An African farmer collects leaves from a gourd plant – smallholders are critical to food security and nutritional diversity – and marginalized by global food systems.

Between 702 million and 828 million people suffered from hunger in 2021, more than at any time since 2005, five UN agencies reported on Wednesday.

The proportion of people affected by hunger had remained relatively unchanged since 2015, affecting 8% of the global population in 2019.

Once the COVID-19 pandemic hit in early 2020, those numbers soared to 9.3% in 2020 and to 9.89% in 2021, according to the State of Food Security and Nutrition in the World 2022 report published by the Food and Agriculture Organization (FAO), World Health Organization (WHO), UNICEF, World Food Programme (WFP) and International Fund for Agricultural Development (IFAD). 

That represents an increase of about 46 million people since 2020 and 150 million people since the outbreak of the pandemic.

At current rates, 8% of the global population will still face hunger in 2030, unchanged from when the UN’s 2030 Agenda for Sustainable Development launched. 

Among the key goals of that ambitious plan, adopted at the UN Sustainable Development Summit in September 2015, was a determination “to end poverty and hunger, in all their forms and dimensions, and to ensure that all human beings can fulfil their potential in dignity and equality and in a healthy environment.”

Progress on hunger stalled: Numbers of people who are going hungry today is about the same, or even more, than in 2005.
Botswana’s Collen Vixen Kelapile, President of the United Nations Economic and Social Council (ECOSOC)

Almost 3.1 billion people couldn’t afford a healthy diet in 2020, the report says. Massive food subsidies behind the production and consumption of milk, rice, sugar and meat also are disincentivizing production and consumption of healthy fruits, vegetables and protein-rich legumes, the report finds.

Critically, the report calls upon a restructuring of global and national food subsidies to encourage more consumption of healthier foods including fruits and vegetables – which would also reduce carbon emissions from agricultural production of livestock and products that contribute to climate change.  

“Transformed agro-food systems need to be part of the solution to climate change and biodiversity loss … our very existence depends on it. Hundreds of millions of hungry and malnourished fellow human beings depend on it,” said Botswana’s Collen Vixen Kelapile, president of the UN Economic and Social Council (ECOSOC), which hosted the report’s launch in New York City.

‘Starvation and mass migration on an ‘unprecedented’ scale

Trends in hunger by region

WFP’s Executive Director David Beasley noted the world already faced “a perfect storm from the combined effects of conflicts and climate change and COVID economic ripple effects and global inflation” as this year was getting started.

David Beasley, WFP executive director

“And just when you think it can’t get any worse,” he said, “because we had Ethiopia and Afghanistan, then boom, Ukraine happens, the breadbasket of the world. The impact this conflict is having on global food security means the number of chronically hungry people in the world is likely already much higher than the 828 million people outlined in this work.”

Beasley said the latest analysis shows a record 345 million acutely hungry people are marching to the brink of starvation today, a huge increase 276 million at the start of 2022 and from 135 million in the pre-COVID era.

“There’s a real danger it will climb even higher in the months ahead,” he warned.

“The global price spikes in food, fuel and fertilizers that we are seeing as a result of the crisis in Ukraine threaten to push countries around the world,” Beasley said. “The result will be global destabilization – to starvation and mass migration on an unprecedented scale. We have to act, and we have to act today to avert this looming catastrophe.”

Africa hardest hit by hunger – women suffer more than men 

Laotian children get a fresh and healthy meal; WHO has urged policymakers to prioritize the introduction of healthier foods at schools.

The prevalence of hunger, childhood wasting and stunting is highest in Africa, with a substantial burden in Asia, Latin America and the Caribbean (LAC), the report says. 

Hunger affected 278 million people in Africa; 425 million people in Asia; and 56.5 million people in LAC in 2021. Women are more likely to go hungry across the developing world, the report stresses. 

Globally, 149.2 million children under the age of 5, or 22% of the total population, suffered from stunting, and 6.7% suffered from wasting. Both are nutrition indicators of low height and weight in proportion to age. 

Another 38.9 million children under the age of five, or 5.7% of babies and toddlers globally, are overweight, reflecting a rise in unhealthy diets.

Healthy diets became even more unaffordable in 2021.

Almost 3.1 billion people could not afford a healthy diet in 2020, up by 112 million people from 2019, reflecting what the report describes as the effects of inflation in consumer food prices stemming from the economic impacts of the pandemic and the measures put in place to contain it.

The poor in Asia, Africa and Latin America are also among those least able to afford a healthy diet, with Asia seeing the highest surge in costs – 4% in just one year. 

Political solution to Ukraine among the most immediate measures 

The global food crisis is being exacerbated by Russia’s blockage of exports from Ukraine, the world’s breadbasket.

An end to the Russian blockade of Ukrainian ports is an important first step in addressing the crisis but only the beginning, Beasley said, listing the top priorities as follows: 

“Firstly we urgently need a political solution to Ukrainian wheat and grain so they can re-enter global markets.. Open up the ports.. Let’s get it moving. 

“Number 2, humanitarian organizations need substantial new funding to deal with the skyrocketing levels of hunger that we’re seeing around the world. 

“Thirdly, governments have to resist protectionism and keep trade flowing across borders. And fourthly, we need to learn the lessons of this crisis and invest in resilience programmes to help the poorest communities protect themselves against hunger and against shocks. 

“If we had successfully threaded this needle in the past, the war in Ukraine wouldn’t be having such a disastrous global impact today.” 

Rewriting the rules on agricultural and food subsidies to promote healthier foods

Shifting food and agriculture subsidies to production and consumption of healthier foods would both reduce climate emissions and average costs of a healthy diet. But some farmers  invested in unhealthy foods production could lose out.

Fundamentally, the report calls for a major restructuring of deeply embedded global and national subsidies that are currently driving a significant portion of agricultural production – and unhealthy consumption of meat, sugar and basic commodities such as rice – at the expense of other healthier and lower-carbon intensive alternatives.  

FAO chief economist Máximo Torero Cullen said overall support for agricultural production largely concentrates on staple foods such as dairy and other animal source protein-rich foods, especially in high and upper middle income countries.

“Rice, sugar and meat of various types are the foods most incentivized worldwide, while producers of fruits and vegetables are less supported overall, and even penalized in some low-income countries,” he said. “This needs to change. We are doing the opposite of what we are talking about. We need to change abruptly what is happening.”

FAO chief economist Máximo Torero Cullen.

The new report offers scenarios through 2030 in which public support to all farmers is reallocated around priority foods needed for healthy diets.

FAO says adjusting price incentives will also reduce the cost of nutritious foods, which can healthy diets more affordable.

That would also lower greenhouse gas emissions, particularly with livestock production, which has a high carbon pricetag.

Shifting certain kinds of subsidies could, however, also create negative impacts on some farmers – who would then need new kinds of support, he pointed out. 

Needed: new flexibilities in national and WTO subsidy rules  

Cullen said understanding the tradeoffs are key to mapping out the future, and come further into play with the World Trade Organization.

“We need commitments and flexibilities, and we need to follow what we have agreed with the WTO rules,” he said. “It may be necessary to set up new fiscal subsidies to consumers or to use proper social protection systems. International development finance will be needed for low-income countries and upper lower middle income countries, given that they have smaller amount of mechanisms.”  

Agricultural subsidies rules, however, tend to penalize small farmers in low-income countries, delegates from Latin America, Africa and Asia told the ECOSOC meeting.

Pakistan’s UN representative Munir Akram

“Massive subsidies distort global markets and make it impossible for farmers from developing countries to produce food at competitive prices,” said Pakistan’s UN representative Munir Akram. 

Gilbert Houngbo, president of IFAD, said the report highlights ways to repurpose agricultural and food policies to support small-scale producers and to build their resilience.

Gilbert F. Houngbo, president of IFAD

“Policies on subsidies often fall short of reducing hunger or improving food security and inclusion,” he said. “Instead, they have promoted an overreliance on starches, sugars, high protein and processed foods, while not supporting the production of healthier fruits and vegetables, for example.”

 

Image Credits: @veerajayanth03, The Future of Food , State of Food Security and Nutrition 2022, FAO, Flickr: Bart Verweij / World Bank, Joseph C. Okechukwu/Twitter .

COVAX, the best-known part of the ACT-Accelerator, has delivered over a billion vaccines globally.

Organizers say they have no plans to “sunset” the support they offer countries through the Access to COVID-19 Tools (ACT) Accelerator, the global partnership to facilitate equitable access to COVID-19 tests, treatments, and vaccines.

The ACT-A, however, will undergo a “transition” when its strategic plan and budget ends in September, according to the World Health Organization’s (WHO) Dr Bruce Aylward, who represents the global body at the ACT-A.

Its COVID-19 response will likely be incorporated into the usual work of key ACT-A partners, including Gavi, the global vaccine alliance, which is a co-leader of COVAX, the vaccine arm of the ACT-A.

COVAX also is co-led by WHO and the Coalition for Epidemic Preparedness Innovations (CEPI), alongside key delivery partner UNICEF.

Dr Bruce Aylward

Aylward told a media briefing on Wednesday that ACT-A’s work to enhance equitable access to COVID-19 tools will continue, since the pandemic hasn’t ended.

“As countries are moving from managing COVID-19 as an acute emergency to integration into longer-term disease control programmes, the ACT-Accelerator partnership is adjusting its ways of working,” he said.

A Gavi spokesperson told Health Policy Watch that COVAX partners and other ACT-Accelerator organizations, mindful of the need to prepare the global health response for future pandemics, “are looking at how to transition temporary emergency response structures into an integrated approach that builds COVID-19 and pandemic preparedness and response capacity into existing global health architecture”.

Though WHO hasn’t changed its designation of COVID-19 as a pandemic, Dr Mike Ryan, WHO’s head of health emergencies, described it as more of “a series of national epidemics” and stressed that the real work needed to take place at the national level.

Globally, COVID-19 cases have increased by at least 30%, driven by variants BA.4 and BA.5 in Europe and the US, while a new sub-lineage of BA.2.75 is rising in India, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the briefing.

ACT-A transition plan

Aylward indicated there is little appetite among ACT-A partners to develop another strategic plan.

Therefore the focus is on a “transition plan,” he said, to “make sure that this extraordinary collaboration that we’ve put together can continue to operate but in a mode and in a manner that allows us to make sure the core business of the [partner] organisations also gets attention”.

The pandemic’s strain on nations’ resources, financial markets and global supply chains have caused setbacks in key global health programmes, particularly childhood vaccinations and tuberculosis diagnosis and care.

“The ACT-A agencies will not sunset their support to the countries that rely on them for equitable access to these tools,” stressed Aylward. “What we will do is make sure that we work efficiently and effectively to deliver right across our mandates in the longer term.”

At the ACT-A’s Council Meeting, also held on Wednesday, some countries offered their views of what form this transition could take. India’s Dr Vinod Paul, for example, called for ACT-A to become “a long-term institutional mechanism to support countries in future health emergencies”.

Indonesia and South Africa called ACT-A’s evaluation to feed into international discussions on pandemic preparedness. France’s John Valadou, meanwhile, called for an assessment of ACT-A before any decisions were made about its future.

“We should avoid two risks when it comes to global governance,” Valadou said. “We shouldn’t make the existing architecture too complex, and secondly, we should not weaken the central role that should be played by WHO.”

Dr Fifa Rahman

Dr Fifa Rahman, a civil society representative on ACT-A, told the council that her sector looked forward to seeing the transition plans. She endorsed Germany’s call for “some kind of mechanism for coordinating and evaluating the global risk response to COVID”, describing this as essential.

Rahman also called for resources to build more resilient health systems, including community health systems, pointing out that only 14% of community health workers in Africa were paid, while health workers in many countries were grossly underpaid.

She also called for transparency in government procurement of COVID-19 goods during this transition phase. 

Norway’s Ambassador and ACT-A council co-chair John-Arne Rottingen closed the council meeting by noting that “members support a gradual transitioning” of ACT-A.

“We cannot go back to where we were before the pandemic,” he said. “We need to continue coordination and collaboration across the implementing agencies and ACT-A actors. And we also need to use the evaluation and other learning efforts to learn for the future both on the countermeasure side as well as long-term strengthening of health systems, primary health care capacities and supporting the health care workforce.”

Goodwill COVID-19 support does not mean equity

Reflecting on ACT-A’s future, Aylward said “what we’ve learned in this pandemic is that goodwill alone is not enough to get to equity”, which is why a pandemic accord or instrument is important.

And to address future pandemics, he said, more financing is needed to prepare so that low-and middle-income countries can purchase what they need, manufacturers are included, and supply chains keep flowing with the free trade of raw materials and finished products.

“All of this needs to be captured under something like a pandemic accord,” Aylward said. “This is not charity. This is not handouts. This is in everyone’s interest to end pandemics, like the one we’re in the midst of now has been going on much longer than it should have given the science that we had so early in this in this pandemic.”

Image Credits: UNICEF, Gavi .

A Bill that aims to improve access to sexual and reproductive health services for women and girls in six East African countries faces a tough uphill battle to approval, with opposition from conservatives who claim that it would promote abortion and LBGTQ rights

Over the past week, the East African Legislative Assembly (EALA) has conducted public hearings on East African Community Sexual and Reproductive Health Bill 2021 in its six member states, Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda.

Various members of the legislative assembly have been trying for five years to pass a Bill to address the very high maternal mortality and teen pregnancy rates in region.

At the public hearings in the capital cities of the member states, the Bill received support from a range of maternal health and sexual and reproductive health practitioners, academics and activists, particularly in Kenya.

But it also faced opposition from a number of conservative and religious organisations, including international right-wing organisations such as CitizenGo and Empowered Youth Coalition, some of which made objections at public hearings claiming that the Bill is pro-abortion and pro-LBGTQ rights.

In the past, various Catholic organisations have opposed the Bill, and at the Nairobi hearings held last week, the Catholic Doctors Association was one of the groups opposing the Bill.

Ending female genital mutilation

The aims of the Bill are to protect and facilitate the SRH and rights of all people in the region, provide for the progressive realisation of SRH information and services and prohibit harmful practices such as female genital mutilation and forced sterilisation.

It also aims to prevent newborn, child mortality and maternal mortality and “facilitate and promote reduction and elimination of unsafe abortions, HIV and other sexually transmitted infections, early and unintended pregnancies”.

Article 16 of the Bill states that a woman should be able to terminate her pregnancy if, in the opinion of a health professional, there is a need for emergency treatment, it endangers her mental or physical health or life, or is the result of rape or incest.

But it also provides for member states to use their own laws to decide what to do in such situations.

The region is in desperate need of improved SRH services. According to a 2020 EALA scorecard (see below), many member states are lagging behind in agreed-on targets on reproductive health and HIV, particularly South Sudan, which is not on track to meet any targets.

South Sudan’s maternal mortality rate of 730 women per 100,000 is one of the worst in the world, while only Rwanda and Tanzania are on track to meet maternal mortality targets.

EALA has tried to introduce a Bill on SRH since 2017 but faced various obstacles, including having to start from scratch when the term of the previous assembly ended and new representatives were sworn in. 

The current Bill has been introduced by South Sudan’s EALA representative Kennedy Mukulia as a Private Members’ Bill.

However, Mukulia has faced vilification and online harassment including a CitizenGo petition calling for his removal for sponsoring the Bill.

The Bill aims to give expression to Article 118 of the East African Community (EAC) Treaty, in terms of which member states have committed to providing reproductive health services to their citizens. But a number of member states do not have laws or policies in regard to a number of issues and the Bill aims to provide guidance in cases where there are legal vacuums. 

The EALA General Purpose Committee has 30 days to send a report on the public hearings to the Speaker, and thereafter it should be tabled and debated. However, it still faces an uphill battle in the male-dominated legislature, where a number of members objected to earlier versions of the Bill. 

Should the Bill be passed, each member state will have to report to the secretary-general of the EAC on the status of its implementation every two years.

The secretary-general is obliged to report to the EALA on each country’s progress, and one state can even bring legal action against another at the East African Court of Justice.

Teen girls ‘desperately need’ SRH services

Almost one-third of women in developing countries had their first baby in their teens, a UNFPA  report released last week shows.

“When nearly a third of all women in developing countries are becoming mothers during adolescence, it is clear the world is failing adolescent girls,” said UNFPA Executive Director Dr Natalia Kanem. “The repeat pregnancies we see among adolescent mothers are a glaring signpost that they desperately need sexual and reproductive health information and services.”

“Complications in pregnancy and childbirth are the leading cause of death among girls aged 15 to 19 years, who are also far more likely to suffer a litany of other violations of their human rights, from forced marriage and intimate partner violence to serious mental health impacts of bearing children before they are out of childhood themselves,” according to UNFPA.

Image Credits: Reproductive Health Supplies Coalition/ Unsplash.

Pharmaceuticals, Diabetes
An exhibition marks the discovery of insulin, a life-saving treatment for diabetes, at the University of Toronto in 1921

French drugmaker Sanofi is the latest pharmaceuticals manufacturer to offer a package of essential medicines at cost to health systems in the world’s most impoverished countries – including much-needed cancer and diabetes treatments.

Sanofi on Monday announced the launch of the new nonprofit Impact® brand for dozens of medicines, that is supposed to ease support medicines procurement in 40 low-income countries. 

The new brand will enable the secure distribution of 30 Sanofi medicines, including glibenclamide and insulin for diabetes and oxaliplatin for chemotherapy, France’s largest drug company said in a statement.

The prevalence of diabetes has nearly doubled over the past three decades, with rates soaring in low- and middle-income countries beset by an epidemic of obesity related to higher processed foods and junk food cosumption and less physical activity. But high prices have limited people’s access to essential diabetes treatments, with a market dominated by three firms worldwide- including Sanofi.

Only about 50% of the estimated 100 million people requiring insulin worldwide are able to access treatment, according to a 2017 study led by Health Action International.  Human insulin, traditionally the least costly insulin treatment, is also gradually replaced in markets by longer-acting and often higher-priced “insulin analogues” – which can make treatment even harder to access  in low- and middle income countries and even in some high-income settings. 

Making essential medicines affordable for diabetes, cancer, malaria, tuberculosis and other areas

All of the medicines to be distributed by Sanofi Global Health, a nonprofit unit within the company, are on the World Health Organization’s list of essential medicines that is updated in consultation with experts worldwide every two years.

The list covers a wide range of therapeutic areas, including diabetes, cancer, cardiovascular disease, malaria, and tuberculosis, as well Hepatitis C and common bacterial infections.

Last year’s Model Lists of Essential Medicines (EML) from WHO – which provides a baseline of guidance to national health authorities on products and services that should be made the most widely available – included for the first time ever, long-lasting insulin analogues, also produced by Sanofi.

Previously, the EML expert committee had rejected their inclusion on the basis of fears that broader reliance on the higher-priced analogue formulations could restrict access to lower-cost human insulin products.

However, in view of increasing availability, WHO Director-General Dr Tedros Adhanom Ghebreyesus said the inclusion of insulin analogues is a step in the right direction towards affordable access to a lifesaving treatment.

The inclusion of four new cancer medicines also was a priority for the updated EML. Additional childhood cancer indicators were also added for 16 medicines already listed, including low-grade glioma, the most common form of brain cancer in children.

Underserved populations, startups and innovators

The launch of the Impact® brand is among the steps taken by Paris-based Sanofi since forming Sanofi Global Health last year to increase healthcare access by distributing medicines and to improve local healthcare systems among some of the poorest nations.  It has also launched a $25 million Impact Fund to support healthcare startups and other innovators to deliver “scalable solutions for sustainable healthcare in underserved regions,” according to the company.

“Sanofi Global Health aims to improve the lives of millions of people who now cannot get the help they need,” Sanofi’s CEO Paul Hudson said. 

Added Jon Fairest, who heads the Global Health Unit: “But we know that we cannot do this alone, and so we are building partnerships at global, regional and local levels that will help to improve and establish health systems to reach our goal of a healthier, more resilient world,” 

Towards a tiered pricing approach for pharmaceuticals

Sanofi’s moves follow on a other announcements by a number of leading drug companies expanding their use of “tiered pricing” to include drugs for common NCD treatments, including Pfizer, the world’s top pharma revenue earner, which is making billions from its COVID-19 vaccine.

The company announced last month at the World Economic Forum that it will begin selling 23 of its patented medicines and vaccines marketed in the United States and European Union on a non-profit basis to 45 of the world’s low-income countries.

The medicines and vaccines in Pfizer’s “Accord for a Healthier World” project include treatments for infectious and rare inflammatory diseases, and some cancers.

Thomas Cueni, director general of International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), said tiered pricing can help improve access to vital treatments, although it is not enough on its own. 

“This works on the basis that lowest-income countries have a pricing that reflects their reduced ability to pay, just as richer countries will pay more,” Cueni told Health Policy Watch.

“However, pricing needs to be understood in the broader context of access to treatments,” he said. “It also requires having in place the health systems to diagnose; the healthcare workers to treat patients; and mark up of medicine prices throughout the supply chain by medicine wholesalers.”

Cape Town’s Afrigen Vaccines & Biologics laboratory. The company has now made a deal with Univercells to produce the first African-owned COVID-19 vaccine.

The wider use of pooled procurement in national health systems can help low- and middle-income countries get a better deal on pharmaceuticals – here’s how and why.

Low- and middle-income countries are making strides in bolstering their domestic pharmaceutical sectors—evidenced by the recent deal between South Africa’s Afrigen Biologics and Belgium’s Univercells, to develop the first African-owned COVID-19 vaccine. 

On the demand side, governments can do more to get better deals when they do need to purchase drugs outside their borders. They should consider banding together their negotiating power via a category of supply chain models known as pooled procurement. 

South Africa’s experience with antiretrovirals for HIV illustrates the benefits buyers can reap. The country has cut the price of the life-saving HIV treatments by 68% since 2011 using a national pooled procurement mechanism that combines the buying power of the country’s nine provinces. This has opened the way for millions more people to access HIV/AIDS treatment every year with the help of affordable antiretrovirals. 

The mechanism is underused but can be a powerful tool to help drive down drug costs, which are often a significant slice of health care budgets in lower-income countries. 

Such an approach will surely boost access to care and promote quality assurance. 

The power of the buyers is facilitated by aggregating their combined knowledge, a harmonized approach, and consequent collective demand. That power is then used to negotiate terms of supply.  

Suppliers, in return, receive greater visibility into production demands, allowing them to maximize capacity and improve product movement. 

How it works in South Africa  

A child with HIV takes a paediatric dose of antiretroviral medication – in South Africa pooled procurement has made life-saving ARV’s much cheaper and more widely accessible.

Here’s how it works in South Africa: The provinces aggregate their demand into a national three-year contract, with multiple awards per product and minimum volume pledges for vendors. To stimulate a dynamic market, price preferences are given for local producers and new market entrants. 

The results? The Clinton Health Access Initiative’s HIV Market Study shows that the price per unit the South African government pays is lower than what many multilaterals such as the Global Fund and even PEPFAR pay. A variety of local manufacturers have invested in local production capacity.  

The benefits for buyers are clear, but vendors may need convincing to take part. Highlighting the predictability of volume, duration of contracts, and security of funding can help.  

On the donor side  

Drone delivery of Gavi bulk-purchased vaccines in Ghana in 2019 to over 2,000 health facilities serving 12 million people across the country.

In the international donor arena, among the most high-profile pooling examples is Gavi, the Vaccine Alliance. Gavi’s private-public partnership comprises a range of players, including the World Health Organization, the Bill & Melinda Gates Foundation and governments such as the U.S., to pool demand for vaccines for the world’s neediest. 

Gavi’s scale has achieved cost savings that have spurred countries to expand their immunization programs, thus broadening the potential market into which vendors can sell. That in turn has inspired manufacturers to invest in scaling up production and to introduce new vaccines. 

Pooled procurement should not be a ‘race to the bottom’

Bulk drug procurement. Price concerns need to be balanced with concerns for quality and the need to foster diverse manufacturers – both to develop LMIC manufacturing and insure stable supply chains.

At the national level, the most efficient pooling systems are often composed of members at similar levels of economic development. Notably, where one province is economically dominant in the South Africa example, this has proven to be an obstacle to developing regional pooling initiatives across the Southern African Development Community.  

Cross country pooling will require a more concerted focus on regulatory harmonization, an intended priority of the newly-minted African Medicines Agency.  

Additionally, a race to the bottom in terms of price shouldn’t be the targeted outcome. It carries the risk of encouraging substandard medicines or even vendors leaving the market. A focus on price alone may also lead to a concentrated marketplace with too few suppliers dominated by big players.   

The pandemic was a wake-up call in this regard, for example, when broken supply chains and the diversion of India’s vaccines for domestic use left many African countries counting on the procurement and distribution of Indian vaccines via COVAX without doses. 

Developing stronger, country-led procurement systems 

Pharmacy in Kenya; stronger national procurement systems are needed to improve medicines access and reduce prices on the African continent.

Also, big funder-controlled pools like UNICEF and the Global Fund have historically tended to dominate decisions on timing, quantity, and standards. That dynamic can impede the development of strong, country-led procurement systems.   

Rather, donors or buyers should seek to maintain a healthy market whereby suppliers want to remain in the business given the potential for volume. This focus moves away from a given set price for a given commodity and realizes there may be a variance, albeit small, between suppliers to keep them in the game.  

All of this underlines the importance of diversified procurement from multiple sources.  

Such a shift in approach is needed to empower countries to work on their own or partner with peers and to reward local industry development. 

Despite these challenges, the upsides far outweigh these potential hurdles. 

Using pooled procurement to tackle NCDs  

Receiving a shot of insulin  – hundreds of millions of people across the world still lack access to this and other basic NCD treatments.

The South Africa example shows what can be achieved in HIV. Extending the approach to more conditions through pooled procurement represents a new frontier of opportunity. 

Noncommunicable diseases (NCDs) like cancer and diabetes are on the rise and affect swathes far greater than HIV. They account for 800,000 deaths annually in the world’s poorest countries—more than HIV, tuberculosis and maternal health combined.  

To be sure, pooled procurement is not a panacea to achieve a resilient, effective health system. 

But focusing only on the supply side of the equation will solve one major problem: availability. 

By banding together, buyers in low- and middle-income countries can work toward achieving greater equity and access in purchasing life-saving pharmaceuticals. 

_______________________

Iain Barton is Senior Fellow at the global health non-profit, Management Sciences for Health, and Founding Principal of Health4Development, which supports the development of successful healthcare services and commodities enterprises in Sub-Saharan Africa. Dr. Barton is a medical doctor with a unique mix of experience, including serving as the CEO of the Clinton Health Access Initiative and as an executive vice president and CEO of various health supply chain logistics companies.

René Berger is the pharmaceutical systems and supply chain practice area lead at Management Sciences for Health. Mr. Berger is a global health, supply chain, and HIV and AIDS expert with more than 25 years of international development experience across sub-Saharan Africa.

 

Image Credits: Rodger Bosch for MPP/WHO, Paul Kamau/ DNDi, Gavi/2019/Tony Noel, Commons Wikimedia, Luigi Guarino , WHO, LinkedIn, Management Sciences for Health .

Ebola vaccination in Mbandaka, Équateur Province (DRC); swift response helped reduce the toll of the province’s most recent outbreak.

The Ebola outbreak that erupted on 23 April in the Democratic Republic of the Congo today was declared to be over  by DRC and WHO authorities – with fewer cases and deaths than previous episodes thanks to a swift response including vaccinations.

The outbreak erupted in Mbandaka, the capital of Equateur Province in the country’s northwest. It was the third outbreak seen in the province since 2018 and the country’s 14th overall.

While DRC is among those countries seeing outbreaks of Ebola and other zoonotic diseases with greater frequency, a swifter response using a new arsenal of Ebola vaccines, as well as stepped-up contact tracing and education around prevention, is also reducing the length of outbreaks and the deadly toll of the disease, the head of WHO’s African Regional Office said.

“Thanks to the robust response by the national authorities, this outbreak has been brought to an end swiftly withlimited transmission of the virus,” said Matshidiso Moeti, WHO Regional Director for Africa. “Crucial lessons have been learned from past outbreaks and they have been applied to devise and deploy an ever more effective Ebola response.”

In the most recent case, vaccinations were launched just four days after the outbreak was declared. In all, there were four confirmed one probable Ebola case – all of whom died. In comparison, in the previous outbreak in Equateur Province that lasted from June to November 2020, there were 130 confirmed cases and 55 deaths.

The recent outbreak saw a total of 2104 people vaccinated, including 302 contacts and 1307 frontline workers. To facilitate the vaccination rollout, an ultra-cold chain freezer was installed in Mbandaka which allowed for vaccine doses to be stored locally and safely and be delivered effectively.

The DRC has now recorded 14 Ebola outbreaks since 1976, six of which have occurred since 2018.

“Africa is seeing an increase in Ebola and other infectious diseases that jump from animals to humans impacting large urban areas,” Moeti warned. “We need to be ever more vigilant to ensure we catch cases quickly. This outbreak response shows that by bolstering preparedness, disease surveillance and swift detection, we can stay a step ahead.”

Image Credits: WHO/Junior D. Kannah.

Within a week of overturning the constitutional right to an abortion, the United States Supreme Court has now dealt a severe blow to the nation’s ability to strictly regulate and reduce carbon dioxide emissions from power plants that contribute to global warming, with escalating impacts on health and well-being.

US President Joe Biden described Thursday’s ruling as “devastating”, while China questioned the United States’ sincerity in tackling international carbon emission targets.

Voting along ideological lines, the court ruled 6-3 in favour of an appeal brought by 19 states and coal companies against the U.S. Environmental Protection Agency (EPA) that contended it only had narrow authority to regulate carbon emissions generated by power production. 

According to the ruling, the US Congress did not explicitly grant EPA the authority to cap greenhouse gas emissions across the sector in the Clean Air Act, but only to regulate actions at individual power plants.

Chief Justice Roberts, supported by five other conservative judges, stated in the judgement that “it is not plausible that Congress gave EPA the authority to adopt on its own such a regulatory scheme”.

“A decision of such magnitude and consequence rests with Congress itself, or an agency acting pursuant to a clear delegation from that representative body,” he added.

Dissenting opinion – emissions also contribute to air pollution that endanger public health

Health-harmful pollution emissions have declined sharply since 1990, but ozone emissions stalled a decade ago and some PM indicators slightly increased recently.

However, in her dissenting statement, Justice Elena Kagan wrote that “Section 111 of the Clean Air Act directs EPA to regulate stationary sources of any substance that ’causes, or contributes significantly to, air pollution’ and that ‘may reasonably be anticipated to endanger public health or welfare.’ “

Dirty coal and oil-fired power plants that emit the highest levels of CO2 also emit other pollutants harmful to health, including fine particulates (PM10 and PM2.5) , volatile organic compounds (VOCs) and nitrogen dioxide (NO2), which contribute to the formation of ozone. While there has been a decline in such emissions over the past 20 years, ozone emissions have plateaued in the past decade, and PM2.5 emissions even increased recently – and are above new WHO guideline standards of 5 µg/m3. New EPA rules to prompt broader, sector-wide shifts to cleaner power and more renewables would have also helped address those nagging pollution issues.

Higher levels of PM 2.5 and PM10, for instance, lead to more premature deaths from heart attack, stroke, cancers and lung disease, while ozone is closely associated with increased asthma, including childhood asthma cases. There are still an estimated 100,000-200,000 deaths annually from air pollution in the United States, according to a 2020 paper by a leading group of researchers. And one-half of those deaths can be attributed to just five activities, including heat and power production.

In addition to deaths directly attributed to power plant pollution emissions, there is a growing toll in the United States  in terms of deaths and injuries related to wildfires and other extreme weather events, also being exacerbated by climate change.

Power plants are one of the five core sources of health-harmful air pollution in the United States (Thakrar et al, 2020)

Green economy threatened

One of the cornerstones of US President Joe Biden’s administration is boosting the so-called ‘green economy’ of low carbon and low polluting energy technologies, and this ruling could undermine multibillion-dollar efforts underway to phase out fossil fuels and replace them with cleaner energy sources. 

“I have directed my legal team to work with the Department of Justice and affected agencies to review this decision carefully and find ways that we can, under federal law, continue protecting Americans from harmful pollution, including pollution that causes climate change,” Biden said in a statement.

“Since the Clean Air Act was passed by a bipartisan majority in Congress in 1970, the landmark law has enabled both Democratic and Republican administrations to protect and improve the air we breathe, cutting air pollution by 78% even as our economy quadrupled in size,” he said. “Yet today’s decision sides with special interests that have waged a long-term campaign to strip away our right to breathe clean air.”

China’s foreign ministry spokesman Zhao Lijian told a regular media briefing on Friday that his nation took note of the ruling and the international community’s “fair criticism” of it.

“As we always say, to address climate change, it is not enough to just chant slogans. It is about everyone doing their own part,” said Zhao.

“We urge developed countries, including the US, to earnestly abide by the principle of common but differentiated responsibilities, own up to their historical responsibilities and show greater ambition and actions,” he said. “At the same time, developed countries should effectively help developing countries enhance their capacity to cope with climate change in terms of funding, technology and capacity building.”

The main source of greenhouse gas emissions in the US is from electricity, which accounted for a quarter of the emissions in 2020. 

‘Disappointing and disheartening’

EPA Administrator Michael Regan said he was “deeply disappointed” by the decision but emphasised that EPA remains committed to protecting communities and cutting emissions that drive climate change.

“EPA’s number one priority is to protect people’s health, especially those who are on the front lines of environmental pollution. Make no mistake: we will never waiver from that responsibility,” Regan said in a statement. “We will move forward to provide certainty and transparency for the energy sector, which will support the industry’s ongoing efforts to grow our clean energy economy,” he added.

Regan said addressing climate change means putting the US economy on a more competitive footing by creating jobs in the clean energy sector, lowering costs for families and protecting people’s health and well-being.

“EPA will move forward,” he added, “with lawfully setting and implementing environmental standards that meet our obligation to protect all people and all communities from environmental harm.”

More court challenges by polluters? 

The global public health organisation Vital Strategies condemned the Supreme Court ruling, which it described as “an assault on the nature of government as much as nature itself, stripping agencies of their ability to act with scientific authority”. 

The organisation’s senior vice-president, Daniel Kass, warned the ruling would “accelerate our very real climate crisis, leading to more preventable illness and death”, and was likely to result in new challenges by “polluters” in state courts.

“Just this March, the EPA, under its authority from the Clean Air Act, re-enabled California and other states to regulate greenhouse gas emissions from [vehicle] tailpipes. We can now expect polluter-financed challenges to all state-level efforts to regulate CO2 emissions,” Kass said.

“Public health officials must pressure policymakers to join amica briefs to defend state regulations and to align with the overwhelming majority of the public that want to see CO2 regulated,” he said. “The urgency of climate change demands it. There is no time to wait for a generational swing back to centre.”

John Noel, a senior climate campaigner for Greenpeace USA, noted in a statement that air pollution from fossil fuel burning caused about one-in-five deaths worldwide in 2018. 

“Radicals in robes are severely restricting the federal government’s ability to protect people and the ecosystems that support life,” he said. “It is unconscionable that six Supreme Court Justices have ruled in favour of sacrificing more lives to enrich millionaire coal and oil barons.”

Image Credits: Ella Ivanescu/ Unsplash, US EPA, (Environ. Sci. Technol. Lett. 2020, 7, 9, 639-645), Us Environmental Protection Agency.

Dr Ahmed Ogwell Ouma, Africa CDC’s acting director, asserts the continent should be top priority for vaccine doses for monkeypox.

WHO and Africa CDC are trying to close a huge testing gap for monkeypox that has left some health workers reliant on symptomatic diagnosis.

The World Health Organization (WHO) and African Centres for Disease Control and Prevention (Africa CDC) acknowledge they will not be able to gain a clear understanding of the monkeypox outbreak in Africa until the continent improves its ability to test better and close the gap between confirmed and suspected cases.

Just 104 new cases of monkeypox have been confirmed compared with 1,678 suspected cases in Africa since the beginning of 2022, Africa CDC’s acting director, Ahmed Ogwell Ouma, announced during a press briefing on Thursday.

He told Health Policy Watch the gap is due to limited capacity at labs and lack of enough test kits.

“This usually means appropriate training is not yet widespread and the test kits are also not available,” he said, adding that health workers in Africa are resorting to “clinical acumen and high levels of high index of suspicion” to identify monkeypox cases “because of capacity issues.”

This will hopefully change soon, he said, as Africa CDC acquires and provides more training and test kits. In Europe, the Americas and elsewhere some 3414 cases had been confirmed as of 22 June, WHO reported on Tuesday.  

Monkeypox rash

WHO is also procuring test kits for Africa

Along with Africa CDC, the UN health agency is working on building up testing capacity on the continent.

All African countries have the polymerase chain reaction (PCR) equipment needed to test for monkeypox.  But many lack essential reagents and training in specimen collection, handling and test administration, Dr Matshidiso Moeti, WHO AFRO’s regional director, told a press briefing on Thursday.

WHO is working to procure 60,000 tests, she announced, including 2,000 that will be dispatched to the countries at highest risk.

“Over the past month, five African cities have received donations of reagents from partners, bringing to 12 the number with enhanced monkeypox diagnostic capacity, and another group of countries in West Africa receiving agents just after participating in the necessary training,” Moeti said.

Monkeypox virus genome sequencing in Africa

Seven African countries are sequencing the monkeypox virus genome and using an improved genomic sequencing capacity acquired during the COVID-19 pandemic, according to Moeti. That should improve understanding of how the monkeypox virus is spreading across countries and continents.

Some 300 samples have been sequenced since the beginning of the year, with most of the published sequences showing the West African clade of the virus.

WHO says it is working to accelerate capacity through training in monkeypox genome sequencing that it is offering to lab experts from 20 countries in coming weeks.

Image Credits: US Centers for Disease Control.

Rush hour traffic in Ho Chi Minh City, one of the cities supported by Bloomberg Philanthropy’s Global Road Safety Partnership

The world’s transport ministers pledged to cut road traffic deaths and injuries by 50% by 2030, as part of a political declaration adopted at the first-ever United Nations High Level Meeting on Global Road Safety, which opened Thursday in New York City.  

The debate came as a new Lancet series suggested that some half a million lives could be saved by  targeting just four key risk factors for road injuries – speeding, drunk driving, lack of helmet, and seatbelt use –  in 185 countries could save up to half a million lives a year.

Worldwide, road crashes currently kill around 1.3 million people each year – more than 2 every minute, and more than 90% occur in low- and middle-income countries, according to the Lancet study. Road injuries are the leading killer of children and young people globally. 

Despite years of lip service to the issue, the burden of adolescent deaths in poor countries has only grown.  Almost half of adolescents killed by road injuries in 2019 lived in low-income countries, up from around a quarter in 1990, according to the Lancet study.  The study estimates that routinely wearing helmets and seat-belts, obeying speed limits and avoiding drunk-driving could save between 347,000 and 540,000 lives worldwide every year.

Low and middle-income countries experience  disproportionate deaths, due in part to the preponderance of unsafe vehicles on the road as well as lack of safety belts, helmets and speed controls. But there is also a dearth of safe cycling and walking infrastructures for non-motorized users who are often the victims of a crash.

UN Secretary-General António Guterres

Vital opportunity 

“Today’s meeting is a vital opportunity to tackle this silent epidemic,” said UN Secretary General  Antonio Guterres,” speaking at the opening of the UN high level meeting. “We need to address this leading killer of young people.”

Gutteres added that traffic accidents also are a key obstacle to sustainable development, costing 2-5% of GDP in developing countries every year and pushing “entire families into poverty due to the loss of a breadwinner or the costs associated with lost income and prolonged medical care.”

Along with technological and regulatory approaches, Guterres called upon transport ministries to adopt “a more holistic approach to road safety,” with increased financing for more sustainable mobility and greener urban planning, which can advance both safety as well as climate mitigation goals. 

“Traffic crashes caused nearly 1.3 million preventable deaths and an estimated 50 million injuries each year, making it the leading killer of children and young people worldwide. And Jamaica has not been spared,” declared the country’s Minister of Transport, Audley Shaw, as over a dozen countries took to the podium in the opening session of the UN debate.  “We have observed a steady increase in fatality rates since 2012. Fatalities have increased on average by 10%. 

“It has been generally accepted that developing nations despite, having fewer vehicles than developed countries have a larger portion of fatalities globally. The socio- economic impact on developing states is devastating,” he said, calling for those norms to change.

Unsafe road infrastructure

Historically, road safety measures have focused on safer vehicles and users.  

Particularly in developing countries, transport development has focused overwhelmingly on roads for vehicles, ignoring even the presence of pedestrians and other users on roads, experts say.

Road safety programmes have also tended to focus on private vehicles – neglecting the importance of public transport, including the creation of public transport lanes that can ease private vehicle congestion and promote safety. 

Increasingly, evidence points to the importance of urban design as a critical part of the mix, including safe spaces for pedestrians and cyclists. Measures such as footpaths, cycling lanes, safe crossing points, as well as “traffic calming” tactics like speed bumps and stricter limits in cities are therefore critical to reducing the risk of injury among these road users, says WHO. 

Decade of Road Safety 

In September 2020, the UN General Assembly adopted a resolution to proclaim the Decade of Action for Road Safety 2021–2030. WHO and the UN regional commissions, in cooperation with other partners in the UN Road Safety Collaboration, have developed a Global Plan for the Decade of Action, which was released in October 2021.  

The plan calls for continued improvements in the design of roads and vehicles, enhancement of laws and law enforcement, and provision of timely, life-saving emergency care for the injured. In addition, it sought to promote more actively “healthy and environmentally sound modes of transport” that can positively impact child health, gender, poverty and the environment. 

Image Credits: Flickr/ M M.

A Somalian mother with her baby who is being treated for malnutrition.

In the face of growing malnutrition and related diseases of pneumonia, diarrhoea and measles, the World Health Organization (WHO) has announced that it is setting up a hub in Kenya to help fight the “major physical and mental health repercussions” of the food crisis in the Eastern Africa region.

More than 80 million people, or one-in-four people who live in East Africa are food insecure and resorting to desperate measures to feed themselves and their families, according to WHO. And the Horn of Africa, which includes Ethiopia, Kenya and Somalia, is in the midst of a four-year drought.

WHO Director-General Dr Tedros Adhanom Ghebreyusus says the hub will coordinate deliveries of medical supplies to where they are needed most in the region, which is hard hit by the global price spikes of food, fuel and other commodities caused by pandemic-hit supply chains, Russia’s war in Ukraine and inflation.

“People need access to affordable and nutritious food, as well as support through these difficult times. Some regions like the Horn of Africa are facing extremely serious food insecurity issues that could lead to famine,” he told a press briefing on Wednesday. “Over 80 million people, one in four, in the Eastern Africa region are food insecure and resorting to desperate measures in order to feed themselves and their families. Lack of food and nutrition weakens people’s immune system and puts them more at risk of disease.”

Lack of food and nutrition weakens people’s immune system, putting them more at risk of disease. Children who are undernourished are at higher risk of death from pneumonia, diarrhoeal disease and measles, Tedros noted.

WHO says it is working with partners on the ground to deliver essential health services, treat sick children with severe malnutrition, and prevent, detect and respond to infectious disease outbreaks. As part of that effort, Tedros said, WHO is “setting up a hub in Nairobi, from where it will coordinate the response and organize the delivery of live-saving medical supplies to where they are needed most. These supplies include medicines, vaccines, as well the products and equipment to treat children who are severely malnourished.”

The U.N. health agency also is working with the health ministries in Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda to build what Tedros described as a “robust disease surveillance system to be able to quickly detect and respond to disease outbreaks.”

Unprecedented drought

Some 146,000 Somalian children with severe acute malnutrition have already been admitted into therapeutic care this year, and more than 640,000 people have been given emergency water supplies, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). Almost half the population – 7.7 million people – face starvation.

“The current extreme, widespread, and persistent multi-season drought is unprecedented,” said OCHA. “Four consecutive rainy seasons have failed, a climatic event not seen in at least 40 years. The 2022 March-May rainy season has not materialized and is likely to be the driest on record, devastating livelihoods and driving sharp increases in food, water, and nutrition insecurity.” 

Earlier this month, UNICEF reported that the severe water shortages have led to a severe acute watery diarrhoea and cholera outbreak. “Over 18 million people – one in four – in the eastern Africa region are food insecure and resorting to desperate measures in order to feed themselves and their families,” Tedros told a media briefing on Wednesday.

“Lack of food and nutrition weakens a person’s immune system and puts them all at risk of disease. Children that are malnourished are at higher risk of death from pneumonia, diarrhoeal disease and measles.”

Over 9,500 suspected cases of measles have been reported in Somalia alone between January and 30 May, according to UNICEF.

Tedros blamed spiking prices of food, fuel and other commodities, which is “having major physical and mental health repercussions”, warning that the Horn of Africa was facing famine.

“The cost of inaction is high,” said Dr Ibrahima Socé Fall, WHO Assistant Director-General for Emergency Response.  “While the clear priority is to prevent people from starving, we must simultaneously strengthen our health response to prevent disease and save lives. Even one life lost from a vaccine-preventable disease, diarrhoea, or medical complications from malnutrition in today’s world is one life too many.”

Fall was speaking in Nairobi where WHO convened a two-day meeting [26-27 June 2022] to plan its response across the seven countries affected by the health emergency – Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda – and coordinate with other UN agencies and partners.

Image Credits: UNICEF.