As NCDs Increase in Poorer Countries, Innovative Partnerships Have Become Essential 27/09/2022 Alison Cox, Megha Kumar & Anne Stake Medtronics’ Betteh Life project in Sierra Leone Infectious diseases like HIV, tuberculosis and malaria have long been the biggest public health challenges in low- and middle-income countries (LMICs) but over the past decade, non-communicable diseases (NCDs) have risen at an alarming rate. While every country faces a growing NCD burden, low- and middle-income countries are seeing the fastest increase. This epidemiological shift is largely due to increases in exposure to risk factors – urbanization, tobacco, alcohol, ultra-processed food, air pollution and a lack of physical activity – and is exacerbated by more fragile health systems. Getting NCDs under control in LMICs requires new approaches to securing funds, through innovative partnerships that can creatively leverage resources and technology for efficient and effective service delivery. ‘Betteh Lyfe’ in Sierra Leone In Africa, the Betteh Lyfe programme – a collaboration between Medtronic LABS, the Christian Health Association of Sierra Leone, and Sanofi Global Health – was launched in Sierra Leone this year. Medtronic LABS supports end-to-end care with their digital health platform, SPICE, and their team on the ground. It begins with community health workers who carry out screening for diabetes and hypertension close to people’s homes – even those living in remote areas – and referral to health facilities to begin a treatment programme. Follow-up and monitoring are community-based or via tele-counselling, making it easier for patients to adhere to treatment. This also generates real-time data that is valuable for clinical, programmatic and policy decision-making. Private sector funding helped to catalyse the programme while collaboration with the existing faith-based network made it possible to build connections with remote and marginalized communities to bring NCD diagnosis and care to their doorsteps. The total number of people living with diabetes in Africa is predicted to more than double to 55 million by 2045. Hypertension, cardiovascular diseases, cancers and mental health disorders are all on similarly steep upward trajectories. Today, 74% of all deaths are due to NCDs – with the heaviest and fastest rising burden in LMICs – and yet only 1-2% of global health funding supports NCD care. This number has stagnated since NCDs made it onto the global health agenda two decades ago. Medtronic LAB has helped to check people for hypertension in Sierra Leone. Kenya’s public-private partnership Aside from funding, the response on the ground will need to adapt to the evolving epidemiology. It requires ‘all-of-society’ partnerships, that bring together the private sector, public sector, civil society, donors, and most importantly patients themselves in designing and delivering solutions. Such partnerships are essential if we are to overcome numerous barriers to better health in LMICs, like inadequate funding, hard-to-reach services, poor adherence to treatment, and insufficient data to make informed health policy decisions. We’ve seen their effectiveness proven on the ground. A similar approach has been employed in Kenya for the last three years in a landmark public-private partnership with Medtronic LABS, the Ministry of Health, the County Government of Makueni, PATH, Novo Nordisk and Kenya Defeat Diabetes Association. This multi-sectoral model has focused on public health system strengthening. So far, it has screened 114,000 people, enrolled over 21,000 patients in Makueni County alone, and will extend to all 47 counties in Kenya by 2026. Its ethos is based on both reaching and retaining patients. Like the Betteh Lyfe program, community health workers visit people in remote areas for education, screening, follow-up, and blood pressure and blood glucose monitoring while physicians track the readings remotely through the digital health platform. Patients are kept engaged with health services as they do not have to travel prohibitively long distances to access care and begin to see improved outcomes within a year. Digitizing the health information system The program has also digitized the national diabetes and hypertension health information system from data collection all the way to aggregation into District Health Information Software (DHIS2), ensuring consistent availability of data for decision-making. As part of the commitment to work within and sustainably transform health systems for scale, the full ownership of the model, including the digital health component is being transitioned to the Ministry of Health. These examples highlight how a robust multi-sectoral partnership framework can improve access to essential NCD services, ensure optimal and efficient use of scarce resources and leverage the expertise, capacity and experience of the different partners to mount a more coordinated NCD response. Programme leadership from national and sub-national governments and aligning strategies around government priorities whilst engaging faith-based networks and other community groups can ensure sustainable, bespoke and person-centered chronic care. Rwanda’s Universal Health Coverage Rwanda is a good example of this approach. Its government has taken a strong lead in the enactment of Universal Health Coverage (UHC), which integrates NCD prevention and care whilst constructively engaging partners, civil society and the community. Here, 91% of the population is covered by health insurance, primarily the Rwanda Community Based Health Insurance (CBHI) which covers 90% of all health costs at all levels of care. This kind of financial protection, plus ambitious community screening and education programmes, helped increase the use of health services from 30.7% in 2003 to 85% in 2008. These programmes offer many translatable lessons for other countries looking to improve their health systems through multi-sectoral partnerships: the importance of government leadership, working with community organizations, leveraging community health workers to deliver NCD care, and the role of digital innovations to reach remote or marginalized populations. Building experience and evidence from bold partnerships like these will be an important contribution to supporting LMICs as they make gains towards reducing the health and economic burden of NCDs. Alison Cox Alison Cox is the Policy and Advocacy Director of the NCD Alliance. Megha Kumar Megha Kumar is Head of Global Partnerships at Medtronic LABS. Anne Stake Anne Stake is Chief Strategy & Product Officer at Medtronic LABS Image Credits: Medtronics. Northern India Braces for Toxic Air Pollution Spikes as New Punjab Leaders Fail to Control Crop Stubble Fires 26/09/2022 Jyoti Pande Lavakare Aam Admi Party leaders Bhagwant Mann (centre), the Punjab chief minister, and Arvind Kejrwal (left), chief minister of Delhi. NEW DELHI – When India’s Aam Admi Party (AAP) won elections in the northern state of Punjab in March, decisively wresting power away from the Indian National Congress (INC) and defeating the nationalist Bharatiya Janata Party, clean air advocates and activists were optimistic that the burning of crop stubble by Punjab farmers – the biggest contributor to Delhi’s recurring autumn and winter air pollution spikes – would finally be tackled and a real solution found. There were two primary reasons for this optimism. First, of all Indian political parties, the AAP, which came into power in Delhi in 2013, was one of the earliest to acknowledge the health harm of air pollution and speak out most openly about the need to reduce this environmental toxin. It even experimented with implementing an odd-even road-sharing plan for vehicles in the high pollution season in early 2016. Even though this scheme failed to deliver – some research showed pollution actually increased during this period – the AAP succeeded in raising awareness about air pollution and making it a mainstream issue. But it was the second reason that gave activists cause for optimism this season. For years, the AAP has loudly, aggressively and publicly blamed the INC for the winter pollution peaks in Delhi and northern India, saying that the Congress-ruled Punjab government has been unable to control fires set by farmers to prepare their fields for winter sowing. Satellite image of northern India on 26 October 2020 shows the Delhi region with “very poor” to “severe” air quality, largely as a result of of crop burning in Punjab, whose capital is Chandigarh. Now that the AAP had taken control of Punjab with a sweeping majority, the party had all the power to stop farm fires – whose toxic drifts southward towards Delhi in early and mid-winter, setting off choking pollution crises in the city for more than a decade. But the AAP’s proposal that the central government, the Punjab state government and the Delhi state government jointly pay farmers a cash incentive of Rs 2500 per acre – not to burn crop residue appears to have already fallen through. The party has been unable to explain why – although it’s likley attributable to the deep political rivalries that exist between the centre-left AAP, now controlling Punjab state and Prime Minister Narendra Modi’s Hindu nationalist Bharatiya Janata Party (BJP), which controls the government today. Specific questions sent by Health Policy Watch to AAP leaders and spokespersons, including chairperson of the Delhi Assembly’s environment committee and legislative assembly member Atishi Marlena, were either ignored or given generic responses. One AAP spokesperson referred us back to a YouTube video of a speech made by the Punjab Chief Minister, Bhagwant Mann, in which Mann said that the state government has asked the central government for help in paying farmers the no-burn cash incentive. Punjab chief minister claims central government nixed farmer incentives Mann said the proposal calls for the central government to cover Rs 1500 of the cost of the no-burn incenteive, while the Punjab and Delhi state governments would each add Rs 500 per acre – in light of the huge health impacts the stubble burning has downwind – including in New Delhi, India’s capital city, and the greater Delhi metropolitan area, India’s second largest. “The central government has rejected our proposal,” Mann said, speaking in the video in Punjabi. “But doesn’t matter, even if the central government doesn’t help us, we will go ahead with our contributions and also ask every one of our officers to spread awareness (about the harms from burning) and inform farmers that they should not light fires,” he added. However, subsequently, Punjab Agriculture minister Kuldeep Singh Dhaliwal said the plan to give cash incentives to farmers not to burn crop stubble had been shelved in its entirety. “How can we pay when the centre is not giving?” the minister asked. Meanwhile, Mann said the Punjab government would also deploy 105,000 crop residue management machines in to grind the crop waste – another much touted alternative to waste burning. But it remained unclear if the Punjab government intended to buy the machines or merely encourage farmers to buy them via subsidies – and what timelines were being planned. And he said that the government would also incentivize farmers to make wider use of an innovative new chemical composting technique, known as the Pusa decomposer, an indigenous catalyst that converts rice stalks to valuable manure, and has been successfully tested by the Delhi State government over the past two years in its own non-basmati rice-growing farmlands. However, the stalks still take several weeks to decompose and it remains to be seen if farmers will perceive the value of the compost thus created as worth the wait. Early start of toxic air? Pollution in Delhi peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources With the harvest season beginning imminently, however, it is already getting late to take pre-emptive action – with some Punjabi farmers already beginning to set their fields on fire. Like every monsoon season, August and September have seen the cleanest air, and the lowest Air Quality Index (AQI) numbers, in north India in 2022, with rains clearing smoke and fine particulates that are the most hazardous to health, and would otherwise drift hundreds of kilometers towards Delhi. On Friday 16 September, for instance, the AQI in Delhi was 44, putting it squarely in the “good” category (AQI under 50), due to a long period of light rain – the first “good” air day since 18 October 2021, which was the only good air day in 2021. There were only five good air days in 2020, mainly because of the lockdown. But there wasn’t a single good air day in 2015, 2016 and 2018. This post-monsoon air is clean because it has been washed by rains – no political party or smog tower can claim credit for this although that hasn’t stopped politicians from trying. But as those who track air pollution know that this is the calm before the storm. It is a narrow window of time after which, rice paddy straw burning during the dry season that follows begins to push PM2.5 readings up to dangerous levels – made even more hazardous by fireworks from the Hindu Diwali festival, to be celebrated this year on 24 October. PM2.5 is the microscopic particulate matter that bypasses human defences to settle deep into the lungs. It is absorbed by the bloodstream and carried to every organ in the human body, fueling inflammation and a host of cardiovascular and respiratory diseases, among others. Often these can spike more than 250 times above the World Health Organization (WHO) limit of five micrograms per cubic metre on the day after Diwali. With the monsoon receding early, leaving a rainfall deficit of 35% in Delhi according to the India Meteorological Department, wind speeds dropping and some early signs of crop stubble burning, toxic air may make an early entry this year. Farmers already burning fields There is a very brief turn-around between the autumn rice harvest and the time when farmers need to sow wheat, making rice stalk burning attractive to farmers. According to the Punjab Remote Sensing Center, farmers have already begun lighting their fields. Last Tuesday the AQI immediately rose to 182, the highest since 25 June, when it was 230. Farm fires usually begin in Punjab’s Majha region and progress towards the Malwa region. Unless there is some miracle, Delhi and north India’s Gangetic plain are in for another toxic winter, as governments flounder without focus or specific plans to reduce the burning of agricultural waste, North India’s unique geography, topography and meteorology make controlling stubble burning critical to curbing air pollution. The geography of the Indo-Gangetic plain – with the great Himalayan range in the north acting as a physical barrier, preventing dirty air from dissipating quickly – traps pollution generated in the region for long periods. As the monsoons recede and the air becomes cooler and drier over the winter months, wind speeds also reduce. Seasonal temperature inversions – when lighter, warmer air rises and traps cooler, denser air – further confines pollution to the ground level, keeping atmospheric particulate concentration high. Air pollution in this region is bad year round – but during autumn and winter, these geographical and meteorological misfortunes combine with stubble-burning to create the perfect storm, turning India’s northern plains into one gigantic bowl of pollution that its residents are forced to breathe for months on end. Health costs of stubble burning Analysis of the proportions of a) people exposed and b) land area covered by air pollution at various levels, based on data extracted by Washington University, St. Louis USA. Stubble-burning is one of the major contributors to air pollution in South Asia. But the problem is particularly acute in north India due to the unique mix of crop cultivation patterns, the timing of harvests, and weather. In India’s Punjab and neighboring states, farmers burn their fields to quickly clear them of straw in the short window of time that they have between the end of rice-harvesting and the wheat-sowing period. These fires are so large that they can be seen from space. Until September, densely populated urban areas like Delhi experience mixed winds, including the moisture-laden easterlies and south-easterlies. But by early October, the winds change direction, blowing in from the northwest so if paddy fields are on fire at this time, smoke from the fires move directly towards the urban areas – and the 46 million people living in the greater Delhi region who inhale the smoke with every breath they take. According to some estimates, farmers reportedly produce almost 50 million tonnes of straw a year in the northern states of Haryana, Punjab, Rajasthan and Uttar Pradesh, burning about four-fifths of the waste. Punjab alone produces 20 million tonnes of paddy residue. Another, more conservative estimate of the International Wheat and Maize Improvement Center holds that farmers in North India burn around 23 million tonnes of straw from their rice harvests. But this is still huge; if the stalks were packed into 38-cm-high bales, and piled on top of each other, they would reach the moon. The air pollution cost due to stubble burning is estimated at $30 billion annually in terms of health and economic disruptions such as flight and train delays and car crashes, according to National Institute of Public Finance and Policy. Rural as well as urban populations experience the negative health impacts. An October 2021 study on the respiratory effects of crop stubble burning in the Patiala district of Punjab, undertaken by the Energy Resources Institute, found respiratory complaints and reduced lung function across all age groups – with the most reduced lung function in the lowest age groups whose developing bodies may be stunted by pollution for life. Exposure to stubble burning increased a person’s risk of lung cancer by 36%, the study also found, with more adverse health effects among women as compared to men. Stubble burning also harms soil fertility, destroying many nutrients. One report estimated the losses as follows: nitrogen (5.5kg), phosphorous (2.3 kg), potassium (25 kg) and sulphur (1.2 kg). The heat also kills beneficial bacteria and fungi, according to the report. Alternative uses for stubble For nearly a decade, Indian agricultural experts and air quality advocates have tried to promote alternative crop management practices including not only the incorporation of rice stubble into the soil through mechanical tilling or composting, but also other creative uses for the thick rigid stalks as inputs to: pulp and paper production; biofuel; soil-enriching biochar, or for production of cement and bricks. Ashwini Choubey, the national government’s Minister of State for Environment, Forest and Climate Change, told the Parliament in July that Punjab aimed to bring its 20 million tonnes of stubble burning down to zero by 2024 by switching to other crops (reduction of 5.22 million tonnes), in-situ management with composting and mulching in the fields itself (10.70 million) and managing the remainder ex-situ (4.66 million tonnes). However, a big part of this plan was the farmers’ subsidy to not burn crop waste, with the state governments of Delhi, Punjab and the central government sharing the cost of this subsidy in a 1:1:3 ratio. This came to nought with central government declining to share this cost, and later, the AAP itself deciding not to go ahead with this payout. The subsidy was to be supplemented with a two-pronged system of support for crop waste management alternatives – including use of the Pusa decomposer and mechanical waste shredders. Shredding stubble and seeding simultaneously In terms of mechanical methods, machines with names like the Happy Seeder and the Super Seeder have been marketed as devices that can be attached to conventional mechanized harvesters to shred crop residue while simultaneously seeding the winter wheat crop, eliminating the need for rice stalk burning. But while the government has widely promoted their use in the last few years, uptake has still been limited. A substantial increase in diesel fuel prices has proved to be an impediment for farmers’ uptake of the mechanical shredding technologies, as fuel-related costs account for 25% of the total operations costs. Farmers also remain wary about the Pusa decomposer – partly due to lack of awareness and partly because the benefits of the compost produced from the rice stalks is not yet perceived as a benefit that outweighs the cost of the time lost in the process of waiting for the residues to rot – even at an accelerated pace. Rice paddies are too water-intensive. Rice is the wrong crop- above and below ground The more fundamental crux of the problem is that India is growing the wrong crop, experts say. Rice is water-intensive and Punjab and Haryana, and to some extent UP and Rajasthan are short on water, including groundwater. But even so, in recent decades farmers have gradually switched over from the cultivation of traditional food crops like pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize to rice, due to the government subsidies made available for the latter. The irony is that the legumes are healthy sources of nutrition, including iron, for local communities in a country harbors one quarter of the world’s cases of anaemia – while much of the rice is now exported. The air pollution impacts of the changing crop plantation patterns are evident in a mapping of smoke emitted from different farm regions during the autumn, a Council for Energy, Environment and Water (CEEW) study observes. It found higher emissions of PM2.5 from crop stubble burning in the rice paddy-intensive districts of Punjab’s Ludhiana and Sangrur, as compared to other parts of the state, such as Hoshiarpur and Pathankot, where more traditional plants and legumes remain popular. Meanwhile, below ground, the rice cultivation had negative impacts on the stability of underground water aquifers, also vital for drinking water. To remedy that, a Punjab Preservation of Subsoil Water Act in 2009 ordered farmers to delay the start of the rice-planting season from April until June – ensuring that the first summer monsoon rains could adequately recharge groundwater reservoirs before rice cultivation began. This, however, delayed the rice harvest, and that had knock-on effects – shrinking the window of time farmers had to clear their fields between the rice harvest and wheat planting season. From that point in time, Delhi’s autumn air pollution emergencies became more and more acute, studies of trends over time show. More than two decades later, turning the clock back remains a formidable challenge for the new government of Punjab, critics say now. If the AAP is truly to commit itself to controlling pollution, it will have to take a more integrated approach. This means expanding the uptake of non-burn alternatives to crop stubble use, as well as striking at the roots of the problem – literally – by encouraging farmers to shift to more diverse crops, including early-maturing rice varieties such as those now being developed by the Punjab Agricultural University. That would allow farmers to plant and harvest their summer crops earlier, before monsoon rains stop and wind direction and speeds pick up. But that also means changing the regime of price supports so that farmers can still make a profit if they switch from water-guzzling rice paddies to high-nutrient millet and maize. Unfortunately, until those systemic issues are addressed, toxic air pollution is likely to darken Delhi’s skies once more this autumn and winter – at least for another year. Image Credits: @pawanpgupta, Flickr, Zubair Hussain/ Unsplash, urbanemissions.info, Jagamohan Senapati/ Unsplash. Air Pollution is Linked to Adverse Brain Development in Young Children 26/09/2022 Stefan Anderson Infants’ brains are negatively affected by air pollution, according to a study which has documented the effects of children’s exposure to air pollution from conception to the age of eight-and-a-half years for the first time. Tracking 3,515 children aged 9-12, the study found an association between exposure to air pollutants in the womb and their early years of life to alterations in white matter structural connectivity in the brain. “One of the important conclusions of this study is that the infant’s brain is particularly susceptible to the effects of air pollution not only during pregnancy, as has been shown in earlier studies, but also during childhood,” said Anne-Marie Binter, Barcelona Institute for Global Health (ISGlobal) researcher and first author of the study, which was published in the journal Environmental Pollution. White matter is what ensures interconnectivity between different areas of the brain, making up the tissue through which messages are passed from region to region within the central nervous system. Due to its role as a “neurological bridge”, abnormal development of white matter can play an outsized role in learning and brain functions, and has been linked with psychiatric disorders including anxiety, depressive symptoms and autism spectrum disorders. The study also found a link between specific exposure to fine particulate matter (PM2.5) and the volume of the putamen, a brain structure involved in motor function. Beyond its effects on children’s developmental health, PM2.5 is estimated to be responsible for about 4.2 million deaths annually according to researchers at McGill University. “A larger putamen has been associated with certain psychiatric disorders like schizophrenia, autism spectrum disorders, and obsessive-compulsive spectrum disorders,” said Binter. While previous studies have been directed at the question of the effects of air-pollutants on childhood brain development, none have been as granular in their methodology.cr “The novel aspect of the present study is that it identified periods of susceptibility to air pollution,” Binter explained. “We measured exposure using a finer time scale by analysing the data on a month-by-month basis, unlike previous studies in which data was analysed for trimesters of pregnancy or childhood years.” The study is the latest addition to an ever-growing mountain of evidence documenting the negative effects of air pollutants on human health. According to the World Health Organization (WHO), 99% of all people breathe air that exceeds WHO air quality limits, and threatens their health. Earlier this year, The Lancet estimated the overall death toll of “modern” air pollution sources to be nine million, making air pollution the world’s largest environmental risk factor for disease and premature death. “We should follow up and continue to measure the same parameters in this cohort to investigate the possible long-term effects on the brain of exposure to air pollution,” concludes Mònica Guxens, ISGlobal researcher and last author of the study. Image Credits: Vicente Zambrano González, Barcelona City Council. African Teen Pregnancies Skyrocketed During COVID Lockdowns – But Prevention is Possible 23/09/2022 Kerry Cullinan A teen mother in Karongi district in Rwanda. Seventeen-year-old South African Amanda Nkosi* is already a mother and living with HIV – thanks to what she describes as “doing things that teenagers do” without access to accurate health information or contraception. She discovered her HIV status recently when a youth-friendly clinic opened near her home in the coastal city of Durban and offered her a test when she went to get contraception. She liked the clinic as it provided her services without making her feel judged, and now helps to educate other teens about HIV and their bodies. South Africa has one of the highest rates of HIV in the world, and young women bear the brunt of this statistic. Meanwhile, the country’s battle against teen pregnancy was severely undermined by COVID-19 lockdowns and school closures – with spikes in teen pregnancies experienced throughout the continent during the pandemic lockdowns in 2020 and 2021. South Africa’s most populous province, Gauteng, reported a 60% jump in teen pregnancies between April 2020 and March 2021. More than 23,226 teenagers aged between the ages of 10 and 18 girls gave birth during this period compared to 14,577 girls in the same period a year earlier. Nkosi told her story at a webinar convened by Clinton Health Access Initiative (CHAI) and Health Systems Trust to discuss how to address teen pregnancy in South Africa. Describing most teenage pregnancies as “abuse”, CHAI country director Dr Yogan Pillay said that young people in southern Africa had a much higher chance of getting HIV and other sexually transmitted infections as well as mental health problems if they started having sex at an early age. “Children are also more likely to bear babies born premature, with a lower birth weight and higher neonatal mortality,” added Pillay, former deputy director general of the country’s health department. “Teenage mothers experience greater rates of postpartum depression and are less likely to initiate breastfeeding. Teenage mothers are less likely to complete high school, more likely to live in poverty and have children who frequently experience health and developmental problems,” he added. Pillay said that a systematic review of the predictors of teen pregnancies in sub-Saharan Africa found that the most common causes were sexual coercion, low or incorrect use of contraceptives, lack of parental communication and support , low socio-economic status and school dropout. Addressing these would assist to reduce prevent teen pregnancies, and support teen parents to avoid additional unwanted pregnancies. Surge in lockdown pregnancies Many African countries experienced a surge in teen pregnancies during COVID-19 lockdowns and school closures, and concerned health policymakers are struggling to implement effective strategies to curb teen pregnancies. According to Uganda’s 2016 Demographic and Health Survey, a quarter of girls aged 15-19 years had already experienced a pregnancy. However, teen pregnancies rose by 28% during the first COVID-19 lockdown in 2020, according to the Makerere University School of Public Health. In Uganda’s eastern Busoga sub-region, 45% of deliveries were girls under the age of 17, according to the health ministry. Overwhelmed parents or the lockdown … We track down the source of a growing teen pregnancy crisis that has health experts worried as to why more underage girls are having children #NTVNews LINK: https://t.co/1TgYlqf3iK pic.twitter.com/7dH8ahteFK — NTV UGANDA (@ntvuganda) October 3, 2021 The Ugandan government’s approach to combatting teen pregnancy has been to promote abstinence-based education in schools. Comprehensive sexuality education has been banned in schools and abortion is illegal. However, in light of the huge burden of teen pregnancies, some Ugandan parents are demanding more effective sex education in schools and adolescent access to contraception. Ethiopia, Ghana, Kenya and Zambia have also reported jumps in teen pregnancy thanks to lockdowns. For example, a recent Kenyan study found that girls in Siaya County under the age of 17 who were under lockdown containment measures had double the risk of falling pregnancy and triple the risk of dropping out of school as those who were not under lockdown. Tackling the problem UNFPA is spearheading a four-year programme in 10 countries in east and southern Africa called 2gether 4SRHR, with the involvement of UNAIDS UNICEF and the World Health Organization (WHO). Supported by the Swedish International Development Cooperation Agency (SIDA), it aims to improve sexual and reproductive health (SRH) services in the region. “This includes scaling up client-centred, quality-assured, integrated and sustainable services in SRH, HIV and sexual and gender-based violence, and empowering young people to exercise their SRH rights,” according to UNFPA. “In many countries in the region, adolescent and young mothers have higher rates of unplanned pregnancies, lower uptake of antenatal and postnatal care, and those living with HIV have poorer adherence to treatment regimens and lower viral load suppression,” according to the UN agency. “Each week, nearly 3,500 adolescent girls and young women in eastern and southern Africa newly acquire HIV.” Teen mothers also tend to drop out of school and often never return. Peer educator Rebecca holding an HIV-prevention discussion with young mothers. No more pilots Unlike most other African countries, young South Africans are both able to terminate unwanted pregnancies before 20 weeks and get access to contraception – and neither require their parent’s consent. However, many teens shun clinics because of the judgemental treatment of healthworkers. For this reason, youth-friendly clinics have long been hailed as one of the solutions to teen pregnancies. However, Dr Thato Chidarikire, acting chief director of child, youth and school health at the South African health ministry, said lack of resources was a problem. “Not all primary health care facilities are providing youth-friendly services and have functional, dedicated clinic times for young people. There’s a high turnover of trained personnel and no dedicated resources to support the youth health-focused programmes,” she conceded. If you missed the Intergenerational Dialogue on #Unintendedpregnancies, here are some key take aways. 1⃣Need for quality Life Skills-based HIV/Health Education2⃣Parent involvement is key to prevent teen pregnancy3⃣Youth-friendly services should be accessible &available to all pic.twitter.com/AGzNSVCzTN — UNFPA Namibia (@UNFPA_Namibia) July 13, 2022 ‘Considerable evidence’ of what works The WHO’s Dr Venkatraman Chandra-Mouli said that there is considerable evidence of successful approaches to reducing adolescent pregnancy. “What we need are large-scale and sustained programmes. And happily, we now have experiences from a growing number of countries of such programmes,” he said. “All these programmes had five elements,” according to Chandra-Mouli from the sexual and reproductive health and research unit. “Firstly, they put scale-up on the national agenda. Secondly, they offered a multi-component intervention package, not just sexual and reproductive services or sexuality education. Thirdly, they put money on the table from internal sources and external sources and managed the scale-up. Fourthly, they built support for the programme and anticipated and addressed resistance when it occurred. And lastly, they worked strategically to ensure sustainability.” *not her real name. Image Credits: UNFPA Rwanda, UNFPA. Call for Women Health Workers to Share Experiences of Sexual Harassment and Violence 23/09/2022 Megha Kaveri Two women healthcare workers caring for an infant. A significant number of women health care workers are being driven from the professional because of sexual harassment, and Women in Global Health (WGH) collecting their testimonies. There are no laws against sexual harassment at workplace in over 50 countries, and WGH has called for a ‘change at all levels’ of the ecosystem. The organisation recently announced their research project, “HealthToo”, to document testimonies of sexual exploitation, abuse and harassment (SEAH) experienced by women health care workers across the globe. WGH will be accepting testimonies from women healthcare workers till 30 November, and intends to publish the data and findings by December. The intention of the project is to address the gap in the data of SEAH across the world and draw attention to the issue that has caused several women to leave the workforce. Women constitute around 70% of the global health care workforce and that the workforce is already short-staffed. Dr Ann Keeling, a senior fellow at WGH, said that the lack of comparable data and consistency in the terminology used prompted this project to take shape. “When you try and chart this, you can’t get any consistent picture and what isn’t visible in data is easy to ignore. So there is this very widespread denial about the extent of this among policymakers,” she told Health Policy Watch. “This is the time now to use women’s testimonies as data and get a platform out there where we can lock these stories, so that this will no longer be invisible.” The testimonies collected from women healthcare workers will be made public on the WGH website. “We are aiming to have a geographic representation of testimonies on the website,” said Dr Kalkidan Lakew, a policy associate at WGH. “We do not want to concentrate on a specific country but want to show that this happens everywhere – high income country, low income country, hospitals, organisations and NGOs,” she said. Pointing to the International Labour Organization (ILO)’s convention on violence and harassment, referred to as C190, the researchers said that the end goal is to get as many countries as possible to sign up to the convention. The convention, which has been ratified by 20 countries and is in force in eight, defines violence and harassment at the workplace and encourages countries to set up their own legislative framework to address SEAH at the workplace. “ILO’s C190 defines what harassment and violence is and recognises it as a human rights abuse. So, for the first time we actually have a framework that every country can sign up to,” Keeling explained, adding that a “change is needed at all levels of the ecosystem.” Image Credits: Photo by Mufid Majnun on Unsplash. Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Northern India Braces for Toxic Air Pollution Spikes as New Punjab Leaders Fail to Control Crop Stubble Fires 26/09/2022 Jyoti Pande Lavakare Aam Admi Party leaders Bhagwant Mann (centre), the Punjab chief minister, and Arvind Kejrwal (left), chief minister of Delhi. NEW DELHI – When India’s Aam Admi Party (AAP) won elections in the northern state of Punjab in March, decisively wresting power away from the Indian National Congress (INC) and defeating the nationalist Bharatiya Janata Party, clean air advocates and activists were optimistic that the burning of crop stubble by Punjab farmers – the biggest contributor to Delhi’s recurring autumn and winter air pollution spikes – would finally be tackled and a real solution found. There were two primary reasons for this optimism. First, of all Indian political parties, the AAP, which came into power in Delhi in 2013, was one of the earliest to acknowledge the health harm of air pollution and speak out most openly about the need to reduce this environmental toxin. It even experimented with implementing an odd-even road-sharing plan for vehicles in the high pollution season in early 2016. Even though this scheme failed to deliver – some research showed pollution actually increased during this period – the AAP succeeded in raising awareness about air pollution and making it a mainstream issue. But it was the second reason that gave activists cause for optimism this season. For years, the AAP has loudly, aggressively and publicly blamed the INC for the winter pollution peaks in Delhi and northern India, saying that the Congress-ruled Punjab government has been unable to control fires set by farmers to prepare their fields for winter sowing. Satellite image of northern India on 26 October 2020 shows the Delhi region with “very poor” to “severe” air quality, largely as a result of of crop burning in Punjab, whose capital is Chandigarh. Now that the AAP had taken control of Punjab with a sweeping majority, the party had all the power to stop farm fires – whose toxic drifts southward towards Delhi in early and mid-winter, setting off choking pollution crises in the city for more than a decade. But the AAP’s proposal that the central government, the Punjab state government and the Delhi state government jointly pay farmers a cash incentive of Rs 2500 per acre – not to burn crop residue appears to have already fallen through. The party has been unable to explain why – although it’s likley attributable to the deep political rivalries that exist between the centre-left AAP, now controlling Punjab state and Prime Minister Narendra Modi’s Hindu nationalist Bharatiya Janata Party (BJP), which controls the government today. Specific questions sent by Health Policy Watch to AAP leaders and spokespersons, including chairperson of the Delhi Assembly’s environment committee and legislative assembly member Atishi Marlena, were either ignored or given generic responses. One AAP spokesperson referred us back to a YouTube video of a speech made by the Punjab Chief Minister, Bhagwant Mann, in which Mann said that the state government has asked the central government for help in paying farmers the no-burn cash incentive. Punjab chief minister claims central government nixed farmer incentives Mann said the proposal calls for the central government to cover Rs 1500 of the cost of the no-burn incenteive, while the Punjab and Delhi state governments would each add Rs 500 per acre – in light of the huge health impacts the stubble burning has downwind – including in New Delhi, India’s capital city, and the greater Delhi metropolitan area, India’s second largest. “The central government has rejected our proposal,” Mann said, speaking in the video in Punjabi. “But doesn’t matter, even if the central government doesn’t help us, we will go ahead with our contributions and also ask every one of our officers to spread awareness (about the harms from burning) and inform farmers that they should not light fires,” he added. However, subsequently, Punjab Agriculture minister Kuldeep Singh Dhaliwal said the plan to give cash incentives to farmers not to burn crop stubble had been shelved in its entirety. “How can we pay when the centre is not giving?” the minister asked. Meanwhile, Mann said the Punjab government would also deploy 105,000 crop residue management machines in to grind the crop waste – another much touted alternative to waste burning. But it remained unclear if the Punjab government intended to buy the machines or merely encourage farmers to buy them via subsidies – and what timelines were being planned. And he said that the government would also incentivize farmers to make wider use of an innovative new chemical composting technique, known as the Pusa decomposer, an indigenous catalyst that converts rice stalks to valuable manure, and has been successfully tested by the Delhi State government over the past two years in its own non-basmati rice-growing farmlands. However, the stalks still take several weeks to decompose and it remains to be seen if farmers will perceive the value of the compost thus created as worth the wait. Early start of toxic air? Pollution in Delhi peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources With the harvest season beginning imminently, however, it is already getting late to take pre-emptive action – with some Punjabi farmers already beginning to set their fields on fire. Like every monsoon season, August and September have seen the cleanest air, and the lowest Air Quality Index (AQI) numbers, in north India in 2022, with rains clearing smoke and fine particulates that are the most hazardous to health, and would otherwise drift hundreds of kilometers towards Delhi. On Friday 16 September, for instance, the AQI in Delhi was 44, putting it squarely in the “good” category (AQI under 50), due to a long period of light rain – the first “good” air day since 18 October 2021, which was the only good air day in 2021. There were only five good air days in 2020, mainly because of the lockdown. But there wasn’t a single good air day in 2015, 2016 and 2018. This post-monsoon air is clean because it has been washed by rains – no political party or smog tower can claim credit for this although that hasn’t stopped politicians from trying. But as those who track air pollution know that this is the calm before the storm. It is a narrow window of time after which, rice paddy straw burning during the dry season that follows begins to push PM2.5 readings up to dangerous levels – made even more hazardous by fireworks from the Hindu Diwali festival, to be celebrated this year on 24 October. PM2.5 is the microscopic particulate matter that bypasses human defences to settle deep into the lungs. It is absorbed by the bloodstream and carried to every organ in the human body, fueling inflammation and a host of cardiovascular and respiratory diseases, among others. Often these can spike more than 250 times above the World Health Organization (WHO) limit of five micrograms per cubic metre on the day after Diwali. With the monsoon receding early, leaving a rainfall deficit of 35% in Delhi according to the India Meteorological Department, wind speeds dropping and some early signs of crop stubble burning, toxic air may make an early entry this year. Farmers already burning fields There is a very brief turn-around between the autumn rice harvest and the time when farmers need to sow wheat, making rice stalk burning attractive to farmers. According to the Punjab Remote Sensing Center, farmers have already begun lighting their fields. Last Tuesday the AQI immediately rose to 182, the highest since 25 June, when it was 230. Farm fires usually begin in Punjab’s Majha region and progress towards the Malwa region. Unless there is some miracle, Delhi and north India’s Gangetic plain are in for another toxic winter, as governments flounder without focus or specific plans to reduce the burning of agricultural waste, North India’s unique geography, topography and meteorology make controlling stubble burning critical to curbing air pollution. The geography of the Indo-Gangetic plain – with the great Himalayan range in the north acting as a physical barrier, preventing dirty air from dissipating quickly – traps pollution generated in the region for long periods. As the monsoons recede and the air becomes cooler and drier over the winter months, wind speeds also reduce. Seasonal temperature inversions – when lighter, warmer air rises and traps cooler, denser air – further confines pollution to the ground level, keeping atmospheric particulate concentration high. Air pollution in this region is bad year round – but during autumn and winter, these geographical and meteorological misfortunes combine with stubble-burning to create the perfect storm, turning India’s northern plains into one gigantic bowl of pollution that its residents are forced to breathe for months on end. Health costs of stubble burning Analysis of the proportions of a) people exposed and b) land area covered by air pollution at various levels, based on data extracted by Washington University, St. Louis USA. Stubble-burning is one of the major contributors to air pollution in South Asia. But the problem is particularly acute in north India due to the unique mix of crop cultivation patterns, the timing of harvests, and weather. In India’s Punjab and neighboring states, farmers burn their fields to quickly clear them of straw in the short window of time that they have between the end of rice-harvesting and the wheat-sowing period. These fires are so large that they can be seen from space. Until September, densely populated urban areas like Delhi experience mixed winds, including the moisture-laden easterlies and south-easterlies. But by early October, the winds change direction, blowing in from the northwest so if paddy fields are on fire at this time, smoke from the fires move directly towards the urban areas – and the 46 million people living in the greater Delhi region who inhale the smoke with every breath they take. According to some estimates, farmers reportedly produce almost 50 million tonnes of straw a year in the northern states of Haryana, Punjab, Rajasthan and Uttar Pradesh, burning about four-fifths of the waste. Punjab alone produces 20 million tonnes of paddy residue. Another, more conservative estimate of the International Wheat and Maize Improvement Center holds that farmers in North India burn around 23 million tonnes of straw from their rice harvests. But this is still huge; if the stalks were packed into 38-cm-high bales, and piled on top of each other, they would reach the moon. The air pollution cost due to stubble burning is estimated at $30 billion annually in terms of health and economic disruptions such as flight and train delays and car crashes, according to National Institute of Public Finance and Policy. Rural as well as urban populations experience the negative health impacts. An October 2021 study on the respiratory effects of crop stubble burning in the Patiala district of Punjab, undertaken by the Energy Resources Institute, found respiratory complaints and reduced lung function across all age groups – with the most reduced lung function in the lowest age groups whose developing bodies may be stunted by pollution for life. Exposure to stubble burning increased a person’s risk of lung cancer by 36%, the study also found, with more adverse health effects among women as compared to men. Stubble burning also harms soil fertility, destroying many nutrients. One report estimated the losses as follows: nitrogen (5.5kg), phosphorous (2.3 kg), potassium (25 kg) and sulphur (1.2 kg). The heat also kills beneficial bacteria and fungi, according to the report. Alternative uses for stubble For nearly a decade, Indian agricultural experts and air quality advocates have tried to promote alternative crop management practices including not only the incorporation of rice stubble into the soil through mechanical tilling or composting, but also other creative uses for the thick rigid stalks as inputs to: pulp and paper production; biofuel; soil-enriching biochar, or for production of cement and bricks. Ashwini Choubey, the national government’s Minister of State for Environment, Forest and Climate Change, told the Parliament in July that Punjab aimed to bring its 20 million tonnes of stubble burning down to zero by 2024 by switching to other crops (reduction of 5.22 million tonnes), in-situ management with composting and mulching in the fields itself (10.70 million) and managing the remainder ex-situ (4.66 million tonnes). However, a big part of this plan was the farmers’ subsidy to not burn crop waste, with the state governments of Delhi, Punjab and the central government sharing the cost of this subsidy in a 1:1:3 ratio. This came to nought with central government declining to share this cost, and later, the AAP itself deciding not to go ahead with this payout. The subsidy was to be supplemented with a two-pronged system of support for crop waste management alternatives – including use of the Pusa decomposer and mechanical waste shredders. Shredding stubble and seeding simultaneously In terms of mechanical methods, machines with names like the Happy Seeder and the Super Seeder have been marketed as devices that can be attached to conventional mechanized harvesters to shred crop residue while simultaneously seeding the winter wheat crop, eliminating the need for rice stalk burning. But while the government has widely promoted their use in the last few years, uptake has still been limited. A substantial increase in diesel fuel prices has proved to be an impediment for farmers’ uptake of the mechanical shredding technologies, as fuel-related costs account for 25% of the total operations costs. Farmers also remain wary about the Pusa decomposer – partly due to lack of awareness and partly because the benefits of the compost produced from the rice stalks is not yet perceived as a benefit that outweighs the cost of the time lost in the process of waiting for the residues to rot – even at an accelerated pace. Rice paddies are too water-intensive. Rice is the wrong crop- above and below ground The more fundamental crux of the problem is that India is growing the wrong crop, experts say. Rice is water-intensive and Punjab and Haryana, and to some extent UP and Rajasthan are short on water, including groundwater. But even so, in recent decades farmers have gradually switched over from the cultivation of traditional food crops like pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize to rice, due to the government subsidies made available for the latter. The irony is that the legumes are healthy sources of nutrition, including iron, for local communities in a country harbors one quarter of the world’s cases of anaemia – while much of the rice is now exported. The air pollution impacts of the changing crop plantation patterns are evident in a mapping of smoke emitted from different farm regions during the autumn, a Council for Energy, Environment and Water (CEEW) study observes. It found higher emissions of PM2.5 from crop stubble burning in the rice paddy-intensive districts of Punjab’s Ludhiana and Sangrur, as compared to other parts of the state, such as Hoshiarpur and Pathankot, where more traditional plants and legumes remain popular. Meanwhile, below ground, the rice cultivation had negative impacts on the stability of underground water aquifers, also vital for drinking water. To remedy that, a Punjab Preservation of Subsoil Water Act in 2009 ordered farmers to delay the start of the rice-planting season from April until June – ensuring that the first summer monsoon rains could adequately recharge groundwater reservoirs before rice cultivation began. This, however, delayed the rice harvest, and that had knock-on effects – shrinking the window of time farmers had to clear their fields between the rice harvest and wheat planting season. From that point in time, Delhi’s autumn air pollution emergencies became more and more acute, studies of trends over time show. More than two decades later, turning the clock back remains a formidable challenge for the new government of Punjab, critics say now. If the AAP is truly to commit itself to controlling pollution, it will have to take a more integrated approach. This means expanding the uptake of non-burn alternatives to crop stubble use, as well as striking at the roots of the problem – literally – by encouraging farmers to shift to more diverse crops, including early-maturing rice varieties such as those now being developed by the Punjab Agricultural University. That would allow farmers to plant and harvest their summer crops earlier, before monsoon rains stop and wind direction and speeds pick up. But that also means changing the regime of price supports so that farmers can still make a profit if they switch from water-guzzling rice paddies to high-nutrient millet and maize. Unfortunately, until those systemic issues are addressed, toxic air pollution is likely to darken Delhi’s skies once more this autumn and winter – at least for another year. Image Credits: @pawanpgupta, Flickr, Zubair Hussain/ Unsplash, urbanemissions.info, Jagamohan Senapati/ Unsplash. Air Pollution is Linked to Adverse Brain Development in Young Children 26/09/2022 Stefan Anderson Infants’ brains are negatively affected by air pollution, according to a study which has documented the effects of children’s exposure to air pollution from conception to the age of eight-and-a-half years for the first time. Tracking 3,515 children aged 9-12, the study found an association between exposure to air pollutants in the womb and their early years of life to alterations in white matter structural connectivity in the brain. “One of the important conclusions of this study is that the infant’s brain is particularly susceptible to the effects of air pollution not only during pregnancy, as has been shown in earlier studies, but also during childhood,” said Anne-Marie Binter, Barcelona Institute for Global Health (ISGlobal) researcher and first author of the study, which was published in the journal Environmental Pollution. White matter is what ensures interconnectivity between different areas of the brain, making up the tissue through which messages are passed from region to region within the central nervous system. Due to its role as a “neurological bridge”, abnormal development of white matter can play an outsized role in learning and brain functions, and has been linked with psychiatric disorders including anxiety, depressive symptoms and autism spectrum disorders. The study also found a link between specific exposure to fine particulate matter (PM2.5) and the volume of the putamen, a brain structure involved in motor function. Beyond its effects on children’s developmental health, PM2.5 is estimated to be responsible for about 4.2 million deaths annually according to researchers at McGill University. “A larger putamen has been associated with certain psychiatric disorders like schizophrenia, autism spectrum disorders, and obsessive-compulsive spectrum disorders,” said Binter. While previous studies have been directed at the question of the effects of air-pollutants on childhood brain development, none have been as granular in their methodology.cr “The novel aspect of the present study is that it identified periods of susceptibility to air pollution,” Binter explained. “We measured exposure using a finer time scale by analysing the data on a month-by-month basis, unlike previous studies in which data was analysed for trimesters of pregnancy or childhood years.” The study is the latest addition to an ever-growing mountain of evidence documenting the negative effects of air pollutants on human health. According to the World Health Organization (WHO), 99% of all people breathe air that exceeds WHO air quality limits, and threatens their health. Earlier this year, The Lancet estimated the overall death toll of “modern” air pollution sources to be nine million, making air pollution the world’s largest environmental risk factor for disease and premature death. “We should follow up and continue to measure the same parameters in this cohort to investigate the possible long-term effects on the brain of exposure to air pollution,” concludes Mònica Guxens, ISGlobal researcher and last author of the study. Image Credits: Vicente Zambrano González, Barcelona City Council. African Teen Pregnancies Skyrocketed During COVID Lockdowns – But Prevention is Possible 23/09/2022 Kerry Cullinan A teen mother in Karongi district in Rwanda. Seventeen-year-old South African Amanda Nkosi* is already a mother and living with HIV – thanks to what she describes as “doing things that teenagers do” without access to accurate health information or contraception. She discovered her HIV status recently when a youth-friendly clinic opened near her home in the coastal city of Durban and offered her a test when she went to get contraception. She liked the clinic as it provided her services without making her feel judged, and now helps to educate other teens about HIV and their bodies. South Africa has one of the highest rates of HIV in the world, and young women bear the brunt of this statistic. Meanwhile, the country’s battle against teen pregnancy was severely undermined by COVID-19 lockdowns and school closures – with spikes in teen pregnancies experienced throughout the continent during the pandemic lockdowns in 2020 and 2021. South Africa’s most populous province, Gauteng, reported a 60% jump in teen pregnancies between April 2020 and March 2021. More than 23,226 teenagers aged between the ages of 10 and 18 girls gave birth during this period compared to 14,577 girls in the same period a year earlier. Nkosi told her story at a webinar convened by Clinton Health Access Initiative (CHAI) and Health Systems Trust to discuss how to address teen pregnancy in South Africa. Describing most teenage pregnancies as “abuse”, CHAI country director Dr Yogan Pillay said that young people in southern Africa had a much higher chance of getting HIV and other sexually transmitted infections as well as mental health problems if they started having sex at an early age. “Children are also more likely to bear babies born premature, with a lower birth weight and higher neonatal mortality,” added Pillay, former deputy director general of the country’s health department. “Teenage mothers experience greater rates of postpartum depression and are less likely to initiate breastfeeding. Teenage mothers are less likely to complete high school, more likely to live in poverty and have children who frequently experience health and developmental problems,” he added. Pillay said that a systematic review of the predictors of teen pregnancies in sub-Saharan Africa found that the most common causes were sexual coercion, low or incorrect use of contraceptives, lack of parental communication and support , low socio-economic status and school dropout. Addressing these would assist to reduce prevent teen pregnancies, and support teen parents to avoid additional unwanted pregnancies. Surge in lockdown pregnancies Many African countries experienced a surge in teen pregnancies during COVID-19 lockdowns and school closures, and concerned health policymakers are struggling to implement effective strategies to curb teen pregnancies. According to Uganda’s 2016 Demographic and Health Survey, a quarter of girls aged 15-19 years had already experienced a pregnancy. However, teen pregnancies rose by 28% during the first COVID-19 lockdown in 2020, according to the Makerere University School of Public Health. In Uganda’s eastern Busoga sub-region, 45% of deliveries were girls under the age of 17, according to the health ministry. Overwhelmed parents or the lockdown … We track down the source of a growing teen pregnancy crisis that has health experts worried as to why more underage girls are having children #NTVNews LINK: https://t.co/1TgYlqf3iK pic.twitter.com/7dH8ahteFK — NTV UGANDA (@ntvuganda) October 3, 2021 The Ugandan government’s approach to combatting teen pregnancy has been to promote abstinence-based education in schools. Comprehensive sexuality education has been banned in schools and abortion is illegal. However, in light of the huge burden of teen pregnancies, some Ugandan parents are demanding more effective sex education in schools and adolescent access to contraception. Ethiopia, Ghana, Kenya and Zambia have also reported jumps in teen pregnancy thanks to lockdowns. For example, a recent Kenyan study found that girls in Siaya County under the age of 17 who were under lockdown containment measures had double the risk of falling pregnancy and triple the risk of dropping out of school as those who were not under lockdown. Tackling the problem UNFPA is spearheading a four-year programme in 10 countries in east and southern Africa called 2gether 4SRHR, with the involvement of UNAIDS UNICEF and the World Health Organization (WHO). Supported by the Swedish International Development Cooperation Agency (SIDA), it aims to improve sexual and reproductive health (SRH) services in the region. “This includes scaling up client-centred, quality-assured, integrated and sustainable services in SRH, HIV and sexual and gender-based violence, and empowering young people to exercise their SRH rights,” according to UNFPA. “In many countries in the region, adolescent and young mothers have higher rates of unplanned pregnancies, lower uptake of antenatal and postnatal care, and those living with HIV have poorer adherence to treatment regimens and lower viral load suppression,” according to the UN agency. “Each week, nearly 3,500 adolescent girls and young women in eastern and southern Africa newly acquire HIV.” Teen mothers also tend to drop out of school and often never return. Peer educator Rebecca holding an HIV-prevention discussion with young mothers. No more pilots Unlike most other African countries, young South Africans are both able to terminate unwanted pregnancies before 20 weeks and get access to contraception – and neither require their parent’s consent. However, many teens shun clinics because of the judgemental treatment of healthworkers. For this reason, youth-friendly clinics have long been hailed as one of the solutions to teen pregnancies. However, Dr Thato Chidarikire, acting chief director of child, youth and school health at the South African health ministry, said lack of resources was a problem. “Not all primary health care facilities are providing youth-friendly services and have functional, dedicated clinic times for young people. There’s a high turnover of trained personnel and no dedicated resources to support the youth health-focused programmes,” she conceded. If you missed the Intergenerational Dialogue on #Unintendedpregnancies, here are some key take aways. 1⃣Need for quality Life Skills-based HIV/Health Education2⃣Parent involvement is key to prevent teen pregnancy3⃣Youth-friendly services should be accessible &available to all pic.twitter.com/AGzNSVCzTN — UNFPA Namibia (@UNFPA_Namibia) July 13, 2022 ‘Considerable evidence’ of what works The WHO’s Dr Venkatraman Chandra-Mouli said that there is considerable evidence of successful approaches to reducing adolescent pregnancy. “What we need are large-scale and sustained programmes. And happily, we now have experiences from a growing number of countries of such programmes,” he said. “All these programmes had five elements,” according to Chandra-Mouli from the sexual and reproductive health and research unit. “Firstly, they put scale-up on the national agenda. Secondly, they offered a multi-component intervention package, not just sexual and reproductive services or sexuality education. Thirdly, they put money on the table from internal sources and external sources and managed the scale-up. Fourthly, they built support for the programme and anticipated and addressed resistance when it occurred. And lastly, they worked strategically to ensure sustainability.” *not her real name. Image Credits: UNFPA Rwanda, UNFPA. Call for Women Health Workers to Share Experiences of Sexual Harassment and Violence 23/09/2022 Megha Kaveri Two women healthcare workers caring for an infant. A significant number of women health care workers are being driven from the professional because of sexual harassment, and Women in Global Health (WGH) collecting their testimonies. There are no laws against sexual harassment at workplace in over 50 countries, and WGH has called for a ‘change at all levels’ of the ecosystem. The organisation recently announced their research project, “HealthToo”, to document testimonies of sexual exploitation, abuse and harassment (SEAH) experienced by women health care workers across the globe. WGH will be accepting testimonies from women healthcare workers till 30 November, and intends to publish the data and findings by December. The intention of the project is to address the gap in the data of SEAH across the world and draw attention to the issue that has caused several women to leave the workforce. Women constitute around 70% of the global health care workforce and that the workforce is already short-staffed. Dr Ann Keeling, a senior fellow at WGH, said that the lack of comparable data and consistency in the terminology used prompted this project to take shape. “When you try and chart this, you can’t get any consistent picture and what isn’t visible in data is easy to ignore. So there is this very widespread denial about the extent of this among policymakers,” she told Health Policy Watch. “This is the time now to use women’s testimonies as data and get a platform out there where we can lock these stories, so that this will no longer be invisible.” The testimonies collected from women healthcare workers will be made public on the WGH website. “We are aiming to have a geographic representation of testimonies on the website,” said Dr Kalkidan Lakew, a policy associate at WGH. “We do not want to concentrate on a specific country but want to show that this happens everywhere – high income country, low income country, hospitals, organisations and NGOs,” she said. Pointing to the International Labour Organization (ILO)’s convention on violence and harassment, referred to as C190, the researchers said that the end goal is to get as many countries as possible to sign up to the convention. The convention, which has been ratified by 20 countries and is in force in eight, defines violence and harassment at the workplace and encourages countries to set up their own legislative framework to address SEAH at the workplace. “ILO’s C190 defines what harassment and violence is and recognises it as a human rights abuse. So, for the first time we actually have a framework that every country can sign up to,” Keeling explained, adding that a “change is needed at all levels of the ecosystem.” Image Credits: Photo by Mufid Majnun on Unsplash. Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Air Pollution is Linked to Adverse Brain Development in Young Children 26/09/2022 Stefan Anderson Infants’ brains are negatively affected by air pollution, according to a study which has documented the effects of children’s exposure to air pollution from conception to the age of eight-and-a-half years for the first time. Tracking 3,515 children aged 9-12, the study found an association between exposure to air pollutants in the womb and their early years of life to alterations in white matter structural connectivity in the brain. “One of the important conclusions of this study is that the infant’s brain is particularly susceptible to the effects of air pollution not only during pregnancy, as has been shown in earlier studies, but also during childhood,” said Anne-Marie Binter, Barcelona Institute for Global Health (ISGlobal) researcher and first author of the study, which was published in the journal Environmental Pollution. White matter is what ensures interconnectivity between different areas of the brain, making up the tissue through which messages are passed from region to region within the central nervous system. Due to its role as a “neurological bridge”, abnormal development of white matter can play an outsized role in learning and brain functions, and has been linked with psychiatric disorders including anxiety, depressive symptoms and autism spectrum disorders. The study also found a link between specific exposure to fine particulate matter (PM2.5) and the volume of the putamen, a brain structure involved in motor function. Beyond its effects on children’s developmental health, PM2.5 is estimated to be responsible for about 4.2 million deaths annually according to researchers at McGill University. “A larger putamen has been associated with certain psychiatric disorders like schizophrenia, autism spectrum disorders, and obsessive-compulsive spectrum disorders,” said Binter. While previous studies have been directed at the question of the effects of air-pollutants on childhood brain development, none have been as granular in their methodology.cr “The novel aspect of the present study is that it identified periods of susceptibility to air pollution,” Binter explained. “We measured exposure using a finer time scale by analysing the data on a month-by-month basis, unlike previous studies in which data was analysed for trimesters of pregnancy or childhood years.” The study is the latest addition to an ever-growing mountain of evidence documenting the negative effects of air pollutants on human health. According to the World Health Organization (WHO), 99% of all people breathe air that exceeds WHO air quality limits, and threatens their health. Earlier this year, The Lancet estimated the overall death toll of “modern” air pollution sources to be nine million, making air pollution the world’s largest environmental risk factor for disease and premature death. “We should follow up and continue to measure the same parameters in this cohort to investigate the possible long-term effects on the brain of exposure to air pollution,” concludes Mònica Guxens, ISGlobal researcher and last author of the study. Image Credits: Vicente Zambrano González, Barcelona City Council. African Teen Pregnancies Skyrocketed During COVID Lockdowns – But Prevention is Possible 23/09/2022 Kerry Cullinan A teen mother in Karongi district in Rwanda. Seventeen-year-old South African Amanda Nkosi* is already a mother and living with HIV – thanks to what she describes as “doing things that teenagers do” without access to accurate health information or contraception. She discovered her HIV status recently when a youth-friendly clinic opened near her home in the coastal city of Durban and offered her a test when she went to get contraception. She liked the clinic as it provided her services without making her feel judged, and now helps to educate other teens about HIV and their bodies. South Africa has one of the highest rates of HIV in the world, and young women bear the brunt of this statistic. Meanwhile, the country’s battle against teen pregnancy was severely undermined by COVID-19 lockdowns and school closures – with spikes in teen pregnancies experienced throughout the continent during the pandemic lockdowns in 2020 and 2021. South Africa’s most populous province, Gauteng, reported a 60% jump in teen pregnancies between April 2020 and March 2021. More than 23,226 teenagers aged between the ages of 10 and 18 girls gave birth during this period compared to 14,577 girls in the same period a year earlier. Nkosi told her story at a webinar convened by Clinton Health Access Initiative (CHAI) and Health Systems Trust to discuss how to address teen pregnancy in South Africa. Describing most teenage pregnancies as “abuse”, CHAI country director Dr Yogan Pillay said that young people in southern Africa had a much higher chance of getting HIV and other sexually transmitted infections as well as mental health problems if they started having sex at an early age. “Children are also more likely to bear babies born premature, with a lower birth weight and higher neonatal mortality,” added Pillay, former deputy director general of the country’s health department. “Teenage mothers experience greater rates of postpartum depression and are less likely to initiate breastfeeding. Teenage mothers are less likely to complete high school, more likely to live in poverty and have children who frequently experience health and developmental problems,” he added. Pillay said that a systematic review of the predictors of teen pregnancies in sub-Saharan Africa found that the most common causes were sexual coercion, low or incorrect use of contraceptives, lack of parental communication and support , low socio-economic status and school dropout. Addressing these would assist to reduce prevent teen pregnancies, and support teen parents to avoid additional unwanted pregnancies. Surge in lockdown pregnancies Many African countries experienced a surge in teen pregnancies during COVID-19 lockdowns and school closures, and concerned health policymakers are struggling to implement effective strategies to curb teen pregnancies. According to Uganda’s 2016 Demographic and Health Survey, a quarter of girls aged 15-19 years had already experienced a pregnancy. However, teen pregnancies rose by 28% during the first COVID-19 lockdown in 2020, according to the Makerere University School of Public Health. In Uganda’s eastern Busoga sub-region, 45% of deliveries were girls under the age of 17, according to the health ministry. Overwhelmed parents or the lockdown … We track down the source of a growing teen pregnancy crisis that has health experts worried as to why more underage girls are having children #NTVNews LINK: https://t.co/1TgYlqf3iK pic.twitter.com/7dH8ahteFK — NTV UGANDA (@ntvuganda) October 3, 2021 The Ugandan government’s approach to combatting teen pregnancy has been to promote abstinence-based education in schools. Comprehensive sexuality education has been banned in schools and abortion is illegal. However, in light of the huge burden of teen pregnancies, some Ugandan parents are demanding more effective sex education in schools and adolescent access to contraception. Ethiopia, Ghana, Kenya and Zambia have also reported jumps in teen pregnancy thanks to lockdowns. For example, a recent Kenyan study found that girls in Siaya County under the age of 17 who were under lockdown containment measures had double the risk of falling pregnancy and triple the risk of dropping out of school as those who were not under lockdown. Tackling the problem UNFPA is spearheading a four-year programme in 10 countries in east and southern Africa called 2gether 4SRHR, with the involvement of UNAIDS UNICEF and the World Health Organization (WHO). Supported by the Swedish International Development Cooperation Agency (SIDA), it aims to improve sexual and reproductive health (SRH) services in the region. “This includes scaling up client-centred, quality-assured, integrated and sustainable services in SRH, HIV and sexual and gender-based violence, and empowering young people to exercise their SRH rights,” according to UNFPA. “In many countries in the region, adolescent and young mothers have higher rates of unplanned pregnancies, lower uptake of antenatal and postnatal care, and those living with HIV have poorer adherence to treatment regimens and lower viral load suppression,” according to the UN agency. “Each week, nearly 3,500 adolescent girls and young women in eastern and southern Africa newly acquire HIV.” Teen mothers also tend to drop out of school and often never return. Peer educator Rebecca holding an HIV-prevention discussion with young mothers. No more pilots Unlike most other African countries, young South Africans are both able to terminate unwanted pregnancies before 20 weeks and get access to contraception – and neither require their parent’s consent. However, many teens shun clinics because of the judgemental treatment of healthworkers. For this reason, youth-friendly clinics have long been hailed as one of the solutions to teen pregnancies. However, Dr Thato Chidarikire, acting chief director of child, youth and school health at the South African health ministry, said lack of resources was a problem. “Not all primary health care facilities are providing youth-friendly services and have functional, dedicated clinic times for young people. There’s a high turnover of trained personnel and no dedicated resources to support the youth health-focused programmes,” she conceded. If you missed the Intergenerational Dialogue on #Unintendedpregnancies, here are some key take aways. 1⃣Need for quality Life Skills-based HIV/Health Education2⃣Parent involvement is key to prevent teen pregnancy3⃣Youth-friendly services should be accessible &available to all pic.twitter.com/AGzNSVCzTN — UNFPA Namibia (@UNFPA_Namibia) July 13, 2022 ‘Considerable evidence’ of what works The WHO’s Dr Venkatraman Chandra-Mouli said that there is considerable evidence of successful approaches to reducing adolescent pregnancy. “What we need are large-scale and sustained programmes. And happily, we now have experiences from a growing number of countries of such programmes,” he said. “All these programmes had five elements,” according to Chandra-Mouli from the sexual and reproductive health and research unit. “Firstly, they put scale-up on the national agenda. Secondly, they offered a multi-component intervention package, not just sexual and reproductive services or sexuality education. Thirdly, they put money on the table from internal sources and external sources and managed the scale-up. Fourthly, they built support for the programme and anticipated and addressed resistance when it occurred. And lastly, they worked strategically to ensure sustainability.” *not her real name. Image Credits: UNFPA Rwanda, UNFPA. Call for Women Health Workers to Share Experiences of Sexual Harassment and Violence 23/09/2022 Megha Kaveri Two women healthcare workers caring for an infant. A significant number of women health care workers are being driven from the professional because of sexual harassment, and Women in Global Health (WGH) collecting their testimonies. There are no laws against sexual harassment at workplace in over 50 countries, and WGH has called for a ‘change at all levels’ of the ecosystem. The organisation recently announced their research project, “HealthToo”, to document testimonies of sexual exploitation, abuse and harassment (SEAH) experienced by women health care workers across the globe. WGH will be accepting testimonies from women healthcare workers till 30 November, and intends to publish the data and findings by December. The intention of the project is to address the gap in the data of SEAH across the world and draw attention to the issue that has caused several women to leave the workforce. Women constitute around 70% of the global health care workforce and that the workforce is already short-staffed. Dr Ann Keeling, a senior fellow at WGH, said that the lack of comparable data and consistency in the terminology used prompted this project to take shape. “When you try and chart this, you can’t get any consistent picture and what isn’t visible in data is easy to ignore. So there is this very widespread denial about the extent of this among policymakers,” she told Health Policy Watch. “This is the time now to use women’s testimonies as data and get a platform out there where we can lock these stories, so that this will no longer be invisible.” The testimonies collected from women healthcare workers will be made public on the WGH website. “We are aiming to have a geographic representation of testimonies on the website,” said Dr Kalkidan Lakew, a policy associate at WGH. “We do not want to concentrate on a specific country but want to show that this happens everywhere – high income country, low income country, hospitals, organisations and NGOs,” she said. Pointing to the International Labour Organization (ILO)’s convention on violence and harassment, referred to as C190, the researchers said that the end goal is to get as many countries as possible to sign up to the convention. The convention, which has been ratified by 20 countries and is in force in eight, defines violence and harassment at the workplace and encourages countries to set up their own legislative framework to address SEAH at the workplace. “ILO’s C190 defines what harassment and violence is and recognises it as a human rights abuse. So, for the first time we actually have a framework that every country can sign up to,” Keeling explained, adding that a “change is needed at all levels of the ecosystem.” Image Credits: Photo by Mufid Majnun on Unsplash. Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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African Teen Pregnancies Skyrocketed During COVID Lockdowns – But Prevention is Possible 23/09/2022 Kerry Cullinan A teen mother in Karongi district in Rwanda. Seventeen-year-old South African Amanda Nkosi* is already a mother and living with HIV – thanks to what she describes as “doing things that teenagers do” without access to accurate health information or contraception. She discovered her HIV status recently when a youth-friendly clinic opened near her home in the coastal city of Durban and offered her a test when she went to get contraception. She liked the clinic as it provided her services without making her feel judged, and now helps to educate other teens about HIV and their bodies. South Africa has one of the highest rates of HIV in the world, and young women bear the brunt of this statistic. Meanwhile, the country’s battle against teen pregnancy was severely undermined by COVID-19 lockdowns and school closures – with spikes in teen pregnancies experienced throughout the continent during the pandemic lockdowns in 2020 and 2021. South Africa’s most populous province, Gauteng, reported a 60% jump in teen pregnancies between April 2020 and March 2021. More than 23,226 teenagers aged between the ages of 10 and 18 girls gave birth during this period compared to 14,577 girls in the same period a year earlier. Nkosi told her story at a webinar convened by Clinton Health Access Initiative (CHAI) and Health Systems Trust to discuss how to address teen pregnancy in South Africa. Describing most teenage pregnancies as “abuse”, CHAI country director Dr Yogan Pillay said that young people in southern Africa had a much higher chance of getting HIV and other sexually transmitted infections as well as mental health problems if they started having sex at an early age. “Children are also more likely to bear babies born premature, with a lower birth weight and higher neonatal mortality,” added Pillay, former deputy director general of the country’s health department. “Teenage mothers experience greater rates of postpartum depression and are less likely to initiate breastfeeding. Teenage mothers are less likely to complete high school, more likely to live in poverty and have children who frequently experience health and developmental problems,” he added. Pillay said that a systematic review of the predictors of teen pregnancies in sub-Saharan Africa found that the most common causes were sexual coercion, low or incorrect use of contraceptives, lack of parental communication and support , low socio-economic status and school dropout. Addressing these would assist to reduce prevent teen pregnancies, and support teen parents to avoid additional unwanted pregnancies. Surge in lockdown pregnancies Many African countries experienced a surge in teen pregnancies during COVID-19 lockdowns and school closures, and concerned health policymakers are struggling to implement effective strategies to curb teen pregnancies. According to Uganda’s 2016 Demographic and Health Survey, a quarter of girls aged 15-19 years had already experienced a pregnancy. However, teen pregnancies rose by 28% during the first COVID-19 lockdown in 2020, according to the Makerere University School of Public Health. In Uganda’s eastern Busoga sub-region, 45% of deliveries were girls under the age of 17, according to the health ministry. Overwhelmed parents or the lockdown … We track down the source of a growing teen pregnancy crisis that has health experts worried as to why more underage girls are having children #NTVNews LINK: https://t.co/1TgYlqf3iK pic.twitter.com/7dH8ahteFK — NTV UGANDA (@ntvuganda) October 3, 2021 The Ugandan government’s approach to combatting teen pregnancy has been to promote abstinence-based education in schools. Comprehensive sexuality education has been banned in schools and abortion is illegal. However, in light of the huge burden of teen pregnancies, some Ugandan parents are demanding more effective sex education in schools and adolescent access to contraception. Ethiopia, Ghana, Kenya and Zambia have also reported jumps in teen pregnancy thanks to lockdowns. For example, a recent Kenyan study found that girls in Siaya County under the age of 17 who were under lockdown containment measures had double the risk of falling pregnancy and triple the risk of dropping out of school as those who were not under lockdown. Tackling the problem UNFPA is spearheading a four-year programme in 10 countries in east and southern Africa called 2gether 4SRHR, with the involvement of UNAIDS UNICEF and the World Health Organization (WHO). Supported by the Swedish International Development Cooperation Agency (SIDA), it aims to improve sexual and reproductive health (SRH) services in the region. “This includes scaling up client-centred, quality-assured, integrated and sustainable services in SRH, HIV and sexual and gender-based violence, and empowering young people to exercise their SRH rights,” according to UNFPA. “In many countries in the region, adolescent and young mothers have higher rates of unplanned pregnancies, lower uptake of antenatal and postnatal care, and those living with HIV have poorer adherence to treatment regimens and lower viral load suppression,” according to the UN agency. “Each week, nearly 3,500 adolescent girls and young women in eastern and southern Africa newly acquire HIV.” Teen mothers also tend to drop out of school and often never return. Peer educator Rebecca holding an HIV-prevention discussion with young mothers. No more pilots Unlike most other African countries, young South Africans are both able to terminate unwanted pregnancies before 20 weeks and get access to contraception – and neither require their parent’s consent. However, many teens shun clinics because of the judgemental treatment of healthworkers. For this reason, youth-friendly clinics have long been hailed as one of the solutions to teen pregnancies. However, Dr Thato Chidarikire, acting chief director of child, youth and school health at the South African health ministry, said lack of resources was a problem. “Not all primary health care facilities are providing youth-friendly services and have functional, dedicated clinic times for young people. There’s a high turnover of trained personnel and no dedicated resources to support the youth health-focused programmes,” she conceded. If you missed the Intergenerational Dialogue on #Unintendedpregnancies, here are some key take aways. 1⃣Need for quality Life Skills-based HIV/Health Education2⃣Parent involvement is key to prevent teen pregnancy3⃣Youth-friendly services should be accessible &available to all pic.twitter.com/AGzNSVCzTN — UNFPA Namibia (@UNFPA_Namibia) July 13, 2022 ‘Considerable evidence’ of what works The WHO’s Dr Venkatraman Chandra-Mouli said that there is considerable evidence of successful approaches to reducing adolescent pregnancy. “What we need are large-scale and sustained programmes. And happily, we now have experiences from a growing number of countries of such programmes,” he said. “All these programmes had five elements,” according to Chandra-Mouli from the sexual and reproductive health and research unit. “Firstly, they put scale-up on the national agenda. Secondly, they offered a multi-component intervention package, not just sexual and reproductive services or sexuality education. Thirdly, they put money on the table from internal sources and external sources and managed the scale-up. Fourthly, they built support for the programme and anticipated and addressed resistance when it occurred. And lastly, they worked strategically to ensure sustainability.” *not her real name. Image Credits: UNFPA Rwanda, UNFPA. Call for Women Health Workers to Share Experiences of Sexual Harassment and Violence 23/09/2022 Megha Kaveri Two women healthcare workers caring for an infant. A significant number of women health care workers are being driven from the professional because of sexual harassment, and Women in Global Health (WGH) collecting their testimonies. There are no laws against sexual harassment at workplace in over 50 countries, and WGH has called for a ‘change at all levels’ of the ecosystem. The organisation recently announced their research project, “HealthToo”, to document testimonies of sexual exploitation, abuse and harassment (SEAH) experienced by women health care workers across the globe. WGH will be accepting testimonies from women healthcare workers till 30 November, and intends to publish the data and findings by December. The intention of the project is to address the gap in the data of SEAH across the world and draw attention to the issue that has caused several women to leave the workforce. Women constitute around 70% of the global health care workforce and that the workforce is already short-staffed. Dr Ann Keeling, a senior fellow at WGH, said that the lack of comparable data and consistency in the terminology used prompted this project to take shape. “When you try and chart this, you can’t get any consistent picture and what isn’t visible in data is easy to ignore. So there is this very widespread denial about the extent of this among policymakers,” she told Health Policy Watch. “This is the time now to use women’s testimonies as data and get a platform out there where we can lock these stories, so that this will no longer be invisible.” The testimonies collected from women healthcare workers will be made public on the WGH website. “We are aiming to have a geographic representation of testimonies on the website,” said Dr Kalkidan Lakew, a policy associate at WGH. “We do not want to concentrate on a specific country but want to show that this happens everywhere – high income country, low income country, hospitals, organisations and NGOs,” she said. Pointing to the International Labour Organization (ILO)’s convention on violence and harassment, referred to as C190, the researchers said that the end goal is to get as many countries as possible to sign up to the convention. The convention, which has been ratified by 20 countries and is in force in eight, defines violence and harassment at the workplace and encourages countries to set up their own legislative framework to address SEAH at the workplace. “ILO’s C190 defines what harassment and violence is and recognises it as a human rights abuse. So, for the first time we actually have a framework that every country can sign up to,” Keeling explained, adding that a “change is needed at all levels of the ecosystem.” Image Credits: Photo by Mufid Majnun on Unsplash. Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Call for Women Health Workers to Share Experiences of Sexual Harassment and Violence 23/09/2022 Megha Kaveri Two women healthcare workers caring for an infant. A significant number of women health care workers are being driven from the professional because of sexual harassment, and Women in Global Health (WGH) collecting their testimonies. There are no laws against sexual harassment at workplace in over 50 countries, and WGH has called for a ‘change at all levels’ of the ecosystem. The organisation recently announced their research project, “HealthToo”, to document testimonies of sexual exploitation, abuse and harassment (SEAH) experienced by women health care workers across the globe. WGH will be accepting testimonies from women healthcare workers till 30 November, and intends to publish the data and findings by December. The intention of the project is to address the gap in the data of SEAH across the world and draw attention to the issue that has caused several women to leave the workforce. Women constitute around 70% of the global health care workforce and that the workforce is already short-staffed. Dr Ann Keeling, a senior fellow at WGH, said that the lack of comparable data and consistency in the terminology used prompted this project to take shape. “When you try and chart this, you can’t get any consistent picture and what isn’t visible in data is easy to ignore. So there is this very widespread denial about the extent of this among policymakers,” she told Health Policy Watch. “This is the time now to use women’s testimonies as data and get a platform out there where we can lock these stories, so that this will no longer be invisible.” The testimonies collected from women healthcare workers will be made public on the WGH website. “We are aiming to have a geographic representation of testimonies on the website,” said Dr Kalkidan Lakew, a policy associate at WGH. “We do not want to concentrate on a specific country but want to show that this happens everywhere – high income country, low income country, hospitals, organisations and NGOs,” she said. Pointing to the International Labour Organization (ILO)’s convention on violence and harassment, referred to as C190, the researchers said that the end goal is to get as many countries as possible to sign up to the convention. The convention, which has been ratified by 20 countries and is in force in eight, defines violence and harassment at the workplace and encourages countries to set up their own legislative framework to address SEAH at the workplace. “ILO’s C190 defines what harassment and violence is and recognises it as a human rights abuse. So, for the first time we actually have a framework that every country can sign up to,” Keeling explained, adding that a “change is needed at all levels of the ecosystem.” Image Credits: Photo by Mufid Majnun on Unsplash. Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” Posts navigation Older postsNewer posts