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.”

Climate
Two deer take refuge in a river during a wild fire in Bitterroot National Forest, Montana, United States.

The existential project to save the planet set out by the 2016 Paris Agreement is in tatters. There is currently “no credible pathway” to limit increases in global temperatures to the 1.5°C degree target detailed in the accords, the UN Environmental Programme (UNEP) said in its global emissions gap report released Thursday.

The chance of temporarily exceeding 1.5°C has risen steadily since 2015, when it was close to zero.  That probability has increased to nearly 50% for the 2022-2026 period. 

The language of the UNEP report stands in stark contrast to the diplomatic assessment by the UN Framework Convention on Climate Change (UNFCCC) Secretariat released on Wednesday.

The UNFCCC report refers to “glimmers of hope,” noting that progress over the last year shows “a strong signal that the world is starting to aim for net-zero emissions.” But the UNEP does not mince words.

“Inadequate progress on climate action means the rapid transformation of societies is the only option,” the report states. “This lack of progress leaves the world hurtling towards a temperature rise far above the Paris Agreement goals.”

Despite a year of devastating climate-driven disasters, updated pledges by the international community since COP26 in Glasgow represent less than a 1% reduction in projected 2030 greenhouse gas emissions. Emissions in 2021 were also likely the highest on record, breaking the ceiling set by 2019 levels, the report found.

UNEP
To get on track to limiting global warming to 1.5°C, the world would need to cut 45 per cent of current greenhouse gas emissions by 2030.

If countries fully implement all present and future plans to reduce emissions, and additional net-zero commitments, the world will be on track for a 1.8°C temperature increase by the end of the century. But even this scenario is “not credible” given the snail’s pace of progress, the UNEP said.

“We are headed towards global catastrophe,” UN Secretary-General António Guterres said at a press conference accompanying the release of the report. “Our world cannot afford any more greenwashing, fake movers or late movers.”

Current policies set the world on pace for global warming of 2.8°C by the end of the century. The two realistic scenarios laid out in the report – in which countries follow through on their “nationally determined commitments” – reduce warming to 2.6°C and 2.4°C.

“We had our chance to make incremental changes, but that time is over,” said Inger Andersen, executive director of the UNEP. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.”

A decimal can make all the difference

 

Temperatures during the last ice age, known as the Last Glacial Maximum, were an average of just 6 degrees cooler than today.

These temperature discrepancies can appear insignificant, but even minute shifts in the earth’s temperature have drastic impacts. At the peak of the last ice age, when glaciers covered about half of North America, Europe, South America and many parts of Asia, average temperatures were only 6°C degrees colder than today.

“In your own personal experience that might not sound like a big difference, but it’s a huge change,” said Jessica Tierney, primary author of the report on ice age temperatures.

Warming to 2°C, compared with 1.5°C, is estimated to increase the number of people exposed to climate-related risks and poverty by up to several hundred million by 2050. As the most affected regions are among the poorest in the world, possessing little ability to adapt on their own, the impacts will be devastating.

“Nature has been telling us all year, through deadly floods, storms and raging fires: we have to stop filling our atmosphere with greenhouse gasses, and stop doing it fast,” Andersen said. “Every fraction of a degree matters.”

For millions, the climate crisis is already here

Expansion of extremely hot regions in a business-as-usual climate scenario. Black and hashed areas represent unlivable hot zones. Absent migration, that area would be home to 3.5 billion people in 2070

Climate change discourse often unfolds in future-oriented language, but the consequences of the present 1.1°C degree increase in global temperatures are already hitting millions, and many are being forced to flee.

Amid unpredictable monsoon rainfall and increasingly strong droughts, more than eight million people in Southeast Asia have moved toward the Middle East, Europe, and North America, the World Bank found. Droughts and crop failures have impacted millions of rural people in the African Sahel, too, creating streams of internal displacement towards the coasts and cities.

And this is just the beginning. A groundbreaking study in the journal Proceedings of the National Academy of Sciences (PNAS), found that by 2070, up to 19% of land currently inhabited by people could become unlivable hot zones, akin to the Sahara, placing billions – one of every three people alive – in climate situations that will force them to leave. 

Should the flight away from hot climates reach the scale that current research suggests, it will amount to a vast remapping of the world’s populations, a joint investigation by the New York Times and ProPublica reports.

And the visible impacts of climate shifts are already staggering. Bangladesh, a country of 168 million people, now has over 10 million climate refugees – and an estimated 2,000 people move to its capital, Dhaka, every day, according to the Mayor’s Migration Council.

People who have lived in the coastal areas of Bangladesh for generations are migrating to escape flooding, and the government predicts that by 2050, one in every seven Bangladeshi citizens will be displaced by climate change. 

Financial hurdles present big challenges

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

In neighboring Pakistan, historic floods in June devastated millions, killed 1,717, and placed the country at the center of a developing international dialogue set to define the upcoming COP27 climate conference about who should foot the bill for the consequences of our shifting climate.

Cycles triggered by natural disasters and their rebuilding efforts trapped many countries in inescapable debt before the question of infrastructure investment for a clean transition even entered the conversation.

According to the IMF, 60% of low-income countries are in or at risk of debt distress due to climate change-induced events. A study by the World Weather Attribution group showed that climate change contributed to up to 50% of the rains that made this August the wettest on record in Sindh, the region of Pakistan where the floods struck.

“It is imperative to reform financial systems so that indebtedness is not a barrier for access to finance when countries are in need,” Andersen said. “These institutions were created in the shadow of the Second World War, but we are in a different time now. There is homework to be done in the halls of 193 capitals.”

As disasters hit populations in vulnerable regions, they also take a significant toll on the development journey of the countries they call home. All progress towards larger development goals can be wiped out overnight, and countries seeking funds to develop are forced to take out loans to pay for the cost of recovery – trapping them in an interminable cycle.

Pakistan is preparing to issue a request for new loans to rebuild infrastructure that would survive the extreme weather patterns, an effort it estimates will cost $30bn.  

“If you look at the numbers, it is the climate event of the century, not just for Pakistan but for the whole world,” Sherry Rehman, Pakistan’s climate change minister told the Financial Times. “It surpassed all numbers for climate events, and it is now creating a catastrophic health crisis.”

For governments grappling with the human, health, and economic impacts of increasingly frequent natural disasters, green energy is just one piece of a bigger puzzle.

COP27: slim hopes for urgent action amid divisions over funding responsibilities

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

As alarm sirens sound across the world, hopes for a watershed moment in the international community’s approach to combating the climate crisis at next week’s COP27 in Egypt remain slim.

The event will unfold against the backdrop of compounding energy, food and cost of living crises exacerbated by the war in Ukraine, coupled with the deep divisions around who should be responsible for funding the energy transition.

In addition to money for adapting to a shifting climate, low- and middle-income countries require technical assistance and investment to facilitate the envisioned transition directly to sustainable energy sources. The UNEP coordinates a technology sharing mechanism, but getting financing on the table is difficult.

“Climate finance structure today is biased against climate-vulnerable countries. The more vulnerable you are, the less climate finance you receive,” Kevin Chika Urama, chief economist at the African Development Bank, told Reuters.

Leaders of impacted countries are keenly aware of the threats posed by climate change, but the question of how to balance emissions targets with lifting people out of poverty has no easy solution. For them, energy is not a simple question of emissions: it is one of poverty, health, and survival. 

A disproportionate burden

CFR

“For Africa, the problem of energy poverty is as important as our climate ambitions,” Nigerian Vice-President Yemi Osinbajo said in a video address announcing his country’s aim to raise an initial US$10 billion in funding to implement its energy transition plan ahead of the conference. “Energy use is crucial for almost every conceivable aspect of development — wealth, health, nutrition, water, infrastructure, education and life expectancy.”

The perceived hypocrisy displayed in recent months by countries that have fashioned themselves as leaders of the green energy transition have made this conversation even more difficult.

Since the onset of Russia’s invasion, Europe has raced to import as much natural gas from Africa as possible to shore up its domestic supplies. It has provided no additional funding for projects that would allow the world’s poorest continent to burn more gas at home.

Meanwhile, in South Sudan, only 6% of people have access to modern energy. “Energy poverty and injustice is real, but we need to make sure that energy expansion is done sustainably,” Andersen said.

Recent IEA findings estimated the exploitation of all proven natural gas reserves in Africa would amount to an increase of just 0.5% in Africa’s global emissions burden, to 3.5% up from 3.0%. In July, the EU voted to classify natural gas as ‘green’, freeing up public subsidies and greenlighting new infrastructure projects set to extend the bloc’s reliance on fossil fuels.

Together, G20 countries contribute 75% of greenhouse gas emissions annually, and any consensus will likely depend on new commitments from rich countries to invest in the climate transition beyond their own borders.

“The worst impacts of fossil fuel-driven climate change are being felt by developing countries – those least responsible for having caused it,” said Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance. “High-income countries must provide developing countries with the necessary financial and technical support for the equitable access to the clean energy their people need.”

Total systemic change is a big ask

UNEP
The window to reach climate change goals is closing fast: inadequate progress on climate action makes rapid transformation of societies the only option, the UN said.

Though the future of the planet is at stake, success at COP27 appears unlikely. Multilateral negotiations – in the best of circumstances – are exceedingly complicated affairs. The EU and Canada spent over seven years negotiating a mutually beneficial trade deal, and it nearly collapsed at the last hurdle.

That a total transformation of global financial, food, electricity and financial systems is the requirement set out by the UNEP makes the stakes of COP27 as daunting as they appear unfeasible, the report acknowledges.

“The task facing the world is immense: not just to set more ambitious targets, but also to deliver on all commitments made,” it states. “This will require not just incremental sector-by-sector change, but wide-ranging, large-scale, rapid and systemic transformation. This will not be easy, given the many other pressures on policymakers at all levels.”

In this context, any progress will be welcomed.

“Even if we don’t meet our 2030 goals, we must strive to get as close as possible to 1.5°C,” said Andersen. “This means setting up the foundations of a net-zero future: one that will allow us to bring down temperature overshoots and deliver many other social and environmental benefits, like clean air, green jobs and universal energy access.”

The clock is ticking, but there’s a roadmap: energy, finance, building and food practices must change

UNEP roadmap for a sustainable transition outlined in the report.

If the UNEP report’s findings are dire, they are also constructive. The report is formatted as a roadmap for achieving net-zero greenhouse gas emissions in electricity supply, industry, transportation and buildings, providing a groundwork for launching towards a carbon-neutral future.

“The recommendations in today’s report are clear,” Secretary-General Guterres said. “End our reliance on fossil fuels. Avoid a lock-in of new fossil fuel infrastructure. Invest massively in renewables.”

And significant progress has already been made. The falling prices of renewable power sources like solar and wind make energy the closest sector to attaining the necessary transition outlined in the report. But while market prices have caught up and requisite technologies exist, the world is not transitioning to them fast enough.

On the other extreme, food systems are in critical need of an overhaul. The sector already accounts for one-third of all emissions, and if current practices remain in place, this is on track to double by 2050.

Global systemic change is a tall order, but “we have to try”

Inger Andersen, executive director of the UNEP, speaking to reporters on Thursday.

Without a systemic reform of the global financial system, the targets set out by the UNEP are unatainable: change requires capital.

The report estimates that an international transformation to a low-carbon future will require at least $4-6 trillion per year. For scale, the World Economic Forum estimates India’s transition to net-zero emissions will require $10 trillion in investment. Financial systems must play a crucial role in enabling the energy transition, Andersen said, and massive reform is required.

“There is a conversation that needs to take place in capitals across the world between the governors of central banks, ministers of finance, and their environmental or meteorology counterparts,” she said. “Unless these talks happen, and a broader understanding of how climate shifts hurt our chances of reaching the Sustainable Development Goals is understood, we will be stuck.”

Hopes for increased climate investment hinge on the successful communication of the win-win opportunity renewables present. Researchers at Stanford University found that while a global transition to 100% renewable energy sources would cost countries $73 trillion upfront, it would pay for itself in less than seven years and create 28.6 million more jobs. 

Decisions made today can define emissions trajectories for decades to come. If the international community does not act decisively, the window of opportunity will close by 2030.

“I don’t want to waste your time talking about the impacts of climate change, we all know they are going to get worse,” an impassioned Andersen told reporters. “Is it a tall order to transform our systems in just eight years? Yes. Can we reduce greenhouse gas emissions by so much in that timeframe? Perhaps not. But we must try.”

Image Credits: PNAS, OXFAM.

Scene at last year’s Glasgow’s COP26 Climate Conference, which punted the ball on hard decisions about climate emissions to COP27 in Sharm el-Sheikh.

Countries’ voluntary commitments to fight climate change will still mean an increase in global emissions by some 10.6% as of 2030, according to the latest report of UN Climate Change,  which tabulates the most recent ‘Nationally Determined Commitments (NDCs) of countries to the climate battle.

This represents only a slight “improvement” over the commitments as of the same time last year – when countries were projected to increase climate change emissions by 13.7% as of 2030, in comparison to 2010 levels rather than make the drastic reductions needed to halt dangerous warming trends.

At the current pace, the world remains on track for a 2.5 C increase in global temperatures by the end of the century, warns the new report by the UN Framework Convention on Climate Change (UNFCCC) Secretariat, released less than two weeks ahead of the start of the UN Climate Conference (COP 27) in Sharm el-Sheikh, Egypt.

Positive signs of movement – but not nearly fast enough

UN Climate Change officials noted that the receipt of some new or updated climate commitments, made by some two dozen countries over the past year, had bent the curve of emissions increases downward, but only slightly.

“Today’s report also shows current commitments will increase emissions by 10.6% by 2030, compared to 2010 levels. This is an improvement over last year’s assessment, which found countries were on a path to increase emissions by 13.7% by 2030, compared to 2010 levels,” stated UN Climate Change in a press release.

But this is still very far away from the 43% reduction in emissions that has been identified by scientists as the required target to keep warming limited to 1.5 C.

“The latest science from the IPCC released earlier this year uses 2019 as a baseline, indicating that greenhouse gas emissions need to be cut 43% by 2030,” the press release stated. “This is critical to meeting the Paris Agreement goal of limiting temperature rise to 1.5 degrees Celsius by the end of this century and avoiding the worst impacts of climate change, including more frequent and severe droughts, heatwaves and rainfall”,”

Additionally, the report only assesses the impacts of countries’ climate commitments – not their actual implementation. And in many cases, the commitments made by heads of state have not translated into legislative actions or financial investments needed to follow them through.

“The downward trend in emissions expected by 2030 shows that nations have made some progress this year,” said Simon Stiell, Executive Secretary of UN Climate Change. “But the science is clear and so are our climate goals under the Paris Agreement. We are still nowhere near the scale and pace of emission reductions required to put us on track towards a 1.5 degrees Celsius world. To keep this goal alive, national governments need to strengthen their climate action plans now and implement them in the next eight years.”

The UN Climate Change assessment covers the climate action plans – or NDCs – of the 193 Parties to the Paris Agreement. Some 24 countries have submitted new or updated NDCs since last year’s UN Climate Change Conference in Glasgow (COP26). Taken together, the plans cover 94.9% of total global greenhouse gas emissions in 2019.

Sharm el Sheikh will be pivotal moment 

Can fossil fuels give way to solar power? COP27 may provide some answers.

The UN Climate report refers to “glimmers of hope” in an otherwise gloomy picture, citing a second UN Climate Change report, also released today, on the prospects for the more robust development of long-term low-emission development strategies.

The review of 62 countries’ plans to transition to net-zero emissions by or around mid-century found that these countries’ greenhouse gas emissions could be roughly 68% per cent lower in 2050 than in 2019 if all the long-term strategies were fully implemented on time.

These countries’ long-term strategies also account for 83% of the world’s GDP, 47% of the global population in 2019, and around 69% of total energy consumption in 2019.

“This is a strong signal that the world is starting to aim for net-zero emissions,” the report notes.

However, many net-zero targets remain “uncertain and postpone into the future” and critical action needs to take place now, the UN Climate Change secretariat stated. “Ambitious climate action before 2030 is urgently needed to achieve the long-term goals of the Paris Agreement.”

COP26 in Glasgow ended on an ambivalent note with countries’ postponing more decisive action on emissions reductions that scientists say is urgently needed. That left the world with a big “to do list” for this year’s COP27, hosted by Egypt.

Climate impacts more visible – but will that really move politicians?

Pakistani floods have displaced some 33 million people, according to government and UN estimates.

Now, with climate impacts becoming more visible by the day – from the recent, massive flooding in Pakistan and Nigeria to drought and hunger in the Horn of Africa, and wildfires in the western United States, policymakers are at a pivotal moment.

However, war in Ukraine, geopolitical tensions between China and its neighbours in the South China Sea and a raft of other regional conflicts and crises, have also provided plenty of distraction to world leaders – as well as propping up fossil fuel production and exports.

In addition, developing countries are clamouring even more adamantly for more action on the “loss and damage” provisions of the 2015 Paris Accord – which are supposed to help countries in the global South adapt to the negative effects of climate change.

Oil and coal-producing countries in Asia and Africa remain keen on developing their unexplored fossil fuel reserves – despite calls from scientists and some global leaders to make a more rapid shift to renewable energy sources. 

Just last week, South Africa’s Minister of Mineral Resources and Energy Gwede Mantashe, known for his pro-fossil fuel sentiments, charged that developed economies offering green finance to African economies are using them as “guinea pigs” on which to perform energy experiments.

Such rhetoric pushes aside scientific evidence that climate change is turning all of humanity into guinea pigs with a range of escalating health impacts from weather extremes, diseases and air pollution – while Africa is amongst those regions most at risk.

At the same time, developed countries have failed to come through on a promised $100 billion for financing the Green Climate Fund, part of the landmark 2015 Paris Climate accord that aimed to help the developing world transition out of fossil fuels.

Fund-raising for climate adaptation, which also would be directed into green energy sources, has fallen way short of goals, charged Ghanian President Nana Akufo-Addo after a visit to France earlier this month.  He was protesting the outcomes of a climate summit in Rotterdam last month, where European Nations pledged only $55 million to climate adapatation- as compared to the $25 billion that is supposed to be committed by 2025, Akufo-Addo has, in the past, spoken out about the importance of Ghana developing its fossil fuel reserves.

“COP27 will be the world’s watershed moment on climate action,” said Sameh Shoukry, Egyptian Minister of Foreign Affairs and COP27 President-Designate. “The report from UN Climate Change and before that from the IPCC are a timely reminder for all of us. Raising ambition and urgent implementation is indispensable for addressing the climate crisis. This includes cutting and removing emissions faster and a wider scope of economic sectors, to protect us from more severe adverse climate impacts and devastating loss and damage.”

“The synthesis report is a testimony to the fact that we are off-track on achieving the Paris Climate Goal and keeping the 1.5 degrees within reach,” added Shoukry. “This is a sobering moment, and we are in a race against time. Several of those who are expected to do more, are far from doing enough, and the consequences of this is affecting lives and livelihoods across the globe. I am conscious that it is and should be a continuum of action until 2030 then 2050, however, these alarming findings merit a transformative response at COP27.”

Image Credits: UNFCCC , Gellscom/CC BY-ND 2.0., Rahul Rajput.

Shelves stand empty in a Wuhan supermarket in an earlier lockdown.

China administered the world’s first oral aerosol COVID-19 vaccine boosters in Shanghai on Wednesday, as new lockdown measures were imposed on Wuhan, the supposed birthplace of the pandemic.

Chinese vaccine manufacturer CanSino Biologics said in a media statement that the inclusion of its vaccine in Shanghai’s booster vaccination program marked “the start of the rollout of the world’s first inhaled COVID-19 vaccine, Convidecia Air”.

The inhaler, approved as a booster for adults last month by the National Medical Products Administration of China, “provides a non-invasive option that uses a nebulizer to change liquid into an aerosol for inhalation through the mouth”, according to the company.

“Convidecia Air is needle-free and can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” it added. The aerosol vaccine is based on Sinovac (marketed as CoronaVac).

The Chinese-developed Sinovac uses a modified version of an adenovirus to deliver inactive parts of SARS CoV2 to a person’s immune system to prime it recognise and attack the virus when it becomes infected. This is followed by a second vaccine to boost the immune system a few weeks later.

Results from a clinical trial that compared the oral aerosol vaccine to an injectable version of Sinovac, published in The Lancet in August, found that the aerosol elicited 6.7 to 10.7 more neutralising antibodies than the injection after two to four weeks.

However, Sinovac is less efficacious against COVID-19 than mRNA vaccines, and there are some early indications that it offers very little protection against the latest variants.

Nasal sprays

Meanwhile, there are other clinical trials of SARS-CoV-2 vaccines delivered through the mucosa, but these are all nasal sprays.

Researchers at Yale University in the US recently published a pre-print paper reporting early success in mice using a vaccine booster strategy, “prime and spike”.

Noting that protection offered by mRNA vaccines weakens fairly fast, particularly in the nasal mucosa and respiratory tract, in those already vaccinated (“primed”), they tested an intranasal “spike” to “elicit mucosal immune memory within the respiratory tract”. 

Their trial found that “prime and spike” induced a robust immune response in animals that protected against SARS-CoV-2 infection. 

Indian company Bharat has also developed an intranasal vaccine for Covaxin, which it says has been successful in animal studies although it has not yet submitted results for peer review.

Wuhan locks down

Meanwhile, China has locked down Wuhan’s central Hanyang district after COVID cases were found, as China persists with a zero-tolerance approach almost three years after the virus was first reported in the city, and about 900,000 residents were told to stay at home, according to Bloomberg.

This follows the re-election of Chinese President Xi Jinping – the architect of the “zero-COVID” strategy – for a third five-year term as leader of the country’s ruling communist party.

China’s zero-COVID strategy has resulted in lockdowns of entire cities. People living in districts where COVID-19 cases are detected are obliged to stay indoors for seven days and take a daily test.

The lockdowns have had a negative effect on the country’s economy, with a 1.7% contraction in sales last month largely as a result of quarantines in various parts of the country.

Meanwhile, a 14-year-old girl teenager, Guo Jingjing, died in a quarantine facility earlier this month, according to the BBC.

She apparently developed a fever two days after being taken to a facility in Ruzhou, and her family posted videos on social media of her shaking and convulsing on a bed. Her father, Guo Lele, said in a video on Douyin (Chinese TikTok) that the facility had not provided her with any help.

However, the videos and most references to the incident have since been removed.

Image Credits: Studio Incendo.

Testing for antimicrobial resistance at the Liverpool School of Tropical Science.

The World Health Organization (WHO) has raised the alarm over drug-resistant fungi as it released its first-ever priority list of fungal pathogens at risk from antimicrobial resistance (AMR). Nineteen species of fungi have been identified by the global health agency as representing “the greatest threat to public health” due to their growing drug resistance.  

Meanwhile,  a new report by a civil society coalition warned that unmitigated use of anti-fungal and antibacterial drugs on crop and animal production is fueling the fires of AMR – with too little action by countries and the UN system.

Speaking to media Tuesday, Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, said that WHO had compiled a list of piority fungal pathogens to put the issue on the public agenda and identify the areas for further research and development on fungal diseases.

Underlining the need for more documentation and surveillance on the fungal infections and diseases, Dr Getahun said, “ “We want the documentation of what’s happening currently … to dictate or to guide, while waiting for the evidence to be complete, what public health actions can be taken, particularly in raising awareness around these fungal infections.” 

Of the 19 species of fungi identified as priority pathogens, four pathogens were labelled as having “critical priority”. Those include Aspergillus fumigates, which causes respiratory infections in humans.  Others are Cryptococcus neoformans, Candida auris, which can cause bloodstream infections, wound infections and ear infections, and Candida albicans (thrush).  

Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, explaining the risk posed by drug-resistant fungi
Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, at the virtual press briefing on Tuesday.

The WHO report highlights how common fungal infections are becoming increasingly resistant to available treatments, raising risks particularly for people with low immunity. “Populations at greatest risk of invasive fungal infections include those with cancer, HIV/AIDS, organ transplants, chronic respiratory disease, and post-primary tuberculosis infection,” the report stated. During the Covid-19 pandemic, many health agencies also reported spikes in drug-resistant bacteria in samples collected from patients. 

While bacterial antimicrobial resistance (bacterial AMR) has received increasing attention from researchers and health ministries, information and data on fungal AMR is nowhere close. This is reflected in the fact that currently there are only four classes of antifungal medicines available to treat pathogenic fungal diseases. With few more treatment candidates in the clinical pipeline, WHO has warned that drug-resistant fungal pathogens are spreading far and wide across the globe due to many factors including unchecked use of antifungal agents in agriculture and aquaculture and climate change. 

All-age rate of deaths attributable to and associated with bacterial antimicrobial resistance by GBD
region, 2019

Role of azoles in fungal AMR

Rice fields are one type of agriculture where azoles are widely used.

Meanwhile, the new report on AMR released Monday by a civil society coalition carried an even stiffer warning abou the role of agrobusiness in spurring AMR – through rampant use of antifungal, antiboitic and antiviral agents on livestock and crops.

The report was co-authored by Nicoletta Dentico of the Society for International Development and the Geneva-based AMR Think-Do Tank.

The report, Untangling Antimicrobial Resistance, highlights, in particular, the role played by the widespread use of fungicides belonging to the azole family on agricultural crops – in the process fostering more drug resistant strains of Aspergillus fumigates, one of the pathogens on WHO’s priority list as a hazard for human health.

While antifungals may be regarded as key to food security, wanton use is increasing drug resistant mutations of fungi, and thus “selective pressure on human pathogens”, especially in regions where regulations against the on the use of fungicides are weak, the SID report added. 

Aspergillus fumigates causes an “environmentally acquired respiratory illness,” with Europe reporting the highest number of cases from the fungus. A 2021-study described how Aspergillus fumigatus has been spreading in all continents across the world, except Antarctica. 

Uncontrolled release of drug-laced effluents by industry, agriculture, households and the health sector is another pathway by which AMR resistance is growing silently, but steadily – particularly in parts of the world lacking good sewage treatment systems, the report states.

Not enough data on drug-resistant fungi

Deaths from drug resistant bacteria such as S. pneumonia and K. pneumonia have been mapped recently – but similar work is lacking for fungal agents.

Another issue faced in coming to grips with the surge of fungal AMR, is the lack of data, WHO officials said at their briefing. There are no systematic requirements for countries’ reporting on the use of antimicrobial or antifungal agents in human health or agriculture – or for reporting on AMR hotspots that emerge from overuse.  Whatever data may be collected by WHO, it is not harmonised with data collected by FAO or OIE.  Without data, it is tough to know where fungal drug resistance is growing, and what is the global burden of diseases from related deaths.

“But it doesn’t mean that it’s not a problem,” Dr Getahun pointed out. “That is why we have identified the priority pathogen list. And that is why we are actually encouraging more research, more surveillance, to understand the actual extent. Then we will be able to have appropriate estimates about global [burden].”

“Currently, fungal infections receive less than 1.5% of all infectious disease research funding. Consequently, the evidence base is weak, and most treatment guidelines are informed by limited evidence and expert opinion. Tackling the problems posed by invasive fungal disease will require increased research funding, targeted at the key priorities, new antifungal medicines and improved diagnostics,” the report added. 

While a recent Lancet study estimated that drug-resistant bacterial infections directly cause around 1.3 million deaths every year, and are associated with the deaths of some five million people every year, no such numbers are available for drug-resistant fungi. “We do need surveillance to identify the real burden and direct the public health as it is.”

Coordination between WHO, FAO, OIE and UNEP – hope or smokescreen?

Stefano Prato, top left, describes the economic model that has locked in farmers to overuse of drugs critical to human health. Nicoletta Dentico, lower left, moderates.

Recognizing the growing AMR threats from animal production and crop cultivation, WHO in April 2022 signed a Memorandum of Understanding (MoU) with Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE) and United Nations Environment Programme (UNEP) to collaborate on so-called One Health, approaches encouraging more judicious use of available drugs and chemical agents. 

Getahun, who is also director of the Quadripartite joint secretariat, told Health Policy Watch that under the MoU, the agencies – dubbed the Quadripartite – are working more closely together to identify those antibiotics that are critical to human and veterinary health. “[This was done] in order to ensure that these antimicrobials are not prescribed without the necessary veterinary or physiotherapy, you know, indications for plants.”

However, Getahun acknowledged that this work is in its early stages.

Speaking at the launch of the civil society report on AMR at Geneva’s South Centre, SID managing director Stefano Prato criticized the Quadripartite’s work as largely “theatrical” lacking normative teeth.  Meanwhile, veterinarians and farm extension advisors often receive huge financial incentives from encouraging farmers’ over-use of antibiotics, antivirals, antifungal agents and other drugs, driving uncontrolled use of such products.

“In many countries vets are really the ones who prescribe, earn and enjoy income and profits from the prescription of antiviral or antibiotics at the farm level,” observed Prato, who is both a veterinarian and an economist by training.”

In addition, developing countries have become locked into monoculture systems of industrial crop production, which typically require large drug and chemical applications – in order to generate cash crops for export.  Shifting out of that model to more sustainable agriculture systems that can supply more nutritious foods locally, is now extremely difficult because of their foreign debt burden, Prato said.

“Many countries that are locked into that export-driven model are also exposed to significan foreign debt… That means that they need the income and the currencies that are related to their export of commodities, because they need to repay those currencies”

“And so the conflicts of interest are so entrenched, not only at the global level but also at the national and micro level,” he said.

As for the new collaborations between WHO, FAO OIE and UNEP, Prato observed: “Without a proper governance structure, there will be no solution… it will end up being some kind of policy entertainment..theatrical red carpet solutions.”

-Updated 26 October with correction to the names of the report co-authors.

Image Credits: Flickr – UK Department for International Development, WHO, The Lancet, Creative Commons Zero, E. Fletcher/Health Policy Watch.

Exercise is an essential part of health.

Most countries are failing dismally to promote physical exercise despite inactivity playing a major role in heart disease, obesity and diabetes, according to the World Health Organization (WHO).

The WHO’s newly released Global status report on physical activity 2022 measures the extent to which governments are implementing recommendations to increase physical activity across all ages and abilities. 

Data from 194 countries shows that less than half the countries have a national physical activity policy, and only 30% have physical activity guidelines for all age groups. Just over 40% of countries have roads designed to enable safer walking and cycling.  

“We need more countries to scale up implementation of policies to support people to be more active through walking, cycling, sport, and other physical activity. The benefits are huge, not only for the physical and mental health of individuals, but also for societies, environments, and economies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, “We hope countries and partners will use this report to build more active, healthier, and fairer societies for all.”  

The economic burden of physical inactivity is significant and the cost of treating new cases of preventable non-communicable diseases (NCDs) will reach nearly $300 billion by 2030, according to the WHO. 

To help countries increase physical activity, WHO’s Global action plan on physical activity 2018-2030 offers 20 policy recommendations, including policies to create safer roads to encourage more active transport, provide more programmes and opportunities for physical activity in key settings, such as childcare, schools, primary health care and the workplace. 

The report calls for countries to prioritize physical activity as key to improving health and tackling NCDs, integrate physical activity into all relevant policies, and develop tools, guidance and training to improve implementation. 

“It is good for public health and makes economic sense to promote more physical activity for everyone,” said Dr Ruediger Krech, Director Department of Health

Exercise and COVID-19 vaccine

Meanwhile, a South African observational study of over 190,000 people suggests that regular physical activity may have boosted the efficacy of the Johnson & Johnson (J&J) COVID-19 vaccine. 

The study, published in the British Journal of Sports Medicine on Wednesday, was conducted by the health insurance company, Discovery Health, and its wellness programme, Vitality, in collaboration with Witwatersrand Sport and Health Research Group and the South African Medical Research Council (SAMRC).

It drew on the anonymised medical records, and recordable activity tracker data for 196,444 healthcare workers vaccinated with the J&J vaccine, who were clients of both a Discovery Health Administered Scheme and a Vitality wellness programme.

Those who were fully vaccinated and had high weekly levels of physical activity were nearly three times less likely to be admitted to hospital than those who were vaccinated but in the low physical activity category. 

“We set out to test the hypothesis that regular physical activity enhances the immune-boosting effect of COVID-19 vaccines, reducing severe outcomes in vaccinated people (measured by hospital admission),” explains Discovery Health’s analytics actuary, Shirley Collie. 

“The risk of hospital admission among fully vaccinated healthcare workers was reduced by 60% in the group who engaged in low levels of physical activity, and by 72% and 86% in the medium and high physical activity groups, respectively.” 

However, Professor Glenda Gray, President of the South African Medical Research Council, cautions that more research is needed to understand why exercise enhances the vaccine’s effects.

“For now, we suggest this may be a combination of enhanced antibody levels, improved T-cell immunosurveillance and psychosocial factors,” said Gray.

Image Credits: WHO/A. Loke.

Polio
Representatives from Rotary International and the government of the Philippines sign the agreement that starts Rotary International’s first polio project, 1979.

A historic window of opportunity to eradicate polio could be slipping away, World Health Organization (WHO) Europe leaders warned at a press conference marking World Polio Day on Monday. 

Since the 1980s, global polio cases have fallen by 99.9% and if polio were to be eradicated, it would join smallpox as only the second disease to be consigned to history.

“Polio is on the verge of becoming a story of the past,” said Dr Hans Kluge, WHO Europe Regional Director. “We stand on the cusp of eradicating the virus, but progress and the European region’s polio free status remain vulnerable.” 

The European region has been free from wild polio for two decades. But over the past year, circulation of vaccine-derived polio virus – a strain mutated from the weakened virus contained in the oral polio vaccine – has been confirmed in Israel, Ukraine, and the United Kingdom. This weakened variant can only spread in pockets of under-immunized communities, highlighting the need to reinforce vaccination efforts.

“The fight against polio has demonstrated the wonders of immunization, but this is not something we can take for granted,” Kluge said. “We are so close to the prospect of a polio free world. Choosing to leave the fight now would be a tragedy for future generations.”

Journey to eradication: from dream to reality

Polio
The 1979 agreement between Rotary International and the Philippine Ministry of Health for a joint multi-year effort to immunize children against polio

In 1979, a member of Rotary International issued a challenge to their peers in the Philippines chapter to eliminate polio from the island nation. It would take years of work, but the initiative was successful. The last case of wild polio in the Philippines was recorded in 1993. 

The challenge was then put to Rotary’s 1.4 million members globally. With representatives in over 200 countries, the goal became global eradication of the disease. Since the start of the 1979 vaccination campaign in the Philippines, Rotary International has invested $2.6 billion in the fight against polio.

“The thought was ‘if we can do it here, can we do it everywhere?‘” explained Rotary international president Jennifer Jones in her opening statement at the Monday press conference. “We started to speak with health professionals and organizations around the world, but it wasn’t seen as being a possibility at all.”

In 1988, the WHO, UNICEF and the Centers for Disease Control and Prevention, came together to form the Global Polio Eradication Initiative (GPEI). Later, the Bill and the Melinda Gates Foundation joined and GPEI became the largest international public health initiative in history.

Just last week, GPEI secured $2.6 billion in commitments at the World Health Summit, which is over half of its funding target of $4.8 billion set out in its 2022-2026 Strategy. This money is needed to provide vaccinations and essential healthcare services to over 370 million children worldwide. In total, over $19 billion has been invested into the programme since its launch.

The global effort has led to a reduction in polio cases by 99.9%.  “We are closer than we’ve ever been,” Jones said.

Endemic regions making progress

The mountains of North Waziristan, Pakistan.

Two years ago, wild polio was eradicated from endemic reservoirs in India and the African continent, and efforts in the last two endemic countries – Pakistan and Afghanistan – are trending in the right direction. But with the finish line in sight, the last mile is proving difficult.

“Pakistan has made incredible progress against polio, but recent challenges have allowed the virus to persist,” said Dr Zulfi Bhutta, professor at Aga Khan University in Pakistan. “Polio, like any virus, knows no borders; its continued transmission threatens children everywhere.”

Waziristan, a mountainous region of Pakistan on its Afghan border, faces high levels of vaccine hesitancy that have led to it becoming polios’ most resilient reservoir. The surrounding mountains – once strongholds of the Taliban – are a fitting backdrop for the disease to take its final stand.

The return of the Taliban from these very mountains to the levers of power in Afghanistan have complicated progress in reaching its unvaccinated communities. But negotiations to allow vaccinators better access to the country are underway.

Children pay the price of low-vaccination

Vaccine-derived polio strains are only a threat to the under-immunized. Too often, this means the heaviest burden falls on children.

“The occurrence of vaccine-derived polio around the globe clearly indicates one thing: we have left our children behind by not getting them vaccinated,” said Dr Siddhartha Datta, WHO Europe’s Regional Immunization Advisor. “It is extremely important that every child gets the vaccine doses which are part of the national vaccination schedule.”

Hundreds of children have already been paralyzed this year due to the spread of a vaccine derived strain amongst non-immune people in parts of Africa, Asia and Europe.

“Children deserve to live in a polio-free world, but as we have seen this year with painful clarity, until we reach every community and vaccinate every child, the threat of polio will persist,” said UNICEF Executive Director Catherine Russell. 

Polio anywhere is a threat everywhere

The re-emergence of polio in non-endemic regions highlights the difficulties of eradicating diseases in an increasingly interconnected world.  

“Polio is still a plane ride away,” Carol Pandak, the Chicago-based director of Rotary’s PolioPlus program told Bloomberg. “We’re sticking with the fight until we finish the job and keep our promise to the children of the world.”

But while cases in non-endemic countries are cause for anxiety, there is no need to panic, Jones explained.

“Seeing cases outside of the endemic areas is concerning, but we don’t need to fear-monger,” she said. “We should utilize the opportunity to raise awareness of what polio is and why it’s important to eradicate.”

COVID-19 has also taken a toll on polio immunization programmes. Across the WHO’s European region, coverage of the third dose of polio vaccine fell by 1% between 2019 and 2020. In 2021, only 25 out of 53 of the region’s countries had reached the 95% polio vaccination coverage rate recommended by the WHO.

“It is paramount that we ensure high vaccination coverage in all population groups,” said Kluge. “Until polio is eradicated, every country will remain at risk.”

COVID remains a threat, and forecasting is shaky

WHO Europe Director Hans Kluge at a press conference marking World Polio Day.

Last week marked 1000 days since the first cases of COVID-19 arrived in Europe. Entering the third pandemic winter, the continued evolution of the virus driven by a range of sub-lineages of the Omicron variant remains a concern.

An autumn surge has led to a tripling of cases in the European region since early September. In the second week of October, the region accounted for nearly 60% of new global cases and 42% of deaths.

“We are much better prepared, and the surge has not led to previous ICU admission or severe disease levels,” Kluge noted. “But the virus has surprised us more than once, and forecasting is tricky.”

WHO Senior Emergency Officer Dr Catherine Smallwood echoed the difficulty of projecting how the disease will develop through the winter.

“We’re having trouble isolating which of the omicron sub-variants will have a growth advantage and will take over in dominating the spread,” she explained. “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.”

Image Credits: Rotary International, Rizwan Ullah Wazir.

IFPMA Director-General Thomas Cueni

The Biotechnology Innovation Organization (BIO) and Developing Countries Vaccine Manufacturers’ Network (DCVMN) have thrown their weight behind the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) proposal to improve access to vaccines in future pandemics.

The proposal, known as the Berlin Declaration, outlines how the pharmaceutical industry would reserve an allocation of real-time production of vaccines for priority populations in lower-income countries in future global pandemics.

In exchange, the industry wants their intellectual property protected, and for governments to “guarantee the immediate and unhindered sharing of emerging pathogens and their associated data to all researchers”, as well as committing to unrestricted trade, no export bans, and expedited processes for import and export during a pandemic.

The three pharma associations –  representing vaccines innovators as well as manufacturers – announced their agreement on Monday following a meeting in India hosted by DCVMN.  They called upon the G20, G7 and multilateral organizations to implement their part of the proposed bargain, etched out by the Berlin Declaration. 

“By supporting the vision for equitable access in pandemics, vaccine innovators and manufacturers acknowledge that while innovation, business-to-business voluntary collaboration and manufacturing scaling up succeeded in an unprecedented way during COVID-19, efforts to achieve equitable access were not fully realised,” the three bodies acknowledged.

“The three trade bodies invite the G7, G20, as well as multilateral organizations and other decision-makers to accept this practical solution and include it in their future pandemic preparedness response plans, whilst impressing upon governments that for the proposal to succeed the health systems in lower-income countries need to be better prepared to absorb and deliver vaccines and treatments, while high-income countries need to provide the necessary political and financial support,” according to the statement.

Industry ‘power-grab’?

Manufacturing COVID-19 vaccine at a Pfizer facility.

However, the People’s Vaccine Alliance once again denounced the industry’s offer.  A policy brief on the Berlin Declaration, issued by the alliance last week described it as “a continuation of a consistent ‘third way’ campaign by the biopharmaceutical industry to maintain exclusive intellectual property (IP) protections and monopoly control over the medical technologies needed to defeat the pandemic”.

The alliance, which is made up of over 100 civil society organisations, has taken issue with a number of clauses including the declaration’s insistence on IP protection, pointing out that  “decades of publicly funded research” was behind the development of mRNA vaccines.

​​“Waiting for pharmaceutical companies to voluntarily supply life-saving medicines and vaccines to people in developing countries has not worked in the AIDS pandemic, it has not worked in the COVID-19 pandemic, and it will not work in future pandemics,” said Winnie Byanyima, executive director of UNAIDS and co-chair of the People’s Vaccine Alliance, in a media release.

“Governments negotiating a pandemic treaty need to resist the siren calls of industry. The profiteers of this pandemic must not set the rules that govern the preparations for the next pandemic. The world needs an international agreement that guarantees fair and equitable access to medical products for everyone, everywhere, not a power grab by big pharma,” she added.

The World Health Organization (WHO)’s intergovernmental negotiating body (INB), established to guide member state discussions on developing a pandemic accord for future pandemics, is currently refining the current working draft of the initial agreement, referred to as document A/INB/2/3. This will be presented as a “conceptual zero draft of the accord” at the INB’s third meeting in December.  Framing of equity and medicines access in the zero draft will set the stage for how member states negotiate over these charged issues in their attempts to reach a binding international accord.  

The INB will submit a progress report to the Seventy-sixth World Health Assembly in 2023 and the final accord is expected to be presented for consideration at the Seventy-seventh World Health Assembly in 2024.

Vaccine price hikes

People’s Vaccine Alliance co-chair, UNAIDS Executive Director Winnie Byanyima.

Meanwhile, the People’s Vaccine Alliance also condemned the announcement by Pfizer that it will increase the price of its COVID-19 vaccine fourfold, to around $110-$130 after the US government’s federally-sponsored purchase programme for the vaccine expires at the end of this year.  Currently, the vaccine is sold for $30 a dose to the US government and provided for free.  As of 2023, the vaccine will be provided through the usual US public and private insurance channels, Pfizer said, in a statement that justified its price-hike to weakened demand for the vaccine. 

However, in a statement to Health Policy Watch, a Pfizer spokesperson said that the “company comments made regarding potential future vaccine pricing were specific to the United States.”

The spokesperson added: “We have government contracts in many developed markets outside the US, valid through 2023. And as such, have agreed prices for those markets.  During the pandemic, we priced our vaccine and oral treatment to ensure equitable global access for all countries, regardless of income levels… This tiered pricing, which provides to low and middle-income countries at cost, remains in effect.”

A People’s Vaccine Alliance spokesperson said that at its current US sale price, the vaccine already is priced nearly 30 times above its manufacturing cost – even at current US rates: “Experts have estimated that Pfizer’s vaccine costs just $1.18 per dose to make. Charging $130 per dose would represent a markup of more than 10,000%. This is daylight robbery. Governments must not stand by while companies like Pfizer hold the world to ransom in a global pandemic,” said alliance policy advisor Julia Kosgei.

Cost price estimates, she said. are based on Oxfam analysis of studies of mRNA production techniques, carried out by Public Citizen with engineers at Imperial College. Public Citizen and Imperial College’s analysis suggests that it could cost $9.4 billion to produce 8 billion doses of the Pfizer/BioNTech vaccine ―$1.18 per vaccine.

“While health workers and the vulnerable continue to go unvaccinated in developing countries, Pfizer is shamelessly fleecing the public for ever-greater sums of money. This latest obscene price hike is truly a mask-off moment for one of the great profiteers of this pandemic,” said Kosgei.

Not just about vaccines

Mapping of the MPP-brokered licenses awarded for the manufacture of a generic version of Paxlovid

“This isn’t just about vaccines. Right now, people in developing countries are dying without access to Paxlovid, an antiviral COVID-19 treatment for which Pfizer is charging hundreds of dollars per course. But there is a proposal at the World Trade Organization that would make it easier for poorer countries to produce generic doses. It’s time for governments to stand up to pandemic profiteers and support it.”

With regard to Paxlovid, the Pfizer spokesperson said that the company had established “a comprehensive strategy with governments, international global health leaders and global manufacturers to optimize overall supply and access to all parts of the world. ”

That, the spokesperson said, includes: a voluntary license agreement with the Medicines Patent Pool to allow generic production of the treatment, sublicensed to 38 manufacturers in 13 different countries; agreements with the Global Fund and UNICEF to supply some 10 million treatment courses through their channels; and collaborations with WHO and its partners to enable supply to reach “more vulnerable populations.

In a separate channel, World Trade Organization members are still negotiating over a proposal to extend a limited intellectual property waiver on vaccine manufacture, approved by the WTO in June, to treatments as well. The 17 June agreement calls for a WTO decision on whether to extend the waiver to diagnostics and treatments “no later than six months from the date of this decision.”

Image Credits: Pfizer, Medicines Patent Pool .