Sugary drinks are now taxed in Nigeria to tackle obesity, diabetes, and other NCDs.

Nigeria began imposing a new tax on sugar-sweetened beverages on 1 June, but the aim of using the money raised to help curb the growing rates of obesity, diabetes and other diet-related non-communicable diseases (NCDs) faces a host of challenges including a multibillion-dollar industry.

IBADAN, Nigeria – Working for long hours under a scorching sun, automotive repair worker Alfa Sodeeq gets thirsty often but isn’t content to just drink water. Since he can’t afford to take breaks long enough to find something healthy to drink, he often settles for a cold soda — loaded with sugar.

“A woman sells cold drinks from across my shop. All I need to shout is ‘give me one bottle’ and she will be there with one,” says Sodeeq, who operates a one-man automotive body repair shop. “On the average day, I drink about three large (50cl) bottles of Coke.”

That translates to 36 cubes of sugar daily, or 12 per bottle, which, when added to the late-40s Sodeeq’s three calorie-heavy meals, puts him at risk of obesity and diabetes, according to a Nigerian NGO, the National Action on Sugar Reduction (NASR). But Sodeeq, who weighs about 80kg, says he prefers not to know too much about his diet because “what you don’t know cannot kill you.”

Sodeeq’s dependency on sugary drinks may put him at risk of diabetes and obesity.

Sugary drink tax may generate more revenue than  health benefits

Sugary drink taxes around the world.

With the introduction of a tax on sugar-sweetened beverages under  Nigeria’s 2021 Finance Act, the Nigerian Customs Service on 1 June began implementing a new tax on sugary drinks.

The tax rate of N10 per litre applies to all non-alcoholic, carbonated beverages that contain sugar and are produced domestically — in a country where local manufacturers account for the majority of all soft-drinks production.

WHO has projected that a 20% rise in prices will lead to a comparable 20% reduction in consumption, but that has not turned out to be case always. The actual figures reflect a need for policymakers to adapt to the local context.

Despite the new tax, Sodeeq says he won’t stop drinking soda since it’s so convenient while he’s working. As he sees it, everything in his local market is already priced high — and the little bit more he will have to pay for sodas won’t alter his lifestyle.

“Everything is more costly, not just Coke,” he says. “So why will I stop when I’m making money from my work?”

Nigeria has highest prevalence of diabetes in Africa

Checking blood sugar levels for control of diabetes

Sodeeq’s example shows the challenge that Nigeria faces; the nation’s new sugary drinks tax is intended to discourage people like him from consuming too much sugar in their beverages.

The new tax is in line with the thinking of the World Health Organization (WHO) and some NGOs, along with a variety of major donors and researchers, that recommend addressing some of the health risks of NCDs through higher taxation of sugary drinks, in a bid to lessen their consumption.

Excessive sugar consumption, particularly in beverages, is associated with NCDs such as diabetes, heart disease and obesity, which in turn is an important risk factor in cancer. 

Tackling excessive sugar intake in Nigeria is particularly important considering the country has Africa’s highest prevalence of diabetes with over 12 million Nigerians living with the disease. 

According to the WHO, people who drink one to two cans a day or more of sugar-sweetened beverages regularly have a greater risk (26%) of developing Type 2 diabetes than people who rarely consume such drinks. 

Relative to other countries in Africa, Nigeria has a high burden of NCDs, which account for 24% of total deaths and are projected to be the leading cause of morbidity and mortality by 2030. 

“Sugar taxes are a proven and evidence-informed solution to the prevention and control of NCDs and related risk factors, and their use needs to be stepped up globally,” the NCD Alliance says in a policy brief welcoming the Nigerian move.

Nigerian price surge too small, and muted by inflation

African soda brands.

The Nigerian policy, however, has some drawbacks, the NCD Alliance notes. The new tax will only increase the total price of the average 50cl bottle of soda by 5% or less, it notes, which is far from WHO’s 20% recommendation. A bottle that used to cost N120 will now cost N125.

Even in countries with stiffer price increases, the impacts are mixed.  In Barbados, a 10% tax on sugary drinks led to just 4.3% less consumption, Barbados Health Minister Ian Gooding-Edghill told a World Health Assembly side event in May.

Sugary drink taxes in Mexico, Caribbean, Central and South America

On the other hand, Mexico’s 10% sugary drinks tax is considered a success since it began in 2014. In the first two years, consumption fell by an average of 7%, and more recently by as much as 12%, said Mexico’s Vice Minister of Health Hugo Lopez-Gatell told another recent WHA side event.

In South Africa, a 10% sugary drinks tax since 2018 led to a nearly 40% decline in sugar consumption from the taxed beverages among South Africans, according to a four-year study of 113,000 households published in The Lancet in April 2021. 

But the most successful initiatives also were part of a broader approach, proponents say.

That has included more awareness-raising about unhealthy foods in general, said Lopez-Gatell, noting Mexico recently implemented front-of-package labels about foods high in sugar and salts.

“It’s not confusing labeling, it’s warning,” he said. Further pending measures include limits on the types of unhealthy foods that markets can offer, and a law banning unhealthy foods sold in schools. 

Tax won’t yield dedicated revenues for health services 

Omei Bongos-Ikwue

WHO envisions a secondary aim for these taxes that goes beyond discouraging sugar consumption. It believes they also should provide revenue earmarked for health-related spending.

The UN health agency recommends spending it to improve health care systems and to put in place more effective programmes that encourage healthier diets, increase physical activity, or build capacity for effective tax administration. 

But in Nigeria, the law does not clearly earmark the revenue for health care; advocates say doing that would also engender more popular support for the tax increase. Instead, the money goes to the Finance Ministry’s general coffers. 

“There is a general pool where taxes go in,” NASR spokesperson Omei Bongos-Ikwue told Health Policy Watch. “Depending on the priority needs of the country, tax funds can be allocated. So earmarking the tax for health purposes doesn’t automatically mean that it will happen.

In her remarks at the announcement of the new tax, Zainab Ahmed, Nigeria’s Minister of Finance, Budget and National Planning, said that some of the revenue would be used for health but she didn’t make any commitments. 

“It is also used to raise excise duties and revenues for health-related and other critical expenditures.  This is in line also with the 2022 budget priorities,” the minister said.

Bongos-Ikwue described this as highlighting the need for raising more awareness and advocacy so as to press the government to allocate funds generated for health.

 Tax may be perceived as inflation related 

Prices at the market have risen in Nigeria.

In terms of impacts on consumers, the price increase attributable to the sugar tax also has been muted by the overall increase in the prices of commodities in Nigeria. 

As Sodeeq observed, costs of everything are rising now with inflation, and particularly at the market. 

Beverage distributors like Ige Olutoyin told Health Policy Watch that consumers will not necessarily appreciate that the increased price has anything to do with the drink’s sugar content, or with health.

“When the suppliers said the price is higher now, we simply implemented the price increase and when any buyer asks, we simply tell them that things are now more expensive in the market,” he said.

Further blurring the issue, particularly for middle-aged Nigerians like Sodeeq,  is the fact that taxes on carbonated drinks are not entirely new.

Between 1984 and 2009, the Nigerian government taxed sugar-sweetened beverages, alcoholic drinks and tobacco as luxury items to raise revenue, but the tax on sugar-sweetened beverages was removed in 2009 after such drinks became ubiquitous in the country.  

‘Everything else has gone up’

Bongos-Ikwue says the price of “everything else has gone up” in Nigeria, so people might attribute the cost increase for sugary drinks to inflation.

“This is why I think it is more important to engage with the stakeholders knowing that an additional tax has been placed on the beverages,” she says.

Beverage distributor Olutoyin agrees there is a need for more awareness about the supposed rationale behind the tax. Otherwise, he says, the government may generate more revenues, but the tax will not discourage excessive consumption of sugar-sweetened beverages.

Method of collection also muddies health argument 

He also says the method of collection plays a role in muddying the waters of the health argument. 

The fact that the government will bill the manufacturers directly, rather than taxing the drink at point of sale, Olutoyin says, also means that manufacturers and their distributors can even more easily steer the narrative about the tax to inflation, rather than health, especially if the government is not aggressively raising public awareness.

“I believe the government decided to collect it from the manufacturers because it is much easier to do,” he said. “If they want this to have more effect, it should be collected directly from the customer.” 

At the same time, taxing beverage manufacturers’ production may be the only realistic way to collect the new levy on a good that is later traded and sold by shops and informal markets across the vast nation. “This way, the [government] is able to account for the beverages produced within a period,” said Bongos-Ikwue.

The Herculean task ahead

Some argue that the tax may be counterproductive.

In anticipation of the tax, the Manufacturers Association of Nigeria (MAN) said the tax could be counterproductive and result in a loss of revenue for the government.

According to the report, about NGN81 billion could be collected from the excise duty on carbonated drinks between 2022 and 2025. But the government says it could lose up to NGN197 billion within that period from other taxes paid by drink manufacturers, such as Value Added Tax and Company Income Tax, if consumption of sugary drinks declines.

“The introduction of the excise duty, despite its potential overwhelming negative impact, is rather unfortunate. The revenue aspirations of the government in introducing this excise tax may not be justified in the long run,” said Segun Ajayi-Kadir, MAN’s director-general.

He said the tax could lead to job losses, but Bongos-Ikwue said such claims are unfounded.

In East and southern Africa, other sugary tax initiatives blocked by industry interests 

Industries have pushed back against Africa’s soft drink taxes.

Over the past few years, industry pushback in a number of other African countries, including Kenya, and Uganda, has effectively undermined efforts to introduce  sugary drinks taxation.

Research published in April 2021 by Global Health Action on seven east and southern African countries – Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda and Zambia – found all have excise taxes on soft drinks, but the tax levels are well below WHO recommendations. None of those taxes target sugar content. 

Only a few African countries impose sugary drink taxes, and these are well below WHO recommendations.

In Uganda, where NCDs account for one-third all deaths, authorities decided in 2018 to gradually reduce the excise tax on non-alcoholic drinks to 10%, down from 13%, as an enticement for Coca-Cola Co. to invest in the country; the company’s CEO in Uganda agreed it was a favorable move.

“The soft drink industry has been influential in framing the taxation debate,” says the authors of the 2021 Uganda case study.

Win-win  approaches – changing industry drink formulas and consumer awareness

There are multiple methods to reduce NCDs.

Not everything has to be a win-lose approach. In the UK, sugary drinks taxes, combined with stepped-up pressure and advocacy on manufacturers, prompted soft-drinks companies to reduce the sugar content in key products by changing formulations. This, along with  changes in consumer purchasing, led to a 30% reduction per capita in the daily volume of sugars sold in soft drinks.

In Nigeria, however, manufacturers are not yet being aggressively encouraged to fully embrace reformulation and, as such, the available options in significantly reducing sugar intake among the population is not being fully explored, Bongos-Ikwue says.

Advocacy was responsible for the progress made so far, she says, but still more advocacy is needed to extend the tax to other priorities. And she says other approaches can help, too, such as health education, front-of-package labeling about how much sugar is in beverages, and school programs.

“It’s a multipronged approach, she says. “Taxes are just one way; there are other different things, including education, on how to reduce NCDs.”

Kerry Cullinan contributed to this story with reporting from southern and eastern Africa.

Image Credits: Heala_SA/Twitter, Alan/Flickr, Global Health Research Program , Tih Ntiabang/Twitter , Thomas Stellmach/Flickr, James Hall/Twitter , Global Food Research Progrma, World Bank Tanzania/Twitter .

Diversity is closely linked to dignity, and if separated, it can become “a checkbox exercise that fails to shift the dominant power dynamics,” according to Garry Aslanyan in his latest edition of “Global Health Matters.

In a dialogue with Marie Ba, director of the Ouagadougou Partnership Coordination Unit based in Dakar, Senegal, and Tom Wein, director at IDinsight, based in Nairobi, Kenya, Aslanyan discusses how although dignity has a universality to it, it can also be regarded as a capability that if lacking, can result in the best intentions achieving rather unintended and even harmful consequences.

“Strengthening one’s own dignity capability should be a daily intention that all of us in global health pursue,” Aslanyan says. “In doing so, we can hopefully foster more respectful engagement in global health, making everyone feel seen and valued.”

Wein focused his part of the podcast on how to define dignity, emphasising the subjective experience of the person with the least power in any interaction. And said that there are three pathways that can help serve as a framework for dignity: representation, agency and equality.

According to Wein:

  • Representation is about people feeling seen by the institutions that they’re interacting with and seeing themselves represented in those institutions.
  • Agency is about having choices and a meaningful chance to consent for the decisions that are being made about their lives.
  • And equality is about the power inequalities being reduced, and even where they cannot be eliminated, people feeling treated as if they were fundamentally equal, even if those power differentials persist.
The Three Pathways of the Dignity Framework
The Three Pathways of the Dignity Framework

He added that capability and purpose are other key ingredients in dignity.

Ba pointed out that in any situation, accountability and good intentions needs to come from both sides.

“I know we talk a lot about shifting powers, decolonizing global health and really putting the focus on the Global North, but I feel like there’s some work that needs to be done from the Global South first,” she said.

Learn more about this episode.
Listen to previous episodes on Health Policy Watch.

Image Credits: Tom Wein.

US Health and Human Services Secretary Xavier Becerra – Monkeypox vaccine ‘sparing’ in the face of a national health emergency

The United States is considering shifting to intradermal injections of Monkeypox vaccine that could potentially stretch one dose of the approved MVA-BN vaccine, available only in limited quantities, into five doses, said US Food and Drug Administration Commissioner Robert Califf on Thursday.

He was speaking at a press briefing minutes after Xavier Becerra, US Secretary of Health and Human Services (HHS)  said he would declare a national health emergency over the monkeypox outbreak, which has now 6,600 confirmed cases in the United States – making it the global hotspot for the virus, followed by Spain and Germany. Some 26,000 cases had been reported worldwide, as of Thursday – not including several thousand suspected cases in central and western Africa, where the disease is endemic, but testing capacity remains poor.

 

“I will be declaring a public health emergency on Monkeypox.  We are prepared to take our response to the next level in addressing this virus,” said Becerra, speaking at a Thursday virtual press briefing in Washington, DC.

The United States currently holds about 1.4 million of the only  FDA-approved approved monkeypox vaccine in a strategic stockpile, which until recently had been intended for use mainly against any future smallpox threat, according to estimates by the global forecasting firm, Airfinity. HHS officials have already released about 1.1 million doses from the stockpile to cope with the emerging outbreak – which WHO declared a global health emergency on 23 July.

While the US has contracts to receive another 13 million doses in 2022, a significant proportion remain in bulk formulation, requiring fill-and-finish. Meanwhile, the only plant manufacturing the raw vaccine formula, produced by Denmark’s Bavarian Nordic, is closed for renovations until late 2022 – meaning that the global supply also is finite – in the face of a rapidly-developing outbreak.

‘Dose-sparing’ at critical inflection point

“Given the continued spread of the virus we are at a critical inflection point, dictating the need for continued solutions,” said Califf. While he said that the US was “working closely with the manufacturer to accelerate the delivery of doses,” another solution could be to “allow health care providers to use an existing 1 dose vial to administer up to 5 separate doses.

“Under the proposed approach, a fifth of the proposed dose would be introduced intradermally,” he said, explaining this is a more “shallow injection” than the typical subcutaneous injection.  But evidence suggests than if administered correctly, it could provide a powerful immune response for Monkeypox.

Intradermal administration is used only for a few vaccines. Here is a graphic description.

“This approach which we’re referring to, as dose sparing, would change the method of administration of Jynneos [the brand name for the MVA-BN vaccine], which is currently administered subcutaneously,” he said.

“Under the proposed approach, one-fifth of the current vaccines dose would be administered intradermally. There are some advantages to intradermal administration including an improved immune response to the vaccine,” he declared.  Although in fact the procedure is relatively rare, it is widely for hepatitis B vaccines in adults as well as the BCG tuberculosis vaccine in infants as well as children.

Califf said that a while a decision had not yet been made whether to move ahead with the dose-sparing strategy, “we are exploring all scientifically feasible options and we believe this could be a promising approach. … We look forward to sharing more information on the dose sparing approach in the days ahead.” 

Dose-sparing previously was recommended by WHO in the case of COVID vaccines, during much of 2021, when there was a global scarcity.

More than 600,000 vaccines already distributed in the United States

Becerra meanwhile said that of the 1.1 million BVA-MN vaccine doses committed by the US from its stockpiles to the health emergency, more than 600,000 doses have already been distributed to health providers around the country.

The US expects to receive another I50,000 finished vaccine doses in September, said Dawn O’Connell, HHS Assistant Secretary for Preparedness and Response, adding that “we expedited those doses that they were previously scheduled to arrive in October. We anticipate continued delivery of additional doses in October, November and December,” she said, referring to vaccines now held in bulk by Bavarian Nordic, which need to undergo fill-and-finish.

As for testing, Becerra said that  “we have the capacity to administer some 80,000 tests a week, and that has continued to rise. … On treatments, we have deployed some 14,000 treatments of TPOXX, [Tecovirimat anti-viral treatment], and we have roughly 1,700,000 doses in our strategic stockpiles.” 

Meanwhile, the Director of the US Centers for Disease Control, Rochelle Walensky, said that the CDC estimates that there are about 1.6 -1.7 million Americans “who are at highest risk right now and that is the population that we have been focused on in terms of vaccination.” That includes groups such as men who have sex with men, as well as people already infected with HIV, and therefore with a potentially weakened immunity overall. 

Image Credits: Global Health , https://mvec.mcri.edu.au/references/intradermal-vaccination/.

africa
Africa recorded the world’s highest gain in life expectancy in the new WHO report.

Africa recorded the world’s highest gain in healthy life expectancy over the past decade. But the lack of sustainable finance for health systems is a major threat to the gains recorded.

Africa recorded the world’s highest growth in healthy life expectancy—or the number of years an individual is in a good state of health—between 2000 and 2019. Healthy life expectancy increased on average 10 years per person, the World Health Organization (WHO) assessment reported.

The Tracking Universal Health Coverage in the WHO African Region 2022 report shows that healthy life expectancy—or the number of years an individual is in a good state of health—increased to 56 years in 2019, compared to 46 in 2000. While still well below the global average of 64, over the same period global healthy life expectancy increased by only five years.  

At a press briefing launching the report Thursday, WHO officials and other invited experts attributed the gains to increased universal health coverage (UHC) on the continent. But sustainable financing remains a major challenge for the 47 sub-Saharan countries that belong to WHO’s Africa Region – with all but seven of the 47 WHO African region countries depending on outside donors for more than 50% of the costs of health services delivery.  

Many WHO Afro countries rely on outside funding for health care costs.

At the same time, increased provision of essential health services, including for reproductive, maternal, newborn and child health were among the factors to which the gains of the past decade could be attributed. Other contributors are progress in the fight against infectious diseases notably rapid scale-up of HIV, tuberculosis, and malaria control measures from 2005. 

“The sharp rise in healthy life expectancy during the past two decades is a testament to the region’s drive for improved health and well-being of the population,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

“It means that more people are living healthier, longer lives, with fewer threats of infectious diseases and with better access to care and disease prevention services,” she said. “But the progress must not stall. Unless countries enhance measures against the threat of cancer and other noncommunicable diseases, the health gains could be jeopardized.”  

Most governments in Africa fund less than 50% of their national health budgets 

Progress in healthy life expectancy could also be undermined by the impact of the COVID-19 pandemic unless robust catch-up measures are instituted, WHO and other experts at the briefing warned. Insofar as the report’s data ends at 2019 – the COVID years were not captured by the data presented. 

On average, for instance, African countries reported greater disruptions across essential services compared with other regions, according to a 2021 WHO survey.  

Efforts have been made to restore essential services affected by the pandemic. However, to ensure long-term sustainability, it is crucial for governments to step up self-financing of services – weaning their countries away from heavy reliance on international donors.  

Most governments in Africa fund less than 50% of their national health budgets, the report notes.. Only Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa fund more than 50% of their national health budgets. 

“COVID-19 has shown how investing in health is critical to a country’s security. The better Africa can cope with pandemics and other health threats, the more our people and economies thrive. I urge governments to invest in health and be ready to tackle head on the next pathogen to come bearing down on us,” said Dr Moeti.      

UHC coverage increased in the region an average of 22 points.

According to the report, UHC coverage across the region increased by an average of 22 points on a scale of 0 to 100, rising to 46 in 2019 up from from 24 in 2000, along the lines of a Service Coverage Index (SCI). The scale measures some 14 UHC indicators including those for reproduction, material and child health, infectious diseases, and non-communicable diseases.  Even so, only four countries had a UHC index between 56 and 75, with the highest values in southern and northern African subregions respectively. 

“This progress, though significant, falls short of meeting the SDG 3.8.1 global target of a minimum of 80% coverage of essential health services by 2030,” the report notes.

Inequality across many countries remains a crucial determinant of the level of health service coverage.

Botswana provides good practice 

Moses Keetile, of Botswana’s Ministry of Health and Wellness Botswana

Botswana is one of the African countries making appreciable progress in public funding for healthcare, the report says, with almost 80% of its health spending in 2019 going towards the government’s domestic programs.

Speaking at the briefing, Moses Keetile, of Botswana’s Ministry of Health and Wellness Botswana, told Health Policy Watch the country’s ability to sustain its gains on UHC  largely hinges on ensuring that health ranks high on the priority list of politicians.

“Allocation of national resources is very important,” he said. “To what extent is health given a priority? What is it that we are spending our resources on? Is it on health, physical education, or is it in the military. So it’s very important that we speak to our politicians for that political will and ownership.” 

He also described reliance on external funds as unsustainable for Botswana and other African countries. Countries have to implement innovative ways of creating revenue and funding for health care delivery, he said, stressing that the private sector is also an important partner in advancing UHC. 

“The Botswana UHC experience is still predominantly government but that is not the most ideal situation. It is important to have all the necessary sectors, including the private sector, to be part of it,” he concluded.

The exception, rather than the norm

The overall change in out-of-pocket expenditure between 2000 and 2019.

Botswana remains the exception, rather than the norm, however, the report says.  

Government coverage of catastrophic and out-of-pocket expenditures through health insurance or free health care systems is one of the measures key to improving health coverage. Health expenditure is considered “not catastrophic” when families spend less than 10% of their annual income on it, irrespective of their poverty level. 

Yet over the past 20 years out-of-pocket spending stagnated or increased in 15 countries out of the African Region’s 46 countries, the report finds. And out- of-pocket expenditure increased by more than 90% in at least three countries.

Conversely, a total of 15 countries are faring above the regional average, in terms of combined service coverage and financial risk protection. 

Good performance among that latter group of countries is not entirely income driven, the report says. Rwanda, Malawi and Mozambique are low-income countries among the 15 good performers on that scale of measurement.  Angola, Nigeria, Mauritania, Côte d’Ivoire, Cameroon and Comoros are middle-income countries with low performance in both service coverage and financial risk protection.

Lack of investment in health threatens economic and national security

Professor Muhammad Ali Pate, of the Harvard T. H. Chan School of Public Health

Professor Muhammad Ali Pate,of the Harvard T. H. Chan School of Public Health agreed with Keetile. He noted that public and private investments in health in Africa can also be pitched to policymakers as contributing to economic growth.

“There is scope to harness private capital to invest in laboratories in hospitals. But with a public mission protected, every citizen should be guaranteed basic access to quality health care. The public health function should be publicly financed, and tax financing is a key part of that,” he told Health Policy Watch. 

According to Pate, enhancing the private sector’s role should not, however, absolve African governments from domestically investing in health services, including through robust tax collection.  

“What we have seen with the pandemic is a lack of investment in health that threatens economic and national security,” he said. “Finance ministers and economic planning ministers have a vested interest to ensure the public health outbreaks are contained, and that equipment and the test kits are available and produced locally so they also contribute to economic growth.”

Dr Lindiwe Makubalo, Assistant Director, WHO Regional Office for Africa

Dr Lindiwe Makubalo, assistant director of WHO’s Regional Office for Africa, also highlighted the importance of multi-party partnerships. She noted that the new report provides guidance towards properly building health systems and ensuring health security in Africa.

“We elaborate the different components of what needs to be done. At the end of the day, I think it’s the value of understanding the value of health and health security, and appreciating all of the wider sector approach that is really what is going to be important,” she told Health Policy Watch.

Image Credits: World , WHO Afro.

Breastfeed
Woman breastfeeding her child.

Nearly $575 million in global economic and human capital is lost every year due to insufficient government promotion of, and support for, breastfeeding, according to data from the latest report on  The Cost of Not Breastfeeding. 

The 2022 report, released for World Breastfeeding Week (1 August – 7 August) finds that these losses are the result of increased child and maternal mortality and other healthcare costs, and account for an average 0.7% of a nation’s gross national income. 

However, increasing country-level support for breastfeeding could save not only 515,000 lives each year, it could also save the global economy $1.5 billion each day, according to the report by the Alive and Thrive initiative and Nutrition International. 

This support would be in line with the World Health Organization’s recommendations, which include initiating breastfeeding within the first hour of birth, exclusive breastfeeding for the first six months, and continuing breastfeeding alongside complementary feeding from six months to two years and beyond.

“Breastfeeding is the primary building block of a healthy food system and one of the best ways to give a child the right start in life,” said Joel Spicer, President and CEO, Nutrition International. 

“But women around the world aren’t getting the support, resources, and protection they need to begin breastfeeding soon enough and sustain it for the recommended period. Governments need to make breastfeeding a top public policy priority, and with the Cost of Not Breastfeeding Tool, policymakers can see the real-world benefits of doing just that.”

The revamped report includes tools like a new user-friendly dashboard and data from 180 countries. In addition to mortality rates and healthcare costs, the report offers new calculations for the impact of not breastfeeding on childhood obesity, IQ losses and education. 

Inadequate breastfeeding has negative impacts for children ‘down the line’ 

Investment in breastfeeding can improve health outcomes later in life.

Inadequate rates of exclusive and continued breastfeeding can lead to increased healthcare costs down the line, as well as decreased cognitive ability for children, impacting their education and future income potential. 

The lack of support may have to do with the increased promotion for breast milk substitutes, which were found by WHO to undermine breastfeeding through use of digital ads and other forms of advertisement. 

For families, not breastfeeding also increases the cost of living, as household income is redirected to formula or other breastmilk substitutes. 

The Global Breastfeeding Collective recommends seven policy actions that national governments can implement to support and promote breastfeeding, including enacting paid leave and workplace breastfeeding practices, strengthening the links between health facilities and communities, and implementing the International Code of Marketing of Breastmilk Substitutes.

The Code is meant to stop the “aggressive and inappropriate marketing of breast milk substitutes.”

“Increasing breastfeeding rates through supportive actions and policies can help to save the lives of mothers and children, and protect economies from preventable losses,” said Sandra Remancus, Director, Alive & Thrive.

Image Credits: WHO, UNICEF.

food crisis
Millions of lives are at risk due to an unprecedented food crisis in the greater Horn of Africa.

In light of an unprecedented food crisis in the Horn of Africa, the World Health Organization has launched a $123.7 million funding appeal for urgently needed supplies to treat severe malnutrition and related health conditions. 

Driven by conflict, changes in climate and the COVID-19 pandemic, this largely arid Eastern African region of some 2 million square kilometres spanning the Indian Ocean to the sources of the Nile, traditionally home to pastoralists and subsistence farmers living off of livestock and harvests of rain-fed crops, has become a hunger hotspot with disastrous consequences for the health and lives of its people.

“Hunger is a direct threat to the health and survival of millions of people in the greater Horn of Africa, but it also weakens the body’s defenses and opens the door to disease,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, in a statement. 

Four consecutive failed rainy seasons have decimated locally grown crops such as maize, wheat and caused abnormally high numbers of livestock deaths, in a crisis considered to be one of the worst climate change-related disasters in over 40 years. 

In addition, Russia’s invasion of Ukraine has disrupted supply chains and sent prices of imported wheat, cooking oil, and other cooking staples soaring, further worsening the crisis.

Prior to war, Russia and Ukraine supplied 40% of Africa’s grain

Children across the Horn of Africa are at risk for acute malnutrition. 

Prior to the war, Russia and Ukraine supplied Africa with more than 40% of the continent’s grain. Somalia alone used to import more than 92% of its wheat from these two countries, but supply lines have since been blocked. 

Now over 80 million people in the 7 countries spanning the region – Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda — are estimated to be food insecure, as a result of this food crisis. 

Upwards of 37.5 million people are classified by WHO as being in a Phase 3 food crisis, a stage where people have to sell their possessions in order to feed themselves and their families, and where malnutrition is rife.

Additionally, more than 1.7 million children across parts of Somalia, Ethiopia, and Kenya urgently need treatment for acute malnutrition, according to UNICEF. 

“WHO is looking to the international community to support our work on the ground responding to this dual threat, providing treatment for malnourished people, and defending them against infectious diseases,” Tedros said. 

“Hunger is a direct threat to the health and survival of millions of people in the greater Horn of Africa, but it also weakens the body’s defenses and opens the door to disease,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

“WHO is looking to the international community to support our work on the ground responding to this dual threat, providing treatment for malnourished people, and defending them against infectious diseases.”

The funds raised from the appeal will go towards urgent measures to protect lives in the region, including increasing countries’ capacity to detect and respond to disease outbreaks, procuring and ensuring the supply of life-saving medicines and equipment, identifying and filling gaps in health care provisions, and providing treatment to sick and severely malnourished children. 

Situation continues to worsen

With the start of the autumn rainy season expected to be delayed once more, thus delaying the planting of new crops, the food insecurity in the Horn of Africa is expected to continue to grow through the autumn. 

In Somalia alone, about 7.1 million people — almost half the population — will confront crisis-level food insecurity or worse until at least September and 213,000 of them face catastrophic hunger and starvation, according to the Integrated Food Security Classification (IPC), an intergovernmental consortium including UNICEF, the World Food Programme and the UN Food and Agriculture Organization, that tracks and ranks food insecurity hotspots.  

“Ensuring people have enough to eat is central. Ensuring that they have safe water is central. But in situations like these, access to basic health services is also central,” said Dr Michael Ryan, Executive Director of WHO’s Health Emergencies Programme. 

“Services like therapeutic feeding programmes, primary health care, immunization, safe deliveries and mother and child services can be the difference between life and death for those caught up in these awful circumstances.”

 Violence, disease outbreaks, and displacement result from food crisis  

The food crisis has resulted in avoidable death of children and women in childbirth.

The food crisis has also resulted in increased violence, outbreaks of disease, and mass displacement. 

​​There are already reports of avoidable deaths among children and women in childbirth. Gender-based violence is on the rise. There are outbreaks of measles in 6 of the 7 countries, against a background of low vaccination coverage, in addition to the mass displacement of people and relaxation of social distancing norms. 

Countries are also simultaneously fighting cholera and meningitis outbreaks as hygiene conditions have deteriorated, with clean water becoming scarce as people migrate.

The region already has an estimated 4.2 million refugees and asylum seekers, with this number expected to increase as more people are forced to leave their homes in search of food, water, and pasture for their animals. When on the road, communities find it harder to access health care, a service already in short supply following years of underinvestment and conflict.

WHO has already released US$ 16.5 million from its Contingency Fund for Emergencies to ensure people have access to health services, to treat sick children with severe malnutrition and to prevent, detect, and respond to infectious disease outbreaks.

The global health agency has also set up a hub in Nairobi to coordinate delivery of medical supplies and other WHO support to areas of the region in the throes of conflict, humanitarian and climate-related crises.

Image Credits: Mohammed Omer Mukhier/Twitter , WHO/Twitter , HBNonline/Twitter .

Administering monkeypox vaccine in the United States after HHS deploys 1.1 milion doses.

High income countries like the United States and Canada are casting a wide net in their vaccine strategy for monkeypox, vaccinating people exposed to an infected case and groups at risk of exposure while scrambling to study the results in terms of efficacy. 

That was the upshot of a WHO-sponsored symposium on monkeypox research involving some 40 panelists and over 1,100 participants from around the world that coincided with the closing day of the 24th International AIDS Conference.

Canadian health authorities, for instance, authorized a single monkeypox vaccine dose for people with “high risk exposures to a probable or confirmed case of monkeypox, or within a setting where transmission is happening,” said Matthew Tunis, a researcher with Canada’s Public Health Agency. “If after 28 days, if an individual is assessed as having a predictable, ongoing risk of exposure, a second dose may be offered.”

Tunis said the vaccine also may be offered to special populations, including people who are immunosuppressed, pregnant, breastfeeding, under 18 years of age or have atopic dermatitis. “So the overall gist of the main recommendations are really focused on pre-exposure prophylaxis,” he added, comparing Canada’s approach to that of the United States.

Canada and US take similar approach

Like Canada, the United States emphasizes a prophylactic approach to vaccination. Last Friday it authorized the release of more than 1.1 million vaccine doses, effectively most of what is believed to be in its strategic stockpile.

“We have a strategy to deploy these additional vaccine doses in a way that protects those at risk and limits the spread of the virus, while also working with states to ensure equitable and fair distribution,” US Health and Human Services Secretary Xavier Becerra said last Friday in a statement that specifies the distribution plan accounts for the total population of at-risk people and the number of new cases in each jurisdiction.

WHO stresses vaccine ‘equity’  – unclear how that will be achieved

Monkeypox cases and distribution in global mapping led by Oxford and Harvard Universities

WHO officials at the research meeting, meanwhile, stressed that equity must be part of studies into how the vaccine is used and how effective it is. “Equity should be an underlying focus of our efforts,” said Ana Maria Henao Restrepo, a senior WHO scientist.

However, with preemptive campaigns being carried out among those at risk, it remains even more uncertain how far limited monkeypox vaccine supplies can really extend beyond countries that have bought or stockpiled doses recently.   

WHO’s Ana Maria Henao-Restrepo: equity an underlying concern.

Worldwide, there are only about 16.4 million doses of the approved vaccine, MVA-BN, produced by the Danish firm Bavarian Nordic.  Most of those are in bulk form, still requiring a final step of “fill and finish.” The United States already has or has contracted to receive 14.4 million doses, leaving the rest for Canada, the United Kingdom and a handful of other European countries. 

And yet based on last week’s reported cases, then at 17,000, u

However, up to 10 million doses would be needed for a preventive campaign aimed at all high-risk groups in the 77 countries that reported cases, WHO’s Tim Nguyen estimated based on last week’s 17,000 reported cases. That figure has already swelled to 24,406 reported cases, with the US, Spain, Germany and the United Kingdom reporting the highest case loads. 

Meanwhile, the shuttering of Bavarian Nordic’s main manufacturing plant until late 2022 highlights the constraints to global supplies, meaning that outside of a few rich countries, other nations seeing significant cases may not have the option of vaccinating high-risk groups for some time to come. See more here: 

Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand

Research questions: one vaccine dose versus 2 and real-life efficacy 

Researchers at the symposium expressed hopes that a few other vaccines now in early or late-stage R&D could eventually be approved for monkeypox. Those could range from KM Biologics‘  smallpox vaccine to a potential mRNA vaccine for monkeypox, which Moderna recently said it is exploring at a “preclinical level.”

At the same time, researchers underlined that critical questions still need to be answered about the efficacy of the approved MVA-BN vaccine in people getting the jab.

The vaccine has mainly been tested on non-human primates such as monkeys, leaving big questions over how it will perform in a variety of real-life settings, including people already exposed and those at potential risk, and in cases such as those involving an infected person’s bedding or closed, confined office spaces or sexual contacts.

Additionally, there are questions over whether a single jab may be sufficient for certain risk groups or with virus variants. 

Experts say these issues will only be resolved following further studies, including some already underway in areas with high caseloads in the US, UK and Spain.  

They agreed, however, that the search for answers must occur in tandem with the rapid deployment of the already approved MVA-BN vaccine in light of the global health emergency recently declared by the World Health Organization. 

Randomized trials problematic

The urgency of vaccine deployment is already influencing the design of studies, many of which are “retrospective” or “observational studies” of people or groups who received the vaccine or are getting it now. This is in contrast to the “randomized controlled trials” (RCTs) that involve the deliberate administration of a vaccine and placebo to different groups of people at risk, which is typically the gold standard for research trials.

In terms of RCTs, selectively administering placebos to some high-risk groups would likely be both unethical and impractical in terms of attempts to control the new health emergency, experts pointed out.

For instance, in major Canadian cities like Toronto and Montreal, at-risk individuals registered with primary care or sexual health clinics have been invited to get vaccinated, according to Tunis. Singling out some of those people to receive the real vaccine while others get a placebo isn’t really in the cards, he said.

“I don’t think that the randomization of a list approach would really be feasible. It’s been much more driven at the at the community level,” said Tunis.

Speed and agility coupled with validity

Professor John Danesh, Cambridge University

WHO’s Restrepo said what’s needed is a portfolio of randomized and observational evaluations to complement a database that the world can rally around, and the UN health agency wil work with its members to use existing and new vaccines against monkeypox within the framework of clinical efficacy research.

“We are committed to doing so in a way that does not prevent the deployment of such vaccines but in parallel with the deployment of such vaccines,” she said.  

John Danesh of Cambridge University said the evaluation needs to be specific. “We shouldn’t slow down the action, but speed and agility has to be coupled with validity and robustness so that the action has an enduring effect,” he said. Most of the evaluation during the symposium was oriented towards high income countries, he said, but in sub-Saharan Africa it “requires a somewhat different approach.” 

Monkeypox infection has spread globally mainly through communities of men that have sex with men. In central and western African countries where the disease is endemic, however, the infection has traditionally been transmitted to people through contact with infected animals who then might pass it to other household members before it burns itself out. 

In central Africa, the prevailing virus variant, Clade 1, is particularly deadly, with up to a 10% mortality rate. That reflects the importance of prioritizing monkeypox vaccination there, as well, for what has long been a neglected disease.

In those countries, Danesh noted, researchers had pointed to the potential benefits of a “ring vaccination approach” similar to that used with Ebola. That approach prioritizes vaccinating health workers and family contacts of an infected case. 

But as new African countries report monkeypox cases – mostly the milder, West African virus variant, Clade 2, that has been circulating globally – Africa could be experiencing patterns of transmission between men who have sex with men, similar to those globally, along with traditional modes of transmission.

Image Credits: The Hill/Twitter , Global Health Map .

Twelve African nations have joined with the United Nations and other international organizations in forming a new alliance that will work to prevent new infant HIV infections and to ensure no child living with HIV is denied treatment by the end of the decade.

Proponents of the new Global Alliance for Ending AIDS in Children by 2030 announced its creation on Tuesday at an International AIDS Conference wrapping up in Montreal, Canada.

The first phase includes Angola, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

Three UN agencies — UNAIDS, UNICEF and the World Health Organization (WHO) — are behind it along with the Global Network of People Living with HIV (GNP+), the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR).

At the conference, UNAIDS revealed that progress against HIV slowed down during the COVID-19 pandemic as donors pull back, countries test and treat fewer people and miss key targets.

Countries with the biggest increases in new HIV infections include Philippines, Madagascar, Congo and South Sudan, according to UNAIDS’ annual report, issued just ahead of the opening of the 24th Annual AIDS conference.

Nearly Half of All Children with HIV Lack Life-Saving Treatment

Just 52% of all children living with HIV are receiving treatment that can save their lives, far behind the 76% of all adults that are receiving antiretrovirals. That’s according to data released in the UNAIDS Global AIDS Update 2022.

Because of that the alliance says over the next eight years it will focus on closing the treatment gap and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment, and on preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women.

Its other priorities include ensuring there is accessible testing, optimized treatment, and comprehensive care for infants, children, and adolescents exposed to and living with HIV, and that the rights, gender equality, and social and structural barriers that hinder access to services are adequately addressed.

“The wide gap in treatment coverage between children and adults is an outrage. Through this alliance, we will channel that outrage into action,” UNAIDS Executive Director Winnie Byanyima said.

“By bringing together new improved medicines, new political commitment, and the determined activism of communities, we can be the generation who end AIDS in children,” said Byanyima. We can win this, but we can only win together.”

Aids in children prompts call for community leadership

AIDS in Children
A mother from Lesotho, Limpho Nteko, who serves as a spokesperson for the female-led mothers2mothers program (Credit: m2m.org)

A mother from Lesotho, Limpho Nteko, who serves as a spokesperson for the female-led mothers2mothers programme that works to combat HIV pregnancy transmission, told the conference that community leadership is an important factor.

“To succeed, we need a healthy, informed generation of young people who feel free to talk about HIV, and to get the services and support they need to protect themselves and their children from HIV,” said Nteko, who found out she had HIV while pregnant at age 21 with her first child.

WHO’s Director-General Dr Tedros Adhanom Gheberyesus said no child should be born with or grow up with HIV, and no child with HIV should go without treatment.

“The fact that only half of children with HIV receive antiretrovirals is a scandal, and a stain on our collective conscience,” he said. “The Global Alliance to End AIDS in Children is an opportunity to renew our commitment to children and their families to unite, to speak and to act with purpose and in solidarity with all mothers, children and adolescents.”

Image Credits: Emmanuel Museruka/DNDi, m2m.org.

Demonstrators at the 24th International AIDS Conference in Montreal, Canada.

MONTREAL – HIV is one of the most studied diseases of all time and an arsenal of treatment and prevention tools have been amassed over the past 40 years – the latest being an antiretroviral (ARV) injection taken every eight weeks that can prevent 99% of infections.

But HIV is still spreading – primarily amongst people who have been deemed criminals or invisible by their governments.

Some 70% of new infections last year were in groups designated by UNAIDS as “key populations” for their vulnerability to infection: men who have sex with men (MSM), sex workers, transgender people, people who inject drugs, and prisoners.

Adolescent girls in sub-Saharan Africa, many of whom are infected during coerced sex, are another vulnerable group.

“We have the tools. We know what we are supposed to do. But we need a people-centred approach to meet people where they are,” Professor Linda-Gail Bekker, head of the Desmond Tutu Health Centre and infectious diseases expert, told the International AIDS Conference in Montreal.

Global battles at UN forums

Yet growing political conservatism means that, despite the scientific tools, many governments operate according to prejudice rather than science, ensuring that HIV continues to flourish in the crevices of restrictive societies that chose not to recognise behaviours they find unacceptable.

These conservative forces are increasingly raising their voices at international forums to undermine proven methods to address HIV.

During the United Nations High-Level Meeting on AIDS in June last year, Russia refused to support the final political declaration as it opposed references to “rights”, the decriminalisation of sex work, and harm reduction in the context of the battle against HIV/AIDS.

HIV infections in Russia re rising, driven by people who inject drugs, and less than a quarter of Russians living with HIV know their status.

This June, the World Health Assembly – the highest decision-making body of the World Health Organization (WHO) – was delayed for hours as countries fought over terms in the body’s new strategy on HIV, hepatitis B and sexually transmitted infections. 

Member states primarily from North Africa and the Middle Eastern led the assault on the guide for including “sexual orientation”, “men who have sex with men” and “comprehensive sexuality education” (CSE) for school children.

Eventually, an almost unprecedented vote was held and a watered-down version of the strategy was passed, but around 120 countries either abstained or were absent.

HIV infections rose in the Middle East and North Africa last year, along with Eastern Europe, Central Asia and Latin America, according to the UNAIDS latest report, In Danger.

Human rights backlash

UNAIDS executive director Winnie Byanyima acknowledged at the launch of the report that “today we see a huge backlash against certain human rights that some were won many years ago, for example, sexual and reproductive health and rights”. 

“We’re seeing countries that are pushing back against the human rights of LGBTQ people and we’re seeing further enforcement of punitive laws against people who inject drugs, sex workers, and LGBTQ people,” Byanyima said in response to a Health Policy Watch question.

“The international community must stand together on human rights. Human rights are an important part of creating the enabling environment for everyone to access what science has to offer.”

UNAIDS is supporting “key populations” in many countries to “have a voice to defend their human rights”, she added. 

“This is a critical part of HIV and indeed, in the United Nations system, UNAIDS will continue to advance international legislation to strengthen those rights but it is a battleground today.”

Rights-based approach saves lives

Groundbreaking research published in the BMJ last year by Dr Matthew Kavanagh has quantified the effect of official discrimination, concluding that countries where same-sex acts, sex work and drug use were criminalised “had approximately 18%–24% worse outcomes” in preventing HIV infections.

“One of the most powerful lessons from the history of the fight against HIV is that success in confronting such a formidable disease cannot be achieved through biomedical interventions alone,” said Peter Sands, Executive Director of the Global Fund. 

“We must also confront the injustices that make some people especially vulnerable to the disease and unable to access the health services they need. The same is true for TB, malaria, and other diseases, including COVID-19.”

Since 2017, the Global Fund has provided financial and technical support in 20 countries to address “stigma, discrimination, criminalisation and other human rights-related obstacles” that undermine progress against HIV, tuberculosis (TB), and malaria.

A progress report released by the Global Fund on Sunday showed that this initiative, called Breaking Down Barriers, is slowly starting to make progress.

One of the strategies of the initiative is to empower the groups facing discrimination to take legal action to protect and advance their rights in the 20 countries – Benin, Botswana, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Ghana, Honduras, Indonesia, Jamaica, Kenya, Kyrgyzstan, Mozambique, Nepal, Philippines, Senegal, Sierra Leone, South Africa, Tunisia, Uganda and Ukraine.

Successes include human rights training for health care workers and police as well as legal literacy and “know your rights” campaigns for key populations. 

Jamaica has trained over 1,000 police officers in protecting the human rights of people living with HIV and key populations, while Sierra Leone has explained its needle and syringe exchange programme to key government officials and police officers.

In Kenya, community activists have been trained to document human rights violations of key populations.

The Viva+ Project in Mozambique has implemented community dialogues and radio programmes to address stigma and discrimination in 11 provinces and 63 districts. 

Botswana has held community dialogues with traditional chiefs to discuss men who have sex with men and transgender people.

A partnership of civil society organisations led by the Global Network of People with HIV (GNP+) launched a “Not a Criminal” campaign over the weekend at the AIDS conference to decriminalise HIV non-disclosure, exposure and transmission; same-sex relationships; sex works and drug use.

The goal of the campaign is to “mobilise a multifaceted community action to hold governments, law, and decision-makers accountable for their global political commitments to ensure access to health and respect human rights”.

“We call on countries to retract laws that criminalise people based on their HIV status, who they choose to love and what they choose to do with their bodies in the form of sex work or the use of drugs,” said the group.

According to the group, 134 countries “criminalise HIV transmission, non-disclosure of or exposure to HIV” and a 2021 international review found that almost 90% of nations globally criminalise drug use in full, three-quarters similarly police sex work and in nearly 40% of countries, being in a same-sex relationship is either partially (24) or completely (39) illegal.

 

Image Credits: Marcus Rose/ IAS.

A delegate at the 24th International AIDS Conference.

MONTREAL – People with mental health conditions are more likely to get HIV, while people with HIV often struggle with depression and other mental health issues – but few countries offer psychosocial support as part of their HIV services.

“As a result of systemic inequalities, mental health issues keep coming up and you have to deal with them head-on,” said Lucy Njenga from Positive Young Women Voices, who works with women and girls with HIV in some of the poorest communities in Kenya.

“Violence against women and girls and poor socio-economic conditions are the key challenges ,” Njenga told International AIDS Conference delegates.

Her organisation has a counsellor available but addressing poverty through cash transfers that enabled girls to remain in school and food parcels “that made them feel that they are loved” have also proved important.

“Mental health is a necessary, essential part of any HIV programme,” Dr Don Operario from Brown University’s School of Public Health in the US, told delegates.

“Mental health and HIV aren’t two co-occurring, siloed epidemics, but operate interactively, exacerbating each other’s negative effects in the most marginalised populations,” he added.

“We’re seeing a consistently high prevalence of depression, anxiety, suicidality, post-traumatic stress disorder and substance abuse in men who have sex with men (MSM), and substantially higher relative to heterosexual peers,” said Operario, who is one of the authors of a Lancet-published series on mental health iand HIV.

South Africa’s mission to broaden HIV services

Aside from mental health, few HIV programmes include screening and treatment for a host of other non-communicable diseases (NCDs) that prey on people with HIV – including diabetes, hypertension and cervical cancer. 

In South Africa, which has the biggest population of people living with HIV in the world, more people are now dying of diabetes than AIDS. People with HIV are living longer thanks to antiretroviral treatment, and having to confront a range of NCDs.

South Africa’s health minister, Dr Joe Phaahla, told Health Policy Watch that his mission in Montreal is to persuade donors to allow his country the flexibility to build screening for diabetes and hypertension into HIV programmes as a start.

“Of course, HIV and TB are still important because they are still killing people, but we want donors to accept that the HIV resources we get for training health workers, for laboratories and so on, will be expanded to include diabetes and hypertension screening and diagnosis,” said Phaahla.

“The cancers are more complicated, but diabetes and hypertension are our priorities.”

Phaahla’s targets for persuasion are the Global Fund to Fight AIDS, TB and Malaria and the US President’s Emergency Plan for AIDS Relief  (PEPFAR). 

Earlier, a presentation at the conference that involved spatial mapping data of people’s health needs in rural KwaZulu-Natal, a province in South Africa, found that people living with HIV also had a high burden of diabetes and hypertension.

The Global Fund’s replenishment conference is being held in September and much of the focus of the conference involves discussion about how money raised should be spent.

Marijke Wijnroks from the Global Fund’s secretariat conceded that the fund had only made “small scale” investments in mental health so far, citing Zimbabwe as one example of a country that is trying to address this in its HIV services – but that there is a global growing impetus for integrated services.

Last year, the United Nations Political Declaration on HIV/AIDS pledged to ensure that 90% of people living with, or at risk of, HIV should be able to get essential health services, including mental health and other NCD care by 2025. 

Wijnroks said that the fund had not been “explicit enough” about the importance of integrated care in the past although the evidence of its impact was “clear”.

However, the fund’s new 2023-2028 funding strategy adopted in December includes integrated people-centred primary health care with “explicit language” about including NCD diagnosis and treatment in HIV services, she said.

“It’s really about looking at a person and trying to provide support to that person in a comprehensive way because people don’t live in siloes. They have a whole range of issues that they need support with,” said Wijnroks. 

Integration makes financial sense too. Modelling by the non-profit United for Global Mental Health estimates that reducing new HIV infections could be at least 10% faster if mental health services and psychosocial support are included as a core part of HIV services – and up to 20% faster if included in tuberculosis care.

24th International AIDS Conference (AIDS 2022), Montreal, Canada.

NCD Alliance appeals to Global Fund

Despite the growing realisation that NCDs have to be factored into HIV services, the AIDS conference offered few successful models – and only two sessions focused on NCDs and HIV.

In an open letter to the Global Fund issued shortly before the AIDS conference, the NCD Alliance (NCDA) called on the fund to “prioritize the inclusion of NCD interventions” in its  2023-2028 strategy.

This should include financial and technical support for HIV and NCD prevention and care at the primary healthcare level, said the NCDA.

It also called for people living with the fund’s target diseases – HIV, TB and malaria – and NCDs to be properly consulted about their “ full health care needs to improve quality of life and physical and financial barriers to access”, and for proper data to be collected about needs and gaps in health coverage.

Image Credits: Marcus Rose/IAS, Jordi Ruiz Cirera/IAS.