The majority of Africans with high blood pressure are unaware of their condition.

Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. 

This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis.

The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday.

The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway.

“Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.”  

NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia.

While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere.  

“This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.”

 Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.”

Air pollution not fully represented as an NCD risk factor in database

Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both.

Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”.

Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data.

However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. 

This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO.  The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. 

But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity.

When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. 

A rich country problem? The data can be misleading

However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past.

“The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.”

“There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.”

A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions.

While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average.

But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically.

In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. 

In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. 

Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. 

In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations.

Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it.

As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. 

“If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. 

WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. 

“The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. 

Underinvestment, lack of treatment facilities 

In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. 

Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey.

About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. 

A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes.

Diabetes, cardiovascular disease and their uneven risks

Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. 

In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region.

In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%.

Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000.

“Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi.

Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe.

“Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.”

“NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.”

SDG goal out of reach?

Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third.

If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. 

In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030.

“There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.”

According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years.

“The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised.

‘It isn’t that simple’

“It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.”

With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. 

While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. 

“Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. 

“I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year.

“In our time,” Afuko-Addo said, “this will be our legacy.”

Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck:  this is urgent.”

Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO.

Global Fund
The Global Fund has electronic displays in Times Square in New York City this week.

The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years.

Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world.

“We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday.

The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget.

“In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.”

Sands said this has had a “transformative impact” on Malawi and other countries.

“We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands.

US pledges one-third of budget

At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask.

Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources.

However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19.

Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference.

Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. 

Bill and Melinda Gates Foundation CEO Mark Suzman.

‘Kindest thing’

“My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday.

The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector.

“Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. 

“Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.”

Global Fund executive director Peter Sands addressing the private sector conference on Monday.

Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate.

“But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said.

Ebola Treatment
A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019.

Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. 

According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility.

“This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. 

“Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.”

Vaccine may not against Sudan strain

Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. 

WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain.

This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. 

Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region.

Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease.

Ghana overcomes Marburg

Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. 

During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days.

Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries.

Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda.

Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. 

The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days.

Image Credits: Photo: Anna Dubuis / DFID.

NCDs
A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children

DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs).

A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment.

“The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. 

But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. 

Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres.

“Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.”

NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. 

But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance.

In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office.

But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. 

A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. 

Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. 

“The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says.

Ghana’s universal health coverage, NCDs yet to be integrated

Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply.

Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City.

Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health.

Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas.

Ghana’s primary care challenges affect not only patients but also caregivers.

One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. 

“We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.”

Ghana’s concept of primary care to expand to NCDs 

Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs.

But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings.

But that is changing, according to Commeh.

“The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.”

Ghana is not the only African country challenged by not having enough resources to fight NCDs.

Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care.

Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions.

Restructuring Ghana’s health insurance provisions to include NCDs

A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public.

“We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams.

“People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.”

Image Credits: Kate Holt/USAID.

Patient
Patients are at risk from errors in the prescription, administration, and surveillance of medicines.

“We all know that medicines save lives, but they can also harm in cases where they are inappropriately prescribed, taken the wrong way, without proper monitoring, or are not of an adequate quality,” said World Health Organization (WHO) Deputy Director-General Dr Zsuzsanna Jakab as she opened the floor on World Patient Safety Day 2022. 

The WHO chose the theme for this year’s day, which falls on Saturday, as “Medication Without Harm”, in light of the heavy burden of preventable errors in the prescription, administration, and surveillance of medicines.

“Nobody should be harmed while seeking care,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Yet every year, nearly three million preventable deaths occur around the world because of medication errors, and WHO estimates the cost to healthcare systems to be up to $42 billion annually.  

“Evidence suggests that medication-related harm accounts for 50% of overall avoidable harm in medical care,” said Dr Neelam Dhingra, unit head of the Patient Safety Flagship at WHO responsible for coordinating the event.

The abundant availability of information related to medication incident reports means researchers have a deeper understanding of the reasons that medications and their use can cause harm than in many other areas of patient safety. 

This, Dhingra says, is a very good reason to believe that much more can be done: “There is a huge opportunity here for us to work on medical errors because all medication errors are avoidable.”

Progress has faltered

Since the time the Patient Safety Alliance was launched in 2004, progress in reducing medical errors has faltered.

“Of all the categories of avoidable harm and death that occur in health care, medication-related harm is the biggest single category,” said Sir Liam Donaldson, former UK Chief Medical Officer and current WHO Patient Safety Envoy.

“But over the last few decades, the trajectory of progress has been slow and faltering. There is a need to drive progress further and faster,” said Donaldson. “We have built very strong foundations, but what we now need is a major push forward on medication safety,” 

“There are five preventable deaths every single minute of every single day”, said Jeremy Hunt, former British health secretary and co-chair of the World Patient Safety Day steering committee alongside Jakab. “If we removed medication error and dealt with the patient safety issues before us today, we would be tackling one of the top 10 killers in the world.”

Hunt emphasized that the technology and medical expertise to change patients’ lives are already out there.

“This is one of the great causes of our time in medicine”, he said. “And the great thing is that lives can be saved today, just by the spreading of good practise. This is not about inventing a new cure for cancer or scientific advances – wonderful as they are – these are things that we can improve today.”

Africa carries heaviest burden

Patients in low- and middle-income countries are twice more likely to experience preventable medication harm than in high-income countries, according to the WHO. 

COVID-19, and the strain it has placed on health care systems, has made things worse.

“More than two years of the COVID-19 pandemic have caused a high-risk emergency which has exacerbated many of the circumstances that drive medication errors,” said WHO Africa Regional Director Dr Matshidiso Moeti.

 Africa also faces a uniquely acute challenge in the area of substandard and falsified medicines.

 WHO estimates that between 72,000 and 169,000 children under five-years-old die as a result of inadequate pneumonia antibiotics every year, while bad antimalarials are estimated to lead to anywhere from 31,000 to 116,000 deaths in Sub-Saharan Africa annually.

WHO
Low- and middle-income countries suffer the highest negative impacts from substandard and falsified medicines. / Credit: WHO

“While the extent of unsafe medical practices in the African region is unknown, the region accounts for the highest prevalence of substandard and falsified medicines in the world, with about 1 in 5 of all medicines being either substandard or falsified,” said Moeti. “Inefficient regulatory systems present among the biggest barriers to access to safe, effective, high-quality medical products.”

But the region has made heartening progress on this front in recent years. Ghana, Nigeria, and Tanzania have already achieved the level of efficiency in their national regulatory agencies strived for under WHO guidelines, and, Moeti says, many others are following close behind.

Opioids responsible for 70% of global drug deaths

The global opioid overdose crisis is perhaps the starkest example of what impact bad medical practise can have on the lives of patients around the world. 

“The opioid crisis will not be news to any of you, I am sure”, said Ewan Maule, Director of Medicines and Pharmacy for the Integrated Care Board of the UK’s North-East and North Cumbria region. “But perhaps the scale will be.” 

Worldwide, there are about half a million deaths every year attributable to drug use, both prescribed and illicit, and more than 70% of that is caused by opioids.

“Opioid addiction touches every family unit, every demographic, and every single one of us in some way,” Maule said. “This is something that will be an issue regardless of where you are in the world.”

In North Cumbria, thanks to a campaign directed by Maule and his agency, the last few years have seen a 30% drop in overall opioid use, and a 50% reduction in high-dose opioid use.

The foundational pillar to this success, he says, has been patient education. 

“One of the things we heard from our clinicians was that one of the biggest barriers to reducing the risk of high, long-term opioid use was the percentage of patients that did not have an understanding of the relative benefits of opioid use for pain management”, Maule said.

While clinical best practice no longer supports the use of opioids for chronic pain, the UK Royal College of Anesthetists found “little evidence that they are helpful for long term pain” and can present “substantial risk of harm”, patient education has not yet caught up. 

The normalisation of this use of opioids over the previous decades, Maule explained, has meant many patients are not in a position to make informed decisions about their care. 

“They vastly underestimate the size of the risk they are exposing themselves to.”

Addressing opioid overdose is “a difficult thing to do”, Maule said. “But not only can we do it, but we should also do it. And I believe that for the patients, we must do it.”

Nurse Victor Kaphaso advises 14-year-old Wiliyamu Kerefasi about his insulin at Lisungwi Community Hospital in Neno District, Malawi

Children with type 1 diabetes living in rural parts of the world’s poorest countries often struggle to get life-saving insulin as programmes addressing non-communicable diseases (NCDs) tend to be urban-based and adult-focused.

But an initiative to address life-threatening NCDs affecting children and young adults – particularly type 1 diabetes, rheumatic and congenital heart disease, and sickle cell disease – is being extended to rural parts of a number of African and Southeast Asian countries.

Called PEN-Plus, the initiative is based on the World Health Organization’s (WHO) Package of Essential NCD Interventions (WHO PEN), which encourages the decentralisation of NCD services to the primary care level. The “plus” indicates the inclusion of these more severe NCDs that mostly affect young people.

“When we think of non-communicable diseases, we think of a problem that’s becoming epidemic that is associated with ageing, lifestyle diseases and urbanisation,” Dr Gene Bukhman, co-chair of the NCDI Poverty Network, told a meeting on Thursday to announce the extension of PEN-Plus to a further 10 countries.

“But what’s lost in that narrative is the particular features of the burden of non-communicable diseases among the very poorest people in the world who live in largely in rural sub-Saharan Africa and South Asia,” he added.

“There was a particular gap in treatment for a diverse set of diseases that were killing and incapacitating those under age 40,” said Bukhman, whose network is dedicated to addressing the gaps in universal health coverage for the world’s poorest one billion people.

Pioneered in Rwanda

PEN-Plus was first pioneered by the Rwandan Health Ministry together with the international NGO, Partners in Health, and has since been extended to 22 countries.

Ten of these countries were announced this week at a meeting hosted by NCDI Poverty Network, Helmsley Charitable Trust, UNICEF, and WHO AFRO.

At last month’s WHO Regional Committee for Africa, the 47 member states also adopted PEN-Plus, committing to achieve high levels of coverage by 2030. 

“The strategy supports building the capacity of district hospitals and other first-level referral facilities to diagnose and manage severe noncommunicable diseases early, resulting in fewer deaths,” according to WHO Africa.

In Rwanda, primary health nurses were trained to manage insulin, heart medications and echocardiography, services that previously had only been available in referral centres in the capital city.

“This integrated approach allowed Rwanda to quickly decentralise the services down to intermediate care facilities, such as district hospitals, and to better support primary care,” said Bukhman.

As a result, he added, the number of people receiving care for example, for type 1 diabetes increased by a factor of 10 between 2000 and 2015, reaching 202,000 patients by 2015. 

Haiti, Sierra Leone, Liberia, Cameroon, Nigeria, Burkina Faso, Benin, Ghana, the Democratic Republic of Congo, Rwanda, Uganda, Kenya, Tanzania, Ethiopia, Malawi, Zambia, Zimbabwe, Mozambique, Nepal, Chattisgarh state in India, Cambodia and, most recently, Bangladesh are all rolling out PEN-Plus programmes.

Struggle for insulin

Malawian clinician Dr Bright Mailosi (centre)

Dr Emily Wroe, who has assisted Malawi to roll out PEN-Plus, said that treatment gaps manifested as patients showing up in hospitals with conditions that should have been managed at outpatients level: “A 16-year-old coming in with diabetic ketoacidosis (DKA), very sick. A small child with pneumonia non-attrition that we would find has sickle cell disease. A 28-year-old pregnant woman with heart failure because of severe mitral stenosis who had somehow had walked seven hours to see us.”

“The gap was the fact they were in the hospital in first place, but also what was the discharge plan?” asked Wroe. “These were patients needed more than the primary care system. They needed labs, follow-up ultrasounds. They often needed food packages or school fees, and they needed to be back in school.”

Malawian clinician Dr Bright Mailosi, who works full-time on implementing PEN-Plus in his country, mostly by training healthcare workers from rural facilities, says that his typical day can be summed up by one patient:

“This 13-year-old girl has been two days in this ward. She’s a known type 1 diabetic. I realise she is in DKA because she had stayed for nearly a week without her insulin because her family cannot afford to get the insulin. Her guardian doesn’t have an idea of what to do. Even to get insulin from within the hospital takes like forever.

“So my typical day, is trying to answer this question: How do we support this 13-year-old girl not to stay like for a week without insulin?”

Resource shortages

Mozambican physician Dr Ana Mocumbi, the other co-chair of the NCDI Poverty Network, says that the 10 new countries are each establishing two PEN-Plus training sites inand plan to enrol 500 to 1000 patients per siteto start with.

“PEN-Plus providers, typically mid-level nurses and clinical officers, can be effectively trained within three to six months, with most of the focus being on mentored clinical practice, while master trainers need about a year.”

The mentorship and supervision often involve specialists such as endocrinologists, cardiologists, diabetologists and haematologists “because PEN plus providers are dealing with risky conditions, and risky medications where the difference between too much and too little can mean a difference between life and death”, adds Mocumbi.

“So we are also focused on efforts increasing the production of these types of specialists and supporting them to strengthen care at district hospitals in poor rural areas and not just in urban practises.”

By 2025, the NCDI Poverty network could be ready to grow from 22 to 30 countries – with a total price tag of around $30 million annually. 

“This may not seem a lot of money,” said Mocumbi. “But we have found that even with very optimistic projections regarding economic growth, taxation in domestic investments in healthcare, low-income countries will simply be unable to finance their most basic services without external support for the next decade.”

Image Credits: KSchermbrucker/PiH.

WHO Europe panel on health worker shortage 2022

TEL AVIV – Ageing doctors and overworked staff are just two of the consequences of the severe shortage of health care workers, even in the comparatively wealthy Europe region of the World Health Organization (WHO).

“In one out of three countries in the region, more than 40% of the doctors are older than 55 years of age,” Tomas Zapata, Unit Head at the WHO Europe Health Workforce and Service Delivery, told the WHO Europe regional committee meeting, which took place in Tel Aviv, Israel this week.

“This means that in those countries more than 40% of the doctors will retire in the next 10 years. This is a crisis. This is a ticking time bomb. If we don’t take action now, we’ll have huge shortages in 10 years in addition to those that we have now,” added Zapata, the author of a report on the issue that was launched at the meeting. 

COVID-19 toll on health workers

Some 50,000 healthcare workers in Europe have died as a result of COVID-19, and health worker absences in the European Region increased by 62% during the first wave of the pandemic in 2020, according to WHO.

The pandemic also took a severe toll on the mental health of the workers. In some countries, over 80% of nurses reported some form of psychological distress caused by the pandemic and as many as 9 out of 10 nurses planned to quit their jobs. 

“I often work shifts without even the possibility to go to the toilet, without breaks or time to eat,” German midwife Annika Schröder told a panel devoted to the health workforce in the European Region. “The doorbell and the phones ring while we rush from one room to the other. On average, I take care of two women in labour at a time. 

“This is not how I imagined my profession or my everyday working life to be. I am often exhausted and tired. The shortage of midwives makes births unsafe. And since the pandemic things have got even worse.”

Huge disparities between member states

The European region can in general boast a high number of healthcare workers. Data shows that the region enjoys 80 nurses, 37 doctors, 8 physiotherapists, 6.9 pharmacists, 6.7 dentists and 4.1 midwives per 10,000 people.

However, huge gaps between countries remain. The doctor-, nurse- and midwife-to-population density ranges from 54.3 per 10,000 people in Turkey to over 200 per 10,000 people in Iceland, Norway, Monaco, and Switzerland.

As highlighted by Zapata, the report also offers several action points, including aligning education with health service needs, improving health information systems and digitalization of services and raising awareness about the needs of health systems in governments. 

“We also need to improve working conditions of the health workforce and this also links to the next point, which is protecting their health and well-being,” he said. “A big lesson we learned from the COVID pandemic is how we can really make efforts to improve health and well-being of our health workers.”

Regional and national needs

 People from a range of countries shared experiences about tackling the challenges related to healthcare staff. 

In Georgia for instance, over 85% of healthcare providers are currently privately employed, said Tamar Gabunia, a Deputy Minister. 

“Many factors have led us where we stand right now, including commercial interests and market factors dictated by human resource-related developments,” she remarked.  

“Now it’s time to change the situation. Our government is really very keen to achieve universal health coverage and we all know that health systems cannot function without human resources,” she said, emphasizing that they have been working hard to solve the issues related to recruiting and retaining health personnel.

In Romania, there are 700 towns and villages without doctors, said Prof Alexandru Rafila, Bucharest’s Health Minister. 

“When we discuss inequalities we are not talking just about inequalities between countries but also inside the countries,” he said. “I think the involvement of the local authorities is crucial in order to respond to some of these issues.” 

He said that Romania is getting ready to launch a new strategic approach: “The WHO/Europe will give us the technical assistance needed for the development of human resources in the health sector and we are glad to be part of this process and to host a special meeting on the topic in March 2023.”

More support from WHO

When COVID-19 hit Israel in the early spring of 2020 its health system, as in the rest of the world, was severely strained.

“We had several new challenges,” Dr Shoshy Goldberg, head of Nursing Administration at the Israeli Ministry of Health, recalled. “We didn’t know anything about the disease at the beginning, and we had been in shortage of manpower in all the occupations in the system for more than 10 years.”

Goldberg explained that the Israeli Health Ministry was able to hire new staff and train thousands of people in a short period of time. 

According, Dr Natasha Azzopardi-Muscat, WHO Europe’s Director of Country Health Policies and Systems, the report highlights the huge diversity between the different countries in the region and the need to work with every nation to find solutions that fit their contexts.

“This is not a “one size fits all” approach,” she said. “But with the support of the Regional Director, we shall also be increasing our capacity to support countries in this area.”  

Dr Tedros Adhanom Ghebreyesus

Global COVID-19 cases have dropped to their lowest level since the start of the pandemic in March 2020, World Health Organization (WHO) Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

In the past week alone (5-11 September), the number of new weekly cases decreased by 28% while new weekly deaths decreased by 22%, with just under 11 000 fatalities reported. 

“We have never been in a better position to end the pandemic. We’re not there yet, but the end is in sight,” said Tedros.

“A marathon runner does not stop when the finish line comes into view. She runs harder with all the energy she has left. So must we, as we can see the finish line.”

Tedros urged countries to vaccinate 100% of their most at-risk groups, including health workers and older people, and keep testing and sequencing the SARS-CoV2 virus to identify any possible variants.

He also said that the WHO advised member states to integrate COVID-19 surveillance and testing services with those for other respiratory diseases including influenza, and integrate care for COVID-19 into primary health care systems. 

“We are in a winning position, but now is the worst time to stop running,” said Tedros. “Now is the time to run harder and make sure we cross the line and reap the rewards of all our hard work. If we don’t take this opportunity now, we run the risk of more variants, more disruption and uncertainty.

“We can end this pandemic together, but only if all countries, manufacturers, communities and individuals step up and seize this opportunity,” he said, adding that he was “incredibly proud” of WHO’s people and what they had done during the pandemic.

Lower testing levels

However, Dr Maria van Kerkhove, WHO’s technical lead on COVID-19 warned that, because of lower testing levels, cases were likely to be a lot higher than reported.

“We expect there to be future waves of infection, potentially at different time points throughout the world, caused by different sub-variants of Omicron or even different variants of concern,” she warned.

“The more this virus circulates, the more opportunities it has to change. But those future waves of infection do not need to translate into future waves of death because we have tools that can prevent infections, and critically the use of vaccines and vaccination and early use of antivirals can prevent people from developing severe disease and dying.”

The WHO published six policy briefs on Wednesday to assist countries to end COVID-19 on Wednesday, describing them as providing the basis for “an agile response as countries continue to confront the pandemic while consolidating the foundation for a stronger public health infrastructure and strengthening the global architecture for health emergency preparedness, response and resilience”.

“These policy briefs are an urgent call for governments to take a hard look at their policies, and strengthen them for COVID-19 and future pathogens with pandemic potential,” urged Tedros.

The 6 policy briefs issued by WHO cover:
* COVID-19 testing
* Clinical management of COVID-19  
* Reaching COVID-19 vaccination targets 
* Maintaining infection prevention and control measures for COVID-19 in health care facilities
* Building trust through risk communication and community engagement 
* Managing the COVID-19 infodemic.

Preparing for post-flood health emergencies in Pakistan 

Meanwhile, the WHO is assisting Pakistan to recover from its recent floods, which affected 33 million people and damaged almost 1500 health facilities.

The global body is supporting Pakistan’s Ministry of Health to prepare for, and respond to, outbreaks of measles, cholera, malaria, respiratory, skin and eye infections, typhoid and malnutrition expected in the wake of the floods.

 

The lack of access to necessary medicines and vaccines creates a vacuum often filled by falsified and substandard medical products.

Despite numerous announcements and plans to tackle antimicrobial resistance (AMR) in Africa, the basic requirements for testing for drug-resistant pathogens are unmet in most areas, according to a new study of 14 countries.

Only 1.3% of the 50,000 medical laboratories in the participating countries are conducting routine bacteriological testing to definitively identify the type of infection presenting in symptomatic patients, according to the study. Of those, only a fraction are able to handle the scientific processes needed to evaluate if a bacteria is drug-resistant, and if so, to which drugs, so that more appropriate treatment could be administered.  

Even where laboratories were testing for AMR, only five out of the 15 antibiotic-resistant pathogens designated by the World Health Organization (WHO) as priority pathogens are being consistently tested, and there was high resistance to all five.

The study reviewed about 820,000 AMR records from over 200 laboratories in Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Kenya, Tanzania, Uganda, Malawi, Eswatini, Zambia, Zimbabwe, Gabon, and Cameroon from 2016 to 2019. 

Data from 327 hospital and community pharmacies and 16 national level datasets was also included in the study, which was carried out by the Mapping Antimicrobial Resistance and Antimicrobial use Partnership (MAAP). MAAP is spearheaded by the African Society for Laboratory Medicine (ASLM), with partners including the Africa Center for Disease Control and Prevention (Africa CDC) and the One Health Trust.

No patient information

Out of almost 187,000 samples tested for AMR, around 88% had no information on patients’ clinical profile, including a diagnosis of the possible origin of infection. The remaining 12% had incomplete information. 

“The disconnect between patient data and antimicrobial resistance results, coupled with the extreme antimicrobial resistance burden, makes it incredibly difficult to provide accurate guidelines for patient care and wider public health policies,” said Dr Yewande Alimi, Africa CDC’s AMR programme coordinator. 

“Hence, collecting and connecting laboratory, pharmacy and clinical data will be essential to provide a baseline and a reference for public health actions.”

The research also found that only four drugs comprised more than two-thirds (67%) of all the antibiotics used in healthcare settings. Stronger medicines to treat more resistant infections such as severe pneumonia, sepsis, and complicated intra-abdominal infections were not available.

 

Deaths attributable to and associated with bacterial antimicrobial resistance (2019).

 Lack of access to antibiotics

“Collectively, the data highlights a dual problem of limited access to antibiotics, and irrational use of those that are available,” said Deepak Batra, from IQVIA, a clinical research company that is part of MAAP. 

“As a result, people don’t get the right treatment for severe infections, and irrational use of antibiotics drives antimicrobial resistance for existing available treatment options. Routine monitoring of antimicrobial consumption could help monitor the limited access and irrational use.”

The WHO has described antimicrobial resistance (AMR) as one of the top ten global public health threats facing humanity this century, threatening the effectiveness of the current panel of antibiotic drugs. 

Pascale Ondoa, Director of Science and New Initiatives at ASLM, noted that Africa’s struggle to fight drug-resistant pathogens is being compounded by the lack of information about how AMR is impacting Africans and the continent’s health systems. 

“This study shines much-needed light on the crisis within the crisis,” Ondoa said.

A role for African Medicines Agency?

Dr Ramanan Laxminarayan, Director and President of One Health Trust noted that the future of modern medicine and the world’s ability to treat infectious diseases reliably hinges on the ability to control AMR. 

“This study is an important step forward for Africa’s health systems and the health of people across the continent. I hope MAAP inspires more investment in essential data collection and desperately needed resources,” Laxminarayan said.

The newly formed Africa Medicines Agency (AMA) could become the lead in fighting AMR, considering that this is what its counterparts elsewhere do, including the European Medicines Agency.

But prior to the ratification of its treaty and announcement of Rwanda as the host country for the AMA headquarters, the Africa CDC in 2018 introduced a Framework for Antimicrobial Resistance Control in Africa that did not mention the AMA. 

Instead, it proposed the establishment of the Anti-Microbial Resistance Surveillance Network (AMRSNET) – a network of public health institutions and leaders from human and animal health sectors who will collaborate to measure, prevent, and mitigate harm from AMR organisms.

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobials, which include antibiotics, antivirals, antifungals, and antiparasitics. This makes infections harder to treat and increases the risk of disease spread, severe illness and death. 

Given the urgency of the threat of the rise of resistant organisms, the World Health Assembly at its 68th assembly in May 2015, adopted the Global Action Plan on antimicrobial resistance and established the Global Antimicrobial Resistance Surveillance System. 

In February 2020, African Union (AU) Heads of State and Government committed to addressing the threat of AMR across multiple sectors, especially human health, animal health and agriculture.

Image Credits: WHO, The Lancet.

fossil fuel
Calls are growing for fossil fuels to be phased out.

Nearly 200 health organizations and more than 1,400 health professionals have signed  a letter published on Wednesday calling on governments to negotiate a legally binding international treaty that would phase out fossil fuels, which they blame for “severe threats to human and planetary health.”

Among the treaty’s supporters is the World Health Organization (WHO), a significant step and an indicator of how urgent the climate question has become.

“The modern addiction to fossil fuels is not just an act of environmental vandalism. From the health perspective, it is an act of self-sabotage”, said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

Initiated by the Global Climate and Health Alliance and Physicians for Social Responsibility, the treaty would be modelled on the WHO’s Framework Convention on Tobacco Control (FCTC), the first global public health treaty. It took effect in 2005 in response to decades of concern over the increasing death toll from tobacco use.

“The proposed Fossil Fuel Nonproliferation Treaty would be an evidence-based international agreement to control a category of substances well-known to be harmful to human health”, the group stated.

That the term “nonproliferation” is more often used in connection with nuclear weapons is no accident. To the treaty’s supporters, the threat of nuclear war is no more existential than that of climate catastrophe. 

“The two overriding issues of our era — the climate crisis and the danger of nuclear war — are deeply intertwined,” said Dr Ira Helfand, a 1985 Nobel Peace Prize winner and immediate past president of the International Physicians for the Prevention of Nuclear War.

“The climate crisis is leading to greater international conflict and a growing risk of nuclear war, and nuclear war will cause catastrophic abrupt climate disruption. The world must come together to prevent both of these existential threats.”

But in the way of emulating the success of the FCTC — and to a lesser degree the 1970 Nuclear Nonproliferation Treaty, a cornerstone of global nonproliferation — stands a significant obstacle: climate transition funding.

Missed Funding Targets, Broken Emission Promises

COP25
The UK government is pushing for more exploration of North Sea oil and gas wells.

“Clean energy alternatives to burning fossil fuels exist, but many countries do not have the means and technical expertise to make the transition,” said Jeni Miller, executive director of the Global Climate and Health Alliance.

“High-income countries have benefited from the last hundred plus years of fossil fuel use,” Miller said. “These countries have the resources and moral responsibility not only to make the clean energy transition, but to support developing countries to do the same.”

The current roadmap for low- and middle-income countries to move straight to green energy depends on substantial investment from development banks, rich countries, and the private sector that is falling short.

Rich countries failed to close a $10 billion climate finance shortfall ahead of the last round of UN climate talks and failed to mobilize $100 billion a year in promised climate aid by 2020 to help low- and middle-income countries deal with global warming and transition to cleaner-burning energy sources.

Most of the world’s biggest greenhouse gas emitters have also yet to meet pledges to strengthen the emissions-cutting targets that they made at the COP26, the UN climate talks in Glasgow, Scotland last year. 

This schism is further exacerbated by Russia’s war in Ukraine, which in Europe has prompted a race to import as much natural gas from Africa as possible but no additional funding for projects that would allow the world’s poorest continent to burn more gas at home.

This comes despite recent IEA findings that 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%.  

fossil fuel emissions

“The whole of the West developed on the back of fossil fuels — even as we speak, some Western nations are deciding to bring coal back into their energy mix because of the war. So when the world wants to transition to zero carbon emissions, who has to do more?” Matthew Opoku Prempeh, energy minister for Ghana, told Bloomberg in July. “Is the West saying Africa should remain undeveloped?”

While low- and middle-income country leaders are keenly aware of the threats posed by climate change, the question of how to balance emissions targets with lifting people out of poverty has no easy solution.

“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 next round of UN climate talks, known as COP27, slated for November in Egypt.

“Energy use is crucial for almost every conceivable aspect of development — wealth, health, nutrition, water, infrastructure, education and life expectancy,” he said.

From COP26 to COP27: “Code red for humanity”

United Nations Climate Change
Commonwealth of Nations Secretary-General Patricia Scotland (centre) at Africa Climate Week

When African leaders from 21 countries gathered in Gabon for Africa Climate Week earlier this month to set a united agenda ahead of COP27, to be held in Egypt in November, the focus was clear: this COP is not about bold new sets of commitments. It is about achieving implementation of what’s already been committed.  

In her opening address, the Commonwealth of Nations Secretary-General, Patricia Scotland, emphasized the importance of COP27.

“We are at code red for humanity, and the window for action is rapidly closing,” she said. “Tackling climate change will require the most significant political, social, and economic effort that the world has ever seen. It is up to us to set the tone and shape the quality of that effort.”

Host country Egypt emphasizes the need for real action. “For us, what we want this COP to be about is moving from pledges to implementation,” Egypt’s minister for international cooperation, Rania Al Mashat, told the Guardian. “We want this COP to be about the practicalities: What is it that we need to do to operationalize the pledges into implementation?”

Kevin Chika Urama, chief economist at the African Development Bank, told Reuters this week that Africa faces a climate financing gap of about US$108 billion each year.

“Climate finance structure today is actually biased against climate-vulnerable countries. The more vulnerable you are, the less climate finance you receive,” he said.

For scale, the World Economic Forum estimates India’s transition to net-zero emissions will require $10 trillion in investment. It’s a staggering figure, but the anticipated payoff is even bigger.

Stanford University researchers said in a 2019 report that a global transition to 100% renewable energy sources would cost countries US$73 trillion upfront, but it would pay for itself in less than seven years and create 28.6 million more jobs.

Ruth Etzel, co-chair of the International Pediatric Association’s environmental health group, described the consequences of inaction in no uncertain terms. 

“Our message to government leaders is this,” said Etzel. ”The health of everyone alive today, and of future generations, depends on phasing out fossil fuels rapidly, justly, and completely.”

Image Credits: Gellscom/CC BY-ND 2.0..