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 .

Haiti
Child Amputee in Recovery at Jacmel, Haiti, Hospital. UN Photo/Marco Dormino.

Hospitals in Haiti’s capital of Port-au-Prince face the threat of shutting down if fuel supplies for diesel power generators and vital medical supplies aren’t made available soon, Médecins Sans Frontières (MSF) warned Friday. 

“We will not be able to operate our medical facilities for more than a few weeks if we do not have access to fuel,” said Mumuza Muhindo, MSF’s head of activities in Haiti. “In addition, medical equipment, which we also need to continue to treat cholera cases and provide care to the population, is currently blocked at the port.”

Shortages have been exacerbated by the ongoing gang blockade of a key fuel terminal in the country, which has led its neighbour, the Domican Republic, to approve a request to export 20,500 gallons of diesel to Haiti for use principally in hospitals, according to documents seen by Reuters.

As chronic outages continue to hit Haiti’s power grid, fuel is the only way hospitals can ensure consistent electricity. And the Haitian capital’s health services are already on the brink of collapse.

For the last several days, Port-au-Prince hospitals have been forced to reduce their services due to the fuel shortage as the country teeters between prospects of foreign intervention and revolution. 

MSF reports over 100 people a day with cholera like symptoms

Amid the chaos, the re-emergence of cholera, officially confirmed on October 2, poses a growing threat. As of 8 October there were 224 cases officially confirmed, according to WHO.  

Accounting for the breakdown of the government’s ability to operate, experts warn official figures drastically underestimate the scale of the outbreak. Over the last seven days, MSF reported receiving over a hundred patients with cholera-like symptoms in each of its four treatment centers.

Unsafe water is one of the main causes for the spread of cholera, and with no functioning government, escalating violence, and no clear path to a resolution of its political crisis, the resurgence of the disease in Haiti could be disastrous, warned Auguste Ngantsélé, MSF’s Haiti Medical coordinator.

“Without drinkable water, treatment, and good waste management, the risk of a spike in the number of cases is very high and needs to be addressed urgently,” he said.

Additional reports emerged last week of an outbreak in an overcrowded prison where dozens of people were infected, triggering fears that transmission may grow out of control.  

Patients can’t get to hospitals 

Areal view of CIté Soleil, a deeply impoverished area of Port-au-Prince now under gang control.

Even if hospitals in the island’s capital manage to remain open, the roads to treatment are dangerous. Violence on the streets has made every trip through Port-au-Prince perilous, and even seeking access to facilities capable of providing adequate treatment present a life-threatening challenge for patients. 

“In 20 years of working in Haiti, we have never seen something like this,” Fiammetta Cappellini, country representative for the Avsi Foundation told the Guardian. “Violence is everywhere and touches everybody. The most vulnerable people are literally struggling to survive as humanitarian aid is failing to reach people.”

Accounts from doctors on the ground provide grim evidence for Cappellini’s view. 

“Last week, a pregnant woman came to our hospital in Cité Soleil needing an emergency cesarean section. We tried to transfer her to a medical facility where she might find that kind of treatment, but she died”, said MSF doctor Dr. Luxamilda Jean-Louis. “Whether it’s due to insecurity on the roads, or to health structures no longer functioning, events like this happen every day in Port-au-Prince.”

The gangs – who took the opportunity to expand their control over the country after the assassination of its prime minister last year – have gone to extremes to enforce their rule over the capital. 

Last week, the UN Human Rights Office published a report detailing that children as young as 10 have been subjected to sexual violence – including collective rapes for hours in front of their parents or children by more than half a dozen armed elements. 

“Gangs use sexual violence to instil fear, and alarmingly the number of cases increases by the day as the humanitarian and human rights crisis in Haiti deepens,” said acting UN Human Rights Chief Nada Al-Nashif. “The gruesome testimonies shared by victims underscore the imperative for urgent action to stop this depraved behaviour, ensure that those responsible are held to account, and the victims are provided support.”

On Friday, the UN Security Council unanimously approved a sanctions regime for Haiti, targeting gang leaders and those who finance them, in hopes of easing the violence and lawlessness. The resolution specifically sanctions notorious gang leader Jimmy Cherizier, an ex-police officer who is reportedly the most powerful gang boss in the country, known by his alias “Barbeque”.

“We are sending a clear message to the bad actors that are holding Haiti hostage,” said US UN Ambassador and co-pen holder on Haiti, Linda Thomas-Greenfield. “The international community will not stand idly by while you wreak havoc on the Haitian people.”

Thomas-Greenfield added that the US and Mexico are working on a resolution to authorize a “non-UN international security assistance mission” to address security issues and facilitate humanitarian aid. Given Haiti’s past experiences with foreign intrusions, the plan is controversial, and has sparked large protests in the capital.

Haiti’s acting, but unelected prime minister, Ariel Henry, asked for the international community to deploy a “specialized armed force” in the country on October 7. Despite United States acknowledgement of the depths of the Hatian crisis on the international stage, many refugees arriving at its borders fleeing the violence continue to be sent back.

Crises collide: ‘catastrophic’ hunger recorded in Haiti for first time

On the same day of the release of the sexual violence report, the UN’s World Food Programme published its own finding: hunger in Haiti has reached catastrophic levels. 

According to the media release, a record 4.7 million people are facing acute hunger, including 1.8 million facing what the UN describes as “emergency phase” hunger. And, for the first time ever in Haiti, 19,000 people are facing “catastrophic” hunger, and are barely surviving. 

Today, 65% of the residents in Cité Soleil, an extremely impoverished and densely populated neighborhood of Port-au-Prince, are facing high levels of food insecurity.

With armed groups vying for control of this now lawless area of the capital, people have lost access to their jobs, markets, health and nutrition services. Many have been forced to flee or simply hide indoors, the UN said. 

Haiti
The epicenter of Haiti’s 2021 earthquake hit rural areas, leaving a lasting impact on food supplies.

Beyond the chaos of Port-au-Prince, rural communities are not faring much better. Food security has continued to deteriorate in these areas as harvest losses due to light rainfall compounded by the 2021 earthquake that struck the island in August last year hit food supplies. 

“For years, natural hazards and political turmoil have taken a toll on Hatians already in need in both rural and urban areas,” the UN stated. “The onset of the global food crisis, with rising food and fuel prices, has led to growing civil unrest that has plunged Haiti into chaos.”

As the parallel crises of hunger, violence, and cholera collide, whether Haiti’s hospitals survive the fuel shortage will determine the lives of thousands of Haitians. 

A health worker monitors a cholera vaccination campaign in Sinnar, Sudan.

With more cholera outbreaks overstretching the world’s limited vaccine supply, WHO recommends temporarily suspending the standard two-dose regimen to vaccinate more people. Meanwhile, Africa aims to re-energize its COVID-19 vaccine rollout, despite steady decline in public turnout for vaccination. 

A shortage in the global supply of cholera vaccines has forced the World Health Organization to recommend that countries administer only a single vaccine dose – rather than the standard two doses to groups at risk, in order to conserve desperately-needed supplies. 

“The pivot in strategy will allow for the doses to be used in more countries, at a time of unprecedented rise in cholera outbreaks worldwide,” WHO stated in a news release just ahead of a briefing by WHO Africa Region officials Thursday on the regional situation, one of the regions seeing a sharp rise in cholera cases.

Globally, this year, a total of 29 countries have reported cholera cases to WHO. In Haiti, Malawi, Somalia and Syria, large outbreaks of cholera are currently underway, while the Democratic Republic of Congo, South Sudan, and Cameroon are among the other hotspots. In contrast, in the previous five years, fewer than 20 countries worldwide, on average, reported outbreaks.

The global trend is towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks, experts say.

“Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive and reactive campaigns,” reported WHO.  “And an additional 8 million doses were approved by the ICG for the second round for emergency vaccination in 4 countries, illustrating the dire shortage of the vaccine. As vaccine manufactures are producing at their maximum current capacity, there is no short-term solution to increase production. The temporary suspension of the two-dose strategy will allow the remaining doses to be redirected for any needs for the rest of the year.

“This is a short-term solution but to ease the problem in the longer term, urgent action is needed to increase global vaccine production,” WHO concluded.

Recommendation made by group  managing emergency vaccine supplies

Dr Phionah Atuhebwe, Vaccines Medical Officer, WHO African Region

WHO said the recommendation was initially made by its the International Coordinating Group (ICG) expert group, which manages emergency supplies of vaccines.

Defending its decision, ICG said the one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children.  

With a two-dose regimen, when the second dose is administered within 6 months of the first, immunity against infection lasts for 3 years,” it said.

Addressing the WHO AFRO briefing, Dr Phionah Atuhebwe, Vaccines Introduction Medical Officer said the temporary use of the one dose strategy will allow more people to be vaccinated and provide them with protection in the near term. 

“So it means we get more doses for DRC and Cameroon. However, while vaccines are still a critical tool in the prevention of these cholera outbreaks, they’re not the only tool we have. Cholera can be prevented with access to safe water and sanitation and also treated with oral rehydration or antibiotics for severe cases,” she said.

An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from the disease, according to the US Centers for Disease Control.

Africa has administered 70% of the 1 billion doses of COVID-19 vaccine received

Matshidiso Moeti, WHO African Regional Director

Since COVID-19 vaccination began in Africa, the continent has now received more than one billion doses of vaccines out of which it has administered over 70%, according to Africa CDC. Despite this milestone, Matshidiso Moeti, WHO Regional Director for Africa, told Health Policy Watch that Africa is far from the global goal set by WHO for vaccinating 70% of its population. 

In fact, only 8 countries in Africa have vaccinated more than half of their populations, Aurelia Nguyen, Gavi Special Adviser, told Health Policy Watch.

Moreover, COVID-19 vaccination coverage has stagnated in half of African countries, as the number of doses administered monthly declined by over 50% between July and September. Despite this, the continent has made modest progress in vaccinating high-risk population groups, including health workers and the elderly, the officials stated.

“I think it’s clear that we are far from the original targets that have been set as far as coverage with COVID-19 vaccination in the African region is concerned. At a certain point in time early this year, we were saying we need to ramp up seven times the rate at which vaccination was happening in the African region,” Moeti said.

Aurelia Nguyen, Special Adviser, Gavi, the Vaccine Alliance.

While COVID-19 vaccination coverage in Africa is way below global averages, booster coverage is even lower, Nguyen said.

“Programs that address these [issues] will really be where we’re going to save the most lives. And it’s also going to be the part that helps protect the health system overall, as we respond to the pandemic and other diseases,” she said.

Image Credits: Twitter: @WHOSudan, European Centers for Disease Control , Adepoju/Health Policy Watch .

‘He died without feeling a last kiss from his loving mother,’ Ricardo Baptista Leite on his journey from the bedside to the boardroom to create UNITE

BERLIN – Nearly 20 years ago, Ricardo Baptista Leite began his work as a young medical doctor in an infectious disease ward in Portugal – an experience that changed his life. 

“I met patients who couldn’t make it to the hospital because they couldn’t afford public transportation,” he said.  “I diagnosed patients infected with multi resistant tuberculosis; keeping them in isolation, I prayed that the treatment would work that time. 

“I particularly particularly remember a man in his twenties who was in the hospital, and his mother would visit him every day, but she would not go inside the room because she was ashamed that her son was living with HIV. 

“He died without feeling a last hug and kiss from his loving mother. And all because of lack of education, stigma, discrimination, inequities and poverty have led to poor health and deaths across the world.”

Leite, who is now a member of the Portuguese National Assembly, recalled those early days at a ceremony this week where he signed a collaboration agreement between the World Health Organization and the UNITE Parliamentarians Network for Global Health, founded just five years ago.

The aim is to expand outreach to the world’s elected politicians on burning global health priorities, whose direction is ultimately “a political choice” to use the oft-cited mantra of WHO’s Director General Dr Tedros Adhanom Ghebreyesus.

‘Straightforward’ but not simple mission

Parliamentarians from six WHO regions speak about advancing global health goals at a World Health Summit event marking the establishment of official relations between the World Health Organization and the UNITE Network of Parliamentarians for Global Health.

UNITE was only a glimmer in the imagination of Baptista-Leite six years ago when he first proposed the idea of a global health-focused parliamentary intiative at the 2016 World Health Summit.

Established a year later in 2017, it now includes senators and congresspersons from more than 85 countries. Along with gaining formal WHO recognition, UNITE is also leading work with about a dozen other long-standing parliamentary networks under the umbrella of the International Forum on Global Health, to coordinate parliamentarians’ inputs to the WHO’s development of a pandemic treaty.

“Our mission is straightforward,” said Baptista Leite at the WHS event where he signed the MoU on behalf of UNITE with WHO’s Tedros. The ceremonial signing wa followed by a panel discussion with leading MPs from all six WHO regions of the world on the role parliamentarians can play in turning global health policies into reality. 

“We aim to transform scientifically sound recommendations into concrete laws. We ensure that money gets where it is needed through budgets, and we hold governments accountable,” Baptista Leite said, summing it up. 

“We will work together towards achieving a new pandemic treaty or convention to be ratified by parliaments to ensure that all will be done to contain outbreaks and prevent future pandemics. 

“We will actively transform current disease response systems into health ecosystems capable of promoting wellbeing for all and not just for the few. Together we will foster innovation and digital health as a means towards achieving universal health coverage and the SDGs by 2030. And by joining efforts with civil society and patient advocates, we will put citizens front and center. 

“And as we have seen in the COVID pandemic health threats do not recognize borders, and if we do not work together we will indeed fail the people we have been elected to serve, unite and who have come together to ensure that failure is not an option.”

WHO rolling out new parliamentary engagement strategy 

‘As a former parliamentarian myself, I know the critical role parliaments play’ – Tedros at the signing of an MoU recognizing formal relations with UNITE.

While UNITE is a relatively new parliamentary network, and small in comparison to groups like the Interparliamentary Union (IPU), which includes tens of thousands of members worldwide, its added value is its laser-focus on global health. Recognition by WHO can ease collaborations that support WHO’s efforts to reach out more directly to parliamentarians around the world, said Dr Tedros, noting that WHO is just now rolling out a first-ever strategy on parliamentary engagement. 

The WHO strategy includes the creation of a new global network of parliamentary chairs of health committees from all 194 WHO member states “to establish a systematic dialogue with national parliamentary bodies in charge of health and mobilize political support around key global health priorities,” Tedros said.  

“As new members of the WHO partners family, UNITE will support WHO’s engagement with parliaments with a focus on three major areas: equitable access to health with a focus on adequate budget allocation for universal health coverage; sustainable financing for health system strengthening; and strengthening the global health security architecture…especially the implementation of the international accord in countries,” said Tedros at the event.  

While governments’ can approve new WHO initiatives and  policies, it remains up to parliaments to pass the legislation to actually implement them – along with ensuring sufficient budget allocations, Tedros noted.  And that is what makes their role so pivotal.

Speeding up ratification of a new pandemic accord 

This is a key particular concern with regards to any new pandemic treaty or accord.  Even if an accord is approved on schedule by May 2024, it would still have to be ratified by a critical mass of countries in order to take effect as international law and be universally binding. 

And that process could take years, critics have warned. In fact,  the International Health Regulations (IHR), the present-day set of WHO rules on health emergencies, only became legally binding in 2020 – 15 years after the IHR was approved by the World Health Organization member states.  

“As a former parliamentarian myself, I know the critical role parliaments play in driving progress in global health by passing legislation;  keeping governments accountable, allocating adequate funding for health and by representing the needs of the communities they represent,” Tedros added.  

“Over the last few years, WHO has intensified its engagement with parliaments on our key priorities of: universal health coverage, global health security and health promotion, especially for vulnerable groups, including women, children and adolescents. 

“A significant milestone was the adoption by the Interparliamentary Union Assembly of a resolution on Universal Health Coverage in 2019. 

“This is only the first of many milestones we would like to achieve with your support,” said Tedros, turning to Baptista-Leite and the parliamentarians on the panel, including Spain’s José Ignacio Echániz, chair of the advisory group on health at the IPU, a broad-based body representing 46,000 MPs around the world.  

Inherent tensions between parliamentarians and government 

Ghanaian politician Akua Sena Dansua describes experiences serving in parliament and government.

Reaching out to parliamentarians is a delicate, but important task for WHO, in light of the inherent tensions that typically exists between the parliamentary and executive branches of government.  It is with the latter that WHO maintains its formal relations.  But presidents or prime ministers and their cabinet ministers don’t always have the last word either, as anyone watching the hotly-debated US mid-term elections knows. 

Within any presidential or parliamentary democracy, there is typically a wide array of of political parties and constituencies that need to be persuaded to support measures that require legislative action, including spending on new domestic programmes as well as international accords.

Ghana’s Akua Sena Dansua can speak to that issue well, 

“I had the benefit of experience on both sides of the aisle,” recalled Dansua, who moderated a panel discussion that followed the ceremonial signing of the MoU. “I was in opposition for  8 years, and then in government for four years, 

“And during this time, I will say that I had the best time in opposition, because then I had the opportunity to criticize the government of the day – you can shout at the top of your voice. 

“But the government is adamant – they are there to promote their vision, which may not include what you are trying to propose to them. So you can shout the loudest but you will not, unfortunately, [always] get the hearing you deserve.” 

Conversely, when her party was controlling the government, “you have to tow the party line. You have to tow the government’s line. … Even if you have issues to raise, you couldn’t express yourself.”

WHO’s recognition should empower parliamentarians 

Andrew Ullmann, chair of the Health Committee in the German Budestag.

Against those limitations and constraints,  WHO’s engagement can equip parliamentarians with evidence based know-how, enabling them to provide better guidance and leadership on critical health issues, Dansua said. 

“We are happy that WHO has recognized or is recognizing parliamentarians as a very strong partner. What we ask for them is to empower us,  to give us the training, to give us the information and to give us the support that parliamentarians need in their various countries to push the global agenda forward,”  Dansua said. 

Health can also be a unifying theme amongst disparate political parties, observed another panelist, Andrew Ullmann, chair of the Health Committee in Germany’s Bundestag.

“We as parliamentarians are essential to achieving global health goals because of our ability to enact legislation, harmonize existing laws, create an enabling legislative environment, and eliminate existing legal barriers to existing health care,” Ullmann stressed. 

“We are responsible for budget allocations and keep our governments accountable. For my experience as chair of the subcommittee, I can assure you that German parliamentarians independents, in the governmental coalition or the opposition, are committed to global health.

Germany has also become the first country in the world to create a subcommittee on global health within its parliament, Ullmann noted. 

“The idea was born out of the fact that health challenges go beyond national borders, health and well being need to be understood on a global level,” he said. 

“The effects of infectious diseases such as Ebola or tuberculosis, as well as antibiotic resistance and climate change go far beyond national borders. In order to take this development into account, and to facilitate bridging cooperation exchange between all voluntary bodies involved, the global health committee established this subcommittee, which gives global health policy more visibility and real relevance among the members of the Budestag,” Ullmann added. 

Addressing health versus healthcare

Parliamentarians Andrea Álvarez Marín, Costa Rica and José Ignacio Echániz, Spain, discuss the role of MPs in global health policy-making Tuesday 18 October at the World Health Summit in Berlin.

One other key challenge parliamentarians face is understanding and championing health-based legislation that address the upstream determinants of health, social, commerical or environmental, as compared to healthcare per se, pointed out Andrea Álvarez Marín, an MP from Costa Rica and president of the Costa Rican National Assembly’s social affairs committee. 

“If we focus on the kinds of conversations that we have been having in this summit, all of us usually speak about the social determinants of health and risk factors and the causes of the causes.” she observed. “But if we go to the general public, the general public still thinks of health as access to health care only. 

“And this makes it hard to push legislation and partly explains why recently in our committee on social issues, a cancer treatment bill passed swiftly through – although in my opinion, it will have a low impact, while legislation such as labeling, taxes and food marketing tends to be archived. It’s because other Congress people don’t see these measures as being effective for prevention.”

She said that regional networks of parliamentarians, complementing global networks like UNITE, can also help bridge the knowledge gap.  

“Since 2015, the Pan American Health Organization (WHO/PAHO) has been organizing yearly conferences in which the heads of the [parliamentary] health and social committees come together and discuss best practices, common failures and the most recent evidence, so that among parliamentarians, we can see what worked in other countries and apply it to our own. 

“So I still think that a global network such as the one that was announced today has to be complemented with regional networks, because globally the conversations will be around the main challenges and the main solutions, but these solutions always need to be operationalized on the national level. And by having regional networks, such as the one we have in PAHO, we can get with countries that have a common history and common challenges.” 

Health emergencies intertwined with conflict, economic and food challenges

British MP Liam Byrne speaks at a World Health Summit event on the role of parliamentarians in advancing global health policies on Monday, 17 October.

Recognizing the increasingly complex relationships between social, environmental and economic risks and the health emergencies that they can produce has never been so important,  underlined participants at another UNITE session the day before, focusing on the pandemic accord. 

Today’s global health issues are intertwined more deeply than ever with global challenges of war and peace, migration and climate change, and even the debt crisis, emphasized Liam Byrne, a British MP and former member of Prime Minister Gordon Brown’s cabinet, from 2008-2010.  

“Some 41 countries now face a threat of civil war and conflict and violence. That now means the number of people living in conflict zones has doubled in the last 10 to 15 years; we have something like 20 million refugees around the world, living in the most unspeakable conditions. 

“But that is not the only crisis. Because as countries came out of COVID with debts high and we now face the rising American interest rates, we have something like 40 to 50 countries now facing debt distress. On top of that, there is the food crisis that is now confronting hundreds of millions of people around the world with the threat of starvation,” he added. 

“After millennia of being able to predict the seasons, actually we can’t predict the seasons anymore.…We now face a crisis of farming and food insecurity that threatens the lives of 205 million people. 3.1 billion people now do not have enough money to afford a good diet.

“And 11 million people now die each year because they cannot afford the nutrition that they need. So when you put all of that together, the risks are really clear. 

“We have to be so careful today that we don’t get caught in a vicious cycle of how a pandemic of disease triggers a pandemic of poverty, which in turn triggers future pandemic disease in the years to come. 

“We know that prevention is better than cure. So what do we, as parliamentarians do, sit back and hope it doesn’t happen again?  

“That is why this initiative is so important. We have to insist as representatives of the families of the 6.5 million people who lost their lives in this pandemic, that this never happens again.”

Image Credits: Fletcher/Health Policy Watch , Fletcher/Health Policy Watch.

A precedent-setting agreement to permit an expensive cancer drug to be produced more affordably by generic manufacturers has been signed between the Medicines Patent Pool (MPP) and pharmaceutical company Novartis, enabling much wider access to a medicine that treats a rare blood cancer.

Nilotinib is a twice-daily oral medication used to treat chronic myeloid leukaemia (CML), and it is included on the World Health Organization (WHO) Essential Medicines List. 

In the US, the drug costs almost $9000 for a month’s supply, and is used to treat patients in the early stages of CML and those resistant to an earlier drug called imatinib.

According to the agreement, MPP-selected generic manufacturers will be able to develop, manufacture and supply generic versions of nilotinib to 44 countries, including seven middle-income countries – Egypt, Guatemala, Indonesia, Morocco, Pakistan, the Philippines and Tunisia. 

“There are also other low- and middle-income countries around the world that do not have patents on nilotinib (or where such patents have expired) who will also be able to manufacture and procure generic versions once they become available,” an MPP spokesperson explained to Health Policy Watch.

This is the first agreement MPP has reached on a cancer drug. Charles Gore, the Pool’s executive director, said that “although the remaining patent life [on nilotinib] is relatively short, this voluntary licence in the non-communicable disease space sets a vital precedent that I hope other companies will follow.”

“Access to high-quality cancer medicines is a crucial component of the global health response to the cancer burden,” added Gore, making the announcement on the sidelines of the World Cancer Congress in Geneva.

New coalition brokers deal

“While there has been tremendous progress in new technologies to treat cancer, major challenges persist in many low- and middle-income countries (LMICs) that face inequity in access to new-generation cancer medicines which could allow patients to live better and longer. Advances in treatment, such as nilotinib, have contributed to a greatly improved prognosis for people diagnosed with CML,” MPP said in a statement on Thursday.

Delegates to the cancer congress have already noted that cancer deaths in LMICs are being driven by a lack of access to early diagnosis and treatment for a range of common cancers.

The agreement developed out of the new Access to Oncology Medicines (ATOM) Coalition, which was launched in May and consists of major players in the cancer sector, including pharmaceutical companies.

Lutz Hegemann, Novartis president of global health and sustainability, said that his company was  “proud to be pioneering this new licensing model with MPP in collaboration with the ATOM Coalition”.

In May 2022 Novartis and MPP both joined ATOM, which is being led by the Union for International Cancer Control (UICC) to improve access to essential cancer medicines in LMICs, and to increase the capacity for diagnosing cancer and for the proper handling and supply monitoring of these medicines. 

ATOM co-chair Anil D’Cruz hailed the agreement, saying that it showed “that the combined efforts of the private and public sectors can pave the way to help save millions of lives”.

Gilberto Lopes, ATOM’s other chair, said that “innovative solutions like the one announced today should be an example for others to follow, helping millions more people access essential, life-saving cancer medicines”.

The MPP is a United Nations-backed public health organisation working to increase access to, and facilitate the development of, life-saving medicines for LMICs – mostly by encouraging the generic manufacture and the development of various medicines.

To date, MPP has signed agreements with 18 patent holders for 13 HIV antiretrovirals, one HIV technology platform, three hepatitis C antivirals, a tuberculosis treatment, a cancer treatment, four long-acting technologies, three oral antiviral treatments for COVID-19 and 12 COVID-19 technologies.

Affordable, healthy food options are key to good health.

“The bottom line is that our food environment is deeply unhealthy. And unless we change that, millions of people will suffer from avoidable illness and die early from preventable death,” Dr Tom Frieden, CEO of Resolve to Save Lives, told the World Health Summit in Berlin.

“Voluntary changes are much less likely to result in sustainable positive healthy development than a predictable regulatory framework,” said Frieden, speaking at a session on ‘Transforming Food Systems for Healthy and Sustainable Diets. 

He pointed to five areas that needed targeted action to address malnutrition – micronutrient deficiencies, artificial transfat, excessive sodium, excessive sugar and the higher cost of healthier foods.

“Let’s be clear that simply encouraging people to eat better and exercise more will not only fail, but is essentially a form of blaming the victim.

According to the WHO, 1.9 billion adults in the world are obese and 462 million are underweight. Almost 233 million children under the age of five suffer from some form of malnutrition and around 45% of deaths among children in that age group is linked to undernutrition. 


In 2019, The Lancet Commission on obesity, undernutrition and climate change identified these three issues as the biggest threats to the world, and called for significant funding to address them, including but not limited to agriculture, food production and policy, land use and environment. 

The United Nations Food Systems Summit in New York in 2021 also called for sustainable food systems and healthy diets for all, and Tuesday’s session was aimed at addressing the various commercial determinants involved in achieving this goal. 

Some countries are already reforming their food systems to deliver healthier options to their populations using measures such as investment in agriculture, tax subsidies for companies that produce healthier foods to make them more affordable and regulations ensure processed food adheres to strict health standards. 

More regulation

Government regulation of companies that manufacture processed and unhealthy foods and their marketing strategies can help the cause, according to Frieden.

“We’re not absolving individuals from responsibility. But we’re not absolving society from the responsibility of establishing the structure to make the healthy choice the easier choice either,” added Frieden, explaining that measures like front-of-the-pack warnings, increasing the price of unhealthy food and reducing the price of healthy food have helped. 

Commercial determinants of obesity and chronic diseases are very well-documented and so is the power wielded by influential processed food corporations across the world, said Dr Marion Nestle, professor of nutrition, food studies, and public health at New York University.

Prof Dr Marion Nestle
Dr Marion Nestle speaking at the World Health Summit 2022.

She pointed to the Lancet Commission’s report and stated that big food companies are not social service agencies with public health as the goal: “They’re businesses with stockholders to please. They have to put profits to stockholders as their first priority, no matter what the people in the companies think they would like to do about hunger, malnutrition, chronic disease and climate change,” she said, calling for a regulatory framework that puts all food companies on the same level playing field.

Keep companies out of public policy

One of the Lancet Commission’s recommendations was the reduction in the influence of large commercial interests in public policy development to “enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet”.

Explaining the complicated relationship many governments have with processed food companies, Nestle said that this is a difficult situation. “It’s one that public health advocates have to figure out how to deal with, which means increasing advocacy in civil society,” she said. 

“We ought to be doing what the Lancet Commission suggested, which is keeping food companies out of public policy decisions. They should not be at the table when public health policy is being discussed. They need to be regulated in terms of marketing, and in terms of what the formulation of their products is.”

Secy General IFBA
Rocco Renaldi, secretary-general of the International Food and Beverage Alliance.

However, companies that manufacture and market processed foods play a crucial role in the eco-system and should not be ignored, argued Rocco Renaldi, the secretary-general of the International Food and Beverage Alliance (IFBA).

“We made a commitment on (reducing) sodium…to achieve a global set of sodium targets for our products by 2025, and 2030. These are minimum global targets, you can go further at national level,” he said. 

He was referring to the Nutrition for Growth Summit held in Tokyo in 2021, where the member states of the WHO agreed to a 30% reduction in the global salt intake by 2025. 

While reformulation of products to reduce salt and sugar was important, demonising processed foods is not the answer, he said. “The real answer is how to rebalance the system so that different types of food occupy the right space within that system,” Renaldi argued.

Food financing

Like many other public health challenges, money is a crucial bottleneck in addressing the issue of malnutrition across the world. 

Food financing needs to be envisioned in a different way to achieve these goals, said Dr Geeta Sethi, an advisor at the World Bank. She added that the private sector has deep pockets that will help fund these goals but are deterred by perceived risks. 

“For some reason, we in the food sector have not been able to price risk in a way that allows private finance to come in. This is urgently needed.. the change agents have to be the private finance,” she added. 

“In a nutshell, food systems do not lack financing…the public support for agriculture and food is $700billion a year,” she stated, adding that if food subsidies were a country, they would be the 19th largest economy in the world. “And this is not even considering the massive spending of the private sector, which is around $2 trillion.”

Sustainable food systems

While countries like Indonesia and Bhutan are actively redesigning their food systems and production pathways, countries like Germany, Sweden and Fiji have been successful in creating sustainable food systems that are healthy for their populations. 

“We would like to establish a framework that will be tracking institutional things that are happening in the governments, but also the behavioural change that’s happening in the stakeholders and in the private sector,” Dr Stefanos Fotiou, the director of the UN Food Systems Coordination Hub said. 

The need for political will to address these challenges also came up repeatedly as various ministers shared their experiences in designing and implementing policies around the issue. 

Speaking about her experience in Germany, Dr Doris Heberle, from the federal ministry of food and agriculture said that reducing the intake of salt is not an easy task since it impacts trade-related issues like the shelf-life of food products. 

“But we are going to have more scientific advice and scientific evidence to get better targets for reduction patterns and also to attune those to the target groups which are the most vulnerable,” she added. 

Dr Ifereimi Waqainabete
Dr Ifereimi Waqainabete, Fiji’s Health Minister, at the World Health Summit 2022.

Taking public health decisions when trade is a huge factor in the economy is difficult, said Dr Ifereimi Waqainabete, Fiji’s health minister. He added that small countries like Fiji are pushed to choose between nutritious food that is expensive and cheap food that is less nutritious. 

Waqainabete added that his government had distributed seeds and plants to people during the COVID-19 lockdown to encourage local food production and the regeneration of agriculture.

“We also regenerated our ocean area by bringing back the village system and the tribal system where you have your own ‘parish’ where you fish traditionally and stop fishing at a particular time. And we found that by doing that we’re able to regenerate our ocean,” said Waqainabete.

Sweden’s Ambassador for Global Health, Dr Anders Nordström said his government only procured healthy food for the education and healthcare sectors and this ensured that the most vulnerable received the healthiest options. 

“This has been a policy for a long time… we serve about three million meals every day and this has had a dramatic positive impact. What is interesting is that (the government) has been also putting into those policies that those meals should not just be healthy, they should be affordable.”

Image Credits: Scott Warman/ Unsplash, Megha Kaveri/Health Policy Watch.

For “Nundy,” a mother of two living in South Africa’s Khayelitsha township, going to the doctor more than once a year is not an option.

She would have to pay 50% of her total household income in a month in order to see a doctor, so she saves up all of her medical questions and then makes one appointment, at which she tries to collect as much information as possible to take care of her 18-year-old son, two-year-old daughter and ailing mother.

In the meantime, she buys over-the-counter health products and tries to treat her families ailments herself.

“She told us a story of having many products and she told us all the ways she used them. And she was not sure what their expiry date was or exactly what they were for … but she knew she had to do something,” said Manoj Raghunandanan, global president of self-care and consumer experience at Johnson & Johnson.

He met Nundy a few years ago during a visit to the area.

Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J
Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J

Raghunandanan was speaking Wednesday at the launch of the Global Self-Care Readiness Index (SCRI) 2.0, the kick-off session of the Global Self-Care Federation World Congress 2022, which runs until Thursday.

“She was a consumer that deserved better,” Raghunandanan said, “someone that deserved access, affordability and the right to take care of herself, her family and her loved ones in a responsible way.”

How to improve self-care health policies and practices for people like Nundy was the topic of the congress and the focus of the SCRI report, which is published by the Global Self-Care Federation (GSCF).

The index is 89 pages long and covers 10 additional countries, which supplements the original set of countries examined in the 2021 edition and covers at least one from each of the World Health Organization’s (WHO) six regions: Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean, and Western Pacific.

The index is supported by the WHO and forms part of the working plan between itself and GSCF. It aims to arm healthcare decision-makers and professionals with the data they need to increase self-care in their own countries and around the world.

Judy Stenmark, Director General of the Global Self-Care Federation (GSCF), speaks at the launch of the Self-Care Readiness Index 2.0 on Wednesday, October 19, 2022
Judy Stenmark, director-general of the Global Self-Care Federation (GSCF), speaks at the launch of the Self-Care Readiness Index 2.0.

Regulatory environment

The self-care industry has sometimes come under fire for making far-fetched claims about products to encourage people to spend money on things that don’t work, but GSCF director-general Judy Stenmark said that is something her organization is working to fix.

“Consumers become aware of the products or activities mainly through marketing and advertising, especially online,” she told Health Policy Watch. “We must ensure that we continue with our self-care literacy education efforts, especially in the digital sphere, including product guidance and e-labelling.”

SCRI 2.0 highlights the regulatory environment as one of the key enablers of self-care, advising countries to “focus on regulations and processes governing approval of new health products, from prescriptions to over-the-counter medications.”

Stenmark also stressed that while some people think of self-care as providing consumers with over-the-counter medicines, it is a multi-dimensional concept, which encompasses different notions, starting from self-medication to maintaining a healthy diet and raising health literacy levels.

WHO resolution by 2025

In order to help persuade policymakers of the importance of self-care, GSCF is working to have a self-care resolution adopted by WHO by 2025, something Stenmark said would provide a clear articulation of self-care and outline the value for health systems, governments and a people-centered care network.

It would also help facilitate member states’ development and effective implementation of national self-care strategies and provide them with direction on aligning resources.

“If we pass a resolution, things start to change, and then we get self-care embedded in policy,” she stressed. “That is why we want a WHO resolution. We want to build the political wheel for self-care.”

Socio-economic benefits

Currently, half the world lacks access to adequate healthcare, according to Dr Bente Mikkelsen, WHO’s director of non-communicable Diseases, who spoke at the beginning of the launch event.

According to the SCRI report, the sector could be improved by increased support and trust of self-care behaviors and products by healthcare providers, patients, consumers and regulators; increased health literacy; and policymakers’ recognition that self-care has economic value.

Low- and middle-income countries, often plagued by disease, have the highest potential to benefit from self-care policies.

Africa faces the “largest and biggest disease burden of all the regions in the world,” said Skhumbuzo Ngozwana, Chief Executive Officer of Kiara Health in South Africa. Some 90% of malaria deaths take place on the continent, tuberculous is still common and there is a “burgeoning and exploding” non-communicable disease problem,  Ngozwana said.

“Clearly Africa has a major problem,” he said. “All of this is in the context of significant infrastructure challenges, constrained budgets and that less than 3% of global healthcare workers are deployed on this continent. If people have to spend 50% of their monthly income on doctors, it makes it impossible.”

GSCF has also put out a supplementary report, Global Social and Economic Value of Self-Care,  which shows the potential socio-economic benefits of self-care around the world and specifically in sub-Saharan Africa.

If proper self-care policies were put into practice, the report showed, it would represent a $4 billion savings on annual healthcare costs in sub-Saharan Africa by 2030. Moreover, it could save individuals a collective 513 million hours in time savings and physicians 44 million hours. It would also reduce welfare spending by $31.5 billion.

Annual socio-economic benefits of self-care in Sub-Saharan Africa presented by the Global Self-Care Federation
Annual socio-economic benefits of self-care in Sub-Saharan Africa presented by the Global Self-Care Federation

Globally, the numbers are even greater: $179 billion in healthcare cost savings and $2.8 trillion in welfare spending.

“Self-care integration has significant long-term economic benefits for health budgets and health systems in general,” GSCF told Health Policy Watch. “Integrating self-care into the healthcare continuum allows for better resource allocation, alleviates burden placed on health systems, and ultimately improves the quality of care provided.”

Image Credits: The Global Social and Economic Value of Self-Care report, Screenshot.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

A shortage of cholera vaccines and a number of outbreaks have prompted the World Health Organization (WHO) to advise countries to administer single doses of the vaccine instead of the usual two doses.

So far, 29 countries have reported cholera outbreaks, with Haiti, Syria and Malawi dealing with large outbreaks. The standard preventive approach to cholera is two-dose vaccination with the second dose administered within six months of the first. The immunity of a fully vaccinated person against cholera lasts for three years. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Tedros Adhanom Ghebreyesus, the director-general of WHO told a media briefing on Wednesday. 

However, he stressed that “this is clearly less than ideal and rationing must only be a temporary solution”.

“In the long term, we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks. The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation,” he stressed.

Stockpile depleted

Four organisations – WHO, UNICEF, Médecins sans Frontières and the International Federation of the Red Cross and Red Crescent Societies – have managed the global stockpile of cholera vaccines since 2013. 

Of the 36 million doses produced this year, 24 million doses have already been shipped to countries facing outbreaks. The International Coordination Group (ICG), a WHO group that manages and coordinates emergency vaccine supplies and antibiotics during major outbreaks, has approved eight million doses for the second round of emergency vaccination in four countries, leaving only four million doses for further outbreak management. 

This shortage has prompted the ICG to recommend that countries temporarily suspend the two-dose vaccination regime and instead follow a single-dose regime so that more people can be protected against the bacteria. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Ghebreyesus said, calling for a scale-up of vaccine production. “The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation.”

Narrow window to prevent Tigray genocide

Tedros also called for international attention to the civil war in Tigray, Ethiopia, which has left around six million people “under siege for almost two years”.

“I’m running out of diplomatic language for the deliberate targeting of civilians in Tigray, Ethiopia,” said Tedros. “There is a very narrow window now to prevent genocide in Tigray.”

The WHO Chief quoted Antonio Guterres, the UN Secretary-General, who called for the immediate withdrawal of Eritrean armed forces from the region.

Tedros described the “indiscriminate attacks” on civilians as “war crimes”.

“There are no services for tuberculosis, HIV, diabetes, hypertension and more – those diseases, which are treatable elsewhere, are now a death sentence in Tigray…This is a health crisis for six million people, and the world is not paying enough attention,” added Tedros, who was a former health minister of Ethiopia.

“Banking, fuel, food, electricity and health care are being used as weapons of war. Media is also not allowed and destruction of civilians is done in darkness.”

Ebola and COVID-19

WHO expressed concerns about the Ebola outbreak in Uganda and added that there is a possibility that more transmission chains and contacts might be involved in the spread of the virus. 

As of Wednesday, there are 60 confirmed and 20 probable cases of Ebola in the country, with 25 recoveries and 44  deaths.

Two people with confirmed infection in Mubende district had travelled to Uganda’s capital city, Kampal,a for treatment, thus prompting fears of transmission in the capital. The Ugandan government issued lockdown orders in Mubende on 16 October. 

“The Ministry of Health is investigating the most recent eight cases, as initial reports indicate they were not among known contacts,” Tedros said. 

Meanwhile, COVID-19 remains a public health emergency of global concern as per the Emergency Committee meeting last week. WHO urged countries to strengthen surveillance, and not reduce testing, treatment and vaccination for their populations.

“While the global situation has obviously improved since the pandemic began, the virus continues to change, and there remain many risks and uncertainties.”

Cary Adams, Bente Mikkelsen, Alejandra de Cima Aldrete, Valerie McCormack, Miriam Mutebi and Olivier Michielin address the World Cancer Congress press conference.

Common cancers that can be treated successfully when they’re detected early – breast, cervical, colorectal and prostate – are causing high mortality in low and middle-income countries (LMICs) because of a lack of screening and treatment, Dr Cary Adams, CEO of the Union for International Cancer Control (UICC), told a press conference at the start of the World Cancer Congress in Geneva on Tuesday.

“We see this inequity in childhood cancer, with 80% survival rates in high-income countries and as low as 20% in low and middle-income countries,” he added at the start of the hybrid in-person and online congress, which is being attended by some 2,000 scientists, public health officials, civil society representatives and cancer control experts from 120 countries.

A new study by members of the Bloomberg New Economy International Cancer Coalition released this week calculates that at least 1.5 million deaths, representing 20% of global cancer deaths, could be avoided each year if international regulations around patient trials were more standardized and people placed on life-saving treatment immunotherapy treatments such as Pembrolizumab (for lung cancer) and Enzalutamide (prostate cancer).

Despite the US Food and Drug Administration (FDA) approval of Pembrolizumab in 2016 and Enzalutamide in 2012, neither drug is yet available in many countries and regions of the world due to “regulatory isolationism that is preventing approval and usage of these and other much-needed oncology therapies”, according to the study.

The  Access to Oncology Medicines (ATOM) Coalition, which was formed in May, has started to engage with pharmaceutical generic and biosimilar companies “to see whether we can find ways to get their medicines into LMIC countries either by increasing donations, by tier pricing or using a voluntary licence mechanism”, said Adams. 

Dr Bente Mikkelsen, director of non-communicable diseases (NCDs) at the World Health Organization (WHO), said that the WHO had private sector dialogues every six months “where we have defined asks for most of the diseases and we call for commitments to be able to increase access to medicines and devices”. 

“On cancer, our focus is now of course on the medicines that are already on the essential medicine list, but we don’t shy away from the innovative new drugs and devices,” said Mikkelsen, adding that the dialogue was a structured and safe way to discuss access to medicine.

COVID disruptions

Mikkelsen pointed out that, in the four years since the last cancer congress, 30 million people had died of cancer – and there had been disruptions to 50-60% of cancer treatments during the COVID-19 pandemic.

“This is happening because the health system is actually too weak,” said Mikkelsen. “There is no [pandemic] preparedness without including cancer in universal health coverage. We will not be able to manage the new pandemic or for a humanitarian crisis unless we build stronger health systems.”

Mikkelsen added that over 70% of people diagnosed with cancer in LMICs “pay out of their own pocket for things that should be covered by the governments and this is very often the choice between food, care of the family or actual treatment and diagnosis”.

‘Financial toxicity’

Dr Miriam Mutebi, UICC Board Member and a breast surgical oncologist, said that “financial toxicity –  the fact that patients paid themselves for cancer treatment”, was a big reason why the majority of African patients are “still getting diagnosed with advanced disease and frequently not completing their care”. 

Women were particularly affected by a lack of finances as many were involved in the informal economy.

“Looking at the system’s challenges, we know in sub-Saharan Africa, women patients will see, on average four to six healthcare providers before a definitive diagnosis of their cancer, and this really underscores the need for increasing awareness, not just in the community but also amongst healthcare workers,” stressed Mutebi.

Mexico’s civil society makes cancer ‘law’

Mexican cancer survivor Alejandra de Cima Aldrete, Founder and President of Fundación CIMA, said that civil society in her country was in the process of drawing up cancer laws themselves.

“Every day I hear horrible stories about a massive shortages of medicine, about women that have to wait months before they get they get seen by a specialist, of woman that died because they didn’t have the money to continue their treatment,” said Aldrete.

“So my commitment today with my people in my country is to improve the lives of people living with cancer through changes in the legislation, the most meaningful, efficient and with the outmost reach being the general cancer law from Mexico that is currently being drawn up by 13 NGOs, mine included.”

“The cancer law would provide the very needed legal instrument that will allow us citizens to demand the policies that ensure quality and timely medical care for cancer patients. It will force also the government to comply to its sections which include amongst others, the national cancer plan and the National Cancer Registry,” said Aldrete.

A million maternal orphans

Over one million children lose their mothers to cancer every year, according to a congress paper that modelled maternal orphans for the first time using data from 185 countries. 

In 2020, an estimated 4.4 million women died from all types of cancer worldwide leaving behind 1.04 million new orphans (aged 18 and under), according to researcher Dr Valerie McCormack from the French International Agency for Research on Cancer (IARC).

Almost half the orphans were in Asia (49%), and over one-third were from Africa (35%). 

Their mothers died predominantly from breast (25%), cervical (18%) and upper-gastrointestinal cancers (13%). 

The mortality rate of cervical cancer should be reduced through screening for, and vaccinating against, the human papillomavirus (HPV), while early detection and quality treatment of other cancers was essential “to avoid the impact on on the next generation”, said McCormack.

“Orphans in some settings have lower educational levels and higher mortality than their peers. So it’s not only the women who die, we need to prevent their deaths,” she added.

WHO cancer survey

Meanwhile, the WHO launched the first global survey on Tuesday to better understand and address the needs of all those affected by cancer. 

Noting that nearly every family globally is affected by cancer, either directly – 1 in 5 people are diagnosed with cancer during their lifetime – or as caregivers or family members, the survey “is part of a broader campaign, designed with and intended to amplify the voices of those affected by cancer – survivors, caregivers and the bereaved – as part of WHO’s Framework for Meaningful Engagement of People Living with Noncommunicable diseases”. 

“For too long, the focus in cancer control has been on clinical care and not on the broader needs of people affected by cancer,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Global cancer policies must be shaped by more than data and scientific research, to include the voices and insight of people impacted by the disease.”