Many children with tuberculosis don’t receive the necessary treatment because of challenges with diagnosis.

Two-fifths of people with tuberculosis are unaware that they are infected because their diagnosis relies on outdated tests – something Unitaid and partners aim to change with a $30 million investment in new diagnostic technologies to enable same-day results.

Announcing the investment on Tuesday, the global health agency explained that the current diagnosis in low and middle-income countries relies on sputum tests that have low sensitivity, especially in the presence of HIV coinfection, require patients to make multiple visits to health centres and are “largely ineffective in diagnosing children or people in advanced stages of disease who have difficulty producing sputum”.

The announcement comes shortly after the publication in this month’s International Journal of Infectious Diseases of a massive 29-year study of TB in South Africa, which found that incidence and mortality were substantially reduced by the introduction of antiretroviral HIV therapy and increased screening.

South Africa has one of the highest TB rates in the world and the researchers, from the Universities of Cape Town and Stellenbosch, found that 8.8 million people had developed TB, and 2.1 million died during the study period from 1990 to 2019. 

HIV, which weakens a person’s immunity, was responsible for 4.8 million of the cases and 1.4 million deaths.

Testing doubled

The study also estimated the impact on TB incidence of various treatment interventions, finding that antiretroviral therapy (ART) and increased TB screening, were the most effective.

“Between 2005 and 2012, South Africa scaled-up efforts to identify TB cases and testing rates doubled. As a result, there were rapid reductions in TB incidence owing to increased TB screening during this period. In 2019, increased screening led to a 28% reduction in TB incidence,” according to lead author, Mmamapudi Kubjane, a researcher in the School of Public Health and Family Medicine at the University of Cape Town.

The study also found that the provision of ART led to a 20% reduction in TB incidence by 2019. 

“The benefits of ART in reducing incidence depend on CD4 count and duration of ART. HIV-positive individuals who initiate ART earlier at higher CD4 counts and stay on ART for longer experience the greatest benefits of ART,” said Kubjane.

The impact of the other treatment interventions – directly observed therapy (DOTS), isoniazid preventive therapy (IPT), and Xpert MTB/RIF – were “modest” single-figure percentages. Xpert MTB/RIF is a highly sensitive test that can simultaneously detect TB and resistance to the TB drug rifampin (RIF) in less than two hours.

When South Africa introduced this new Xpert MTB/RIF test in 2011 to replace sputum testing, it was expected to bring substantial health benefits – yet clinical trials have found little or no impact on TB mortality, according to recent analyses.

“To understand these dynamics better, modelling studies with detailed diagnostic algorithms that account for empirical treatment are required,” the study recommends.

Combination approaches to diagnosis

This is something that Untaid and its partners could tackle. Unitaid has partnered with FIND, the global alliance for diagnostics and the Liverpool School of Tropical Medicine (LSTM), to evaluate alternative TB sampling approaches, and develop and evaluate combination approaches to diagnosis. 

More than 10 million people each year fall ill with tuberculosis (TB), and an estimated four million people with TB – two out of every five – go undiagnosed, according to Unitaid.

“Efforts to reduce the TB burden are greatly hampered by the large number of people who never receive a diagnosis and therefore do not access treatment,” it adds. 

“For those who do receive a positive diagnosis, the process can be lengthy and sometimes means patients do not start on the correct treatment from the outset, which can lead to drug resistance.”

 

Image Credits: University of Cape Town Lung Institute.

argentina
Big food companies in Argentina now need to add warning labels to their ultra-processed products.

Consumers in Argentina are getting help to identify unhealthy food, thanks to new food promotion laws that mandate front-of-package warning labels, the first phase of which started recently. 

Last year, Argentina’s president signed one of the world’s strongest and most comprehensive food policy laws, requiring ultra-processed products with excess levels of sodium, sugar, fats and calories to include black octagonal warnings on the front of the package. 

Big food companies were given until 20 August to add the warnings, while small and medium food and beverage companies have until 20 February 2023 to do so. 

Companies that produce products that are high in sugar, calories, sodium and fat are prohibited from advertising these to children or selling them at schools.

Argentinian civil society groups applauded the start of the new law, emphasizing it was a step in the right direction after years of advocacy. 

“This moment is the time when people in Argentina will start to have the chance to know what they are eating,” said Luciana Castronuovo of Fundacion InterAmerica del Corazon (FIC) Argentina, speaking to the Global Health Advocacy Incubator. 

The law is comprehensive as it also includes the regulation of food marketing and school environments, guaranteeing the rights to health and healthy food of children and youth, Victoria Tiscornia, nutritionist and researcher at FIC Argentina, told Health Policy Watch. 

“This comprehensive law is evidence-based and includes the best public health standards to tackle the double burden of malnutrition in Argentina.”

‘Major step’ to ensuring the right to healthy food

Argentina’s accomplishment comes at a time when advocates are pushing for healthy food policies across Latin America in response to high rates of diet-related diseases like diabetes, obesity and heart disease and an increase in the availability of ultra-processed food and drinks.

For the past five years, civil society organizations in Argentina fought for a package of policies that include front-of-package warning labels (FOPL), marketing restrictions and the removal of unhealthy food and drinks from schools. 

“This law is a major step towards guaranteeing both the population’s right to healthy food and the right to information.,” said Tiscornia. “It seeks to provide clear and truthful information to consumers about the products they buy so that they can make informed decisions and choose the healthiest consumption options.”

The new law in Argentina is based on the experiences of other countries in the region, such as Chile, Mexico, and Peru, which have also implemented FOPL in their packaging.  

Chile was the first country to implement front-of-package labelling in 2016. Research has shown favourable significant positive changes in food choices as a result of labelling. Some 68% of people changed their eating habits and 20% of industries reformulated their products to comply with the established profile and thus avoid warning seals on the packaging. 

In addition, the purchase of sugar-sweetened beverages showed a significant decrease of almost 24% since the implementation of labelling.

Other parts of the world have also been working towards changing food policy with highly processed foods. Nigeria recently introduced a new tax on sugar-sweetened beverages in June in an effort to curb the growing rates of obesity, diabetes, and other diet-related non-communicable diseases in the country.  

Challenges in implementation and communication in months to come 

Supermarket in Argentina with processed sugary food products.

However, the new law in Argentina includes an article that allows companies to request a time extension for including the front of package warning labels (FOPL), Tiscornia added. 

FIC Argentina and other civil society organizations have been monitoring this process and conducting information requests but no official response explaining the number and reason for extensions has been yet provided. 

“This situation, although legal, affects the transparency of the policy process and the proper implementation of the law.” she said

FIC Argentina and other civil society groups will be facing many challenges in the coming months in regards to the new law, such as implementation and communication to the public, said Maga Ailén Merlo Vijarra from Argentinian human rights nonprofit FUNDEPS.

“In the coming months we will be working on disseminating key information about the law and the need for this public health strategy and we will also focus on the human right to healthy food.”

Products that were manufactured and packaged before the law came into force are not required to add labels. Additionally, rice, dry noodles and legumes, as well as fresh fruits and vegetables and milk, amongst other unprocessed or minimally processed foods are exempted from the labels. Table sugar and salt, vegetable oils, dried fruits and nuts, will also be exempted from labelling.

Vijarra noted that the challenges with implementation include understanding which products have labels and which companies will have extensions approved.

“In the coming months we expect to better protect Argentinean children and adolescents from abusive marketing strategies employed by the food industry, leading to a safer and healthier environment to develop and grow,” she concluded.

Image Credits: Global Health Policy Incubator , Vera and Jean-Christophe/Flickr .

Solar panels in the Egyptian desert.

The US government committed itself to supporting Nigeria’s transition away from fossil fuels during a meeting between US vice-president Kamala Harris and Nigeria’s vice-president, Yemi Osinbajo, last Friday.

However, despite global commitments to reduce fossil fuel reliance to address climate change, a number of African countries have recently committed to expanding their oil and coal production, including the Democratic Republic of Congo, Kenya, Ghana and South Africa. 

African leaders have also asserted that achieving global climate goals cannot come at the price of economic development on the continent – and they intend to invest in gas as a transitional form of energy on the continent’s path to renewable energy.

Nigeria launched its Energy Transition Plan on 24 August, mapping out how the country intends to achieve carbon emission neutrality by 2060, including by transitioning from petrol to gas – but the continent’s most populous nation needs over $400 billion to implement the plan and many western countries have moratoriums on financing hydrocarbon projects.

 

During last week’s meeting, Harris welcomed Nigeria’s Energy Transition Plan and applauded Osinbajo’s leadership for just energy transitions in Africa and “the two leaders committed to working closely to support Nigeria’s energy access and energy security goals, as well as our shared global climate goals”, according to a White House statement. 

Continued investment in oil

But some African countries’ actions are not in line with the globally set climate goals. The Democratic Republic of Congo is planning to issue 30 new licenses for oil rigs that could threaten some parts of the country’s rainforest.

“We had concerns about the announcement of the auction of these oil and gas exploration blocks, some of the blocks infringe on sensitive rainforest and peatland areas, including in the Virunga National Park and Salonga National Park,” said US Secretary of State Anthony Blinken during a recent visit to the DRC.

Meanwhile in Kenya, in early August President Uhuru Kenyatta commissioned the Kipevu terminal, a large new oil storage facility at the Mombasa port intended to store large volumes of oil for the country’s development. 

In August 2021, the government of Ghana revealed plans to invest $1.65 billion to accelerate oil and gas exploration via the acquisition and development of oil and gas assets.

Following an EU ban on coal importation from Russia, South Africa’s coal sales to Europe rose eight-fold during the first half of 2022 compared with last year.

‘Moral and economic madness’

After the 2021 Intergovernmental Panel on Climate Change report reported that the expansion of coal, oil and gas production is a great risk to global climate goals, United Nations Secretary-General António Guterres, described the expansion as “moral and economic madness”. 

But many African governments are getting behind the gas transition, arguing that moving immediately to renewable energy will hamper the continent’s economy and development.

In May, 10 countries – the Democratic Republic of Congo, Ghana, Kenya, Malawi, Morocco, Nigeria, Rwanda, Senegal, Uganda, and Zimbabwe – adopted a seven-point communique urging the international community to support gas “as a transition fuel and the long-term displacement of gas by renewable energy and green hydrogen for industrial development, if financially and technically sustainable”.

In Senegal, $5 billion is projected to be spent on the second phase of the country’s liquefied natural gas project. President Macky Sall is a firm critic of what he described as the hypocrisy of western governments that guzzle gas at home but have declared a virtual moratorium on financing hydrocarbon projects abroad.

“You cannot tell us that renewables alone can develop a continent — it has never been the case anywhere else and it cannot be the case in Africa,” Sall said.

Egypt to host COP27

In November, Egypt’s “green city” of Sharm El Sheikh will host the 27th United Nations climate change conference, COP27, and this will offer an opportunity to show what the continent is doing to align with global climate goals including net zero carbon emissions by 2060 and mainstreaming renewable energies.

Egypt has described the provision, mobilization and delivery of climate finance for developing countries as an urgent priority — particularly in light of current financial crises, debt challenges and increasing interest rates. 

“It is imperative to make appropriate financial flows that are based on needs identified through Nationally Determined Contributions (NDCs) and other vehicles, with a focus on concessional finance instruments, and grants as appropriate, while providing a clear revision of the definition of bankable projects that takes into consideration climate benefits and not only risks, and achieving cross-cutting impacts,” Egypt said on its website for COP27.

At COP26, a major talking point among African delegates and climate activists was the need for richer countries, who are also the world’s majornpolluters, to provide sufficient funds for developing countries to fight the crisis.

During COP26, South Africa, the European Union, France, Germany, the UK and the US launched an ambitious long-term Just Energy Transition Partnership (JETP) to support the South Africa’s decarbonisation efforts in order to move its economy towards more reliance on renewable energy resources. The JETP aims to mobilise $8.5 billion for South Africa, and Nigeria hopes to achieve similar support for its energy transition plan.

Bernard Pecoul Luis Pizzaro
Dr Bernard Pécoul (left) and new DNDi Executive Director Luis Pizarro. Photo by Kenny Mbala / DNDi

The Drugs for Neglected Diseases initiative (DNDi), one of the most important nonprofit drug developers in the world, has appointed a new leader to fill the shoes of its outgoing founder.

Dr Luis Pizarro, a Chilean-French doctor and global health expert, will serve as DNDi’s new executive director, succeeding DNDi founder Dr Bernard Pécoul, who has led the Geneva-based organisation for the past 19 years.

Pécoul said he was confident that Pizarro can fulfil the organisation’s promise to deliver 25 new treatments in its first 25 years through cross-regional collaboration, innovation in low- and middle-income countries, South-South cooperation, and better clinical research in endemic regions.

“Luis is the ideal person to lead that effort,” said Pécoul.

Twelve new treatments for six neglected diseases

DNDi launched in 2003 in response to the frustration felt by front-line researchers and doctors that drugs for neglected diseases were ineffective, unsafe, and unaffordable – or nonexistent.

Only 1% of new drugs developed between 1975 and 2000 could be used to treat neglected illnesses, even though they accounted for 11% of the global disease burden then.

When Médecins Sans Frontières won the 1999 Nobel Peace Prize for its pioneering humanitarian work on several continents, it chose to dedicate a portion of its prize money to helping to create a new nonprofit model for developing drugs for neglected populations, giving rise to DNDi.

Pécoul, fresh off leading the MSF Campaign for Access to Essential Medicines after founding it in 1998, was tapped to take the lead.

He has since overseen projects and partnerships spanning the globe that have developed and delivered 12 new treatments for six deadly neglected diseases including sleeping sickness, leishmaniasis, hepatitis C, Chagas and a landmark malaria treatment.

DNDi‘s treatments are developed as public goods, so they are affordable and have no patents, making them available for production by any generic drug manufacturer that meets quality standards.

Twenty five Treatments in 25 Years

DNDi
Dr. Luis Pizzaro, new Executive Director of the Drugs for Neglected Diseases Intiative. Photo by Kenny Mbala / DNDi

Under Pizarro’s leadership, DNDi has the ambitious goal of delivering another 13 treatments by 2028. But while Pécoul started from scratch, Pizarro takes over an organisation that now has more than 250 employees located across nine hubs in Africa, South-East and East Asia, North and Latin America, and 200 public-private partners.

As the first CEO of Solthis from 2007 until 2019, an international health organization dedicated to increasing access to care for HIV, and recent manager of Unitaid’s HIV portfolio, Pizarro has seen the urgency of the challenges faced by those DNDi was set up to help. 

“We have seen that during social and economic crises, the most neglected populations are always the ones that suffer the most,” he told Health Policy Watch.

“Neglected diseases are fuelling a vicious circle of poverty, as degraded socio-economic conditions lead to an increased prevalence of diseases, which translates into loss of income and education opportunities, and ultimately more poverty.”

Building on DNDi‘s success in establishing strong working partnerships with global pharmaceutical companies, academic, and research institutions, Pizarro says DNDi is ready to rise to the occasion.

“More than ever, there is a need for patient-centric and not-for-profit drug development models like DNDi”, he said. “I look forward to working with the DNDi team to bring like-minded stakeholders together and advance medical innovation in pursuit of our common vision: to deliver the best science to the most neglected populations.”

Amber Huett-Garcia has struggled with obesity since she was in first grade.

“Now in adulthood, despite reducing my BMI from 69 to 24 (245 lbs. lost), I still carry the expensive diagnosis of obesity,” she wrote in a recent blog for the Noncommunicable Disease Alliance (NCD Alliance). “I’ve used pharmacotherapy, surgical interventions, mental health care and more to achieve the combination of treatment needed to maintain healthy body weight, but not without cost.”

More than 650 million people are affected by obesity globally. It is an NCD that progresses overtime without medical intervention and lifestyle changes. For many, access to affordable medical care does not exist.

NCDs have become a major 21st century social justice issue, the alliance has said. They push poor households further into poverty and prevent developing countries from achieving strong and sustainable economies.

This week, the NCD Alliance will host The annual Global Week for Action on NCDs, including a special “Invest to Protect” virtual event on September 8 that will open with remarks by World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus and former New York City Mayor Michael Bloomberg, who is now WHO’s global ambassador for noncommunicable diseases and injuries.

The Global Week of Action on NCDs aims to get a message across to governments, donors, international agencies and the private sector: Invest in NCDs today, save lives and money tomorrow. Financing for NCDs has stagnated at a pitiful 1% to 2% of development assistance for health for two decades, causing many millions of deaths and pushing millions more into extreme poverty due to health care costs and disability.

“Many NCDs can be prevented through a set of cost-effective interventions,” explained NCD Alliance Executive Director Katie Dain. “We have the solutions, we have the tools, we have the know-how to prevent and treat NCDs. What’s needed is political will at the highest level.”

NCDs account for deaths of 41 million people a year

NCDs account for seven of the top 10 causes of death around the world, translating to the deaths of 41 million people and 74% of all deaths worldwide. And the number is projected to grow, according to the NCD Alliance, to 52 million people annually by 2030.

These top killers are cancers, cardiovascular disease, stroke, chronic respiratory diseases, diabetes, mental health and neurological conditions and chronic kidney disease.

For perspective: in 2020 some 1.5 million people died from tuberculosis, 627,000 from malaria and 680,000 from HIV/AIDS.

Moreover, although they hit everyone and every country, such as Garcia, who is living in the United States, the burden on low- and middle-income countries (LMICs) is much greater. In those countries, an estimated more than 85% of premature deaths between the ages of 30 and 70 are caused by NCDs.

COVID-19 further highlighted the challenges of NCDs, with 60% to 90% of more than six million COVID deaths being people who were living with one or more NCD. It has also likely exacerbated the NCD burden due to missed diagnoses and treatments.

For example, a recent report showed that for every week of lockdown, an estimated 2,300 cancer cases went undiagnosed. In LMICs, the alliance predicted, the situation is likely even worse, as these countries’ levels of undiagnosed NCDs were already extremely high before the pandemic.

“Sweeping changes, including legislation, were made in a matter of weeks to protect the public from COVID-19,” Dain said. “We need the same urgency to stop the premature morbidity and mortality caused by NCDs.”

NCDs expected to cost developing world $7 trillion between 2011 and 2030

NCDs are costing global GDP losses of between 3.5% and 5.9%. The alliance predicted they will cost $7 trillion in losses in the developing world over the period 2011-2030.

Just the five leading NCDs are estimated to cost the world more than $2 trillion annually.

But beyond the dollar signs, it is also costing human capital – in the short term by ending millions of lives and in the long term by leading to disabilities that keep people out of their jobs.

NCDs cause 80% of years lived with disability, according to a report by Institute for Health Metrics and Evaluation. Another report, this one by WHO, found that heart disease, diabetes, stroke, lung cancer, and chronic obstructive pulmonary disease were collectively responsible for nearly 100 million more healthy life-years lost in 2019 compared to 2000.

What actually are non communicable diseases? This infographic revisits all the basics for you to consolidate your knowledge.
What actually are non communicable diseases? This infographic revisits all the basics for you to consolidate your knowledge.

‘Best Buys” could save 10 million lives

In 2015, the World Health Organization rolled out a series of “Sustainable Development Goals” (SDGs), with member countries pledging among other things to deliver health and wellbeing for all. Item 3.4 called for the world to reduce premature mortality from NCDs by a third by 2030.

According to experts, including a report published by the Lancet, despite few efforts being made to date, if countries start now, this goal could still be achieved.

“All countries – and especially LMICs – can achieve or nearly achieve SDG 3.4, saving 39 million lives by 2030, by introducing a cost-effective package of NCD prevention and treatment interventions,” the NCD Alliance explained in its recent policy brief.

The steps needed were outlined in 2017 by WHO in a series of what it calls “Best Buys,” a set of 16 interventions that work on preventing and managing NCDs for prices that have an unprecedented return on investment. These include steps to reduce tobacco and alcohol use, improve unhealthy diets and increase physical exercise, as well as plans for the management of cardiovascular disease, diabetes and cervical cancer.

Implementation of the Best Buys in LMICs would translate to saving 10 million people from heart disease and stroke, for example. It would also add 50 million years of healthy life.

Moreover, on the financial side, the Lancet NCD Countdown 2030 showed that implementing this package of reforms would cost on average $18 billion annually between 2023 and 2030 but would generate an average net economic benefit of $2.7 trillion.

“Unless countries follow through on commitments to reduce mortality from noncommunicable diseases such as diabetes and hypertension, we ‘ll be nursing a huge part of the global population living with chronic conditions,” Dain said. “And most of this preventable suffering, illness and death will be amongst people living in poorer communities. We can avoid that future scenario by investing in cost-effective policies now.”

Dain added that “keeping citizens healthy from preventable NCDs is not simply about a government’s choice to invest in health, it is an investment in a country’s economic stability and security, in its own pandemic preparedness.”

Image Credits: oncommunicable Disease Alliance, Noncommunicable Disease Alliance.

pandemic
During the COVID-19 pandemic, health workers in Guatemala liaise with local partners to maintain essential ANC services, communicate accurate information, and provide social support to pregnant women, thanks to a USAID-supported programme of the NGO MSH.

The United Nations General Assembly voted to hold a summit of heads of state and other world leaders next year to find fair, long-lasting solutions for the global inequities and inadequate responses that the COVID-19 pandemic has all too painfully highlighted.

Delegates to the 193-nation assembly overwhelmingly approved the resolution in a consensus vote on Friday with the backing of 12 sponsors and 117 cosponsors.

The pandemic “revealed serious shortcomings at the country, regional and global levels in preparedness for, timely and effective prevention and detection of, and response to potential health emergencies, including in the capacity and resilience of health systems, indicating the need to better prepare for future health emergencies,” the resolution says.

The resolution calls for a one-day summit of heads of state, ministers and other government officials to be held sometime during the second half of September 2023, when the assembly holds its annual highest-profile gathering at the UN headquarters in New York City.

It is to be convened by the president of the General Assembly in collaboration with the World Health Organization (WHO), at the level of heads of state and government, by no later than the last day of general debate at its 78th session scheduled for 12-30 September 2023.

The summit is expected to “adopt a succinct political declaration aimed at, inter alia, mobilizing political will at the national, regional and international levels for pandemic prevention, preparedness and response,” the resolution says.

The assembly’s president also is supposed to appoint two co-facilitators to present “options and modalities” for the summit and the political declaration, it says. 

pandemic
Former Liberian President Ellen Johnson Sirleaf (left) and Former New Zealand Prime Minister Helen Clark (right), co-chairs of The Independent Panel presented a second report on Monday, 22 November, calling for quick action on a Pandemic Treaty or Convention

Pandemic summit a high priority of the Independent Panel

The Independent Panel chaired by former Liberian President Ellen Johnson Sirleaf and former New Zealand Prime Minister Helen Clark made it a key recommendation last year.

In their report, “COVID-19: Make It the Last Pandemic,” they argued that world leaders must do more to quickly fix vaccine equities and pandemic financing to head off the next disaster.

After the vote, nations such as Brazil, Korea, Switzerland and the US voiced support for the summit but cautioned it must complement the work in Geneva on the International Health Regulations (IHR) amendments and Intergovernmental Negotiating Body (INB) process.

The 194-nation World Health Assembly (WHA) in Geneva approved a resolution in May laying out the complex process it will use to update the IHR’s legally binding rules among nations for responding to global health emergencies like the pandemic.

In July, the INB agreed negotiations towards a pandemic “treaty” intended to improve the world’s pandemic prevention, preparedness and response will be set up in terms of Article 19 of WHO’s Constitution. That would allow WHA to make the treaty legally binding if a two-thirds majority approves it.

Broad support for pandemic summit

The resolution’s 12 sponsors were: Australia, Bangladesh, Canada, Costa Rica, Ghana, Indonesia, Jamaica, New Zealand, Rwanda, South Africa, Sweden and Vietnam.

Another 117 countries were co-sponsors:

Algeria, Andora, Angola, Argentina, Armenia, Austria, Bahrain, Barbados, Belgium, Britain, Bolivia, Bosnia and Herzegovina, Botswana, Bulgaria, Burkina-Faso, Cape Verde, Cambodia, Central African Republic, Chad, Chile, Colombia, Comoros, Côte d’Ivoire, Croatia, Cuba, Cyprus, Czech Republic, Denmark, Djibouti, Dominican Republic, Egypt, El Salvador, Equatorial Guinea, Estonia, Finland, France, Gabon, Gambia, Georgia, Germany, Greece, Grenada, Guinea, Guyana, Haiti, Honduras, Hungary, Iceland, Ireland, Israel, Italy, Japan, Jordan, Kenya, Kuwait, Laos, Latvia, Lebanon, Lesotho, LIberia, Liechtenstein, Lithuania, Luxembourg, Malawi, Malaysia, Maldives, Mali, Malta, Mauritius, Monaco, Montenegro, Moldova, Morocco, Mozambique, Namibia, Nepal, Netherlands, Nicaragua, Norway, Palau, Panama, Papua New Guinea, Poland, Portugal, Qatar, Romania, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, San Morino, Saudi Arabia, Senegal, Serbia, Seychelles, Singapore, Slovakia, Slovenia, South Sudan, Spain, Sudan, Suriname, Tanzania, Tajikistan, Togo, Timor-Leste, Trinidad and Tobago, Tunisia, Turkey, Turkmenistan, Uganda, Ukraine, United Arab Emirates, Uruguay, Vanuatu, Venezuela, Zambia and Zimbabwe.

Image Credits: MSH, @TheIndPanel.

Administering monkeypox doses in the United States after the US signs off on deployment of 1.1 milion doses

The fraction of monkeypox cases with no recent contact with men who have sex with men (MSM) continues to rise in the US – accounting for one-third of cases – suggesting a silent spread of the virus to other communities.

Men with recent MSM contact accounted for 65.78% of cases as of 20 August, according to the US Centers for Disease Control and Prevention (CDC) data, down from 72.44% a week earlier. Currently, men who had no recent MSM contact account for 27.71% of all US cases, while women account for 4.67% and those with other gender identities account for 1.84% of cases. 

monkeypox
Proportion of cases with known data on sexual history and gender reporting recent man-to-man sexual contact (MMSC) by the week in which monkeypox case was reported.

Overall, cases in the Americas continue to rise sharply, accounting for 60% of all cases compared to Europe’s 38% in the past month. The WHO European region is also demonstrating early signs of a declining infection.

However, there is a clear, disproportionate access globally to vaccines against monkeypox. The US holds nearly 80% of the Jynneos vaccine supplies used to fight monkeypox,  but it has only 35% of the global monkeypox cases. Most countries have no access to any doses, according to a Public Citizen analysis on Thursday.

“Once again, vaccines for an outbreak are not available in the vast majority of countries, including in the African states that have fought monkeypox for years,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines Program. 

He called on the US to “put forward a plan to fight global monkeypox and avoid the tragic mistakes of the COVID crisis.”

The analysis compares vaccine access and monkeypox cases in more than a dozen countries. It shows the US and many European countries obtained most of the vaccine, while Africa, where monkeypox is endemic, has not gotten a single dose.

Lack of monkeypox vaccine access mirrors early days of COVID-19 

The World Health Organization has said little about the lack of monkeypox vaccine access and lopsided availability of vaccines overall, despite having been outspoken about the COVID-19 pandemic’s vaccine inequities.

What’s different in this case is there is only one manufacturer of monkeypox vaccines, Bavarian Nordic, and its European plant shut down in the spring for renovations. 

Officials from the Africa Centers for Disease Control Prevention and WHO African region have decried the continent’s lack of access to monkeypox vaccines.

In July, Africa CDC’s acting director, Ahmed Ogwell Ouma, drew attention to the disparity between WHO’s urgent declaration of monkeypox as a global public health emergency (PHEIC) and the sluggish response to the burgeoning risks in Africa.

Countries such as Democratic Republic of the Congo (DRC), which reported multiple deaths from monkeypox, have not received any doses or gotten any orders secured. 

Monkeypox cases and vaccines across 12 countries. Countries in Africa where the virus is endemic, such as DRC, have not secured a single dose.

In contrast, the US had 1.1 million vaccine doses on hand for 16,602 cases as of late August — 22 times more doses hoarded than in even the European Union and U.K. combined.

The US supply is enough to treat each case with 66 doses, and the country also had placed orders for nearly 7 million more doses.

Though the US is considered a hotspot for monkeypox, with cases rising across other groups with no MSM contact, advocacy groups say the disproportionate access is a disturbing contrast to WHO’s aim to eliminate monkeypox.  

“Alarm bells are ringing,” said Zain Rizvi, research director in Public Citizen’s Access to Medicines program. 

“As we have learned all too painfully throughout the coronavirus pandemic,” said Rizvi, an expert on pharmaceutical innovation and access to medicines, “we can’t solve a global public health emergency through national policies alone. A global plan is needed to curb this global crisis.”

Image Credits: The Hill/Twitter , US CDC , Public Citizen.

WHO Regional director put on indefinite leave
Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference.

The World Health Organization says it has put its regional director for the Western Pacific Region “on leave” while it carries out an investigation into him.

“The investigation is still ongoing,” the UN health agency said in a statement provided to Health Policy Watch. “WHO is not in a position to comment on matters pertaining to ongoing investigations.” 

Dr Takeshi Kasai, WHO’s director for a region that is home to almost 1.9 billion people across 37 countries and areas, “is on leave,” according to WHO.

During his absence, WHO says, WHO’s Deputy Director-General Dr Zsuzsanna Jakab will assume responsibility for the region and “ensure business continuity.”

WHO did not specify the reasons for Kasai’s indefinite removal, which was first reported by The Associated Press based on internal correspondence it obtained.

However, it comes months after an AP investigation that revealed dozens of staffers accused him of racist, abusive and unethical behavior.

The staffers said his behavior undermined WHO’s efforts to stop the coronavirus pandemic in Asia.

WHO
The WHO logo on its headquarters in Geneva, Switzerland.

WHO investigation into ‘toxic atmosphere’

The AP cited two senior WHO officials who asked not to be identified because they were not authorized to speak to the press. They said Kasai was put on extended administrative leave after internal investigators substantiated some of the misconduct complaints.

The AP previously reported that more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of its Executive Board alleging Kasai created a “toxic atmosphere” in WHO’s offices across the Western Pacific. Kasai, a Japanese doctor, has denied using racist language or acting unprofessionally.

He began his term as regional director on 1 February 2019, after more than 15 years of serving in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014.

WHO advisory panel finds need to reform

In January, an advisory panel said WHO needs to reform lines of authority and responsibility across all aspects of its emergencies response operations in order to effectively prevent, report, and take measures against sexual exploitation and harrassment.

Those were the highlights of a final report by an Independent Oversight Advisory Committee (IOAC) of the WHO Health Emergencies Programme, examining the claims of sexual exploitation and harrassment that first emerged in connection with WHO’s 2018-2020 Ebola response in the Democratic Republic of Congo.

The report, presented in a session of the WHO Executive Board, marked another milestone in the follow-up to reports of sexual exploitation and abuse claims by some 75 Congolese women against 25 WHO workers deployed to the Democratic Republic of Congo’s 2018-2020 Ebola response.

WHO
A series of media reports have come to light in January about extensive sexual abuse scandals in DR Congo

Following the reports, WHO initiated an independent investigation, as well as initial internal reforms to improve staff training in the prevention of sexual exploitation and harrassment (PRSEH); deployment of more training staff; and new recruitment standards that also consider any exploitation and abuse issues in a candidate’s background, the IOAC report states.

But there remains “ deep, lingering frustration expressed by member and staff about the lack of transparency, delays in responding to incidents and holding perpetrators accountable, and the defensiveness with which the Organization has dealt with SEAH in the past,” states the report, presented to the EB.

And more comprehensive cultural and structural changes need to occur across WHO to reduce the risks of abuse from ever occurring in the first place, said Felicity Harvey, co-chair of the IOAC committee, in her presentation of the report to the WHO Executive Board.

Image Credits: WHO, Flickr – Guilhem Vellut, WHO.

Urban garden in Tapada da Ajuda, Lisbon

From playful elements in street architecture in Cork, Ireland, to teaching children how to grow vegetables in Lisbon, Portugal, cities across Europe are using urban design and health interventions to promote the well-being of their populations.

Europe has a unique opportunity to make city life healthier since it has relatively few mega cities; more than 70% of Europeans live in cities with less than half a million inhabitants. 

These are some of the World Health Organization’s findings in a new report, “Urban design for health: inspiration for the use of urban design to promote physical activity and healthy diets in the WHO European Region,” published Wednesday and launched at the 11th Conference of HEPA Europe on health-enhancing physical activity in Nice, France. 

Launch of the WHO Europe report “Urban design for health: inspiration for the use of urban design to promote physical activity and healthy diets in the WHO European Region” at the HEPA Europe conference on 31 August.

The report, prepared by the WHO European Office for the Prevention and Control of Noncommunicable Diseases, looks at ways to promote physical activity and healthy diets in urban settings.

Rather than simply telling people about the ‘right’ food choices and benefits of physical activity, cities can use better strategies to help people choose more wisely, the report suggests. Research has shown that design also plays a role in the health of communities around the world.

“If we want to make cities a better environment that helps people to live healthier lives, first we need to understand the people’s needs,” said Dr Kremlin Wickramasinghe, head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases.

“This will give us insights to integrate healthier habits into everyday lives effectively.”

Urban environment influences health 

The report says urban design and planning influence public health and human behaviour “by limiting or providing access to healthy foods and active lifestyles, which have profound effects on people’s physical and mental health.”

For instance, in the WHO European Region, environmental risk factors are estimated to cause at least 1.4 million deaths per year, approximately half of which are linked to air pollution, a major contributor to the rise in noncommunicable diseases (NCDs). One in four cases of ischaemic heart disease and strokes, and one in five cancers are estimated to result from environmental exposure.

These risk factors can be the result of inequalities in environment and health from different aspects of home and work life, including housing conditions and access to basic services and transport. 

Traffic tends to be greater in cities’ less affluent neighbourhoods, posing a greater risk of road-related injuries and exposure to air and noise pollution, which has implications for poor health and a higher incidence of NCDs.

That is why it is crucial, the report emphasizes, to find the best approaches to address these risk factors in urban settings: “Cities are places where it all comes together.”

Building connections with communities to facilitate healthy urban planning 

Wickramasinghe emphasizes that gathering data and building connections with local communities is “essential for healthier urban planning.”

WHO’s report presents several tools to facilitate this:

  • collecting data on how people move around in a city
  • identifying local food infrastructures that can improve food security
  • estimating the economic benefits of healthier policies
  • engaging various types of stakeholders, including citizens
  • analyzing data for healthier urban planning

One such tool, called the healthy streets approach, uses an index for large-scale, long-term strategic planning to make improvements across ten indicators. 

Healthy streets are important part of urban design
These 10 healthy streets indicators can be used to engage with citizens and other stakeholders in urban planning.

The index has indicators for things such as how much clean air there is, whether the streets are easy to cross, and the degree to which everyone feels welcome.

The intent, the report says, is to make it easier for citizens to promote a healthy, safe neighborhood through “simple language that everyone can understand and relate to.”

Real-life examples from cities

Many cities are trying to improve urban transport and mobility, as well as access to urban nature and green spaces. The new report highlights some of the positive examples.

Cork, Ireland

As Cork is dominated by cars but lacking in green spaces, air quality was found to be a problem, in addition to limited outdoor spaces for physical activity. 

urban design as per WHO
First Parklet, Douglas Street, Cork City

This city decided to introduce more playful elements into its street architecture by developing ten new “parklets” with entertainment equipment and seating. It also included a “playful culture trail” in July 2021 to encourage active, playful movement between and within the locations. 

Tbilisi, Georgia

Adam Mitskevichi Street, Tbilisi has been transformed into a pedestrian oriented street to improve physical activity.

Tblisi has a transport system that is not pedestrian-friendly and lacks buses and cycling infrastructure. Its car-dependent nature results in traffic congestion and air pollution. 

Additionally, pedestrian areas are considered possible only in tourist areas and are, therefore, not found in resident neighborhoods

To solve this problem, the city is transforming its streets to make them pedestrian-oriented. The new street design is meant to address the main challenges of Tbilisi: air quality, physical inactivity, and mental health.

Adam Mitskevichi Street, a pilot area, was closed down for a few days, to familiarize citizens with a different perception of how the street could be used. From the first hours of the street’s dedication to the public, children arrived with music and started dancing, and some people enjoyed cycling and skateboarding.

Lisbon, Portugal

Tapada da Ajuda, a green space in Lisbon, is located on hilly terrain, and its steep topography makes it difficult to ensure easy access for children. Additionally, the surrounding streets are not safe for children because cars are parked on some sidewalks.

In order to build more connections between local citizens, especially children, in the area, the city promotes healthy eating by putting local produce at the heart of its public space project, while teaching children how to grow vegetables and the importance of a healthy diet.

The tools and examples in the report highlight the types of actions that policy makers and urban planners can use for inspiration to rethink and improve their cities.

Cities in other parts of the world have also come up with other ways to promote health through urban planning and policy, including Buenos Aires, Argentina and Baku, Azerbijian, showing how urban design is crucial to long-term social and health benefits. 

“Urban design is a key determinant of physical activity and healthy diets,” the report concludes, “contributing to the prevention and control of NCDs and improving global health.”

Image Credits: WHO , WHO.

A pharmacist holds two sets of pills in her hand, showing the difference between the amount of tables a patient takes on the new antibiotic regimen (L) versus the old treatment at the Sizwe Tropical Diseases Hospital in Johannesburg, South Africa, on August 05, 2019. Credits: Michele Spatari / AFP

Researchers have significantly strengthened the safety profile of a watershed treatment course for highly drug-resistant strains of tuberculosis — a heartening breakthrough set to change the lives of millions of MDR-TB patients around the world.

The results of a randomized-controlled trial published in the New England Journal of Medicine today showed the new oral TB antibiotic regimen BPaL had half as many side effects but maintained an efficacy rate of 91% after an adjustment to the course of one of the three component antibiotics in the regimen.

The breakthrough findings have already been hailed by experts as one of the most important developments in tuberculosis research this century.

Oral treatment can now safely replace injections

In numbers: the process facing patients under old generation MDR-TB treatments Credit: TB Alliance

The findings mean the new oral regimen may safely replace the 18 to 24 months of intensive treatment via injections that was the standard of care until now — with a global success rate of just 52%.

This grueling process includes daily injections for at least 6 months, multiple daily IV infusions for up to 24 months, and 14,000 pills for a case of drug-resistant tuberculosis.

The new regimen was developed over two years by the TB Alliance, a not-for-profit product development partnership based in South Africa and the United States.

Dose of Linezolid halved in new trial to reduce side effects

KYIV, UKRAINE – DECEMBER 13: Stivlana Pasichnyk tests blood samples at NIPP on December 13, 2021 in Kyiv, Ukraine. (Photo by Brendan Hoffman/Getty Images for TB Alliance)

The trial follows upon the March 2020 Nix-TB trial findings that demonstrated for the first time the efficacy of the all-oral antibiotic regimen. The trial achieved positive outcomes in 90% of its 109 patients over a period of just six to nine months.

That regimen also led to significant side effects, however, including peripheral neuropathy — nerve damage outside the brain and spinal cord — in 81% of patients.

Some 48% of patients also developed myelosuppression, a condition in which bone marrow activity is decreased, resulting in the production of fewer red and white blood cells, and platelets.  

Both conditions were linked to Linezolid, the antibiotic denoted by the “L” in BPaL, which has well-known side effects.

Today’s study results show halving the Linezolid dosage from 1200mg to 600mg achieves a reduction in incidence of peripheral neuropathy and myelosuppression by 56% and 46%, respectively, At the same time, efficacy remained stable at 91%.

WHO recommended new regimen based on early reports of data 

tuberculosis patient
PRETORIA, SOUTH AFRICA – JUNE 18: Panganai Kapfunde (42), a participant in the ZeNix trial, with his children at his home in Pretoria, South Africa, on June 18, 2021.
Photo by: Jonathan Torgovnik/Getty Images for TB Alliance

Privy to early reports from this trial and others, the World Health Organization in May 2022 recommended that the new 6-9-month oral BPaL regime replace the old intravenous one in the treatment of most drug-resistant tuberculosis.  

In addition to early results of the ZeNix trial published today, WHO based its recommendation on early reports from two other randomized control studies, which are still ongoing, about the safety and efficacy of BPaL: TB-PRACTECAL and NExT.

“We now have more and much better treatment options for people with drug-resistant TB thanks to research generating new evidence,” Dr Tereza Kasaeva, director of WHO’s Global TB Programme, said of the new guidance.

“This is major progress compared to what was available even a few years ago,” she said, “and will be of great benefit for people struggling with TB and drug-resistant TB, resulting in better outcomes, saving lives and reducing suffering.”

Accessibility Is key to the patent holder

tuberculosis treatment
A caretaker stands stands at the entrance of Ward 16, where the drug-resistant tuberculosis patients are housed and treated, at the Sizwe Tropical Diseases Hospital in Johannesburg, South Africa, on August 05, 2019. Credits: Jonathan Torgovnik / Getty Images for TB Alliance

Dr. Mel Spigelman, CEO of TB Alliance, said his organization is dedicated to discovering, developing, and delivering new therapies.

“And our mission is not complete until improved TB medicines reach every patient who needs them,” he told Health Policy Watch. “With enhanced commitment and global collaboration, we can advance the science and one day see a world where no one dies of TB.”

As one of the foremost experts on tuberculosis and TB drug development, Spigelman also sits on the Coordinating Board of the WHO Stop TB Partnership, which worked with TB Alliance in 2019 to make BPaL based regimens available to 150 low- and middle-income countries for just $364, or $2 a day.

For countries facing high drug-resistant tuberculosis burdens, this price point is a literal lifesaver.

In numbers: the burden placed by tuberculosis on the world. Credits: TB Alliance.

Old generation treatment options for drug-resistant tuberculosis range from US$2,000–$8,000 for a full course through traditional distribution channels, and have long placed a heavy weight on the finances of health care systems on the front lines.

Through traditional market channels, BPaL-based regimens are available at US$700–$800, up to 10 times cheaper than the old generation alternatives.

The TB Alliance “will continue to innovate and fight for access until the days of lengthy and highly toxic therapies are over for every person with TB,” Spigelman said in a press release accompanying the release of the ZeNix trial’s results, 

Good news at a bad time

KYIV, UKRAINE – DECEMBER 13: Dr. Rastyslav Lyubevich at NIPP on December 13, 2021 in Kyiv, Ukraine. (Photo by Brendan Hoffman/Getty Images for TB Alliance)

The advance in treatments comes at a time when global efforts to fight tuberculosis are still reeling from the devastating impacts of COVID-19.

Two years ago marked the first year on year increase in tuberculosis deaths since 2005, with fatal cases jumping by 100,000 to an estimated 1.5 million in 2020. In the same year, 1.4 million fewer people received care — a 21% reduction globally, and as much as 28% in the top 10 most affected countries.

WHO models project that COVID related disruptions to tuberculosis care and detection could have caused an additional half a million deaths in 2021.

The precise numbers remain unknown.

Impact of the COVID-19 pandemic on TB detection and mortality in 2020. Credits: WHO

Tragically, this may not even paint the full picture.

WHO modeling for mortality in 2021 doesn’t account for exacerbations in social determinants such as extreme poverty and malnutrition that fuel the spread of tuberculosis.

The COVID-19 pandemic pushed 100 million people into poverty in 2019, and nearly 20% of global TB incidence is attributable to undernutrition.

In countries with high tuberculosis burdens, as in India, that number can be far higher, reaching more than 50% in many Indian states.

With the UN estimating that developing economies will have pandemic-related losses of $US12 trillion through 2025, undernutrition-driven tuberculosis could see a steep rise. 

An unimportant emergency

tuberculosis
Doctor Pauline Howell visits a patient known as Nxumalo currently on the NIX treatment at the Sizwe Tropical Diseases Hospital in Johannesburg, South Africa, on August 05, 2019. Credits: Michele Spatari / AFP.

The world’s response to COVID-19 has also drummed up a lot of discussion in the world of TB advocacy and treatment. 

The sheer scale of financing and pace of scientific progress observed during the COVID-19 pandemic had two opposing effects: redefining the limits and hopes for what is possible to eradicate tuberculosis, and — by contrast — laying bare the persistent levels of neglect towards tuberculosis as a serious crisis since it was declared a public health emergency in 1993.

“The global response to TB has clearly failed to reflect the ‘public health emergency,’ which it is,” Spigelman said.

“It is now second only to COVID-19 as the greatest infectious disease killer in the world,” he said, “and unfortunately looks poised to regain the dubious distinction of again becoming the greatest single infectious disease killer.”

Even modest funding for tuberculosis fight could be game changing

tuberculosis patient
SOWETO, SOUTH AFRICA – JUNE 17: Mapalwsa Thafeng (37), a participant in the ZeNix trial, and her children in their hometown of Diepkloof, Soweto, South Africa, on June 17, 2021.
Photo by: Jonathan Torgovnik/Getty Images for TB Alliance

In the first 11 months of the COVID-19 outbreak, US$104 billion was spent on research and development, resulting in more than a dozen vaccines receiving authorization within a year of the public health emergency declaration.

By contrast, US$5.5 billion has been spent on tuberculosis research and development over the last decade, and the century-old Calmette-Guérin vaccine — first approved for use in 1921  — is still used for tuberculosis.

Investments in new TB vaccines amount to US$100 million per year, and overall research and development investment reached US$900 million in 2020. That is far less than the US$2 billion funding goal — more than double current levels — set at the 2018 UN High-Level Meeting on TB Political Declaration.

A significant majority of countries that pledged to the agreement continue to fall short of their fair-share funding targets. 

Despite promises, most countries in the world continue to miss TB funding targets. Credits: StopTB.

“Given the modesty of the TB funding targets, the ongoing failure of global funders to meet even these low targets reflects the deep inequity in the global response to health challenges faced by poor communities versus wealthy ones,” says a joint report on tuberculosis research funding trends by Treatment Action Group and Stop TB Partnership, whose board includes Spigelman. 

“The result of this inequity manifests in the tools available to treat diseases,” it says, “where health systems and health care providers have an array of effective options for the management of some diseases, but must make do [for decades] with substandard or non-existent tools for others.”

tuberculosis patient
KYIV, UKRAINE – DECEMBER 13: Portraits of Maria Slavych, a TB survivor who underwent the BPaL regimen, at NIPP on December 13, 2021 in Kyiv, Ukraine. (Photo by Brendan Hoffman/Getty Images for TB Alliance)

The Global Fund, an organization responsible for providing 77% of all international tuberculosis funding, says the world is at a critical juncture and must increase investment in fighting TB — or accept it is abandoning UN goal to end the disease as a public health threat by 2030.

Spigelman said the world could dramatically improve the diagnosis, treatment and prevention of TB with far less funding than it has dedicated to COVID-19.

“In short, with adequate funding, TB could potentially be eradicated.”

Image Credits: Jonathan Torgovnik/Getty Images for TB Alliance.