. With Delta still circulating in the background, the deadlier variant could return to the fore. 

“The virus has surprised us more than once,” said Dr Hans Kluge, WHO Europe Regional Director. “We are much better prepared, and the fall surge has not led to previous ICU admission or severe disease levels, but forecasting remains tricky.” 

Russia’s invasion of Ukraine – denoted by the red line above – caused the country’s ability to report cases and deaths to fall.

Reports emerged this week of yet another subvariant, BA.5.2.6 taking hold in Ukraine. The dire conditions occasioned by Russia’s invasion of the country have made it conducive ground for viral spread, and reporting since the start of the conflict has dropped off a cliff. 

Little is known about the true state of play on the ground – nor which subvariant will take over next. 

Image Credits: Nature, Stuart Turville.

A woman getting medicine at a shop in India.

NEW DELHI – Govind Ram is still waiting to get justice for the death of his daughter in 2019 – who allegedly died from contaminated cough syrup.

In December 2019, Ram’s two-year-old, Surabhi, had a fever and chest congestion. Ram, a labourer in the Udhampur district of India’s Jammu and Kashmir region, took his daughter to a local doctor who prescribed a cough syrup. 

But her condition deteriorated further, and she was taken to a sub-district hospital then to a district hospital. Doctors there told her father to take her home as there was no chance of her survival, and she died a short while later.

Ram does not know whether he will ever get justice for the death of his daughter, who authorities believed died from ingesting a contaminated cough syrup.

Earlier this month, the deaths of 66 Gambian children were linked to contaminated cough syrup manufactured by Indian company, Maiden Pharmaceuticals. The Maiden-made cough syrups were contaminated with diethylene glycol (DEG), commonly used in anti-freeze, and ethylene glycol (EG).

The Indian government has stopped production at the company’s facility in Haryana at the request of the World Health Organization (WHO).

Cough mixture exported to Gambia by Maiden Pharmaceuticals has been implicated in the deaths of 66 children. The company has a large export base.

Not the first time 

This is not the first time that such contamination has been alleged in Indian pharmaceutical products where substandard and contaminated medicines remain a widespread problem. 

Between 2019 and 2020, 13 children died after reportedly being administered a cough syrup adulterated with DEG in the northern state of Himachal Pradesh.  The deaths of another 12 children in Jammu, including Surabhi, were also alleged to have been tied to their consumption of cough syrup tainted with DEG.  

Both of the syrups were reportedly manufactured by Digital Vision, which is based in Himachal Pradesh. Two years later, the Himachal Pradesh’s Drugs Control Administration (DCA) has yet to complete its probe of the cases, which would allow charges to be filed. 

“The company’s manufacturing license was suspended, but later restored, first partially and then fully,” said Assistant Drugs Controller Garima Sharma, but did not explain how this had happened when the probe was not complete.

Lax regulatory authorities 

These are not isolated cases. The manufacture of sub-standard – and in some cases dangerous – drugs in India is rampant and the lax implementation of regulations enables manufacturers to escape any consequences.

While the sale of inferior quality drugs is a serious offence under Indian law with minimum prison term of a year and fines for the manufacturers, the provisions of the law are rarely enforced against the errant drug manufacturers. In most cases, the regulators simply suspend the drug maker’s license for a few days.

Take Digital Vision, which is supposedly being investigated for Surabhi’s death. It has 19 violations of quality standards since 2009 yet regulators have taken no significant action against it.

The October monthly alert from India’s Central Drugs Standard Control Organization (CDSCO) identifies 59 medicines that failed safety standards, including painkillers and calcium. 

“Due to repeated failure of samples of these medicines, action has been taken against them,” said Himachal Pradesh Drug Controller Navneet Marwah, explaining that these medicines had been withdrawn.

“Monitoring is needed from the time the medicine is made till it reaches the patient because it is a matter of life and death,” said Amulya Nidhi, national co-convener of People’s Health Movement of India. 

“After giving permission to manufacture a medicine it should be seen if the procedure and the guidelines related to it are being followed or not. These are regulatory failures.

“It is also important to see what action they have taken after the death of so many children. They have done nothing. Issuing notices to drug manufacturers can’t be called an action when innocent lives are lost,” added Nidhi.

According to Nidhi, a 2012 parliamentary report from the Standing Committee on Health and Family Welfare on the functioning of the Central Drug Standard Control Organization (CDSCO), had found some instances of collusion between the manufacturers, doctors and regulatory agency and had made a large number of recommendations for drastic revamping of the CDSCO.

“It is a regulatory failure and the monitoring process is very weak in our country which is responsible for such a condition,” he added.

Expired medicines and fake COVID-19 treatments 

Many other cases of the manufacture or sale of substandard drugs have been reported in the recent past. In February, a firm in Agra in the northern state of Uttar Pradesh was found to be buying expired medicine at low cost, repackaging and reselling it.

The Authentication Solution Providers’ Association (ASPA), an organization working against counterfeiting activities, said that fake COVID-19 medicines had been found in most Indian states over the last two years, especially at a time when there was severe shortage of COVID-19 products. 

India lacks suitable regulations for the pharma industry and the regulations and legal structures are not well defined, according to ASPA. 

Exports of substandard Indian drugs 

India is the world’s largest manufacturer of generic drugs, with sales of more than $2.4 billion in March 2022 alone. 

But some experts estimate that probably between 12% and 25% of the active pharmaceutical ingredients and finished medical products supplied globally from India are contaminated, substandard or counterfeit.

In the case of deaths of the contaminated medicines sold in The Gambia, Indian regulators allowed a habitual offender firm to export substandard drugs, public health activists Dinesh Thakur and T Prashant Reddy told India Today. Thakur is the co-author of a book entitled ‘The Truth Pill’, on substandard medicines in India’s pharma industry.

“A Certificate of a Pharmaceutical Product (CoPP) is needed by the importing country when the product in question is intended for registration, with the scope of commercialisation or distribution in that country,” they said.

The CoPPs, effectively export permits, are issued by the CDSCO which operates under the central government’s  Ministry of Health, they added. 

“Therefore, it was not correct to suggest that Haryana’s state regulator gave the approval to this drug and that the central body had nothing to do with the approvals,” they said, adding that the same cough syrups were also authorized for sale in India –  contrary to government statements to the effect that they were only marketed for export. 

WHO’s investigation raises the stakes 

While problems with poor quality medicines have flown under the radar for years, the recent alarm sounded by WHO on the four types substandard cough syrups made by Maiden Pharmaceutical has raised attention about the issues at play. 

India’s Ministry of Health and Family Welfare said that the Central Drugs Standard Control Organisation took up the issue with the regulatory authorities in Haryana, under whose jurisdiction the drug manufacturing unit of Maiden is located. The Indian government and the Haryana government imposed a ban on Maiden Pharmaceuticals. 

External Affairs Minister Dr S Jaishankar told his counterpart in Gambia, Dr Mamadou Tangara, that the matter was being seriously investigated by appropriate authorities.

Despite the accumulating claims and evidence, India’s mainstream medical community has been slow to react. 

“It is too early to say that the syrup has caused deaths in Gambia. Syrup sells a lot, but it has to be seen that the children had not eaten anything else that could have caused their death,” said Sahajanand Prasad Singh, president of the Indian Medical Association.

Brushing aside the WHO reports that syrups used by the children had been adulterated, he added: “I do not think that consuming syrup alone would have such fatal consequences.”

However, the WHO has said clearly that syrups sold in the Gambia and used by the children had definitely been adulterated by a toxic compound that can lead to death. Although the global health agency has been clear that the exact cause of death has not yet been determined.  

Weak or substandard medicines are also a major driver of antimicrobial resistance – which is reaching epidemic proportions in India as well. Experts say India is one of the nations worst hit by antimicrobial resistance. Antibiotic-resistant neonatal infections alone are killing about 60,000 newborns each year. A new government report says things are getting worse, with tests conducted at a hospital revealing that a number of key drugs were barely effective.

Image Credits: Bijay chaurasia, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons, Maiden Phrama.

A Somali boy struggles to find water

The global cholera vaccines shortage relates to the unpredictability of the disease, and the fact that it unattractive to manufacturers as it is a disease of poverty – but if preventive vaccines are part of a routine vaccine package where cholera is endemic, this could stabilise demand and outbreaks

There is no short-term solution to the global cholera vaccine shortage as “the current manufacturers are producing to their maximum capacity, and one is increasing its production capacity but this increase is limited by technical constraints”, according to Dr Philippe Barbosa, the World Health Organization’s (WHO) technical lead on cholera.

Faced with at least 29 global cholera outbreaks – Haiti, Malawi and Syria battling particularly big outbreaks – and a diminishing supply of vaccines in the international stockpile, the WHO recently recommended that affected countries administer only one vaccine dose instead of the usual two. 

 Cholera is an acute diarrhoeal infection caused when people consume food or water contaminated with Vibrio cholera bacteria, and it usually affects those with inadequate access to clean water and proper sanitation.

As the disease primarily affects “the poorest and most vulnerable”, vaccine manufacturers have “no prospect of selling to rich countries”, so production is limited, Barbosa told Health Policy Watch.

“As the demand appears limited, this makes it unappealing for new manufacture to engage in this market,” said Barbosa, adding that the challenge of limited cholera data also made it difficult to forecast of future needs.

But Gavi, the global vaccine alliance, believes that it may be possible to stabilise vaccine production and supply by introducing preventative vaccines in cholera “hot spots”.

“We’re trying to get some preventive vaccination going in regions where cholera is endemic and that will help obviously to prevent outbreaks from a public health perspective,” says Gavi special adviser Aurelia Nguyen.

“It will also help with this ‘peaks and troughs’ view. As you can imagine from a manufacturing perspective, it is difficult to be able to just turn production on and off at very short notice,” added Nguyen, who has over a decade of experience in vaccine supply, most recently as managing director of COVAX, the international COVID-19 vaccine platform.

Gavi advisor Aurelia Nguyen

Only two suppliers

At present, only two suppliers make cholera vaccines available for mass vaccinations. Shanchol is produced by Shanta Biotechnics, a Sanofi subsidiary in India, and Euvichol-Plus, made by EuBiologics in South Korea.

Both companies supply the international cholera vaccine stockpile managed by the International Coordinating Group (ICG), a mechanism that coordinates the provision of emergency vaccines and antibiotics to countries during major outbreaks. The ICG is made up of members from the WHO, UNICEF, Médecins Sans Frontières, and the International Federation of Red Cross and Red Crescent Societies.

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

“What we’ve done with Gavi financing is show manufacturers that there is a certainty of regular funding for vaccines, and the minimum stockpile that we want to have at any point in time for outbreak is five million doses,” says Nguyen.

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

Nguyen said that “production economics” were behind Shanta Biotechnics’ decision to quit the field, and Gavi has been working “very closely” with EuBiologics “and their volumes are going to keep increasing over the course of next year”.

Neither company responded to questions Health Policy Watch sent to them.

However, Gavi has also “been in very active discussions” with other manufacturers to enter the market in the next two to three year to ensure “resilience in the market”.

“We’ve been discussing with potential new entrants what it would take in terms of their developments, and it also links to another conversation in terms of regional manufacturing on the African continent,” said Nguyen.

Gavi has been in discussions with the African Union, and in the past week with the G7 and G20, about having “a stronger and more sustainable manufacturing base in Africa, and this is one of the vaccines that would be perhaps suitable for a new entrant coming from the continent”, she added.

Unpredictable demand

Typically, the international stockpile has about five to seven million vaccine doses which get replenished as it is used – but the unpredictability of outbreaks has made it hard to ensure regular supply.

“In 2020, we used five million doses for outbreak response. This year, so far we’ve already shipped 18 million doses and we have just seven million doses on hand at the moment and we plan to buy another five million through to the end of the year.”

However, what is more predictable is that climate change will drive more cholera outbreaks. The recent floods in 33 of Nigeria’s 36 states  – the worst in a decade – are expected to increase cholera cases, while Pakistan has been bracing itself for more cases after its recent devastating floods.

“The consequences of a humanitarian crisis – such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission, should the bacteria be present or introduced,” the WHO warns.

Meanwhile, earlier this week UNICEF described the cholera outbreaks in Syria and Lebanon as “alarming”.

“The acute epidemic in Syria has left over 20,000 suspected cases with acute watery diarrhoea and 75 cholera-associated deaths since its start. In Lebanon, confirmed cholera cases reached 448 in just two weeks, with 10 associated deaths,”  UNICEF warned in a media release.

“Malnourished children are more vulnerable to developing severe cholera disease, and the cholera outbreak is yet another blow to already overstretched health systems in the region.”

Image Credits: CNN, UNICEF.

ACT-A is going to work more in-country as it transitions out of pandemic mode.

The Access to COVID-19 Tools (ACT) Accelerator is going to focus on vaccinating high-risk populations, introducing new treatments, boosting testing and securing sustained access to COVID-19 tools in the next six months.

ACT-A announced its new transition plan at a meeting on Friday as the world moves to long-term COVID-19 control.  

“Recognizing the evolving nature of the COVID-19 virus and pandemic, the plan outlines changes to ACT-A’s set-up and ways of working, to ensure countries continue to have access to COVID-19 tools in the longer term, while maintaining the coalition’s readiness to help address future disease surges,” according to a media release.

“Through 2023, COVAX will continue to support lower-income countries to protect their populations. In parallel, we will be supporting countries to integrate COVID-19 vaccination into routine national immunization programs, while also preparing for surges and other worst-case scenarios,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance.

Developed through a consultative process with ACT-A agencies, donors, industry partners, civil society organizations (CSOs) and Facilitation Council members, the plan summarizes priority areas of focus for the partnership’s pillars, coordination mechanisms and other core functions, and highlights the work to be maintained, transitioned, sunset, or kept on standby. The transition plan supports the work of ACT-A agencies as they evolve the financing, implementation and mainstreaming of their COVID-19 efforts.

The next phase of ACT-A partners’ work will centre on three overarching areas:

  • research and development (R&D) and market-shaping activities to ensure a pipeline for new and enhanced COVID-19 tools
  •  institutional arrangements for sustained access for all countries to COVID-19 vaccines, tests and treatments, including oxygen
  •  in-country work on new product introduction (eg new oral antivirals) and protection of priority populations in support of national and international targets

“As the world moves towards managing COVID-19 over the long-term, ACT-A will continue to support countries by providing access to vaccines, tests, and treatments,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “But as this plan lays out, we still have a lot of work to do to achieve equitable access to these life-saving tools, with health workers and at-risk populations as our top priority.”

Other changes outlined in the plan include the transition to a new ACT-A Tracking and Monitoring Taskforce, co-chaired by senior officials of India and the US, with the political-level Facilitation Council going into ‘standby’ mode, with the capacity to reactivate if needed due to a surge in severe disease.

Ebola
Contact tracers and village health teams take on Ebola in Uganda.

Six schoolchildren in the Ugandan capital of Kampala are the latest to be infected with Ebola, according to the country’s health minister on Wednesday – and with 15 cases in the densely populated city, some want the government to impose a lockdown.

So far, there have been 109 confirmed cases, including 30 deaths, of the Sudan strain of Ebola for which there is no vaccine – although two vaccines exist for the Zaire strain.

Ebola is highly infectious and has a mortality rate of up to 90%. The 2014-16 Ebola outbreak in West Africa, the largest on record, killed more than 11,000 people. In 2000, Uganda suffered an outbreak of Ebola that killed over 200 people.

After a slow start, contact tracing kicks into gear

With support from the World Health Organization (WHO) and partners, the Ugandan Ministry of Health has trained and deployed around 300 contact tracers, who play a critical role as the country looks to minimize the spread of the virus.

“When the community cooperates in the response and contacts are identified, it becomes easier to contain the disease,” said Dr Bernard Logouomo, the Ministry of Health Surveillance Lead in Mubende district, the outbreak’s epicenter.

In the first days of the outbreak, only 25% of contacts were properly traced, the WHO said. But by mid-October, nearly 94% of people who had come in contact with the virus were being properly monitored.

Despite dangers of urban Ebola, president resisting Kampala lockdown

Uganda
Kampala is home to 1.5 million people. Doctors worry Ebola could escape containment if it spreads throughout the city.

Ugandan President Yoweri Museveni has so far resisted calls to lock down the capital, although he announced a three-week lockdown in Mubende and Kassandra districts, where the outbreak started, on 15 October. 

However, the Kampala schoolchildren’s infections have been traced to a man who travelled to the city from Mubende.

On Tuesday, the head of the Uganda Medical Association, Dr Samuel Oledo, urged health authorities to impose a lockdown in Kampala. “The earlier we lockdown Kampala, the better,” he told reporters. “People are not even reporting cases right now.”

Uganda’s Ministry of Health acknowledged in a press statement on Thursday that urban Ebola can create “a situation of rapid spread,” but that lockdowns would remain limited to the epicentres of Mubende and Kassanda. 

“The situation in Kampala is still under control,” said Health Minister Jane Ruth Aceng. “There is no reason to restrict people’s movement.”

Trials are working

Without any known treatments available, trials are ongoing amid the outbreak. Uganda’s Ministry of Health said that a number of treatment options are being explored, including monoclonal antibodies, and repurposed drugs like Remdeservir donated by the US government. But doses are scarce.

“Thirteen patients have received these trial drugs with relatively good outcomes,” said health authorities. In total, 34 people have recovered from the virus. Four patients admitted in critical condition died despite treatment, highlighting the importance of early reporting and detection of symptoms.

“The spread of the outbreak relies on reducing the time between the first symptoms of the disease and its management,” said Denis Mbae, outreach project coordinator of Médecins Sans Frontières activities in Uganda. “The earlier patients are treated, the greater their chances of survival and the less risk there is of the disease spreading within the community.”

 

 

 

 

 

 

 

 

 

Image Credits: WHO, Angella Birungi.

Traffic in Addis Ababa; air pollution is second leading cause of premature deaths in Africa for 1.1 million deaths a year.

Africa faces some of the world’s most severe health impacts from air pollution – with five countries on the continent ranking among the ten most polluted countries in the world, according to a new report by the US-based research organization Health Effects Institute. 

Those countries include Niger, Nigeria, Egypt, Mauritania and Cameroon, where the report, the State of Air Quality and Health Impacts in Africa, found fine particulate matter (PM2.5) exposures ranging as high as 65-80 micrograms per cubic meter (μg/m3).

Some 1.1 million people in Africa died prematurely from air pollution-related diseases in 2019, one-sixth of the total global estimate of 7 million deaths annually. According to the report’s findings, air pollution is the second leading risk factor for premature deaths after malnutrition, placing it well above the long-discussed issues of unsafe water, sanitation and hygiene, which ranked fourth largest risk factor for deaths.  

Meanwhile, the economic costs of air pollution in African cities will increase by 600% over the next 18 years without urgent action, warned another report by the London-based Clean Air Fund (CAF), published simultaneously on Thursday. 

But shifting away from dirty energy sources for transport, heating/cooling and electricity could save over 120,000 lives, cut climate emissions by 20%, and unlock $20 billion for the urban economies of four key cities – Lagos, Cairo, Johannesburg and Accra, Ghana over the next 17 years – where solution scenarios were further explored, the CAF report predicts.

Under a business-as-usual scenario, air pollution is estimated to cost a total of $115.7 billion from 2023-2040 across the same four cities.

Reports come just ahead of COP 27 climate conference 

Population-weighted annual average PM2.5 exposures in countries across Africa.

The two reports come just ahead of the start of the UN Climate Conference (COP27) in Sharm el Sheikh, Egypt – and in a time when scientists say that there is “no credible pathway” to keep global warming limited to 1.5C – in light of countries’ mitigation actions to date.  

Leading African policymakers remain keen on developing fossil fuel sources and skeptical about  the feasibility of a rapid green energy transition in view of their dismay over the lack of rich country finance to support climate action in developing economies.  

Just last week, South Africa’s Minister of Mineral Resources and Energy Gwede Mantashe, charged that developed economies want to use African countries as “guinea pigs” on which to perform green energy experiments.

Against that background, the health and economic impacts of air pollution, whether it’s from biomass or fossil fuel sources, have played a negligible role in the political calculus leading up to the world’s next big climate moment.

It remains to be seen if the mounting evidence about the knock-on effects of air pollution, for health, climate and economies will make a difference. 

Fossil fuels, biomass and dust among leading pollution sources

Trends in percentage of population exposed to household air pollution for the five countries of interest, 2010–2019.

Africa’s air pollution sources are by no means limited only to fossil fuels – used for transport, urban heating and cooling and power generation. 

They also include significant emissions from the inefficient burning of biomass for household cooking and heating; industry; crop and waste burning; and semi-industrial activities, such as charcoal production and artisanal mining.

In arid and semi-arid parts of Africa, including the Sahara and the Sahel region to the south, dust and sandstorms are also a major contributor to air pollution – a source that African policymakers have emphasized is a factor that cannot be easily curbed. 

West Africa, parts of which border on the Sahel, also has some of the highest PM2.5 pollution levels on the continent. It is among the most heavily dependent regions on solid fuels for household cooking and heating. In Southern Africa, where fossil fuel sources factor more widely, has comparatively lower annual average PM2.5 levels – though still more than 5 times above the WHO recommended guideline levels. 

Limited air quality monitoring and management

Not coincidentally, South Africa also has the continent’s most extensive air quality monitoring system – as well as established air quality management policies. Air quality regulations, and monitoring for their compliance, helps advance progress on cleaner fuels, vehicles and industries.  But of the African Union’s 55 member states, only 17 countries do any air quality monitoring whatsover, the HEI report notes.

On a more positive note, the overall proportion of people relying on solid fuels (biomass and coal) for cooking declined slightly between 2010-2019, the report found.   

But such declines have not always translated into health benefits as population growth means that even more people continue to breathe dangerous household smoke. 

For example, the report found that the proportion of people in Nigeria using solid fuels declined from 82-77% between 2010 and 2019.  But due to population growth, some 29 million more people were cooking with solid fuels in 2019, as compared to 2010. 

Cities a nexus of old and new air pollution sources – and solutions

PM2.5 levels in Africa’s top 10 most populous cities in 2019.

In addition to the human toll in deaths and health impacts from breathing polluted air, the annual cost of health damages due to disease related to air pollution amounts to an average of 6.5% of GDP across Africa, the report said.

Across Egypt, Ghana, the Democratic Republic of the Congo, Kenya, and South Africa, the combined annual cost of health damages from PM2.5 exposure is more than 5.4 billion U.S. dollars.

In many developing African cities, old and new air pollution sources directly collide in a potent toxic stew. The mix typically includes smoke from household cooking and heating with biomass; uncontrolled waste burning; emissions from old diesel vehicles running on congested streets and from diesel generators that back up unreliable electric grids, as well as industrial emissions.  

pollution
Khartoum, Sudan. In Africa’s Sahara and Sahel regions, dusts storms can also be a major air pollution factor.

But where there are problems, cities can also find solutions. Some of Africa’s fastest growing cities could unlock tens of billions of dollars more for their economies – as well as saving lives and cutting greenhouse gas emissions if they invest in greener patterns of growth, according to the Clean Air Fund report, which makes the case for investing in air pollution – for dual health and climate change benefits. 

The CAF analysis mapped the health, economic and climate impacts of increasing air pollution along a “business as usual” growth path for four major cities, Lagos, Cairo, Johannesburg and Accra, Ghana. It contrasted that trajectory with an alternative scenario in which cities implement clean air measures as they grow. 

Those measures include cleaner and more efficient public transport, cleaner cookstoves and alternative fuel sources;  greener industrial technologies and energy systems; reduction of slash and burn land clearing, and open waste incineration.

Projecting out the alternative scenario in the same four cities, the report found that such policies could replace the vicious cycle of pollution and health impacts with a virtuous cycle of over 120,000 lives saved and $20 billion in economic benefits between 2023-2040.  Lagos, Africa’s largest city, would also enjoy the largest total savings, amounting to  $12.5 billion and 64,000 lives over that period. And these benefits could be extrapolated to other African cities, too, the report found. 

Health impacts of air pollution, large and varied 

The percentage of the population using solid fuels for cooking in countries across Africa in 2019.

Health impacts of air pollution tracked in the two reports range from common knoweldge causes – such as lung diseases, cardiovascular diseases, stroke and hypertension –  which mainly affect older people, to less discussed impacts among newborns and young children.  

According to the HEI report, some 236,000 African newborns die within the first month of life from air pollution exposures, mostly related to household air pollution from biomass and charcoal use. 

In 2019, 14% of all deaths in children under the age of 5 across Africa were linked to air pollution, situating air pollution as the third largest risk factor for those deaths after malnutrition, unsafe water, sanitation and hygiene in sub-Saharan African regions.

The impacts on newborns and infants also have long-term consequences for overall health, including issues with lung development, increased risks of asthma, and increased susceptibility to communicable diseases such as lower respiratory infections in young children.

“This report gives evidence of the substantial threat air pollution poses to the health, and even life, of babies and children under the age of 5 years,” said Caradee Wright, Chief Specialist Scientist with the South African Medical Research Council. “This vulnerable group needs special attention to mitigate their exposures through policy and intensive awareness campaigns with practical solutions for mothers and caregivers.”

Added Pallavi Pant, HEI head of global health and one of the report’s key contributors: “The tremendous health impacts from air pollution exposure across Africa, especially in young children, creates an urgency to expand Africa’s clean and green energy infrastructure. Meeting these challenges will bring significant improvements to air quality and public health as well as reduce greenhouse gas emissions.”

Image Credits: Health Effects Institute – State of Air Quality and Health Impacts in Africa l Air, State of Global Air, State of Air Quality and Health Impacts in Africa .

Dr Tereza Kasaeva, director of WHO’s  Global TB Programme.

Tuberculosis cases and deaths have increased for the first time in decades, and fewer cases were detected and fewer people treated during 2021 – all as a result of disruptions caused by the COVID-19 pandemic, according to the World Health Organization (WHO).

An estimated 10.6 million people fell sick with TB last year, an increase of 4.5% from 2020, while 1.6 million people died, according to the WHO’s  2022 Global TB report released on Thursday. 

Drug-resistant TB (DR-TB) also increased by 3% between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB recorded in 2021. DR TB is harder and more expensive to treat.

The TB incidence rate (new cases per 100 000 people per year) also rose by 3.6% between 2020 and 2021 – reversing declines of about 2% per year for most of the past 20 years.

An increase in deaths from TB between 2019 and 2021 also reversed a decline in mortality that started in 2005. 

“Globally, the reduction in the total number of TB deaths between 2015 and 2021 was less than 6%, about one-sixth of the way to the milestone of 35%,” Dr Tereza Kasaeva, director of WHO’s Global TB Programme, told a media briefing on Thursday.

Eight countries accounted for more than two-thirds of the global total of cases: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of the Congo.

“The largest burden of TB was in the WHO Southeast Asian region, 46%, followed by the WHO African region, 23%, and the WHO western Pacific, 18%,” according to Kasaeva.

“Growing rates of poverty, inequity, under-nutrition and other comorbidities, as well as discrimination and stigma, are the major drivers of the TB epidemic,” she added.

“Globally in 2021, of the 10.6  million people who fell ill with the TB, an estimated 2.2 million were attributable to undernourishment and another 2.6 million jointly to other main risk factors such as HIV infection, alcohol use disorders, smoking and diabetes. 

“HIV, poverty and under-nutrition are driving TB in Africa,” she added, also noting a cut in global spending on TB services “from $6 billion in 2019 to $5.4 billion in 2021”, which is less than half the global target of $13 billion annually by 2022.

Short on funds

USAID’s Cheri Vincent with TB survivor Kate O’Brien

As in the previous 10 years, most of the funding used in 2021 (79%) was from domestic sources. In low- and middle-income countries, international donor funding remains crucial. The main source is the Global Fund to Fight AIDS, Tuberculosis and Malaria, while the US contributes close to 50% of international donor funding for TB – via Global Fund donations and bilateral aid.

“USAID has been the leading bilateral donor of the international fight for TB,” said Dr Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID).

“We have spent $4.2 billion since 2000 on this on this effort… 10.6 million people each year get TB and 1.6 million die each year. This is something that we shouldn’t see in our lifetime. We should be able to end TB in our lifetime,” added Vincent.

“This is a very important moment to have this data and reflect on what can we do more how can we recover…. from COVID, mitigate COVID impact on TB but also to end TB.” 

Kate O’Brien, a US TB survivor and advocate for ‘We Are TB’, stressed that ”when we hear numbers like this, sometimes it can be kind of difficult to remember that every single one of those numbers is a person, with a family”. 

“When I had tuberculosis myself, I was in pain. I was terrified, and I was also worried that I was going to lose my baby because I was pregnant. I was going from doctor to doctor and I just couldn’t get a sense of urgency. I didn’t become diagnosed with tuberculosis until I was in an ICU, until my lungs were very, very poorly damaged. And that sense that lack of a sense of urgency really almost cost me and my child our lives.”

Fewer tests, and fewer on treatment

US TB survivor Kate O’Brien was only diagnosed with TB once she was in ICU.

Only 5.8 million new TB cases were detected in 2020, whereas 7.1 million were found in 2019, indicating a drop in testing rather than in new cases. There was a partial recovery to 6.4 million in 2021, but this was still “well below pre-pandemic levels”, the WHO notes.

By 2021, the world was only two-thirds of the way to reaching the global target of treating 40 million people in five years (2018- 2022), with only 26.3 million having been treated.

“The report provides important new evidence and makes a strong case on the need to join forces and urgently redouble efforts to get the TB response back-on-track to reach TB targets and save lives,” said Kasaeva. “This will be an essential tool for countries, partners and civil society as they review progress and prepare for the second UN High Level Meeting on TB mandated for 2023.”