Nigerian veterinary paraprofessionals on an animal health training course; good livestock management practices can help reduce antibiotic use and drug resistance (AMR).

Antimicrobial resistance (AMR), or “superbugs,” is known as one of the most urgent global health threats, killing more than 700,000 people every year, a number that may rise significantly if we fail to address this crisis. Conversations about how to stop it do not focus enough on addressing the overuse of antibiotics in the animal farming sector, which accounts for between 70 and 80% of worldwide antibiotic consumption. Global attempts to curb it have made little progress, as evidenced by the recently adopted declaration at the last UN General Assembly, where language around animal use was weakened in negotiations leading up to the High-Level Meeting where the declaration was approved.

Still, countries can and should do a lot to improve antibiotic use in agriculture.

In response to this growing crisis, the Nigerian government and the Arlington, Virginia-based Management Sciences for Health, have been working to strengthen policies and improve appropriate use of antibiotics in collaboration with stakeholders from both the human and animal health sectors.

Our experience in Nigeria – one of a number of countries in Africa which MSH has supported – illustrates some challenges and opportunities, and where countries might begin their work.

Protecting livestock

Farmers typically turn to antibiotics to protect their livestock. But in many low-and middle-income countries they may do so without professional guidance or in inappropriate doses. They may administer the wrong drugs or for the wrong reasons  – not in response to a specific, lab-identified pathogen and drug susceptibility test, but for widespread disease prevention and growth promotion.

Awareness raising amongst communities, veterinarians and farmers is key – course for veterinary paraprofessionals in Nigeria, sponsored by the FAO.

The problem is exacerbated by the fact that antibiotics are readily available over the counter in local markets, sold by untrained vendors without capacity to guide farmers. In Nigeria, many regions lack effective government regulatory oversight. Public awareness of the AMR risks associated with excessive antibiotic use amongst animals remains low. Farmers who have not been fully educated on the risks will often continue to use antibiotics indiscriminately.

Insofar as the health of animals, humans, and the environment is interconnected, and efforts to address AMR should be too.

Veterinarians, medical professionals, government agencies, farmers, and civil society must work together to develop and implement comprehensive AMR strategies. Several key areas are crucial to these efforts. They include: a) strengthened government policies and regulatory frameworks; b) increased public awareness, particularly among the farmers themselves; and c) promotion of a ‘One Health’ approach that recognizes the linkages between animal and human antibiotic use – and associated health benefits as well as risks.

Strengthening government regulatory efforts

Governments need to build on the regulatory frameworks that exist and ensure that they are enforced effectively. Antibiotics should cease to be sold freely in open markets, and farmers should only have access to antibiotics under the guidance of trained veterinarians. Regulatory bodies must take stronger action to control the distribution of antibiotics, ensuring that they are used in accordance with established World Health Organization guidelines. Laboratories need to be strengthened, ensuring that facilities are equipped with reagents to test for resistant organisms.

Governments should also support farmers to help them reduce AMR. Right now, the cost of testing and treating sick animals is borne by farmers in Nigeria and many other countries. Can the government subsidize some of that cost? What about insurance for farmers who experience losses due to illness among their livestock? Investing in research into effective alternatives to antibiotic use, and enhancing implementation of basic biosecurity measures and animal health services are other areas to which governments could contribute to reduce the need for antibiotics for otherwise healthy animals and herds.

Chicken vendors in Dar es Salaam, Tanzania; meat laced with antibiotics from excessive animal use can lead to more antibiotic resistance in people as well as animals.

Public awareness: education of farmers, veterinarians and communities

The public, veterinarians, and farmers alike must understand the risks of overusing antibiotics and the long-term consequences of antibiotic resistance – for animals as well as people.

For instance, in Nigeria, many of our activities will involve supporting the Federal Ministry of Agriculture and Food Security initiatives on social and behavioural change. This includes activities such as: hosting town hall educational meetings with farmers and suppliers; working with secondary school clubs to promote AMR awareness; educating members of the media; and developing radio jingles to talk about the dangers and promote alternatives to antibiotics and other antimicrobial agents.

Civil society organizations (CSOs) can help bridge the knowledge gap by promoting education to farmers and local communities, particularly in hard-to-reach areas, helping them understand why reducing antibiotic use is so crucial, and encouraging hygienic, responsible, and more sustainable farming practices. With a nuanced understanding of cultural contexts and resource availability at the community level, they can help explain biosecurity measures and why they work and dispel myths that might foster resistance to implementing such measures.

CSOs can continue to advocate for stronger policies and help build public support for AMR-related initiatives. They should engage with policymakers to ensure that AMR remains high on the national agenda and pressure governments for more stringent regulations to control antibiotic use. CSOs provide an important voice to advocate for national governments to fund AMR prevention measures, which are currently funded most often by external donors.

Promoting a One Health Approach

WHO:One Health means “designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes”.

A One Health approach to AMR recognizes that the health of humans, animals, plants, and the environment is interconnected. Global health professionals can help break down the silos between human health and animal health professionals and promote working together toward common goals. Farmers need access to training and resources that can help them manage animal health challenges without over-relying on antibiotics. These include better sanitation practices, the use of vaccines, and effective methods for managing livestock health that don’t require the routine use of antibiotics.

Collaboration across sectors is essential to understand the full scope of AMR and to implement policies that address it comprehensively. In Nigeria, we hold quarterly meetings with stakeholders from the government and the various sectors to share lessons, progress we have made, and how we can coordinate activities based on the data we’re seeing.

AMR is a complex and global problem, but it is not insurmountable. The role of the animal farming sector in reducing antibiotic use is critical, and Nigeria’s experience highlights the importance of coordinated efforts among the government, farmers, veterinary professionals, and civil society. Through stronger regulations, better education, and collaborative approaches, we can contain AMR, prevent the rise of superbugs, and ensure that antibiotics remain effective for future generations—both for the health of our animals and the well-being of all people.

Babatunde Akinola, FAPH, is a director with Management Sciences for Health in Nigeria. A trained pharmacist, he has more than 20 years of experience across the pharmaceutical manufacturing sector, medicines regulatory agencies, multinational corporations, and the public health space.

 

 

Dr Columba Teru Vakuru is Nigeria’s Chief Veterinary Officer in the Federal Ministry of Agriculture and Food Security.

 

 

 

Image Credits: FAO, Peter Mgongo, WHO .

Extreme weather events reached dangerous levels in 2024 due to record-breaking temperatures.

The year 2024 is set to be the warmest year on record, the United Nations’ (UN) weather agency, the World Meteorological Organization (WMO), said in an end-year statement on 30 December. This year caps a decade of unprecedented heat fuelled by human activities, the WMO said.

“In my first year as WMO Secretary-General, I have issued repeated Red Alerts about the state of the climate,” said WMO Secretary-General Celeste Saulo.

“This year we saw record-breaking rainfall and flooding events and terrible loss of life in so many countries, causing heartbreak to communities on every continent. Tropical cyclones caused a terrible human and economic toll, most recently in the French overseas department of Mayotte in the Indian Ocean. Intense heat scorched dozens of countries, with temperatures topping 50°C on a number of occasions. Wildfires wreaked devastation,” Saulo said.

Her comments foreshadowed the expected findings of WMO’s formal consolidated global temperatures report for 2024, due to be published in early January.

In a close-up look at just 26 of the 219 major weather events of 2024, climate change-related extremes contributed to the deaths of at least 3,700 people in floods, typhoons, hurricanes, heat waves and wildfires, while leading to the displacement of millions.

This, according to a separate report by World Weather Attribution (WWA), an international consortium of scientists.

“It’s likely the total number of people killed in extreme weather events intensified by climate change this year is in the tens, or hundreds of thousands,” the report stated.

Extreme heat more and more devastating

Climate change also was responsible for an additional 41 days of dangerous heat exposure, per person, on average, in 2024 as compared to pre-industrial exposure levels, the WWA scientists found.

World Weather Attribution studied 26 weather events closely out of the 219 events in 2024.

What is worse is that the countries that experienced the highest number of dangerous heat days are overwhelmingly small islands and developing states that tend to have limited resources to cope.

“Today I can officially report that we have just endured a decade of deadly heat. The top ten hottest years on record have happened in the last ten years, including 2024,” said UN Secretary-General António Guterres in his own New Year message.

“This is climate breakdown – in real time. We must exit this road to ruin – and we have no time to lose. In 2025, countries must put the world on a safer path by dramatically slashing emissions, and supporting the transition to a renewable future,” Guterres said.

Runaway emissions locking in even more heat

Trends are only getting worse, according to the WMO. Currently, the world is at 1.3°C of human-induced warming. In the next five years the annual global temperature is very likely to temporarily breach the 1.5°C target above pre-industrial era that was the target set as a part of the Paris agreement.

And with the most recent UN climate conference COP in Azerbaijan’s capital Baku this November failing to set any new targets for reining in record high fossil fuel burning and emissions, while delivering only $300 billion annually of the $1trillion in climate finance demanded by the poor countries to make a green energy transition, the chances of halting and reversing those trends any time soon looked grim at year’s end.

“Every fraction of a degree of warming matters, and increases climate extremes, impacts and risks,” WMO’s Saulo also said in her a chilling warning. “Temperatures are only part of the picture. Climate change plays out before our eyes on an almost daily basis in the form of increased occurrence and impact of extreme weather events,” she said.

Better monitoring of GHG concentrations 

WMO is in the process of rolling out the Global Greenhouse Gas Watch initiative that will track the GHG concentrations and monthly net fluxes in the atmosphere, for carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) at a 1° × 1° geographic latitude-longitude grid resolution (about 100×100 km spatial resolution).

The aim is to “reduce uncertainties and improve the reliability of GHG monitoring,” the organization said, thus helping countries track the atmospheric impacts of greenhouse gas emissions, while addressing data gaps.

Climate change also added 41 days of dangerous heat in 2024, according to a report jointly produced by the team at World Weather Attribution (WWA) and Climate Central.

Push for early warning systems, more data

The UN also is pushing countries to ramp up their own early warning extreme weather systems. Under the Early Warnings for All initiative, WMO plans to support countries in developing their climate services and delivery programmes.

Other multilateral agencies are also doing the same. In Asia, the Asian Development Bank Institute is pushing countries in the Asia and Pacific region to collect more climate data that could  help prioritize vulnerable communities and respond effectively.

Image Credits: WMO, WWA, WMO.

WHO Emergency team outside Kamal Adwan Hospital on 20 December, the last such convoy before Israel stormed the building and closed it down.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus issued a stiff rebuke to Israel for its military occupation of Kamal Adwan Hospital – the only hospital left operating in Gaza’s northernmost band of territory – which is now largely depopulated after months of bitter warfare.  

In a post on X, Tedros also called for the release of the Hospital’s director, Dr Hussam Abu Safiya, who was taken into custody by Israel over the weekend of 27-29 December. 

“Kamal Adwan Hospital in northern #Gaza is out of service — following the raid, forced patient and staff evacuation and the detention of its director, Dr Hussam Abu Safiya two days ago. His whereabouts are unknown. We call for his immediate release,” Tedros said in a 30 December post. His appeal was repeated again on Saturday, 4 January, as Abu Safiya’s whereabouts remained unknown.   

The WHO director’s calls for the release of the hospital director were echoed by Amnesty International and the UN Special Rapporteur for the Occupied Territories Francesca Albanese, who also called for a worldwide boycott of Israeli medical professionals. 

The Israeli Defense Forces (IDF) moved into the hospital compound during the last week of December, for the third time in a year. The IDF confirmed it had arrested Abu Safiya as well as some 240 other people suspected of being Hamas fighters, while evacuating patients and health workers deemed to be civilians.   

In his post on 30 December, Tedros said that while critically ill patients had been moved to the Indonesian Hospital, in Beit Lahiya, treatment for critically ill patients was unavailable there, at the severely damaged hospital.  

“Amid ongoing chaos in northern Gaza, @WHO and partners today delivered basic medical and hygiene supplies, food and water to Indonesian Hospital and transferred 10 critical patients to Al-Shifa Hospital. Four patients were detained during the transfer. We urge Israel to ensure their health care needs and rights are upheld,” he said. 

On Saturday 4 January, the Hamas-controlled Gaza Health Ministry said that the Indonesian Hospital had been forced to close as well, as Israel drives the remaining civilians out of the northernmost Gaza neighborhoods, which lie adjacent to its border, and where plans are underway to create a “security perimeter”. The hospital was the last functioning facility north of Gaza City.

Israel says it facilitated evacuation of civilians from the hospital

IDF footage of civilians evacuating Kamal Adwan hospital over the weekend.

In a sharply different account of the hospital’s occupation, Israel’s military said that it had facilitated the evacuation of dozens of civilian patients and health care staff from the Kamal Adwan hospital premises – displaying video footage of  people lining up at night to leave in ambulances, and conducted “precise activities inside the hospital, locating and confiscating weapons in the area, including grenades, guns, munitions, and military equipment.”  

The arrest of some 240 suspected Hamas operatives included 15 men alleged to have participated in the 7 October 2023 Hamas invasion of Israeli communities near the Gaza enclave, which triggered the 14-month war.   Hospital Director Abu Safiya was arrested because he was “suspected of being a Hamas terrorist operative,” the army said.  Israeli and Palestinian media reported he was being held in Israel’s notorious Sde Teiman facility, although that remains unconfirmed. 

While human rights activists worldwide began to clamour for Abu Safiya’s release in a virtual campaign, Israeli media cited published statements by the Hamas-controlled Gaza government referring to Abu Safiya as a ‘’colonel’. Abu Safiya’s Facebook posts from October 2023, also praised the 7 October Hamas attacks on Gaza-area Israeli communities – although some of the most explicit posts cited by critics were no longer not available online.

Allegations of Hamas use of Gaza health facilities

WHO health supplies delivered to Al Nasser Medical complex, Khan Younis on 23 October, 2023.

Throughout the war, Israel has contended Hamas combatants and leaders have regularly used health facilities as bases for combatants and hiding places for Hamas leaders – as well as concealing Israeli hostages, at times, as well. 

WHO has sidestepped the issue, saying it has no means to investigate the veracity of such allegations, while calling periodically on both sides to refrain from militarizing health facilities. No foreign media have been allowed by Israel to enter Gaza since the war began. 

Some former Israeli hostages such as Sharon Aloni Cunio, have spoken in detail about spending extensive time in captivity in Gaza’s Al Nasser Hospital with 30 other captives. 

CCTV footage, confiscated by Israel and later aired by global media, also showed some hostages in the corridors of Al Shifa hospital shortly after their capture – while other freed hostages have related how they underwent procedures at hospitals for injuries sustained during their abduction.  

Forced to undergo procedures without anesthesia

A report to be submitted by Israel this week to the UN Special Rapporteur on Torture, also describes Israeli hostages being denied treatment for injuries, or forced to undergo painful procedures for acute injuries without anesthesia, as among the various forms of physical and sexual “torture” endured by the 100 captives who were among the more than 240 abducted by Hamas on 7 October, and since released.

But the report, Israel’s first official submission on the subject to the UN, doesn’t explicitly call out a hospital role, per se, in the reports of abuse – which included some women sexually assaulted at gunpoint, and a report of two teens forced to perform sexual acts on each other, as well as men who were beaten and branded.

Independent eyewitness reports have, on rare occasions, confirmed at least some of the Israeli allegations about the use of hospitals by Hamas leaders and combatants. In one such testimony, a Kurdish-born doctor from Denmark, described to Rudaw, a Kurdish TV network based in Iraq how foreign humanitarian volunteers like himself had to turn a blind eye to Hamas activities at hospitals in the northern Gaza where he worked – or risk being labelled as spies. 

“Hamas as a political, military organization needs to exploit all places to maintain it’s survival and strategic position,” said Baram, noting that on one or two occasions, he sat down with an official that he thought was a part of the hospital administration, only to find out later that he was meeting a senior Hamas official.

“It is unfortunate that I have to say, I have seen it with my eyes, that the hsopitals have been used for hiding Hamas leaders.  “It is a reality that exists. There are some realities that you cannot resist…. if you make such attempts you would be labelled as a troublemaker, a spy, or any other thing,” said the orthopedist, who said he was in Gaza on behalf of the Norwegian aid committee, NORWAC, in April and May of 2024. “Our job basically was not even to see them at all.”

WHO says positions anchored in international humanitarian law

Responding to a query from Health Policy Watch,  a WHO spokesman cited a statement from 21 February, 2024 by the agency’s principle legal officer, Steven Solomon, which stated:

“The International Humanitarian Law is very clear. Healthcare workers and healthcare facilities are off limits. They must not be attacked. They must not be used for military purposes. They must be protected at all times. The point is both to protect civilians, as well as to protect the health systems and infrastructure that communities depend on for life-giving care and continuity of services.

“Failure to protect and respect healthcare devastates twice. First, in the initial harm, and then again for the months or years it takes to rebuild the health systems.

“The protection of healthcare also includes the prohibition against combatants using health facilities for military purposes. IHL is also clear that even if healthcare facilities are being used for military purposes, there are stringent conditions which apply to taking action against them, including a duty to warn and to wait after warning and even then, disproportionate attacks are strictly prohibited.” The spokesman added, “WHO consistently calls for hostages to be given access to health care, and to be released.”

Tedros criticises slow pace of Israeli approvals for Palestinian medical evacuations from Gaza

In a separate statement, the WHO Director General also also criticised the slow pace of Israeli permissions facilitating the medical evacuations of wounded Palestinians from Gaza.

Of the 5383 patients evacuated by WHO since the war began, only 436 have been permitted to leave via Israel since Gaza’s southernmost Rafah crossing into Egypt was closed in May 2024, Tedros said, including 55 patients and companions on 31 December.

Over 12,000 people are awaiting medical evacuation, according to the WHO DG, who exclaimed in an X post: “At this rate, it would take 5-10 years to evacuate all these critically ill patients, including thousands of children. In the meantime, their conditions get worse and some die.”

–Updated 5.1.2024 with news of the Indonesian hospital closing, new WHO statements and the statement by the UN Special Rapporteur, Francesca Albanese. 

Image Credits: @DrTedros/X, IDF .

Israeli air strike at Yemen’s Sana’a International Airport, Thursday narrowly missed WHO Director General waiting to board a flight.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus was back in Geneva this week, after surviving a near miss from an Israeli Air Force strike on Sana’a International Airport, Thursday.

Airport TV footage aired Monday by the DG on X showed his entourage fleeing the VIP departures hall, where they had been waiting to board a UN flight, as the attack began.  A missile aimed at the airport’s air traffic control tower then sent shrapnel flying in the direction of the passenger terminal.

At least three people were killed while a crew member of the waiting UN plane was injured in the Israeli air strike, the largest to date. It came in response to months of Houthi missile fire into Israel, some 2200 kilometers away, including two strikes on Tel Aviv in the past ten days, which injured over a dozen people and destroyed a school.

Israel – ‘UN assets and staff not a target’

In a first-ever response to the incident on Monday, Israel’s UN Mission in Geneva declared in an X post that “UN assets and UN staff are not a target”. But Israel defended the strike saying it was aimed at “military infrastructure used by the Houthis for their terror activities, including in the Sana’a International Airport….

“Terrorist organizations must stop using civilian infrastructure to cover their terror activities,” the Israeli Mission continued. “The UN and the WHO should recognise terrorist organizations as such, stop justifying their activities, and address the regional situation in a fair and unbiased way. One-state-to-blame policy has never worked out, and never will.”

UN Security Council debate on escalating conflict

In a UN Security Council debate Monday, Khaled Khiari, UN Assistant Secretary-General for Middle East, Asia and the Pacific, warned about the new escalation of regional tensions, saying that attacks “originating from Houthi-controlled areas in Yemen must stop.”  But he also appealed to all sides “to respect and protect civilians and civilian infrastructure. Humanitarian workers must be protected at all times.

“The risks of disruption to vital humanitarian operations at a time when millions of people in Yemen are in need of life-saving assistance are of grave concern,” said Khiari.

But there was no sign that either the UN statements or the Israeli military reprisals would halt the strikes by the ad hoc regime, which is funded by Iran and has pledged to continue its attacks until the declared goal of an  Israeli ceasefire with Gaza is reached.

Late Monday evening, a Houthi missile aimed at Israel’s Tel Aviv and central region sent millions of people scurrying to shelters before it was intercepted, with some fragments showering down on a busy highway. That followed another ballistic missle strike early Saturday morning, aimed at the Negev and Jerusalem regions, and also intercepted.  Unlike the Islamic Hizbullah militia in Lebanon, which operated at close range to Israel’s border, the Houthi forces command vast swathes of distant desert from which they can launch projectiles, and remain unhindered by any other countervailing government force, observers said.

Tedros describes his ordeal

Thursday’s Israeli attack on Yemen targeted Houthi positions in and around the capital, including Hodeidah Port, power and fuel stations, and the airport’s runway and air traffic control tower – rendering the later inoperable.

Sana’a Airport control tower after the Israeli strike Thursday evening.

In his first X post that evening, the WHO Director General described the ordeal tersely, saying only, “As we were about to board our flight from Sana’a, about two hours ago, the airport came under aerial bombardment. One of our plane’s crew members was injured. At least two people were reported killed at the airport. The air traffic control tower, the departure lounge — just a few meters from where we were — and the runway were damaged. We will need to wait for the damage to the airport to be repaired before we can leave.

“My UN and @WHO colleagues and I are safe.”

Evacuated safely to Jordan on Friday

On Friday evening, after the WHO DG was evacuated to Amman, Jordan, accompanying the wounded crew member, a member of the UN Humanitarian Air Service (UNHAS), he spoke about the experience in more emotional terms, telling BBC Radio:

“It’s a matter of luck, if the missile deviated just slightly it could have been on our head.”

In Sana’a to negotiate with Houthi’s over release of UN workers being held hostage

The WHO DG had been in Sana’a with a United Nations team to negotiate with the Houthis over the release of more than a dozen UN workers who are being held as hostages by the rebel force.

Six staff of the Office of the High Commission of Human Rights (OHCHR) – one woman and five men – were arbitrarily arrested by the de facto Houthi authorities in June together with seven other UN personnel. A further two OHCHR staffers and two colleagues from other UN agencies have been detained and held “incommunicado” since 2021 and 2023 respectively.

The Houthis, a Shia movement aligned with Iran, took over the Yemenite capital of Sana’a in 2015, deposing the president who fled with Yemen’s UN-recognized government to Aden.

Since 7 October 2023, Houthi forces have been firing missiles intermittently at Israel, in support of the Palestinian Hamas fighting Israel in Gaza, as well as interrupting international shipping lines. On December 21, a Houthi ballistic missile fell in a Tel Aviv city park injuring some 16 people after Israel’s much-vaunted Iron Dome anti-missile system failed to intercept the projectile.  Two days earlier, another missile destroyed a school in the Tel Aviv suburb of Ramat Gan, although there were no injuries because structure was empty at the time.

Israeli media said the attack Thursday evening was the largest ever and included some 100 Air Force aircraft.

Speaking in a video statement, Prime Minister Benjamin Netanyahu of Israel said: “A short while ago, the Air Force attacked targets of the Houthi terrorist organization in Yemen, both along the coast and in Sana. We are determined to cut off this terrorist arm of Iran’s axis of evil. We will persist until we get the job done.”

Updated Monday 30.12.24

Image Credits: YNet/Yemenite TV , Al-Estiklal .

Filling up with water at a displaced persons’ camp in the war-torn Darfur region, where famine is prevalent.

More than 24.6 million people – one half of Sudan’s population – are experiencing high levels of acute food insecurity, according to the latest report of the Integrated Food Security Phase Classification (IPC), which tracks hunger risks and extreme hunger spots globally.

And famine (IPC phase 5) is present in at least five Sudanese areas in North Darfur and parts of the Western Nuba Mountains, according to the IPC’s Famine Review Committee, in its latest analysis, released on Tuesday, 24 December.

Without further access to aid in the conflict-wracked country, even more North Darfur areas will also face famine over the coming five months, the IPC predicted. And 17 other areas in North and South Darfur, Khartoum, and Al Jazirah states are at risk of famine, particularly in areas with high rates of internally displaced persons (IDPs), the review stated.

‘Famine is the most extreme manifestation of human suffering’

Large parts of Sudan face extreme food insecurity, with risk of famine in some places.

“Twenty months into the conflict, Sudan continues to slide into a widening Famine crisis characterized by widespread starvation and a significant surge in acute malnutrition,” the IPC Famine Review Committee (FRC) analysis stated. “This marks an unprecedented deepening and widening of the food and nutrition crisis, driven by the devastating conflict, which has triggered unprecedented mass displacement, a collapsing economy, the breakdown of essential social services, and severe societal disruptions, and poor humanitarian access.”

“Famine is the most extreme manifestation of human suffering, representing a catastrophic collapse of the systems and resources essential for survival,” the IPC  added. “It is not merely a lack of food but a profound breakdown of health, livelihoods, and social structures, leaving entire communities in a state of desperation.”

Famine (IPC Phase 5) first detected in August 2024 in Zamzam camp, North Darfur state, has not only persisted but also expanded to Al Salam and Abu Shouk camps and the Western Nuba Mountains for the period October to November 2024, the IPC committee found.

“Between December 2024 and May 2025, Famine is projected to expand in North Darfur localities including Um Kadadah, Melit, El Fasher, At Tawisha, and Al Lait,” they stated.  “There is a risk of famine in the Central Nuba Mountains (including in Delami, Western Kadugli, Um Durein, and Al Buram localities), and in areas likely to experience high influxes of IDPs in North and South Darfur,” as well as in Khartoum and Al Jazirah states.

Above-average rainfall during the May-October rainy season did provide relief in some areas of Sudan, allowing for more food production in areas where security conditions allowed, the report found. But the ongoing conflict has severely disrupted farming activities across vast swathes of the most affected regions.

Farmers were forced to abandon fields, and crops were looted or destroyed. Displaced families, particularly those in settlements and public buildings, are unable to access harvested foods.

UN Secretary General calls for warring parties to grant aid groups humanitarian access

UN agencies and partners are scaling up food assistance and other essential support programmes, said UN Secretary-General António Guterres.

However, ongoing fighting and restrictions on the movement of relief supplies and personnel continue to jeopardize aid operations.

“The Secretary-General reiterates his call for the parties to facilitate rapid, safe, unhindered and sustained access so that humanitarian assistance and staff can reach people in need wherever they are,” a statement by the SG’s spokesman warned.

RSF enjoys support from the UAE and Wagner group

The brutal civil war first erupted in April 2023 between the Sudanese Armed Forces, and the Rapid Support Forces, a paramilitary group previously operating under the auspices of the government of Sudan.

Built upon an association of tribal militias, the RSF has long wielded control over Sudanese gold mines in the Darfur area, with the precious metal exported to the United Arab Emirates where it was used to fund the RSF leader Mohamed Hamdan Dagalo (Hemedti) and the militia’s activities. The UAE is reportedly a key backer of the military force, with western countries as well as the UN largely turning a blind eye to the relationship, which has been condemned by Human Rights Watch and other humanitarian groups.  The RSF and its leadership also reportedly has connections with the Russian paramilitary Wagner group, which allegedly provided training and equipment to the fighters.

The conflict has claimed more than 20,000 lives and driven over 12 million people – nearly a quarter of Sudan’s population – from their homes. Fighting continues to rage, including in densely populated areas, with widespread reports of humanitarian law violations, as well as sexual violence, on the part of both the RSF and the Sudanese Armed Forces (SAF). On 19 December, three World Food Programme field officers were killed in an aerial bombardment of the WFP Field Office Compound in Yabus, Blue Nile State. The SAF denounced the attack, saying that it had no military activities in the area, while the RSF did not comment.


Health and education infrastructure lies in ruins while deadly diseases such as cholera are spreading, due to the lack of access to clean water and sanitation.

“Only a ceasefire can reduce the risk of famine spreading further and contain the already high levels of acute food insecurity,” the IPC report concluded.

Image Credits: IPC, UNICEF , IPC .

They reached out for a dialogue at the height of the COVID pandemic: Michelle Williams, then dean of Harvard’s School of Public Health, and Margaret Chan, dean of China’s Vanke’s School – face to face in  Geneva in May 2024.

In April 2022, amidst the continuing uproar of the COVID pandemic, four deans of schools of public health from the USA, China, Switzerland and Singapore, first got on a call with each other to see how they could ramp up cooperation – remotely.

Barred by lockdowns from the usual academic meetings and conferences, the urge to link up was stronger than ever.

Co-founders of the high-powered group were Michelle Williams, then dean of Harvard’s School of Public Health, and former WHO Director General  Margaret Chan, now dean of Beijing’s brand-new Vanke School of Public Health.

“At the height of the pandemic, my good friend here, Margaret and several others amongst us, decided that we needed to come together with deans of schools of public health, to promote solidarity, and to continue to be assertive about what global health diplomacy means for all of us,” said Williams at the first face-to-face Coalition meeting in May 2024.

“We were surprised at the lack of dialogue, the lack of cooperation and collaboration worldwide,” said Chan, of that difficult pandemic period. So, she was delighted when Williams reached out about a conferring virtually. “We felt that change is necessary, and we can make a contribution as universities – which represent the creation and translation of knowledge, through science, to policymaking.”

Other founding members included Antoine Flahault, director of the Zurich-based Swiss School of Public Health and long-time actor in Geneva, the world’s “global health hub”. And the deans of public health schools at the University of Cape Town; Mahidol University, Thailand. Heads of public health institutes in Huazhong, China, Mexico, Sydney, Chile and Singapore.

Online hosted by China

Vanke School of Public Health, Tsinghua University, China.

 That first encounter, organized online by Chan at the Vanke School, was naturally focused on health issues related to the COVID crisis – but with an eye beyond the immediate issues of vaccines, travel restrictions and lockdowns to the long-term challenges that everyone knew lay ahead.

Challenges like the need for countries to come together on the all-important task of building more resilient health systems, better prepared for the next pandemic.

“Working with Dr. Margaret Chan to co-create the Coalition was one of the few bright spots during the early part of the pandemic,” Williams, who recently stepped down as dean, told Health Policy Watch by email from California, where she is currently on sabbatical.

“I was delighted that Margaret, and I joined forces and then had other deans join us. I felt it was important that we academic leaders needed to redouble our efforts to break down real and perceived barriers to global health collaboration, cooperation and diplomacy.

“All around us, in political and public health practice spaces, I observed decision makers looking inward and sometimes missing the important imperatives and values of global public health,” Williams said.

“Vaccine nationalism, unthoughtful border closings and some other policies ran counter to public health, global health diplomacy and practice.  This was disheartening especially as pandemic threats, threats from climate change and other threats like antimicrobial resistance are global threats that require global cooperation.”

Linking academia’s public health leadership

‘Our aim is not to duplicate’, Antoine Flahault, dean of the Swiss School of Public Health (on left), with Geneva University’s Alexandra Calmy at a meeting of the Coalition in May, 2024

Indeed, while there are other established coalitions of Public Health Schools, mostly US-based, such as the American Association of Schools of Public Health, the World Federation of Schools of Public Health, and the Consortium of Universities for Global Health, one unique aspect of the GHF-based Coalition of Deans has been the way it links public health leaders, and not only the institutions, says Flahault.

“Our aim is not to duplicate, but to be complementary to all of these groups, with which we coordinate,” he said.

The loosely-knit group now includes about a dozen institutions, as well as the leading European and American associations or federations of Public Health universities and schools.

“Our vision is that this Global Coalition will allow us to learn more from each other, sharing our experiences, facilitating exchanges of students and faculty among schools and fostering joint research programs,” Flahault observed.

Adds Michel Kazatchkine, a physician, academic and former French diplomat, who also spoke at the group’s last meeting on the margins of the World Health Assembly:

‘Increasing interest in health diplomacy’: Michel Kazatchkine, physician and former diplomat.

“We’re now seeing an increasing interest in health diplomacy. But in this context, academia is particularly important because science is essential in evaluating the impact of policies and providing feedback analysis to politicians so that they can correct trajectories if needed.

“And academia provides the freedom to do research on any topic, even the most sensitive – to collect, analyze and speak about the findings of your data. So, we should not underestimate the role of academia as a fundamental pillar of knowledge-based, democratic societies.”

Focusing on planetary health and other neglected topics

The Sydney School of Public Health’s Flagship planetary health initiative in Fiji was one example featured at the Geneva Health Forum. A study of watershed interventions, it aims to reduce incidence of typhoid, dengue and other deadly diseases in Pacific Island countries.

This year, after two years of remote meetings organized by the Vanke School and Harvard in succession, members of the coalition convened face-to-face, for the first time in Geneva, on the margins of the World Health Assembly, hosted by the Geneva Health Forum and the University of Geneva.

The group focused on planetary health as their principal topic.

“We shared experiences from Australia, China, and the USA about academic programmes dedicated to this issue – and asked the question: how do schools of public health integrate planetary health into their curriculum?” Flahault said. Doctoral and masters’ students from selected schools were also invited to speak along with faculty about lessons learned, he noted.

The discussions continued a thread from the 2023 remote meeting, which examined climate-driven food insecurity in the global health context – another cutting- edge issue that rarely gets much attention in classic public health school textbooks or classrooms.

“The Coalition of Deans have already been instrumental insofar as bringing attention to the importance of creating multi-national and interdisciplinary collaboration to bring multiple perspectives into designing curriculum,” reflected Williams.

“We’ve also provided a platform (as seen in the meeting hosted by Prof Flahault last spring) for showcasing junior faculty members and graduate students working in the fields of global planetary health and environmental justice,” Williams pointed out.

The effort is all the more topical insofar as Harvard’s Chan School of Public Health just launched a concentration in climate and planetary health in 2024.

In China, the Vanke School is also planning to pilot a planetary health course in 2025. That course will bring together students of public health with those in students from economics, urban design, environmental health sciences and engineering to examine multi-sectoral challenges and design solutions, said Chan, speaking with Health Policy Watch.

Chan: Vanke’s new planetary health course will bring together students of diverse disciplines.

“Everyone knows about how John Snow stopped the cholera epidemic [by breaking the pump on a contaminated water cistern], but what about the sanitary engineer who helps to renovate and overhaul the London sewage system,” Chan said.

Tsinghua University, where the Vanke School is located, is world famous for its engineering school, she observes.  “So. this will train future decision-makers to bridge between disciplines such as engineering and health.”

Indoor air pollution and wastewater epidemiology

Along with partners in the WHO, the GHF and European Universities, Coalition members have also supported the development of a series of events on other interdisciplinary health topics over the past year.

These included a conference on Indoor Air Pollution, in September 2023 in Berne, as well as a recent Conference in Paris on Wastewater-based Epidemiology. See related story:

Post Pandemic: Wastewater-based Surveillance of Diseases Comes of Age 

 

“Of course we have moved on from the pandemic to other topics,” noted Chan, speaking with Health Policy Watch recently in a phone interview. “The change in the conversation is a reflection of the changes in the current trends in Public Health. And it’s going to be more diverse as we move along.

One topic she’d like to see the Coalition tackle at some point would be the challenges of harnessing AI for good in the broad context of public health research and policymaking.

“There is a lot of talk about AI in clinical work, but what about AI in public health?” she asks. “Patient confidentiality is important. But we also need policies in place to enable the use of AI in research and outreach, but also to protect people’s privacy.”

Whatever the theme may be, the approach is the same, says Williams, who was instrumental in establishing a student exchange programme between Harvard and the Vanke School in 2021.

“Sharing of teaching materials and experiences related to launching new courses and concentrations are ways we can facilitate the spread of ideas across other universities.

“Developing and supporting annual workshops, and supporting student and faculty exchanges, are another. It is hoped that the Deans can secure resources to help operationalize these collaborative initiatives.”

Looking forward to 2025

Cabo Verde's Minister of Health, Filomena Mendes Gonçalves.
Geneva Health Forum 2024 session on malaria elimination with Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves.

Looking forward, Flahault says the group aims to maintain its informal modus operandi, to facilitate exchange across borders – and keep the focus on meaningful meetings and liaisons.

“We are a lean organization without any budget and staff and not competing with any other organizations,” Flahault said.

At the same time, he envisions the Coalition playing an advisory role in a soon-to-be-formed Think Tank that aims to continue dialogue and problem-solving around the themes of the Geneva Health Forum throughout the year. “One major fruit or byproduct of this will be the GHF Think Tank, which we are launching this spring, and will tap the academic network the Global Coalition assembles,” he said.

That, in addition to their annual meetings, on the margins of the Geneva Health Forum’s annual conference during the World Health Assembly – with the next event organized by Teo Yik-Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Now that face-to-face meetings are once more feasible, working from the Geneva axis offers a unique vantage point that can transcend some of the sharp geopolitical divides that academic leaders face in dialogues at other venues, Flahault also points out.

Says Chan, who served as WHO Director General from 2006-2017, “I’m very biased – to me, Geneva is the capital of public health. And all countries come to the World Health Assembly. So, it’s natural that all of us in the Coalition would meet here, to make our voices heard.”

Returning to basics of infectious disease elimination

A child paralyzed by polio breathes in an iron lung – the best available intervention before the polio vaccine’s discovery in 1955.

Along with emerging global health issues around climate and planetary health – Flahault sees a future role for the group in reviving interest around some of the world’s longstanding, and unsolved public health challenges – such as elimination of polio, cholera and other preventable infectious diseases.

“Personally, I would love to see a WHA resolution against the three major diseases, polio malaria and cholera – with the same sense of determination we displaced against smallpox in the 1950s and 60s, with the same sharp formulation, we want to eradicate these diseases as soon as possible,” he said in a recent interview.

 “All of the major actors would push and row together to make this successful. For polio it’s already done but we have to say we have to end the job.

“We need to be modest and realistic,” Flahault admitted. “Surely, eradicating cholera from the planet, which has already been the subject of one WHA resolution, needs a huge political commitment. This is not in the portfolio of the Global Coalition or schools of public health.

“But we could still play a role. With players in the media ..we could try to mobilize political leadership which is lacking today. We don’t have many political leaders embracing global health issues, as happened during the pandemic, but today global health issues remain a source of power for promoting multilateral commitments.

“And in the coalition, we have a great opportunity for liaison between China, the USA and Europe and all of the other constituencies that are in the room, which give us an opportunity to push public health as a form of ‘soft power’ to move forward agendas.

After all, we succeeded in the 20th century to eliminate smallpox at the height of the cold war between the USSR and the USA.  It was not easy, but we succeeded thanks to a shared commitment to health.”

–Written as part of a Health Policy Watch collaboration with the Geneva Health Forum.

Image Credits: Vanke School of Public Health , Aaron Jenkins, Sydney School of Public Health, Geneva Health Forum, Paul Palmer/ WHO.

A healthworker administers polio vaccination in Pakistan’s sensitive northwestern region.

ISLAMABAD – Pakistan’s last countrywide anti-polio drive of 2024 is set to conclude on 22 December but eradicating polio remains a challenge for the government, and this year’s surge in cases has resulted in calls for an independent audit of the program.

Pakistan and Afghanistan are the last two countries in the world battling to eliminate polio. In Pakistan, 63 polio cases have emerged this year in comparison to six in 2023, raising eyebrows about the strategies adopted by the government and international organizations working on polio eradication.

Shahzaib Khan, a health worker from the northern district of Mansehra in Pakistan’s Khyber Pakhtunkhwa province, is one of those grappling with these concerns.

Shahzaib, who works as a vaccinator in the health department, participated in the countrywide anti-polio drive with the target of vaccinating 44 million children five and under. Around 260,000 frontline workers are involved in the campaign.

As a frontline polio worker, he believes that the check-and-balance system at the district level has weakened, resulting in rising polio cases.

According to Khan, while the number of polio vaccination teams in each district has increased, there has been a reduction in those monitoring their performance at the district level. 

“Previously, these teams numbered up to 80 per district, but now the minimum has reduced to around eight, which has affected the standard of monitoring field teams,” Khan said.

Moreover, the long gaps between national polio campaigns allows the crippling disease to strengthen its roots, he added. For instance, in Naran, Khyber Pakhtunkhwa, the recent campaign was conducted after a seven-month hiatus.

Increase in cases

Aside from the, 63 cases have been reported this year, positive polio samples from 27 districts indicate a potential increase in cases in the coming days.

The highest number of cases has been reported in Balochistan, Pakistan’s southwestern province, with 26 cases, followed by Khyber Pakhtunkhwa with 18, Sindh with 17 and one case each from Punjab and the federal capital, Islamabad.

The polio elimination program faces major challenges from population migration, cross-border movement with Afghanistan and the refusal from some tribal communities and ultra-conservative groups in remote areas to allow vaccinations.

These communities, where the government also struggles to establish its writ, consider anti-polio drives as a ‘Western conspiracy’ against their children, allegedly believing it will harm the children’s fertility.

Polio teams in these areas are sometimes subject to armed attacks. During the recent seven-day national anti-polio campaign, two security personnel and five children were killed in such attacks in Balochistan and Khyber Pakhtunkhwa.

Conspiracy theories

Abdul Basit, a health department official from southern province of Sindh, noted that mistrust about the polio program exists among some communities and parents who either see the polio vaccine as a conspiracy or believe it is harmful to their children’s health.

In areas where security threats hinder polio teams, incidents of fake vaccination marking and data are common, he added. There is no national or provincial law to deal with parents who refuse polio drops for their children or those involved in falsifying data. 

Basit believes paediatricians can play a crucial role in educating parents about the positive effects of the vaccine, as they are often the first to be consulted when children fall ill. He would like to see a comprehensive strategy involving pediatricians at primary health centers to educate parents about the importance of the polio vaccine for their child’s future.

Prime Minister’s intervention 

Prime Minister Shahbaz Sharif, during a high-level meeting on polio, expressed confidence that the country would soon be free of polio, but he has also ordered a third-party audit of the polio campaign.

He has also directed top health officials to form a comprehensive strategy to reduce the immunity gap.

The Prime Minister’s Office in its statement reiterated its commitment to eradicating polio from the country through concerted efforts.

Meanwhile, former federal minister and public health expert Dr Nadeem Jan believes that the current immunity gap can be reduced within two years if there are changes in the polio program.

Jan said that while the high number of polio cases in a single year is concerning, the virus’s spread can be contained with a new approach. He proposes that Pakistan integrate the polio program with the routine immunization program.

“Routine immunization is already accepted within communities and does not face the same level of resistance as the polio program, therefore, the polio program should also be managed under the Expanded Program on Immunization (EPI),” said Jan.

Jan also stressed the need for a third-party audit of the program to ensure its effectiveness.

‘Significant failure’

However, Dr Abdul Ghafoor Shoro, general secretary of the Pakistan Medical Association (PMA), the country’s largest body representing physicians, has described the rise in cases as a failure of the program.

“This alarming trend indicates a significant failure in the polio eradication efforts, and PMA calls on the government to take immediate and decisive action to address this critical situation,” said Shoro.

He claims that the current approach, which appears reliant on a bureaucratic and foreign-funded system, has failed to contain the virus.

The PMA has demanded a comprehensive and transparent investigation into the reasons behind the resurgence of polio, including a thorough assessment of the existing polio eradication program, the role of the government, and the effectiveness of the current strategies.

The PMA also urged the government to immediately implement a robust and effective polio eradication strategy, increase public awareness campaigns and strengthen the surveillance system to ensure timely detection and response to new cases.

It also emphasized that adequate resources and support need to be provided to the polio eradication program, and those responsible for the failure to control the spread of the virus need to be held accountable.

Militancy and insecurity

Door-to-door campaigns, a critical part of the polio eradication strategy, are difficult in districts with high insecurity.

The World Health Organization’s (WHO) regional polio eradication director Dr Hamid Jafari, told a webinar hosted by Global Polio Eradication Program that the current polio resurgence in Pakistan and Afghanistan is not comparable to the catastrophic levels witnessed decades ago, when over 20,000 children were paralyzed annually in Pakistan alone.

“By 2021 to 2022, Pakistan reported just one case of wild poliovirus, while Afghanistan recorded two. This is a dramatic improvement compared to the 176 cases reported in 2019 across both countries,” Jafari noted.

However, he explained that resurgence in polio is a predictable pattern in eradication efforts. “Until you completely eliminate the virus, it will resurge and come back,” he remarked.

Jafari highlighted several immediate causes for the recent rise in polio cases. These include the large-scale repatriation of Afghan nationals which triggered unpredictable population movements within Pakistan and across Afghanistan. 

Challenges such as militant insurgencies and insecurity have hindered vaccination campaigns in certain regions as “children in these insecure areas cannot be consistently vaccinated,” he explained.

Jafari also pointed to vaccine hesitancy and community boycotts driven by unmet expectations for broader services as significant obstacles.

Despite these setbacks, both Pakistan and Afghanistan are actively working to counter the polio resurgence using measures such as remapping and identifying children who missed vaccinations, particularly among migrant and mobile populations, he added. 

Strategies also address vaccine fatigue and hesitancy by rebuilding community trust and confidence. Pakistan and Afghanistan are collaborating with their respective security forces to access children in insecure regions, he added.

“In Afghanistan, where door-to-door vaccination campaigns are not feasible, WHO is working closely with local authorities and communities to ensure children are mobilized for vaccination,” he said.

 Jafari expressed optimism about the future, stating that the current resurgence does not signify a return to high case levels: “Next year, we are confident we will come very close to elimination.”

He emphasized the importance of overcoming challenges in the virus’s remaining safe havens – insecure areas, mobile populations, and vaccine-hesitant communities.

National priority

The Prime Minister’s health coordinator,  Dr Mukhtar Ahmed Bharath said polio eradication is our first national priority under the leadership of the Prime Minister of Pakistan.

He said necessary measures are being taken on an emergency basis for the complete eradication of polio and an effective road map has been laid out for the success of the upcoming polio campaigns.

“All resources and capabilities will be utilized to stop the spread of polio virus and for high-risk areas, the federation and the provinces have jointly formulated an integrated strategy,” said Bharath.

“Complete eradication of polio is our national goal, and the cooperation of parents is very important to achieve this goal.”

The health ministry’s spokesperson Sajid Shah, told Health Policy Watch that that a high-level review meeting,  chaired by the Federal Secretary of Health and the Chief Secretary of Khyber Pakhtunkhwa, was held to discuss the current situation of polio and its related challenges.

The meeting resolved to take strict disciplinary action against those who make fake finger markings in anti-polio drives while special integrated strategy attention is being formulated for the high-risk areas.

“With all efforts from the government parents are requested to cooperate fully with the polio teams for the healthy future of their children,” said Shah.

 

Image Credits: Pakistan Polio Eradication Program .

Sugary drinks now face additional taxes in Brazil.

Brazil’s National Congress approved a selective tax on tobacco, soft drinks, and alcohol this week as part of wide-ranging fiscal reform that also saw a reduction in taxes on healthy foods.

The trio of unhealthy consumables is now located in the same tax category as harmful goods and products including coal, vehicles and betting.

The specific tax rates for tobacco, alcohol, and soft drinks will be determined in 2025, but they will need to be high enough to deter consumers from buying these products to have an impact on health. 

The Congressional vote is a victory for advocacy groups as the Brazilian Senate had removed sugary drinks from the selective tax a week earlier, causing a public outcry.

The tax reform also establishes a National Basic Food Basket (CBNA) that will be tax-exempt. Meat, poultry and fish are included in this basket.

In addition, taxes have been slashed by 60% on horticultural and minimally processed goods including crustaceans, dairy products, honey, flour, cereals, pasta, juices, bread, nuts and fruit.

Lowering the price of healthy food

Brazilian legislators and civil society advocates aim to ensure that the prices of healthy foods are not higher than those of ultra-processed and unhealthy products.

 “This is a landmark moment for Brazil and a historic victory for global public health,” said Pedro de Paula, regional country director for the global public health organisation Vital Strategies in Brazil.

“By implementing a tax on these products, Brazil is not only saving lives by curbing the consumption of harmful products but also championing equitable access to healthier, more sustainable alternatives.  We commend Brazil’s National Congress for their leadership in this critical effort.”

De Paul said fiscal reform was necessary as Brazil had a “very complex, clunky system for production and consumer taxes”.

The new selective tax is an excise tax “for a handful of products which had clear negative externalities in terms of health and environment’, he added.

“This is landmark change, since it establishes a system that has clear taxes on top of the general VAT-like taxing structure with a clear narrative and purpose of reducing consumption and internalising the costs of the mentioned negative externalities,” he added.

While the tax will not be ring-fenced for health, De Paulo said that as the health system in Brazil is based on universal and free access, “any additional revenue implies additional minimum investments on health.”

However, Vital Strategies raised concerns about some of the provisions, such as “the inclusion of infant formula in the basic food basket and reduced tax rates for small alcohol producers.”

It will “collaborate closely with partners to advocate for tax rates that prioritise public health”, as “setting these rates at levels that significantly reduce consumption of harmful products will protect communities from preventable diseases.”

Sweetened beverages including soft drinks, artificial juices, and teas are “among the most consumed food groups in Brazil, with an average consumption of 65 litres per year per individual,” according to a recent article in the journal, Nature.

“Excess sugar is considered one of the main causes of excess weight and, consequently, its associated diseases (type 2 diabetes, hypertension). Therefore, the consumption of sugar-sweetened beverages is associated with an increased risk of developing obesity.”

Image Credits: Heala_SA/Twitter.

Africa CDC Director General Dr Jean Kaseya (centre) visiting DRC to assist with its mpox outbreak

Although malaria, compounded by malnutrition, seems the most likely cause of the mysterious illness in the Democratic Republic of Congo (DRC), haemorrhagic fever syndrome has not been ruled out.

Dr Ngashi Ngongo, mpox lead for Africa Centres for Disease Control and Prevention (Africa CDC), told a media briefing on Thursday that there were two “working hypotheses” currently being verified: either severe malaria against a background of malnutrition and viral infection, or a viral infection against a background of malaria and malnutrition.

The DRC had reported to Africa CDC earlier that day about the death of a man from the Panzi district suffering from the haemorrhagic fever syndrome, a term used for a group of viral diseases that can cause bleeding and damage to the body’s organs.

“His sample has been taken and sent to Kinshasa for laboratory testing,” said Ngongo.

However, with malaria confirmed via PCR in 86% of patients tested, “the diagnosis is leaning more toward malaria”, he said.

But the high case fatality rate of 6.2% (37 deaths out of 592 cases) triggered further investigation as this is way higher than usual for malaria.

The 37 deaths happened in health facilities but a further 44 community-based deaths are still being investigated, he added.

Of the 88 patients given rapid malaria tests, 55% were positive, while 25 of the 29 samples subjected to PCR tests were positive for malaria (86%). 

It is hard to confirm when an accurate diagnosis will be possible given the complications, including getting samples to laboratories, he added.

Mpox vaccinations too slow

Africa CDC is “not at all satisfied” with the fact that only 56,000 people have been vaccinated against mpox in DRC, said Ngongo.

The country has received over one million doses (people need two doses), so the DRC is “very far from reaching the target that they had set for themselves”.

Meanwhile, the arrival of 50,000 doses of the long awaited Japanese LC16 vaccines that are suitable for children is imminent. Japanese experts have been in the DRC training health workers on how to administer the vaccines.

Africa CDC convened a three-day mpox meeting in Ethiopia this week to review the continent’s response. This was attended by Burundi, Central Africa Republic, Cote d’Ivoire, DRC, Kenya, Liberia, Uganda, Nigeria and South Africa and seven partners including Africa CDC and Gavi.

One of the reasons the DRC gave for its slow vaccination rate at the review was “the demotivation of the response teams”, said Ngongo. While partners “have made allocations to provide some financial motivation, that will be conditional on performance”, he added.

The meeting identified eight priorities, the first being to “intensify resource mobilisation, including a funders conference”, as only 20% of pledges have materialised.

Other priorities include intensified country support for the hardest-hit countries, better data management systems and the acceleration and expansion of vaccinations. Countries also want to tackle co-infections like measles.

The mpox outbreak is now active in 15 countries, and continues to spread steadily. In the past week, 3,095 new cases were reported in comparison to 3,545 the previous week, said Ngongo.

Children below the age of 15 now represent about 34% of cases, while females now represent 54%. There has been a 789% increase in cases over 2023.

The DRC has the highest burden of cases, with 2,632 new cases and 29 deaths in the past week. Children under the age of 15 make up almost half its cases.

While Burundi, which has the second highest mpox burden, has not yet committed to vaccinating its citizens, its representatives at the review were “very interested to learn from the experience of DRC”, said Ngongo. 

The DRC shared their initial experiences at the review, and Burundi intends to integrate lessons from this into their country interaction review and make a recommendation on vaccinations.

Africa CDC will be part of Burundi’s action review in early 2025 “to be able to guide them in setting up priorities, including the decision on mpox vaccination”, Ngongo added.

Rwanda celebrates end of Marburg outbreak

Meanwhile, Rwanda has planned a celebration in its capital, Kigali, on Friday (20 December) to mark the end of its Marburg outbreak.

“This success is the result of the swift and coordinated effort that was laid by the [Rwandan] Ministry of Health, in collaboration with Africa CDC, WHO and all the key partners,” said Ngongo.

“Some measures that have contributed to this success include the leadership commitment with a prompt and transparent communication from the Minister of Health,” he added.

“We’ve also seen the enhancement of the national surveillance systems that allowed for early case detection, the intensified contact tracing and the early case isolation. 

“We also saw very high level of laboratory testing with a very short result to turnaround. We saw also the expansion and the upgrading of treatment facilities that were really of a global standard. 

“And finally, there was really an intensification of the awareness campaign to ensure that the public I got the necessary information on how to prevent the infection.”

Rwanda had one of the lowest case fatality rates in a Marburg outbreak, estimated at 22.7%, in comparison to previous outbreaks where the case fatality rate was around 50%.”

Image Credits: Africa CDC.

An Afghan woman amongst ruins caused by ongoing conflict in the country.

Medical institutions were the last hope for Afghan girls and women seeking higher education since the Taliban banned schools and universities for women

“Why do you torture us every day? Just give us poison and end it all,” a heartbroken Afghan medical student told Taliban forces, expressing the despair of thousands of girls whose dreams of becoming healthcare professionals were shattered by the Taliban’s latest decree.

The hardline group has banned all female medical students from pursuing education, marking the closure of nursing and midwifery programs across Afghanistan, the last lifeline for girls seeking higher education in a country where women’s rights have been systematically eroded since the Taliban’s return to power in 2021.

The Taliban’s recent decree, issued directly by the group’s supreme leader, Hebatullah Akhundzada, has caused immediate devastation. 

For the past three years, nursing and midwifery were the only remaining fields of study open to women after the Taliban banned girls from attending secondary schools and universities. The abrupt closure of these institutions has ignited widespread despair across Afghan society.

The ban comes a few months after the Taliban banned women’s voices and faces in public under so-called new vice and virtue laws. 

‘Are we not human?’

The abrupt ban came just days before completion of the last 2024 semester for many aspiring students like Zohra*, a nursing and midwifery student at the Abu Ali Sina Institute in the country’s northern Balkh province.

She told the Health Policy Watch: “These institutes were our last chance to continue our education after schools and universities were closed. I had set a new goal and worked hard, receiving good grades. I was on my way to becoming a midwifery graduate, to help my family, my country, and other women. Now, I’ve truly lost all hope for life.”

Kabul-based Maryam* echoed the despair. “We are Muslims, we observe Islamic hijab, and we just want access to education. Why do they not open the doors of the medical institutes for us? Since the closure of the institutes, I’ve lost track of day and night. I can’t sleep. My parents took me to a psychologist a few times, but nothing is helping. Are we not human?”

‘I have turned homeless’

“I have turned homeless, wandering aimlessly,” one student said in a viral video. Her words, along with others like it, have echoed through Kabul and beyond as girls wearing full-body black veils, many in tears, left their classrooms for the final time, uncertain if they would ever return.

Fariba*, a mother from Kabul, received devastating news when her daughter, Parwana, called early one morning, sobbing uncontrollably. 

“She never calls at this time,” Fariba, who once taught elementary education to girls, told Health Policy Watch. “It’s when she’s in class.” 

Her daughter Sara* had been studying nursing after her dream of attending university to study computer science was dashed by the Taliban’s closure of higher education for girls.

“Now, we are left without hope,” Sara, 20, lamented. “Our dreams are shattered. We are being pushed into the darkness.”

Conservative estimates suggest that around 35,000 girls were enrolled in over 150 private and 10 public medical institutions offering diplomas in fields such as nursing, midwifery, dentistry, and laboratory sciences before the Taliban’s ban. 

These programs were the last available option for young Afghan women who sought to contribute to their communities, particularly in healthcare.

The abrupt suspension has left students in shock. The administrator of one of the nursing institutes sent a message to all female students: “With a heavy heart, I must inform you that until further notice from the Islamic Emirate, you must not come to the institute for studies.”

Deepening health crisis

Training to be a nurse or midwife was the sole remaining career option for Afghan women after the Taliban takeover in 2021.

This move not only marks the end of the academic ambitions of girls and women, but also deepens the country’s already precarious healthcare crisis.

Afghanistan’s healthcare system was already under strain before the Taliban’s return to power, with one of the highest maternal mortality rates in the world. 

In 2020, the country saw 620 women die for every 100,000 live births – a stark contrast to just 10 deaths in the UK, according to the World Health Organization (WHO). 

Less than 60% of births were overseen by trained health personnel in 2019, according to the  United Nations Population Fund (UNFPA), which estimates that Afghanistan requires an additional 18,000 skilled midwives to meet the needs of its women.

Despite the overwhelming need for female healthcare workers, the Taliban’s decision to block access to medical education for women will exacerbate the crisis. 

Médecins Sans Frontières (MSF) warned that the country’s lack of female healthcare professionals would directly impact the provision of essential health services, especially maternal care.

“There is no healthcare system without educated female health practitioners,” said Mickael Le Paih, MSF’s Country Representative in Afghanistan. 

“In MSF, more than 41% of our medical staff are women. The decision to bar women from studying at medical institutes will further exclude them from both education and healthcare.”

The healthcare sector’s reliance on female professionals is especially critical in Afghanistan, where cultural norms often prevent women from being treated by male doctors. 

Dr Ahmed Rashed, a Kabul-based health policy expert, warned that the Taliban’s latest decree would create numerous social challenges, especially for Afghan women who prefer to be treated by female healthcare workers.

“If girls cannot attend secondary school, and women cannot study at universities or medical institutes, where will the future generation of female doctors come from?” Rashed asked. “Who will provide healthcare to Afghan women when they need it most? For essential services to be available to all genders, they must be delivered by all genders.”

International outcry

Last week, the United Nations (UN) Security Council criticized the medical education ban and the “vice and virtue” law issued in August in a unanimous resolution voicing concern about “the increasing erosion” of human rights in the country.

“If implemented, the reported new ban will be yet another inexplicable, totally unjustifiable blow to the health, dignity, and futures of Afghan women and girls. It will constitute yet another direct assault on the rights of women and girls in Afghanistan,” according to UN Special Rapporteurs working on women’s rights, human rights and health. 

“It will undoubtedly lead to unnecessary suffering, illness, and possibly deaths of Afghan women and children, now and in future generations, which could amount to femicide.”

The Norwegian Afghanistan Committee (NAC), which trains female healthcare workers in collaboration with the Ministry of Health, reported that it had been verbally informed that classes for women would be “temporarily suspended.” 

As the Taliban’s gender-based restrictions continue to devastate the lives of millions of Afghan women and girls, the question remains: What is the future of Afghanistan’s healthcare system? Without access to education, Afghan women will be barred from becoming the doctors, nurses, and midwives their country so desperately needs.

This decision, experts warn, will not only create immediate social and healthcare challenges but will have long-term consequences for generations to come.

* Names changed to protect their identities. Updated 22.12.2024.

Manija Mirzaie is an Afghan journalist now based abroad.

 

Image Credits: WHO EMRO, Ifrah Akhter/ Unsplash.