monkeypox
Monkeypox rash.

A World Health Organization emergency committee met Thursday to determine if the monkeypox outbreak spreading in non-endemic countries constitutes a Public Health Emergency of International Concern (PHEIC).

The closed door meeting, including 16 committee members and eight advisors, will make a recommendation to WHO Director-General Dr Tedros Adhanom Ghebreyesus, who will decide whether to designate it a public health emergency.

Tedros told a WHO media briefing last week the global outbreak of monkeypox “is clearly unusual and concerning.” His decision is not expected before Friday, according to a WHO media advisory.

Ibrahima Socé Fall, WHO’s deputy director for emergency response, said it is important to take preventive action now because the risk of spread in Europe is “high” and in other parts of the world it is “moderate,” though much is still unknown about how the virus is being transmitted.

“We don’t want to wait until the situation is out of control,” he said.

More than 3000 monkeypox cases globally, experts urge WHO to take action 

With 3,543 confirmed and suspected cases across 59 countries outside of central and western Africa as of Thursday, other global health organizations have already begun to declare monkeypox a public health emergency, with experts urging WHO to take immediate action to combat what some of them consider to be another pandemic.

Public health research coalition World Health Network declared monkeypox a pandemic on Thursday. 

“There is no justification to wait for the monkeypox pandemic to grow further. The best time to act is now. By taking immediate action, we can control the outbreak with the least effort, and prevent consequences from becoming worse,” said Yaneer Bar-Yam, WHN’s founder and president of New England Complex System Institute.

In places like New York City, public health clinics are offering vaccinations against the disease. 

Monkeypox has plagued Africa for years 

Cases of monkeypox in endemic countries between 15 December 2021 to 1 May 2022

Some experts in Africa have said the WHO consultation is long overdue, but for different reasons. Global concern has only arisen recently, despite the fact that monkeypox has plagued Africa for years.

In 2022 some 1536 suspected cases and 72 deaths have been reported by WHO in the eight countries where the disease is endemic in 2022.

In the case of the more lethal West African clade, the disease can have a fatality rate of up to 10%. 

The different responses to the disease in Africa and Europe have drawn growing attention. “When a disease affects developing countries, it is (apparently) not an emergency. It only becomes an emergency when developed countries are affected,” Emmanuel Nakoune, acting director of Institut Pasteur in Bangui, Central African Republic, told Reuters.

Nakoune, who is running a clinical trial for a monkeypox treatment, said that if WHO declares monkeypox a public health emergency, that would at least be an important step in the right direction. And each will be able to benefit, he said, “if there is the political will to share equitably the means of response between developed and developing countries.”

More intensive person-to-person transmission seen in Europe 

The clade of the virus spreading in Europe was previously seen largely in West African countries, with the exception of isolated cases carried abroad by travelers. But person to person transmission of the virus in African settings was typically limited, with outbreaks occurring largely as a result of contact with wild animal populations, including infected rodents and squirrels. 

In Europe, in contrast, the virus is spreading exclusively through person-to-person transmission, including as a result of men having sex with men or other forms of skin-to skin contact.

Meanwhile, a team of African researchers, including the acting director of the Africa Centers for Disease Control, proposed a new nomenclature for the virus out of concern that the current terms are racist and stigmatizating.  

The proposal calls for the virus to be named in terms of its variants, such as MPXV Clades 1, 2, and 3, in order of discovery.  Newer variants are more likely to be the ones carrying the disease abroad. 

If monkeypox is designated as a public health emergency, or PHEIC, under WHO’s International Health Regulations, it could help unlock more funding from WHO and governments that would help to get transmission under control.  Countries would have a legal obligation to implement their own public health measures.  

Such an emergency declaration also could underpin WHO plans to ensure an equitable distribution of available smallpox and monkeypox vaccines that are effective against the virus. Such vaccines are available now only in wealthy countries.

Only six disease outbreaks have been declared a PHEIC since 2007: swine flu, polio, Ebola, Zika, Kivu Ebola and COVID-19.  [See the WHO explainer about Monkeypox symptoms and treatment below.]

https://twitter.com/WHO/status/1535592685569986561?s=20&t=z9RSw1le1MRLn-9Lh0oxBg

Image Credits: Diverse Stock Photos , WHO, Disease Outbreak News, 21 May 2022 .

electron micrograph of methicillin-resistant Staphylococcus aureus (MRSA, brown), a deadly bacteria resistant to many antibiotics, surrounded by cellular debris

The World Health Organization (WHO) has once more raised the red flag over the lack of new antibacterial treatments being developed to address the mounting threat of antimicrobial resistance (AMR).

In its annual  ‘pipeline report’, which assesses those antibacterial drugs in preclinical and clinical development, WHO describes the pipeline as “stagnant” and “far from meeting global needs.”

Since 2017 only 12 antibiotics have been approved, 10 of which belong to existing classes with established mechanisms of AMR. The 2021 report shows that only 27 new antibiotics are in clinical development against priority pathogens, four less than were being developed in 2017.

“This presents a serious challenge to overcoming the escalating pandemic of antimicrobial resistance and leaves every one of us increasingly vulnerable to bacterial infections including the simplest infections,” said Dr Hanan Balkhy, WHO Assistant Director General on AMR.

Status of drugs in clinical trial development – WHO ‘Pipeline’ report 2021

The 2021 report, published in May and based on data from 2020, also highlights some of the barriers to drug development, foremost the lengthy pathway to approval, high cost and low success rates.

It takes 10 to 15 years to progress an antibiotic candidate from the preclinical and clinical stages and that only one in every 15 existing drugs in preclinical development and one in 30 for new classes reach patients.

“Time is running out to get ahead of antimicrobial resistance, the pace and success of innovation is far below what we need to secure the gains of modern medicine against age-old but devastating conditions like neonatal sepsis,” said Dr. Haileyesus Getahun, WHO Director of AMR Global Coordination.

Pipeline investment challenges and existing drug misuse

The Global Antimicrobial Research and Development Partnership (GARDP) has been created by WHO and the Drugs for Neglected Disease Initiative to accelerate the advancement of promising drug candidates in clinical trials.  However getting new drug candidates through costly Phase 2 and 3 trials remains challenging – with financial rewards insufficient for private industry even if a drug candidate succeeds.

The other problem is drug misuse and fake drug use. Worldwide, some 73% of antibiotics sold every year are used in animal health. That pattern, along with overprescription, misuse and use of weakened formulations in human medical settings all are increasing the prevalence of ‘superbugs’ and thus antimicrobial resistance (AMR) to some of the most common drug formulations.

AMR trends are most pronounced in low- and middle income countries of Asia and Latin America where regulations on both veterinary and human use of such drug are weak – with huge financial incentives to veterinarians who recklessly prescribe antibiotics to animals, and many antibiotics commonly available over-the-counter for human patients who then may use them to treat illnesses for which they are not effective. See related story:

Breeding Superbugs – Veterinary Drugs, More than Human Ones, Drive AMR 

 

Image Credits: NIAID, WHO .

Heiner Wedmeyer reports on Bulevirtide to treat and even cure Hepatitis D, with Maria Buti, EASL Public Health Chair and EASL Secretary General Thomas Berg,

The drug Bulevirtide can successfully treat and even potentially cure Hepatitis D – the most acute diseases of the hepatitis family and hardest to treat until now, according to the results of a Phase III trial of the drug announced on Thursday, the opening day of the International Liver Congress 2022 (ILC 2022). 

An estimated 12 million people worldwide have experienced HDV infection, also known as Chronic Hepatitis Delta. HDV is found in up to 5% of people worldwide living with Hepatitis B (HBV). HBV also has so far eluded a cure. But promising clinical trial results of other new drugs and drug combinations to treat HBV, and related to that, acute hepatic porphyria, also being discussed at the conference, could help advance that goal. 

“With Bulevirtide, an inhibitor of HBV and HDV entry into liver cells, we can for the first time successfully treat Hepatitis D,”  said EASL in a press statement.  Results from 48 weeks of treatment with the drug also showed HDV RNA at undetectable levels in a significant proportion of those treated, leading to hopes that the treatment could also lead to a cure.  

“This is almost a historic moment for heptatology,” said principle investigator, Heiner Wedemeyer, of Germany’s Hannover Medical School, of the findings. He speaking at an ILC press briefing about the Phase 3 trial,  undertaken in Germany, The Russian Federation, Italy and Sweden of 2 and 10 mg doses of the drug daily for a period of 48 weeks. “For us in the Hepatitis D field, this is really exciting times, completely novel data, and game-changing for treatments.”

Results of randomized, Phase 3 study of 2 mg or 10 mg dose of Bulevirtide in patients with HDV virus in four European countries, as presented at the International Liver Conference 23-26 June, 2022

Convened by the European Association for the Study of the Liver (EASL) in a hybrid format, the conference in London, 23-26 June saw 5,000 scientists, doctors, public health officials, and patient groups attending in-person for the first time since the beginning of the COVID pandemic. 

Other advances being discussed at the conference will include: new treatments for reducing liver fat and positive results from the largest human trial of preemptive drugs administered before transplantation of a hepatitis C compromised organ, which can fully protect a patient from risk associated with post operative infection.

“We may well be entering into a new golden age of hepatology science,” said Thomas Berg, Secretary-General of EASL and Head of the Division of Hepatology at Leipzig University Medical Center in Germany. “There is respite coming for those people living with Hepatitis D and we are making progress towards finding a cure for Hepatitis B which affects millions people around the world. The science is inching us towards a potential public health revolution.”

Event takes place against backdrop of increased liver disease 

This year’s EASL takes place against the backdrop of an increased prevalence of liver disease across the globe.

In Europe, chronic liver disease has a substantial impact on young and middle-aged individuals in their prime working years, with the peak age of death occurring in the late 40s and early 50s. Liver disease is now the biggest killer of 35–49-year-olds in the United Kingdom. 

This contrasts with mortality from smoking-related and other obesity-related illnesses, such as lung cancer or type 2 diabetes, for which deaths typically occur in the 60s and 70s. Consequently, data from the World Health Organization shows that liver disease is now second only to ischemic heart disease as the leading cause of years of working life lost in Europe. On average, two-thirds of all potential years of life lost due to mortality from liver diseases are years of working life.

New treatments for Non-Alcoholic Fatty Liver Disease (NAFLD) 

The Congress also will see reports on the results of the human trial of a new drug Pemvidutide with the potential to reduce both weight and liver fat; as well as results of a randomized-controlled trial on a low carbohydrate/high fat diet, and its potential impact on fatty liver disease.

The search for new treatments for Non-Alcoholic Fatty Liver Disease (NAFLD) has gained momentum over the past few years as countries worldwide grapple with a rise in the disease, just one  result of the worldwide increase in obesity levels. NAFLD is now the fastest growing disease in the world, and the most common cause of liver disease in many developed countries.  

In a proportion of people, NAFLD can cause progressive liver damage, and in some cases it may even lead to the development of liver cirrhosis and liver cancer. In the U.S. it is now the most common indication for a liver transplant, according to EASL.

It is estimated that if left unchecked, the annual predicted cost of NAFLD in Europe is estimated to be greater than €35 billion in direct costs to the health system, and a further €200 billion by way of wider costs to society.

–Updated 27 June 2022

Image Credits: Wedemeyer et al, EASL2022 presentation.

A man with symptoms of trypanosomiasis, a neglected tropical disease, is examined by Dr Victor Kande in the Democratic Republic of Congo (DRC).

The Kigali Summit has called for the renewal of commitments in the fight against neglected tropical diseases (NTDs) through the adoption of the Kigali Declaration on NTDs. 

Sponsored by the government of Rwanda, the Kigali Declaration on NTD is the successor to the ground-breaking London Declaration of 2012, which was a pledge made by governments, donors, pharma, research institutions, NGOs, and other stakeholders to collaborate in their efforts to stop NTDs. 

The new Kigali Declaration aims to mobilize political will and secure commitments to achieve the Sustainable Development Goal target on NTDs and to deliver the targets set out in the World Health Organization’s Tropical Disease Roadmap (2021 – 2030).

The summit, hosted on Thursday by President Paul Kagame of Rwanda and co-convened by The RBM Partnership to End Malaria and Uniting to Combat NTDs, builds on progress made in the last two decades, and even more so since the London Declaration, to galvanize action to end malaria and NTDs. 

The summit is also a critical moment to highlight how investments in fighting both malaria and NTDs have a much broader impact, and increased investments will strengthen health systems and protect against future pandemics. 

In conjunction with the summit, Swiss pharmaceutical company Novartis has endorsed the new declaration and has announced a $250 m five-year commitment in the fight against NTDs.

“Today, by endorsing the Kigali Declaration and pledging to invest USD 250 million, we aim to accelerate  progress toward elimination of these diseases, which continue to cause suffering and stigma  for millions of people around the globe, ” said Novartis CEO Vas Narasimhan.  

Ending NTDs is possible 

Ambitious global commitments over the years have shown that ending NTDs is an achievable goal, with 45 countries eliminating at least one NTD, 600 million people no longer requiring treatment for NTDs, and cases of diseases that have plagued humanity for centuries, such as sleeping sickness and Guinea worm disease, at an all-time low.

However, 1.7 billion people continue to suffer from NTDs, and 241 million people are impacted by malaria globally. 

Additionally, according to the annual G-FINDER report, funding for NTDs remained relatively stagnant, with only snakebite envenoming seeing increased investment in 2020. 

Novartis’ $250 million commitment will be used to advance research and development of new treatments to combat NTDs and malaria.  It includes $1 million to advance R&D, focusing on novel drug candidates for four diseases: Chagas disease, visceral leishmaniasis, dengue fever, and Cryptosporidium. 

Some $150 million will be invested to advance the clinical development of three drug candidates to combat emerging resistance to artemisinin, a well-established treatment for malaria.  

With both its adoption of the Kigali Declaration and this new investment, Novartis reiterated its commitment to the fight against NTDs and malaria.

“Over the past decade, great progress has been made against NTDs, but there is still a lot more work to be done. Novartis will continue progressing our longstanding commitment to helping realize a world free of NTDs,” said Narasimhan.

Image Credits: DNDi.

The Global Health Matters podcast with host Garry Aslanyan.

It was 11 November 2022 when Dr Sikhulile Moyo and his team of scientists in Botswana discovered Omicron in a sample of SARS-CoV2 that looked different from the rest. 

“We sent it back to the lab to have it re-sequenced,” Moyo recalled. But by 19 November, the team was confident about what they had found. Two days later they reported what became known as the Omicron variant to the World Health Organization (WHO).

Moyo’s work raised a red flag for countries around the world. Even today, Omicron and its offspring remain the most dominant COVID-19 strain in circulation. 

PLAY PODCAST

Moyo discovered the Omicron variant in Botswana through careful cross-examination of COVID-19 tests – which is the topic of the most recent Global Health Matters podcast with host Garry Aslanyan.

Garry has two guests with a deep understanding of diagnostics and their application worldwide: Sikhulile Moyo, the research laboratory director at the Botswana Harvard AIDS Institute Partnership; and Bill Rodriguez, the CEO of FIND, the global alliance for diagnostics, and the founder of his own diagnostics company, Daktari Diagnostics.

The COVID-19 pandemic has brought a new global awareness of the need for accessibility to diagnostics in order to protect people. In this episode, the guests help Aslanyan answer questions such as “how available are essential diagnostics in low- and middle-income countries (LMICs)?” They also help listeners better understand the state of diagnostic testing in LMICs and how to achieve equity in access to testing in all countries.

Moyo was able to sound the alarm on Omicron because Botswana had put a good testing system in place, meaning the discovery of Omicron was not an accident but the result of a strategic and intentional increase in diagnostics in the region.

“Botswana decided to make sure there was access testing to all districts by identifying ‘COVID zones,’ Moyo explained. “Each of these areas had a PCR lab and we used the infrastructure from HIV to develop a surveillance strategy that could be built on that. When someone tested positive, we could investigate it.”

The surveillance team genetically sequenced samples from entry points into the country and hospitals – both people who developed severe disease and those who died of the virus.

With regards to the general population, while not everyone could be sequenced, they aimed to conduct a representative sampling.

“Because we were sequencing weekly, we caught those Omicron samples in our batch,” Moyo said.

The scientists noticed that the variant appeared to be an unusual lineage, though they could not have known it would become a variant of concern (VOC). However, on reporting it, they learned that other labs had discovered something similar. Then, on 26 November WHO named it at VOC and gave it the name Omicron. Moyo said he is saving and is going to frame that email to WHO because it changed the world.

“For me, I was fulfilled as a scientist to report something like that,” Moyo said. “But it was also a rollercoaster of emotions because of the way the world reacted with travel bans. I think we learned a lot over the past two years and that reaction was unfortunate.”

COVID highlighted the need for diagnostics manufacturing facilities in the Global South

Pandemics, according to Rodriguez, reveal all the existing problems in society. COVID-19 has highlighted the failure to invest in community-based diagnostics and revealed major gaps between the Global North and Global South in terms of equipment, manufacturing and qualified staffing.

“You may not remember, but two years ago, we became acutely aware of how important testing was and how little access we had to it anywhere in the world – for sure in low- and middle-income countries, but even in higher-income countries,” Rodriguez recalled.

“Now people understand it is a critical part of our health system and we need to make sure it is available,” he continued. “Equity in testing became a cornerstone of the global response to COVID.”

He said it highlighted the need to have a leader, like WHO, to deliver the message that testing was critical, but it also called to the forefront the need to establish diagnostic manufacturing facilities in the Global South.

“The factories that made the test kits were mostly in the Global North and that created problems and made a lot of countries realize how dependent they are,” he said.

Over the past 18 months, efforts have been made to establish sites in the Global South, from Latin America to South Africa – efforts that are too late for COVID, but will prove essential for any future pandemic, Rodriguez said.

COVID led to innovation, digitalization in diagnostics

The situation has also led to improvements in diagnostics and innovation. Today, nearly every country in the world now has the capacity to do sequencing of pathogens and share that information publicly so that it can be incorporated into a global response. Variants can be tracked in nearly real time – something that Rodriguez said was not really done before.

Moreover, the cost of testing has gone down, making testing more accessible to LMICs.

Yet, the testing technology has improved, allowing for multi-lineage molecular testing and more, which will change not only the world’s response to COVID but “will transform primary healthcare across the world,” Rodriguez said.

Also, Moyo noted, digital solutions have hit the market, such as mobile apps for communicating testing results, which has made proper diagnostics more viable.

“Some have said we should not waste a crisis,” noted Moyo. “We should use the opportunity COVID has given us to improve public health.”

Global Health Matters is available on Apple Podcasts, Spotify, Google Podcasts, Amazon Music, Stitcher or wherever you find your podcasts.

Read about and listen to more episodes on Health Policy Watch.

This article is part of our TDR Supported Series.

Image Credits: Global Health Matters podcast.

Pro-abortion demonstrators in the US

Americans are bracing for a firestorm over abortion rights as the US Supreme Court prepares to announce its decision soon in the landmark 1973 Roe v. Wade case.

The court’s conservative majority is expected, based on a leaked draft of Justice Samuel Alito’s opinion in Dobbs v. Jackson Women’s Health Organization in early May, to strike down the case. If that happens, 26 of the country’s 50 states are likely to move quickly to ban abortion, according to the Guttmacher Institute, a New York-based NGO that researches and advocates for reproductive rights.

Half of those 13 states — Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming — have laws in place to automatically end legal abortion services, the institute says, noting that more than half of all US women, or 58%, live in states hostile to abortion where the ban would likely take hold.

In contrast, 16 states and the District of Columbia have laws that protect the right to abortion. They already are preparing for a huge jump in demand for abortion services from women who live in states where the bans would likely be enforced.

58% of U.S. women of reproductive age—40 million women—live in states hostile to abortion rights
Last month, New York State Governor Kathy Hochul announced a $35 million investment to directly support abortion providers in anticipation of Roe v. Wade being overturned. 

“New York has always been at the forefront of the fight for abortion rights, and as the first female governor of New York, I will not let us go backwards,” said Hochul. “This landmark funding will get resources into the hands of clinics who need our help, safeguarding access to abortion in our state and setting an example for the rest of the nation to follow.”   

‘I would not be health commissioner’

This week, New York State Health Commissioner Dr Mary Bassett revealed in Elle magazine that she had an abortion as a medical student.

“How could a first-year intern who was expected to work 36-hour shifts also carry and care for a child? She—I—could not,” wrote Bassett, in a rare public acknowledgement by a high-ranking public official in the US. She later gave birth to two children.

“Had it not been for the abortion I received before I began my internship, I would not be New York’s health commissioner today. More importantly, I would not be the committed mother that I have been able to be to my two adult daughters for over 34 years,” added Bassett, in the article published on Tuesday.

Basset said taking away the right to abortion will not stop abortions, it will only make them “more desperate, deadly, and dangerous,” especially for people who are poor and “communities of color.”

Abortion pills to overcome ban?

Abortion advocates believe medical abortions performed using pills are the best solution for women living in states where bans are introduced. In 2020, so-called medication abortion accounted for 54% of all US abortions, outstripping surgical abortions for the first time.

In a letter to the heads of the US Congress, Hochul appealed for greater financial support for telehealth services and to “ensure the US Postal Service’s ability to ship abortion medication to all states”.

European sanction for US anti-abortion move

Earlier in the month, the European Parliament voted 364-154 to pass a resolution that “strongly condemns the backsliding in women’s rights and sexual and reproductive health and rights (SRHR) taking place globally, including in the US and in some EU member states”.

The resolution, which passed on June 9 with 37 abstentions, says SRHR are fundamental human rights that “should be protected and enhanced and cannot in any way be watered down or withdrawn.” It also cites deep concerns over how bans on abortions “will contribute to the trauma of rape and incest victims.”

Because of those concerns, European lawmakers urged the US government to “fully decriminalise abortion” and to ensure adequate protections exist for “the right to terminate a pregnancy,” including adequate funding needed in the US and globally.

“In countries heavily dependent on US aid for public health programmes, [Roe’s] overturning could have an impact on those governments’ commitment to abortion provision and other reproductive rights,” it said.

At 14, Sierre Leone’s Dankay Kanu (on right) was impregnated by an older man who refused to wear a condom then denied paternity.  She is portrayed here with a mentor from 2YoungLives, a programme that helps pregnant girls and teenage mothers in Sierra Leone.

‘Crisis of unintended pregnancies’ – UNFPA

Earlier in the year, the United Nations Population Fund (UNFPA), which coordinates the UN’s work on sexual and reproductive health agency, reported nearly half of all the 121 million a year in pregnancies worldwide between 2015 and 2019 were unintended. 

“Over 60% of unintended pregnancies end in abortion and an estimated 45% of all abortions are unsafe, causing 5 – 13% of all maternal deaths, thereby having a major impact on the world’s ability to reach the Sustainable Development Goals,” according to the UNFPA.

UNFPA Executive Director Dr Natalia Kanem said the staggering number of unintended pregnancies represents a global failure to uphold women and girls’ basic human rights.

“For the women affected, the most life-altering reproductive choice — whether or not to become pregnant — is no choice at all,” she said. “By putting the power to make this most fundamental decision squarely in the hands of women and girls, societies can ensure that motherhood is an aspiration and not an inevitability.”

Image Credits: Gayatri Malhotra/ Unsplash, Michael Duff/ UNFPA.

Nutritionist Claudette Kayitesi counsels Francois Iyamuremye as he receives his monthly antiretroviral medication at TRAC Plus Clinic in Kigali, Rwanda.

People are living with HIV for much longer thanks to greatly improved antiretroviral treatments. But they also are at disproportionately high risk for non-communicable diseases which affect everyone  more as they age. Now is the time to tackle both in a more integrated way.

The extraordinary advances in science over the past three decades that led to the development of highly effective antiretrovirals have transformed HIV/AIDS from a death sentence into a chronically manageable disease when supported with appropriate diagnosis and care. 

But the rising life expectancy of people living with HIV (PLHIV), and the resultant greying of the HIV epidemic, especially in high-income countries, means that they are as vulnerable to non-communicable diseases (NCDs) as the rest of the ageing population.  

In parallel, People living with HIV are also at a disproportionately high risk of some NCDs, creating an HIV-NCD syndemic. For instance, cardiovascular disease is now one of the leading causes of non-AIDS-related morbidity and mortality in PLHIV, who have a two-fold increased risk of cardiovascular disease compared to the rest of the population.

They also are at higher risk of type 2 diabetes and some types of cancer – for example, there is a nearly six-fold increased risk for cervical cancer among women living with HIV.

The disease landscape has shifted drastically over the past decade. NCDs and injuries are emerging as the leading causes of death and disability, in large part due to global progress made in reducing mortality associated with infectious diseases like malaria, tuberculosis and HIV/AIDS.

NCDs are increasingly affecting people living with infectious diseases, undermining decades of hard-won progress on tackling the HIV/AIDS epidemic.

South Africans struggle with diabetes and HIV 

South Africa, home to the largest population of people living with HIV in the world, also has the highest prevalence of diabetes in sub-Saharan Africa. One in eight South Africans (4.5 million people) are living with diabetes, double the number of less than five years ago. 

Deaths due to diabetes reached nearly 90 000 in 2019, double the figure of a decade earlier. AIDS takes the lives of some 125 000 South Africans each year. There is an inevitable intersection between the two diseases as there is between other NCDs such as hypertension and cardiovascular disease. If we are serious about reducing the shifting disease burden for this and future generations, it can’t be business as usual.

Keeping people living with HIV healthy will require a new integrated approach to disease management that better reflects a person’s health throughout their life course, shifting the focus away from the single health crisis or condition that leads them to seek care in the first instance. 

This emerging approach was given impetus for the first time at last year’s United Nations General Assembly High-Level Meeting on AIDS and reinforced in a recently published report.

Checking blood sugar levels of a patient with diabetes.

Integrated community care

On the ground, there are some good examples of HIV/NCD integration. The Cervical Cancer Prevention Program in Zambia (CCPPZ) is the first-ever cervical cancer prevention initiative for women living with HIV to be funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). 

The cervical cancer screening services began with two public sector clinics in the country’s capital city (Lusaka) in 2006, and a decade later CCPPZ was operational in 33 government-run health facilities across all of Zambia’s 10 provinces, serving women regardless of HIV status.

By 2015, the program had screened over 200,000 women, and that year it was adopted as the Ministry of Health’s official cervical cancer prevention programme. By focusing initially on women living with HIV, the programme was able to first reach those who were at highest risk of cervical cancer.

A collaboration between Partners in Health and the Malawi Ministry of Health to decentralise HIV/AIDS services in Neno, one of Malawi’s poorest rural districts, in 2007, is another good example of integration. The initiative used community outreach events to identify patients requiring HIV care and mobilise them to go to one of the district’s 12 primary health centres, with active home-based follow-up and support provided by a team of 900+ trained and mentored community health workers.

Specialised HIV/AIDS treatment and care, for those who required it, was available via referral linkages with the district’s two hospital facilities. The initiative proved highly successful with more than 62 per cent of the total expected district population of PLHIV enrolled in the programme by the end of 2015, and a treatment retention rate of more than 85%. 

The programme was then expanded in early 2015 to an Integrated Chronic Care Clinic, providing comprehensive integrated primary care for a range of chronic conditions – including HIV, hypertension, asthma, epilepsy, diabetes and mental health. With political and institutional commitment, initiatives may well become the rule and not the exception for future HIV management across the African region and beyond.

Katie Dain is the CEO of the NCD Alliance.

Lobna Salem is the Regional Chief Medical Officer for Developed Markets at Viatris, a US-based pharmaceutical company. 

 

 

 

 

 

 

Image Credits: Photo credit Jake Lyell/ Bill & Melinda Gates Foundation, LinkedIn .

gavi
A baby being vaccinated against measles in Gonzagueville, Côte d’Ivoire.

A new $100 million initiative to identify and reach zero-dose children – those who have not received a single routine vaccine shot – has been launched today by Gavi, The Vaccine Alliance in partnership with the International Rescue Committee (IRC) and World Vision (WV). 

The Zero-Dose Immunization Programme (ZIP) will be led by the International Rescue Committee in the Horn of Africa, and World Vision in the Sahel regions respectively, reaching 11 countries. As of 2020, there were over four million zero-dose children living across these targeted countries. 

Building on two decades of remarkable progress in expanding the reach of immunization – which has seen the number of children dying from vaccine-preventable diseases in lower-income countries drop by 70% – Gavi’s latest five-year strategy seeks to push even further. 

“Lower-income countries have made remarkable progress in immunization over the last two decades but too many children, particularly those in hard-to-reach areas and fragile and conflict settings are still missing out on life-saving vaccines,” said Anuradha Gupta, Gavi’s deputy CEO.

“We have an opportunity now to build on the progress so far, and reach ‘zero-dose’ children with vaccines as well as other essential health services. There is a reason these communities are consistently missed and therefore to achieve our goal we need innovative approaches, dedicated focus and resourcing, and new partnerships to address their unique needs and realities. 

Reducing ‘zero-dose’ children by 25%

Gavi and its partners aim to reduce the number of zero-dose children globally by 25% in 2021-2025 by addressing barriers that prevent access to immunization. 

ZIP, which falls under Gavi’s new $500 million Equity Accelerator Fund, will commence with a 3-month inception phase during which children will be identified alongside the unique barriers, including gender-related barriers. 

At the end of the inception phase, work plans and relevant targets will be defined, with the goal of addressing identified barriers and reaching as many zero-dose children as possible to increase full immunization. 

Governments will also play a central role in the inception and implementation phase of the initiative and will be involved in the decision-making process. 

Gavi’s Equity Accelerator Fund is dedicated to reducing zero-dose burden in lower-income countries by investing in targeted initiatives. While $100 million will be provided to ZIP, the remaining $400 million will go directly to Gavi-supported countries to identify where zero-dose children are and to sustainably reach them with a full range of vaccines. 

New partnerships needed to close immunization gap

With half of all under-five deaths occurring in zero-dose children, IRC President David Miliband emphasized the need for new partnerships to close the immunization gap. 

“The IRC is proud to be joining forces with Gavi on this urgent issue at this vital time. Traditional approaches have left more than 12 million children without routine vaccination services, and we are determined to show that new partnerships with diverse actors can deliver results and save children’s lives,“ said Miliband. 

The International Rescue Committee will focus their efforts in Ethiopia, Somalia, South Sudan and Sudan. World Vision will take the lead in Chad, Niger, Nigeria, Central African Republic, Cameroon, Mali and Burkina Faso.

Both IRC and WV were chosen for their extensive experience in conflict areas and strong footprint in remote areas. 

“We are committed to partnership—at every level—as it will be critical to address the systemic challenges and barriers limiting access to vaccines,” said Margaret Schuler, Senior Vice President, International Programs for World Vision US.

Image Credits: UNICEF.

A laboratory technician at South Africa’s mRNA hub, Afrigen.

One year since the establishment of the mRNA Vaccine Technology Transfer Hub, a collaboration between two leading biotech companies – Afrigen Biologics and the Univercells group – was announced on Tuesday, paving the way for the development of the first-ever African-owned COVID-19 vaccine through open-access intellectual property. 

Using intellectual property from partners, the collaboration between the South Africa-based Afrigen and the Belgium-based Univercells will focus on the development of a novel mRNA vaccine.

The companies intend to collectively tackle two major challenges that have hampered COVID-19 vaccine rollout in Africa and other low- and middle-income countries (LMICs): lack of local cost-effective production, and the need for cold- or super-cold chains. 

“The COVID-19 pandemic has shown that there is a pressing need to build African capabilities in vaccine development and manufacturing. Without the capacity to make their own vaccines, too many countries haven’t been able to access them,” said Professor Petro Terblanche, Afrigen managing director, speaking at an event to mark the signing of the agreement.  

“This agreement is an important step towards ensuring that everyone, everywhere – in Africa,  and across low and middle-income countries (LMICs) – has access to life-saving vaccines and medicines.” 

The collaboration will be hosted by Afrigen in Cape Town, South Africa. Afrigen hosts the World Health Organization’s (WHO) Global mRNA Vaccine Technology Transfer Hub and is working to facilitate the production of mRNA vaccines at over 15 designated manufacturing sites in LMICs globally. 

The agreement, and the eventual vaccine produced, will build on expertise developed using the hub.  

Local production and heat-stable vaccine  

Belgian Minister of Development Co-operation, Meryame Kitir, and WHO Director-General Dr Tedros Adhanom Ghebreyesus, during a visit to South Africa’s mRNA vaccine hub in February.

At present, African countries import 99% of all the vaccines they use. While more than 60% of the global population has been fully vaccinated, some LMICs have yet to cover 1% of their population. 

An African-owned COVID-19 vaccine is a critical step in closing the gap in vaccine accessibility and coverage. 

Furthermore, cold chain storage and distribution are additional hurdles to the roll-out of existing mRNA vaccines, made by Pfizer and Moderna. The agreement paves the way for the production of an mRNA vaccine that can be used in regular refrigerators, making it easier to store and distribute in rural and remote locations where few people are currently vaccinated. 

Speaking on the partnership with the WHO mRNA Transfer Hub, Martin Friede of WHO Vaccines and Biologicals said: “This unique partnership model enables the sharing of information, technology and human capital, and has the potential to shape vaccine production worldwide. The WHO and its partners are committed to  ensuring that we build a robust system to further the cause of vaccine equity and access.” 

New model of manufacturing mRNA vaccines 

In addition to developing a novel vaccine, the collaboration intends to pioneer a new model of manufacturing for mRNA vaccines.

Quantoom Biosciences, a Univercells company, is developing an mRNA production technology that encompasses all the steps of RNA production, from sequence construct to large-scale production, which allows for rapid growth and scale-up.

The technology was built with distributed and decentralized manufacturing in mind, which ensures that processes can be easily transferred across LMICs. 

The COVID vaccine produced on the Univercells system – which has been named eTheRNA – will have improved thermostability, meaning it will resist losing potency at higher temperatures. This is critically important in LMICs.

[The technology] will allow for storage in normal fridges which are more accessible than -20 or -80°C freezers, especially in LMIC,” said Bernard Sagaert, Chief Operating Officer of eTheRNA. 

“All of these technologies are needed for the end goal of making a vaccine accessible for low and middle income countries. We are very happy to be part of this initiative and work together to enhance the prospects of making vaccines more accessible globally.

Image Credits: Rodger Bosch for MPP/WHO, Kerry Cullinan.

uv
Woman applying sunscreen.

A new app for mobile phones that provides localized information on ultraviolet (UV) radiation levels has been created by the World Health Organization (WHO), the United Nations Environment Programme (UNEP), the World Meteorological Organization, and the International Labour Organization (ILO). 

The app is available free of charge on both the Apple App and Google Play stores for Iphones and Androids, and includes national and local data streams for UV and weather forecasts. It is available in multiple languages – Chinese, English, French, Russian, Dutch, and Spanish. It’s also a rare example in the UN system of a growing trend – harnessing real-time environmental data for public use and greater health benefits. 

Launched to coincide with the first day of summer in the northern hemisphere, the SunSmart Global UV app provides 5-day UV and weather forecasts at searchable locations. The app is based on the 11-point UV Index scale, with 1 (“Low”) to 11 (“High”) representing the potential for UV damage to skin and eyes. 

In an effort to reduce the global burden of skin cancer and UV-related eye damage, the app also highlights time slots when sun protection is required with the aim of helping people around the world know when to use sun protection. Using sun protection is recommended when the UV index is 3 or above. 

“Evidence shows that overexposure to UV is the major cause of skin cancer. So it’s vital for people to know when and how to protect themselves,” said Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health.

Skin cancer from prolonged unhealthy exposure to UV radiation is highly preventable 

It is estimated that over 1.5 million cases of skin cancer (melanoma and non-melanoma) globally were diagnosed in 2020. And during that same year, more than 120,000 people lost their lives to this highly preventable disease. 

One of the leading factors contributing to skin cancer is the penetration to earth of excess UV radiation as a result of the earth’s thinning stratospheric ozone layer. 

In the course of the last century, the stratospheric ozone layer was significantly depleted as a result of the increased use of, and release to the atmosphere, of certain ozone depleting chemicals, including chlorofluorocarbons (CFCs), hydrochloroflourocarbons (HCFCs), as well as methyl bromide and other bromoflourocarbons into the atmosphere. Such chemicals are used in refrigeration, air cooling, aerosols, and other applications, and in the case of methlbromide, as a pesticide and fumigant agriculture.

While the most powerful ozone-depleting chemicals were banned by the UN Montreal Protocol of 1987, others have continued to be used – and in any case ozone that is already depleted takes years to rebuild.  

Global health leaders and experts encourage use of the app to prevent and protect against prolonged unhealthy exposure to UV radiation. 

”We encourage everyone to use the application to  protect themselves and their children, and to make this a daily habit,” said Neira. 

“The SunSmart App is a fantastic UV monitoring tool, and I would encourage everyone to use it,” advised Meg Seki, Executive Secretary of UNEP’s Ozone Secretariat.

Contributes to safe and healthy work environments, says ILO

The ILO describes the SunSmart app as relevant to both workers and employers in outdoors occupations, enabling them to identify hazardous work conditions and plan protective safety and health measures accordingly.  The app’s release follows the ILO’s adoption of a resolution to add a safe and healthy work environment as part of its Fundamental Principles and Rights at Work earlier this month. 

“It is a global call for increased efforts to prevent work-related injuries and diseases. Tools such as SunSmart Global UV are a small but useful contribution to this endeavour,” said Vera Paquete-Perdigão, Director of the ILO’s Governance and Tripartism Department.

Image Credits: Fort George G. Meade Public Affairs Office/Flickr .