Omicron
Experts have described the array of subvariants as a “swarm”.

The SARS-CoV2 virus just won’t give up. As the northern hemisphere heads into its third pandemic winter, experts say the continued evolution of Omicron’s sub-variants indicates a fresh wave is coming, but no one knows which variant will fuel it.

Scientists have catalogued 390 Omicron lineages and 48 recombinants of the virus – which occur when at least two variants co-infect the same person, allowing them to ‘exchange notes’ and evolve. The sheer number of Omicron strains circulating makes predictions complicated.

“We’re having trouble isolating which of the omicron sub-variants will have a growth advantage and will take over in dominating the spread,” WHO Senior Emergency Officer Dr Catherine Smallwood explained at a press conference last week. “Some variants like BQ.1 have been noted as potentially accelerated, but we’re not sure yet how this is going to pan out in the longer term.”

The variety of offshoots also creates the possibility of a ‘double wave’ in some places if two successive variants with different immune-dodging characteristics succeed each other.

“Looking at all the data, it seems a sizable new infection wave is certain to come,” Tom Wenseleers, an evolutionary biologist at the Catholic University of Leuven told Nature.

Subvariant surges not causing hospitalization spikes – for now

Omicron
Ranking of the immune evasion for the new variants

There is some good news: early signs show that though the BA.4, BA.5, BQ.1.1 and XBB subvariants are able to break through immune protections and resist certain treatments, they do not appear to be causing increases in hospitalizations.

“An encouraging sign for one of – if not the most – immune evasive new variants XBB: it is dominant in India and Bangladesh without a rise in cases or deaths to date,” said Eric Topol, founder and director of Scripps Research.

Despite the dominance of the highly infectious XBB variant, deaths and cases in India and Bengladesh have remained stable.

Similar findings have come out of South Africa, where the Africa Health Research Institute in Durban conducted studies on the BA.4 and BA.5 sub-lineages. The team, led by virologist Alex Sigal, found that while these Omicron families possess strong enough immune-dodging mechanisms to lead to an infection wave, they are “not likely to cause much more severe disease than the previous waves, especially in vaccinated people.”

The World Health Organization’s (WHO) Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE), which released a statement singling out BQ.1 and XBB as key variants of concern on Thursday, issued a similar analysis.

“While we are looking at a vast genetic diversity of Omicron sublineages, they currently display similar clinical outcomes, but with differences in immune escape potential,” TAG-VE’s expert panel found. “So far there is no epidemiological evidence that these sublineages will be of substantially greater risk compared to other Omicron sublineages.”

World trending in the right direction – but surprises could be around the corner

WHO
WHO data as of the October 26 SARS-CoV2 weekly situation report.

The question lingering on the mind of many experts is whether the varying properties of subvariants mean infection by one will provide immunity from others – a key determinant of whether double waves will hit.

A team at Peking University in Beijing, led by Yunglong Richard Cao, has been studying the variants’ immune-evading capacities. “I have a feeling that if you’re infected with BQ.1, you might have some protection against XBB,” he told Nature. “We don’t have data yet.”

Experts warn not to rule out more surprises from the virus. With Delta still circulating in the background, the deadlier variant could return to the fore. 

“The virus has surprised us more than once,” said Dr Hans Kluge, WHO Europe Regional Director. “We are much better prepared, and the fall surge has not led to previous ICU admission or severe disease levels, but forecasting remains tricky.” 

Russia’s invasion of Ukraine – denoted by the red line above – caused the country’s ability to report cases and deaths to fall.

Reports emerged this week of yet another subvariant, BA.5.2.6 taking hold in Ukraine. The dire conditions occasioned by Russia’s invasion of the country have made it conducive ground for viral spread, and reporting since the start of the conflict has dropped off a cliff. 

Little is known about the true state of play on the ground – nor which subvariant will take over next. 

Image Credits: Nature, Stuart Turville.

A woman getting medicine at a shop in India.

NEW DELHI – Govind Ram is still waiting to get justice for the death of his daughter in 2019 – who allegedly died from contaminated cough syrup.

In December 2019, Ram’s two-year-old, Surabhi, had a fever and chest congestion. Ram, a labourer in the Udhampur district of India’s Jammu and Kashmir region, took his daughter to a local doctor who prescribed a cough syrup. 

But her condition deteriorated further, and she was taken to a sub-district hospital then to a district hospital. Doctors there told her father to take her home as there was no chance of her survival, and she died a short while later.

Ram does not know whether he will ever get justice for the death of his daughter, who authorities believed died from ingesting a contaminated cough syrup.

Earlier this month, the deaths of 66 Gambian children were linked to contaminated cough syrup manufactured by Indian company, Maiden Pharmaceuticals. The Maiden-made cough syrups were contaminated with diethylene glycol (DEG), commonly used in anti-freeze, and ethylene glycol (EG).

The Indian government has stopped production at the company’s facility in Haryana at the request of the World Health Organization (WHO).

Cough mixture exported to Gambia by Maiden Pharmaceuticals has been implicated in the deaths of 66 children. The company has a large export base.

Not the first time 

This is not the first time that such contamination has been alleged in Indian pharmaceutical products where substandard and contaminated medicines remain a widespread problem. 

Between 2019 and 2020, 13 children died after reportedly being administered a cough syrup adulterated with DEG in the northern state of Himachal Pradesh.  The deaths of another 12 children in Jammu, including Surabhi, were also alleged to have been tied to their consumption of cough syrup tainted with DEG.  

Both of the syrups were reportedly manufactured by Digital Vision, which is based in Himachal Pradesh. Two years later, the Himachal Pradesh’s Drugs Control Administration (DCA) has yet to complete its probe of the cases, which would allow charges to be filed. 

“The company’s manufacturing license was suspended, but later restored, first partially and then fully,” said Assistant Drugs Controller Garima Sharma, but did not explain how this had happened when the probe was not complete.

Lax regulatory authorities 

These are not isolated cases. The manufacture of sub-standard – and in some cases dangerous – drugs in India is rampant and the lax implementation of regulations enables manufacturers to escape any consequences.

While the sale of inferior quality drugs is a serious offence under Indian law with minimum prison term of a year and fines for the manufacturers, the provisions of the law are rarely enforced against the errant drug manufacturers. In most cases, the regulators simply suspend the drug maker’s license for a few days.

Take Digital Vision, which is supposedly being investigated for Surabhi’s death. It has 19 violations of quality standards since 2009 yet regulators have taken no significant action against it.

The October monthly alert from India’s Central Drugs Standard Control Organization (CDSCO) identifies 59 medicines that failed safety standards, including painkillers and calcium. 

“Due to repeated failure of samples of these medicines, action has been taken against them,” said Himachal Pradesh Drug Controller Navneet Marwah, explaining that these medicines had been withdrawn.

“Monitoring is needed from the time the medicine is made till it reaches the patient because it is a matter of life and death,” said Amulya Nidhi, national co-convener of People’s Health Movement of India. 

“After giving permission to manufacture a medicine it should be seen if the procedure and the guidelines related to it are being followed or not. These are regulatory failures.

“It is also important to see what action they have taken after the death of so many children. They have done nothing. Issuing notices to drug manufacturers can’t be called an action when innocent lives are lost,” added Nidhi.

According to Nidhi, a 2012 parliamentary report from the Standing Committee on Health and Family Welfare on the functioning of the Central Drug Standard Control Organization (CDSCO), had found some instances of collusion between the manufacturers, doctors and regulatory agency and had made a large number of recommendations for drastic revamping of the CDSCO.

“It is a regulatory failure and the monitoring process is very weak in our country which is responsible for such a condition,” he added.

Expired medicines and fake COVID-19 treatments 

Many other cases of the manufacture or sale of substandard drugs have been reported in the recent past. In February, a firm in Agra in the northern state of Uttar Pradesh was found to be buying expired medicine at low cost, repackaging and reselling it.

The Authentication Solution Providers’ Association (ASPA), an organization working against counterfeiting activities, said that fake COVID-19 medicines had been found in most Indian states over the last two years, especially at a time when there was severe shortage of COVID-19 products. 

India lacks suitable regulations for the pharma industry and the regulations and legal structures are not well defined, according to ASPA. 

Exports of substandard Indian drugs 

India is the world’s largest manufacturer of generic drugs, with sales of more than $2.4 billion in March 2022 alone. 

But some experts estimate that probably between 12% and 25% of the active pharmaceutical ingredients and finished medical products supplied globally from India are contaminated, substandard or counterfeit.

In the case of deaths of the contaminated medicines sold in The Gambia, Indian regulators allowed a habitual offender firm to export substandard drugs, public health activists Dinesh Thakur and T Prashant Reddy told India Today. Thakur is the co-author of a book entitled ‘The Truth Pill’, on substandard medicines in India’s pharma industry.

“A Certificate of a Pharmaceutical Product (CoPP) is needed by the importing country when the product in question is intended for registration, with the scope of commercialisation or distribution in that country,” they said.

The CoPPs, effectively export permits, are issued by the CDSCO which operates under the central government’s  Ministry of Health, they added. 

“Therefore, it was not correct to suggest that Haryana’s state regulator gave the approval to this drug and that the central body had nothing to do with the approvals,” they said, adding that the same cough syrups were also authorized for sale in India –  contrary to government statements to the effect that they were only marketed for export. 

WHO’s investigation raises the stakes 

While problems with poor quality medicines have flown under the radar for years, the recent alarm sounded by WHO on the four types substandard cough syrups made by Maiden Pharmaceutical has raised attention about the issues at play. 

India’s Ministry of Health and Family Welfare said that the Central Drugs Standard Control Organisation took up the issue with the regulatory authorities in Haryana, under whose jurisdiction the drug manufacturing unit of Maiden is located. The Indian government and the Haryana government imposed a ban on Maiden Pharmaceuticals. 

External Affairs Minister Dr S Jaishankar told his counterpart in Gambia, Dr Mamadou Tangara, that the matter was being seriously investigated by appropriate authorities.

Despite the accumulating claims and evidence, India’s mainstream medical community has been slow to react. 

“It is too early to say that the syrup has caused deaths in Gambia. Syrup sells a lot, but it has to be seen that the children had not eaten anything else that could have caused their death,” said Sahajanand Prasad Singh, president of the Indian Medical Association.

Brushing aside the WHO reports that syrups used by the children had been adulterated, he added: “I do not think that consuming syrup alone would have such fatal consequences.”

However, the WHO has said clearly that syrups sold in the Gambia and used by the children had definitely been adulterated by a toxic compound that can lead to death. Although the global health agency has been clear that the exact cause of death has not yet been determined.  

Weak or substandard medicines are also a major driver of antimicrobial resistance – which is reaching epidemic proportions in India as well. Experts say India is one of the nations worst hit by antimicrobial resistance. Antibiotic-resistant neonatal infections alone are killing about 60,000 newborns each year. A new government report says things are getting worse, with tests conducted at a hospital revealing that a number of key drugs were barely effective.

Image Credits: Bijay chaurasia, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons, Maiden Phrama.

A Somali boy struggles to find water

The global cholera vaccines shortage relates to the unpredictability of the disease, and the fact that it unattractive to manufacturers as it is a disease of poverty – but if preventive vaccines are part of a routine vaccine package where cholera is endemic, this could stabilise demand and outbreaks

There is no short-term solution to the global cholera vaccine shortage as “the current manufacturers are producing to their maximum capacity, and one is increasing its production capacity but this increase is limited by technical constraints”, according to Dr Philippe Barbosa, the World Health Organization’s (WHO) technical lead on cholera.

Faced with at least 29 global cholera outbreaks – Haiti, Malawi and Syria battling particularly big outbreaks – and a diminishing supply of vaccines in the international stockpile, the WHO recently recommended that affected countries administer only one vaccine dose instead of the usual two. 

 Cholera is an acute diarrhoeal infection caused when people consume food or water contaminated with Vibrio cholera bacteria, and it usually affects those with inadequate access to clean water and proper sanitation.

As the disease primarily affects “the poorest and most vulnerable”, vaccine manufacturers have “no prospect of selling to rich countries”, so production is limited, Barbosa told Health Policy Watch.

“As the demand appears limited, this makes it unappealing for new manufacture to engage in this market,” said Barbosa, adding that the challenge of limited cholera data also made it difficult to forecast of future needs.

But Gavi, the global vaccine alliance, believes that it may be possible to stabilise vaccine production and supply by introducing preventative vaccines in cholera “hot spots”.

“We’re trying to get some preventive vaccination going in regions where cholera is endemic and that will help obviously to prevent outbreaks from a public health perspective,” says Gavi special adviser Aurelia Nguyen.

“It will also help with this ‘peaks and troughs’ view. As you can imagine from a manufacturing perspective, it is difficult to be able to just turn production on and off at very short notice,” added Nguyen, who has over a decade of experience in vaccine supply, most recently as managing director of COVAX, the international COVID-19 vaccine platform.

Gavi advisor Aurelia Nguyen

Only two suppliers

At present, only two suppliers make cholera vaccines available for mass vaccinations. Shanchol is produced by Shanta Biotechnics, a Sanofi subsidiary in India, and Euvichol-Plus, made by EuBiologics in South Korea.

Both companies supply the international cholera vaccine stockpile managed by the International Coordinating Group (ICG), a mechanism that coordinates the provision of emergency vaccines and antibiotics to countries during major outbreaks. The ICG is made up of members from the WHO, UNICEF, Médecins Sans Frontières, and the International Federation of Red Cross and Red Crescent Societies.

All countries that need cholera vaccines apply to the ICG, and those that qualify for Gavi financing get free vaccines while the others need to reimburse the stockpile.

“What we’ve done with Gavi financing is show manufacturers that there is a certainty of regular funding for vaccines, and the minimum stockpile that we want to have at any point in time for outbreak is five million doses,” says Nguyen.

But Shanta Biotechnics announced a while back that it will stop making Shanchol next year, while production at EuBiologics is currently constrained as the company is expanding its facilities. The expansion will ultimately enable it to produce 50 million vaccines a year. 

Nguyen said that “production economics” were behind Shanta Biotechnics’ decision to quit the field, and Gavi has been working “very closely” with EuBiologics “and their volumes are going to keep increasing over the course of next year”.

Neither company responded to questions Health Policy Watch sent to them.

However, Gavi has also “been in very active discussions” with other manufacturers to enter the market in the next two to three year to ensure “resilience in the market”.

“We’ve been discussing with potential new entrants what it would take in terms of their developments, and it also links to another conversation in terms of regional manufacturing on the African continent,” said Nguyen.

Gavi has been in discussions with the African Union, and in the past week with the G7 and G20, about having “a stronger and more sustainable manufacturing base in Africa, and this is one of the vaccines that would be perhaps suitable for a new entrant coming from the continent”, she added.

Unpredictable demand

Typically, the international stockpile has about five to seven million vaccine doses which get replenished as it is used – but the unpredictability of outbreaks has made it hard to ensure regular supply.

“In 2020, we used five million doses for outbreak response. This year, so far we’ve already shipped 18 million doses and we have just seven million doses on hand at the moment and we plan to buy another five million through to the end of the year.”

However, what is more predictable is that climate change will drive more cholera outbreaks. The recent floods in 33 of Nigeria’s 36 states  – the worst in a decade – are expected to increase cholera cases, while Pakistan has been bracing itself for more cases after its recent devastating floods.

“The consequences of a humanitarian crisis – such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission, should the bacteria be present or introduced,” the WHO warns.

Meanwhile, earlier this week UNICEF described the cholera outbreaks in Syria and Lebanon as “alarming”.

“The acute epidemic in Syria has left over 20,000 suspected cases with acute watery diarrhoea and 75 cholera-associated deaths since its start. In Lebanon, confirmed cholera cases reached 448 in just two weeks, with 10 associated deaths,”  UNICEF warned in a media release.

“Malnourished children are more vulnerable to developing severe cholera disease, and the cholera outbreak is yet another blow to already overstretched health systems in the region.”

Image Credits: CNN, UNICEF.

ACT-A is going to work more in-country as it transitions out of pandemic mode.

The Access to COVID-19 Tools (ACT) Accelerator is going to focus on vaccinating high-risk populations, introducing new treatments, boosting testing and securing sustained access to COVID-19 tools in the next six months.

ACT-A announced its new transition plan at a meeting on Friday as the world moves to long-term COVID-19 control.  

“Recognizing the evolving nature of the COVID-19 virus and pandemic, the plan outlines changes to ACT-A’s set-up and ways of working, to ensure countries continue to have access to COVID-19 tools in the longer term, while maintaining the coalition’s readiness to help address future disease surges,” according to a media release.

“Through 2023, COVAX will continue to support lower-income countries to protect their populations. In parallel, we will be supporting countries to integrate COVID-19 vaccination into routine national immunization programs, while also preparing for surges and other worst-case scenarios,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance.

Developed through a consultative process with ACT-A agencies, donors, industry partners, civil society organizations (CSOs) and Facilitation Council members, the plan summarizes priority areas of focus for the partnership’s pillars, coordination mechanisms and other core functions, and highlights the work to be maintained, transitioned, sunset, or kept on standby. The transition plan supports the work of ACT-A agencies as they evolve the financing, implementation and mainstreaming of their COVID-19 efforts.

The next phase of ACT-A partners’ work will centre on three overarching areas:

  • research and development (R&D) and market-shaping activities to ensure a pipeline for new and enhanced COVID-19 tools
  •  institutional arrangements for sustained access for all countries to COVID-19 vaccines, tests and treatments, including oxygen
  •  in-country work on new product introduction (eg new oral antivirals) and protection of priority populations in support of national and international targets

“As the world moves towards managing COVID-19 over the long-term, ACT-A will continue to support countries by providing access to vaccines, tests, and treatments,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “But as this plan lays out, we still have a lot of work to do to achieve equitable access to these life-saving tools, with health workers and at-risk populations as our top priority.”

Other changes outlined in the plan include the transition to a new ACT-A Tracking and Monitoring Taskforce, co-chaired by senior officials of India and the US, with the political-level Facilitation Council going into ‘standby’ mode, with the capacity to reactivate if needed due to a surge in severe disease.

Ebola
Contact tracers and village health teams take on Ebola in Uganda.

Six schoolchildren in the Ugandan capital of Kampala are the latest to be infected with Ebola, according to the country’s health minister on Wednesday – and with 15 cases in the densely populated city, some want the government to impose a lockdown.

So far, there have been 109 confirmed cases, including 30 deaths, of the Sudan strain of Ebola for which there is no vaccine – although two vaccines exist for the Zaire strain.

Ebola is highly infectious and has a mortality rate of up to 90%. The 2014-16 Ebola outbreak in West Africa, the largest on record, killed more than 11,000 people. In 2000, Uganda suffered an outbreak of Ebola that killed over 200 people.

After a slow start, contact tracing kicks into gear

With support from the World Health Organization (WHO) and partners, the Ugandan Ministry of Health has trained and deployed around 300 contact tracers, who play a critical role as the country looks to minimize the spread of the virus.

“When the community cooperates in the response and contacts are identified, it becomes easier to contain the disease,” said Dr Bernard Logouomo, the Ministry of Health Surveillance Lead in Mubende district, the outbreak’s epicenter.

In the first days of the outbreak, only 25% of contacts were properly traced, the WHO said. But by mid-October, nearly 94% of people who had come in contact with the virus were being properly monitored.

Despite dangers of urban Ebola, president resisting Kampala lockdown

Uganda
Kampala is home to 1.5 million people. Doctors worry Ebola could escape containment if it spreads throughout the city.

Ugandan President Yoweri Museveni has so far resisted calls to lock down the capital, although he announced a three-week lockdown in Mubende and Kassandra districts, where the outbreak started, on 15 October. 

However, the Kampala schoolchildren’s infections have been traced to a man who travelled to the city from Mubende.

On Tuesday, the head of the Uganda Medical Association, Dr Samuel Oledo, urged health authorities to impose a lockdown in Kampala. “The earlier we lockdown Kampala, the better,” he told reporters. “People are not even reporting cases right now.”

Uganda’s Ministry of Health acknowledged in a press statement on Thursday that urban Ebola can create “a situation of rapid spread,” but that lockdowns would remain limited to the epicentres of Mubende and Kassanda. 

“The situation in Kampala is still under control,” said Health Minister Jane Ruth Aceng. “There is no reason to restrict people’s movement.”

Trials are working

Without any known treatments available, trials are ongoing amid the outbreak. Uganda’s Ministry of Health said that a number of treatment options are being explored, including monoclonal antibodies, and repurposed drugs like Remdeservir donated by the US government. But doses are scarce.

“Thirteen patients have received these trial drugs with relatively good outcomes,” said health authorities. In total, 34 people have recovered from the virus. Four patients admitted in critical condition died despite treatment, highlighting the importance of early reporting and detection of symptoms.

“The spread of the outbreak relies on reducing the time between the first symptoms of the disease and its management,” said Denis Mbae, outreach project coordinator of Médecins Sans Frontières activities in Uganda. “The earlier patients are treated, the greater their chances of survival and the less risk there is of the disease spreading within the community.”

 

 

 

 

 

 

 

 

 

Image Credits: WHO, Angella Birungi.

Traffic in Addis Ababa; air pollution is second leading cause of premature deaths in Africa for 1.1 million deaths a year.

Africa faces some of the world’s most severe health impacts from air pollution – with five countries on the continent ranking among the ten most polluted countries in the world, according to a new report by the US-based research organization Health Effects Institute. 

Those countries include Niger, Nigeria, Egypt, Mauritania and Cameroon, where the report, the State of Air Quality and Health Impacts in Africa, found fine particulate matter (PM2.5) exposures ranging as high as 65-80 micrograms per cubic meter (μg/m3).

Some 1.1 million people in Africa died prematurely from air pollution-related diseases in 2019, one-sixth of the total global estimate of 7 million deaths annually. According to the report’s findings, air pollution is the second leading risk factor for premature deaths after malnutrition, placing it well above the long-discussed issues of unsafe water, sanitation and hygiene, which ranked fourth largest risk factor for deaths.  

Meanwhile, the economic costs of air pollution in African cities will increase by 600% over the next 18 years without urgent action, warned another report by the London-based Clean Air Fund (CAF), published simultaneously on Thursday. 

But shifting away from dirty energy sources for transport, heating/cooling and electricity could save over 120,000 lives, cut climate emissions by 20%, and unlock $20 billion for the urban economies of four key cities – Lagos, Cairo, Johannesburg and Accra, Ghana over the next 17 years – where solution scenarios were further explored, the CAF report predicts.

Under a business-as-usual scenario, air pollution is estimated to cost a total of $115.7 billion from 2023-2040 across the same four cities.

Reports come just ahead of COP 27 climate conference 

Population-weighted annual average PM2.5 exposures in countries across Africa.

The two reports come just ahead of the start of the UN Climate Conference (COP27) in Sharm el Sheikh, Egypt – and in a time when scientists say that there is “no credible pathway” to keep global warming limited to 1.5C – in light of countries’ mitigation actions to date.  

Leading African policymakers remain keen on developing fossil fuel sources and skeptical about  the feasibility of a rapid green energy transition in view of their dismay over the lack of rich country finance to support climate action in developing economies.  

Just last week, South Africa’s Minister of Mineral Resources and Energy Gwede Mantashe, charged that developed economies want to use African countries as “guinea pigs” on which to perform green energy experiments.

Against that background, the health and economic impacts of air pollution, whether it’s from biomass or fossil fuel sources, have played a negligible role in the political calculus leading up to the world’s next big climate moment.

It remains to be seen if the mounting evidence about the knock-on effects of air pollution, for health, climate and economies will make a difference. 

Fossil fuels, biomass and dust among leading pollution sources

Trends in percentage of population exposed to household air pollution for the five countries of interest, 2010–2019.

Africa’s air pollution sources are by no means limited only to fossil fuels – used for transport, urban heating and cooling and power generation. 

They also include significant emissions from the inefficient burning of biomass for household cooking and heating; industry; crop and waste burning; and semi-industrial activities, such as charcoal production and artisanal mining.

In arid and semi-arid parts of Africa, including the Sahara and the Sahel region to the south, dust and sandstorms are also a major contributor to air pollution – a source that African policymakers have emphasized is a factor that cannot be easily curbed. 

West Africa, parts of which border on the Sahel, also has some of the highest PM2.5 pollution levels on the continent. It is among the most heavily dependent regions on solid fuels for household cooking and heating. In Southern Africa, where fossil fuel sources factor more widely, has comparatively lower annual average PM2.5 levels – though still more than 5 times above the WHO recommended guideline levels. 

Limited air quality monitoring and management

Not coincidentally, South Africa also has the continent’s most extensive air quality monitoring system – as well as established air quality management policies. Air quality regulations, and monitoring for their compliance, helps advance progress on cleaner fuels, vehicles and industries.  But of the African Union’s 55 member states, only 17 countries do any air quality monitoring whatsover, the HEI report notes.

On a more positive note, the overall proportion of people relying on solid fuels (biomass and coal) for cooking declined slightly between 2010-2019, the report found.   

But such declines have not always translated into health benefits as population growth means that even more people continue to breathe dangerous household smoke. 

For example, the report found that the proportion of people in Nigeria using solid fuels declined from 82-77% between 2010 and 2019.  But due to population growth, some 29 million more people were cooking with solid fuels in 2019, as compared to 2010. 

Cities a nexus of old and new air pollution sources – and solutions

PM2.5 levels in Africa’s top 10 most populous cities in 2019.

In addition to the human toll in deaths and health impacts from breathing polluted air, the annual cost of health damages due to disease related to air pollution amounts to an average of 6.5% of GDP across Africa, the report said.

Across Egypt, Ghana, the Democratic Republic of the Congo, Kenya, and South Africa, the combined annual cost of health damages from PM2.5 exposure is more than 5.4 billion U.S. dollars.

In many developing African cities, old and new air pollution sources directly collide in a potent toxic stew. The mix typically includes smoke from household cooking and heating with biomass; uncontrolled waste burning; emissions from old diesel vehicles running on congested streets and from diesel generators that back up unreliable electric grids, as well as industrial emissions.  

pollution
Khartoum, Sudan. In Africa’s Sahara and Sahel regions, dusts storms can also be a major air pollution factor.

But where there are problems, cities can also find solutions. Some of Africa’s fastest growing cities could unlock tens of billions of dollars more for their economies – as well as saving lives and cutting greenhouse gas emissions if they invest in greener patterns of growth, according to the Clean Air Fund report, which makes the case for investing in air pollution – for dual health and climate change benefits. 

The CAF analysis mapped the health, economic and climate impacts of increasing air pollution along a “business as usual” growth path for four major cities, Lagos, Cairo, Johannesburg and Accra, Ghana. It contrasted that trajectory with an alternative scenario in which cities implement clean air measures as they grow. 

Those measures include cleaner and more efficient public transport, cleaner cookstoves and alternative fuel sources;  greener industrial technologies and energy systems; reduction of slash and burn land clearing, and open waste incineration.

Projecting out the alternative scenario in the same four cities, the report found that such policies could replace the vicious cycle of pollution and health impacts with a virtuous cycle of over 120,000 lives saved and $20 billion in economic benefits between 2023-2040.  Lagos, Africa’s largest city, would also enjoy the largest total savings, amounting to  $12.5 billion and 64,000 lives over that period. And these benefits could be extrapolated to other African cities, too, the report found. 

Health impacts of air pollution, large and varied 

The percentage of the population using solid fuels for cooking in countries across Africa in 2019.

Health impacts of air pollution tracked in the two reports range from common knoweldge causes – such as lung diseases, cardiovascular diseases, stroke and hypertension –  which mainly affect older people, to less discussed impacts among newborns and young children.  

According to the HEI report, some 236,000 African newborns die within the first month of life from air pollution exposures, mostly related to household air pollution from biomass and charcoal use. 

In 2019, 14% of all deaths in children under the age of 5 across Africa were linked to air pollution, situating air pollution as the third largest risk factor for those deaths after malnutrition, unsafe water, sanitation and hygiene in sub-Saharan African regions.

The impacts on newborns and infants also have long-term consequences for overall health, including issues with lung development, increased risks of asthma, and increased susceptibility to communicable diseases such as lower respiratory infections in young children.

“This report gives evidence of the substantial threat air pollution poses to the health, and even life, of babies and children under the age of 5 years,” said Caradee Wright, Chief Specialist Scientist with the South African Medical Research Council. “This vulnerable group needs special attention to mitigate their exposures through policy and intensive awareness campaigns with practical solutions for mothers and caregivers.”

Added Pallavi Pant, HEI head of global health and one of the report’s key contributors: “The tremendous health impacts from air pollution exposure across Africa, especially in young children, creates an urgency to expand Africa’s clean and green energy infrastructure. Meeting these challenges will bring significant improvements to air quality and public health as well as reduce greenhouse gas emissions.”

Image Credits: Health Effects Institute – State of Air Quality and Health Impacts in Africa l Air, State of Global Air, State of Air Quality and Health Impacts in Africa .

Dr Tereza Kasaeva, director of WHO’s  Global TB Programme.

Tuberculosis cases and deaths have increased for the first time in decades, and fewer cases were detected and fewer people treated during 2021 – all as a result of disruptions caused by the COVID-19 pandemic, according to the World Health Organization (WHO).

An estimated 10.6 million people fell sick with TB last year, an increase of 4.5% from 2020, while 1.6 million people died, according to the WHO’s  2022 Global TB report released on Thursday. 

Drug-resistant TB (DR-TB) also increased by 3% between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB recorded in 2021. DR TB is harder and more expensive to treat.

The TB incidence rate (new cases per 100 000 people per year) also rose by 3.6% between 2020 and 2021 – reversing declines of about 2% per year for most of the past 20 years.

An increase in deaths from TB between 2019 and 2021 also reversed a decline in mortality that started in 2005. 

“Globally, the reduction in the total number of TB deaths between 2015 and 2021 was less than 6%, about one-sixth of the way to the milestone of 35%,” Dr Tereza Kasaeva, director of WHO’s Global TB Programme, told a media briefing on Thursday.

Eight countries accounted for more than two-thirds of the global total of cases: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of the Congo.

“The largest burden of TB was in the WHO Southeast Asian region, 46%, followed by the WHO African region, 23%, and the WHO western Pacific, 18%,” according to Kasaeva.

“Growing rates of poverty, inequity, under-nutrition and other comorbidities, as well as discrimination and stigma, are the major drivers of the TB epidemic,” she added.

“Globally in 2021, of the 10.6  million people who fell ill with the TB, an estimated 2.2 million were attributable to undernourishment and another 2.6 million jointly to other main risk factors such as HIV infection, alcohol use disorders, smoking and diabetes. 

“HIV, poverty and under-nutrition are driving TB in Africa,” she added, also noting a cut in global spending on TB services “from $6 billion in 2019 to $5.4 billion in 2021”, which is less than half the global target of $13 billion annually by 2022.

Short on funds

USAID’s Cheri Vincent with TB survivor Kate O’Brien

As in the previous 10 years, most of the funding used in 2021 (79%) was from domestic sources. In low- and middle-income countries, international donor funding remains crucial. The main source is the Global Fund to Fight AIDS, Tuberculosis and Malaria, while the US contributes close to 50% of international donor funding for TB – via Global Fund donations and bilateral aid.

“USAID has been the leading bilateral donor of the international fight for TB,” said Dr Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID).

“We have spent $4.2 billion since 2000 on this on this effort… 10.6 million people each year get TB and 1.6 million die each year. This is something that we shouldn’t see in our lifetime. We should be able to end TB in our lifetime,” added Vincent.

“This is a very important moment to have this data and reflect on what can we do more how can we recover…. from COVID, mitigate COVID impact on TB but also to end TB.” 

Kate O’Brien, a US TB survivor and advocate for ‘We Are TB’, stressed that ”when we hear numbers like this, sometimes it can be kind of difficult to remember that every single one of those numbers is a person, with a family”. 

“When I had tuberculosis myself, I was in pain. I was terrified, and I was also worried that I was going to lose my baby because I was pregnant. I was going from doctor to doctor and I just couldn’t get a sense of urgency. I didn’t become diagnosed with tuberculosis until I was in an ICU, until my lungs were very, very poorly damaged. And that sense that lack of a sense of urgency really almost cost me and my child our lives.”

Fewer tests, and fewer on treatment

US TB survivor Kate O’Brien was only diagnosed with TB once she was in ICU.

Only 5.8 million new TB cases were detected in 2020, whereas 7.1 million were found in 2019, indicating a drop in testing rather than in new cases. There was a partial recovery to 6.4 million in 2021, but this was still “well below pre-pandemic levels”, the WHO notes.

By 2021, the world was only two-thirds of the way to reaching the global target of treating 40 million people in five years (2018- 2022), with only 26.3 million having been treated.

“The report provides important new evidence and makes a strong case on the need to join forces and urgently redouble efforts to get the TB response back-on-track to reach TB targets and save lives,” said Kasaeva. “This will be an essential tool for countries, partners and civil society as they review progress and prepare for the second UN High Level Meeting on TB mandated for 2023.”

Climate
Two deer take refuge in a river during a wild fire in Bitterroot National Forest, Montana, United States.

The existential project to save the planet set out by the 2016 Paris Agreement is in tatters. There is currently “no credible pathway” to limit increases in global temperatures to the 1.5°C degree target detailed in the accords, the UN Environmental Programme (UNEP) said in its global emissions gap report released Thursday.

The chance of temporarily exceeding 1.5°C has risen steadily since 2015, when it was close to zero.  That probability has increased to nearly 50% for the 2022-2026 period. 

The language of the UNEP report stands in stark contrast to the diplomatic assessment by the UN Framework Convention on Climate Change (UNFCCC) Secretariat released on Wednesday.

The UNFCCC report refers to “glimmers of hope,” noting that progress over the last year shows “a strong signal that the world is starting to aim for net-zero emissions.” But the UNEP does not mince words.

“Inadequate progress on climate action means the rapid transformation of societies is the only option,” the report states. “This lack of progress leaves the world hurtling towards a temperature rise far above the Paris Agreement goals.”

Despite a year of devastating climate-driven disasters, updated pledges by the international community since COP26 in Glasgow represent less than a 1% reduction in projected 2030 greenhouse gas emissions. Emissions in 2021 were also likely the highest on record, breaking the ceiling set by 2019 levels, the report found.

UNEP
To get on track to limiting global warming to 1.5°C, the world would need to cut 45 per cent of current greenhouse gas emissions by 2030.

If countries fully implement all present and future plans to reduce emissions, and additional net-zero commitments, the world will be on track for a 1.8°C temperature increase by the end of the century. But even this scenario is “not credible” given the snail’s pace of progress, the UNEP said.

“We are headed towards global catastrophe,” UN Secretary-General António Guterres said at a press conference accompanying the release of the report. “Our world cannot afford any more greenwashing, fake movers or late movers.”

Current policies set the world on pace for global warming of 2.8°C by the end of the century. The two realistic scenarios laid out in the report – in which countries follow through on their “nationally determined commitments” – reduce warming to 2.6°C and 2.4°C.

“We had our chance to make incremental changes, but that time is over,” said Inger Andersen, executive director of the UNEP. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.”

A decimal can make all the difference

 

Temperatures during the last ice age, known as the Last Glacial Maximum, were an average of just 6 degrees cooler than today.

These temperature discrepancies can appear insignificant, but even minute shifts in the earth’s temperature have drastic impacts. At the peak of the last ice age, when glaciers covered about half of North America, Europe, South America and many parts of Asia, average temperatures were only 6°C degrees colder than today.

“In your own personal experience that might not sound like a big difference, but it’s a huge change,” said Jessica Tierney, primary author of the report on ice age temperatures.

Warming to 2°C, compared with 1.5°C, is estimated to increase the number of people exposed to climate-related risks and poverty by up to several hundred million by 2050. As the most affected regions are among the poorest in the world, possessing little ability to adapt on their own, the impacts will be devastating.

“Nature has been telling us all year, through deadly floods, storms and raging fires: we have to stop filling our atmosphere with greenhouse gasses, and stop doing it fast,” Andersen said. “Every fraction of a degree matters.”

For millions, the climate crisis is already here

Expansion of extremely hot regions in a business-as-usual climate scenario. Black and hashed areas represent unlivable hot zones. Absent migration, that area would be home to 3.5 billion people in 2070

Climate change discourse often unfolds in future-oriented language, but the consequences of the present 1.1°C degree increase in global temperatures are already hitting millions, and many are being forced to flee.

Amid unpredictable monsoon rainfall and increasingly strong droughts, more than eight million people in Southeast Asia have moved toward the Middle East, Europe, and North America, the World Bank found. Droughts and crop failures have impacted millions of rural people in the African Sahel, too, creating streams of internal displacement towards the coasts and cities.

And this is just the beginning. A groundbreaking study in the journal Proceedings of the National Academy of Sciences (PNAS), found that by 2070, up to 19% of land currently inhabited by people could become unlivable hot zones, akin to the Sahara, placing billions – one of every three people alive – in climate situations that will force them to leave. 

Should the flight away from hot climates reach the scale that current research suggests, it will amount to a vast remapping of the world’s populations, a joint investigation by the New York Times and ProPublica reports.

And the visible impacts of climate shifts are already staggering. Bangladesh, a country of 168 million people, now has over 10 million climate refugees – and an estimated 2,000 people move to its capital, Dhaka, every day, according to the Mayor’s Migration Council.

People who have lived in the coastal areas of Bangladesh for generations are migrating to escape flooding, and the government predicts that by 2050, one in every seven Bangladeshi citizens will be displaced by climate change. 

Financial hurdles present big challenges

June floods in Pakistan killed 1,717 people and the health impacts of the devastation are still unfolding.

In neighboring Pakistan, historic floods in June devastated millions, killed 1,717, and placed the country at the center of a developing international dialogue set to define the upcoming COP27 climate conference about who should foot the bill for the consequences of our shifting climate.

Cycles triggered by natural disasters and their rebuilding efforts trapped many countries in inescapable debt before the question of infrastructure investment for a clean transition even entered the conversation.

According to the IMF, 60% of low-income countries are in or at risk of debt distress due to climate change-induced events. A study by the World Weather Attribution group showed that climate change contributed to up to 50% of the rains that made this August the wettest on record in Sindh, the region of Pakistan where the floods struck.

“It is imperative to reform financial systems so that indebtedness is not a barrier for access to finance when countries are in need,” Andersen said. “These institutions were created in the shadow of the Second World War, but we are in a different time now. There is homework to be done in the halls of 193 capitals.”

As disasters hit populations in vulnerable regions, they also take a significant toll on the development journey of the countries they call home. All progress towards larger development goals can be wiped out overnight, and countries seeking funds to develop are forced to take out loans to pay for the cost of recovery – trapping them in an interminable cycle.

Pakistan is preparing to issue a request for new loans to rebuild infrastructure that would survive the extreme weather patterns, an effort it estimates will cost $30bn.  

“If you look at the numbers, it is the climate event of the century, not just for Pakistan but for the whole world,” Sherry Rehman, Pakistan’s climate change minister told the Financial Times. “It surpassed all numbers for climate events, and it is now creating a catastrophic health crisis.”

For governments grappling with the human, health, and economic impacts of increasingly frequent natural disasters, green energy is just one piece of a bigger puzzle.

COP27: slim hopes for urgent action amid divisions over funding responsibilities

COp27
COP27 will be held from 6 to 18 November 2022 in Sharm El Sheikh, Egypt.

As alarm sirens sound across the world, hopes for a watershed moment in the international community’s approach to combating the climate crisis at next week’s COP27 in Egypt remain slim.

The event will unfold against the backdrop of compounding energy, food and cost of living crises exacerbated by the war in Ukraine, coupled with the deep divisions around who should be responsible for funding the energy transition.

In addition to money for adapting to a shifting climate, low- and middle-income countries require technical assistance and investment to facilitate the envisioned transition directly to sustainable energy sources. The UNEP coordinates a technology sharing mechanism, but getting financing on the table is difficult.

“Climate finance structure today is biased against climate-vulnerable countries. The more vulnerable you are, the less climate finance you receive,” Kevin Chika Urama, chief economist at the African Development Bank, told Reuters.

Leaders of impacted countries are keenly aware of the threats posed by climate change, but the question of how to balance emissions targets with lifting people out of poverty has no easy solution. For them, energy is not a simple question of emissions: it is one of poverty, health, and survival. 

A disproportionate burden

CFR

“For Africa, the problem of energy poverty is as important as our climate ambitions,” Nigerian Vice-President Yemi Osinbajo said in a video address announcing his country’s aim to raise an initial US$10 billion in funding to implement its energy transition plan ahead of the conference. “Energy use is crucial for almost every conceivable aspect of development — wealth, health, nutrition, water, infrastructure, education and life expectancy.”

The perceived hypocrisy displayed in recent months by countries that have fashioned themselves as leaders of the green energy transition have made this conversation even more difficult.

Since the onset of Russia’s invasion, Europe has raced to import as much natural gas from Africa as possible to shore up its domestic supplies. It has provided no additional funding for projects that would allow the world’s poorest continent to burn more gas at home.

Meanwhile, in South Sudan, only 6% of people have access to modern energy. “Energy poverty and injustice is real, but we need to make sure that energy expansion is done sustainably,” Andersen said.

Recent IEA findings estimated the exploitation of all proven natural gas reserves in Africa would amount to an increase of just 0.5% in Africa’s global emissions burden, to 3.5% up from 3.0%. In July, the EU voted to classify natural gas as ‘green’, freeing up public subsidies and greenlighting new infrastructure projects set to extend the bloc’s reliance on fossil fuels.

Together, G20 countries contribute 75% of greenhouse gas emissions annually, and any consensus will likely depend on new commitments from rich countries to invest in the climate transition beyond their own borders.

“The worst impacts of fossil fuel-driven climate change are being felt by developing countries – those least responsible for having caused it,” said Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance. “High-income countries must provide developing countries with the necessary financial and technical support for the equitable access to the clean energy their people need.”

Total systemic change is a big ask

UNEP
The window to reach climate change goals is closing fast: inadequate progress on climate action makes rapid transformation of societies the only option, the UN said.

Though the future of the planet is at stake, success at COP27 appears unlikely. Multilateral negotiations – in the best of circumstances – are exceedingly complicated affairs. The EU and Canada spent over seven years negotiating a mutually beneficial trade deal, and it nearly collapsed at the last hurdle.

That a total transformation of global financial, food, electricity and financial systems is the requirement set out by the UNEP makes the stakes of COP27 as daunting as they appear unfeasible, the report acknowledges.

“The task facing the world is immense: not just to set more ambitious targets, but also to deliver on all commitments made,” it states. “This will require not just incremental sector-by-sector change, but wide-ranging, large-scale, rapid and systemic transformation. This will not be easy, given the many other pressures on policymakers at all levels.”

In this context, any progress will be welcomed.

“Even if we don’t meet our 2030 goals, we must strive to get as close as possible to 1.5°C,” said Andersen. “This means setting up the foundations of a net-zero future: one that will allow us to bring down temperature overshoots and deliver many other social and environmental benefits, like clean air, green jobs and universal energy access.”

The clock is ticking, but there’s a roadmap: energy, finance, building and food practices must change

UNEP roadmap for a sustainable transition outlined in the report.

If the UNEP report’s findings are dire, they are also constructive. The report is formatted as a roadmap for achieving net-zero greenhouse gas emissions in electricity supply, industry, transportation and buildings, providing a groundwork for launching towards a carbon-neutral future.

“The recommendations in today’s report are clear,” Secretary-General Guterres said. “End our reliance on fossil fuels. Avoid a lock-in of new fossil fuel infrastructure. Invest massively in renewables.”

And significant progress has already been made. The falling prices of renewable power sources like solar and wind make energy the closest sector to attaining the necessary transition outlined in the report. But while market prices have caught up and requisite technologies exist, the world is not transitioning to them fast enough.

On the other extreme, food systems are in critical need of an overhaul. The sector already accounts for one-third of all emissions, and if current practices remain in place, this is on track to double by 2050.

Global systemic change is a tall order, but “we have to try”

Inger Andersen, executive director of the UNEP, speaking to reporters on Thursday.

Without a systemic reform of the global financial system, the targets set out by the UNEP are unatainable: change requires capital.

The report estimates that an international transformation to a low-carbon future will require at least $4-6 trillion per year. For scale, the World Economic Forum estimates India’s transition to net-zero emissions will require $10 trillion in investment. Financial systems must play a crucial role in enabling the energy transition, Andersen said, and massive reform is required.

“There is a conversation that needs to take place in capitals across the world between the governors of central banks, ministers of finance, and their environmental or meteorology counterparts,” she said. “Unless these talks happen, and a broader understanding of how climate shifts hurt our chances of reaching the Sustainable Development Goals is understood, we will be stuck.”

Hopes for increased climate investment hinge on the successful communication of the win-win opportunity renewables present. Researchers at Stanford University found that while a global transition to 100% renewable energy sources would cost countries $73 trillion upfront, it would pay for itself in less than seven years and create 28.6 million more jobs. 

Decisions made today can define emissions trajectories for decades to come. If the international community does not act decisively, the window of opportunity will close by 2030.

“I don’t want to waste your time talking about the impacts of climate change, we all know they are going to get worse,” an impassioned Andersen told reporters. “Is it a tall order to transform our systems in just eight years? Yes. Can we reduce greenhouse gas emissions by so much in that timeframe? Perhaps not. But we must try.”

Image Credits: PNAS, OXFAM.

Scene at last year’s Glasgow’s COP26 Climate Conference, which punted the ball on hard decisions about climate emissions to COP27 in Sharm el-Sheikh.

Countries’ voluntary commitments to fight climate change will still mean an increase in global emissions by some 10.6% as of 2030, according to the latest report of UN Climate Change,  which tabulates the most recent ‘Nationally Determined Commitments (NDCs) of countries to the climate battle.

This represents only a slight “improvement” over the commitments as of the same time last year – when countries were projected to increase climate change emissions by 13.7% as of 2030, in comparison to 2010 levels rather than make the drastic reductions needed to halt dangerous warming trends.

At the current pace, the world remains on track for a 2.5 C increase in global temperatures by the end of the century, warns the new report by the UN Framework Convention on Climate Change (UNFCCC) Secretariat, released less than two weeks ahead of the start of the UN Climate Conference (COP 27) in Sharm el-Sheikh, Egypt.

Positive signs of movement – but not nearly fast enough

UN Climate Change officials noted that the receipt of some new or updated climate commitments, made by some two dozen countries over the past year, had bent the curve of emissions increases downward, but only slightly.

“Today’s report also shows current commitments will increase emissions by 10.6% by 2030, compared to 2010 levels. This is an improvement over last year’s assessment, which found countries were on a path to increase emissions by 13.7% by 2030, compared to 2010 levels,” stated UN Climate Change in a press release.

But this is still very far away from the 43% reduction in emissions that has been identified by scientists as the required target to keep warming limited to 1.5 C.

“The latest science from the IPCC released earlier this year uses 2019 as a baseline, indicating that greenhouse gas emissions need to be cut 43% by 2030,” the press release stated. “This is critical to meeting the Paris Agreement goal of limiting temperature rise to 1.5 degrees Celsius by the end of this century and avoiding the worst impacts of climate change, including more frequent and severe droughts, heatwaves and rainfall”,”

Additionally, the report only assesses the impacts of countries’ climate commitments – not their actual implementation. And in many cases, the commitments made by heads of state have not translated into legislative actions or financial investments needed to follow them through.

“The downward trend in emissions expected by 2030 shows that nations have made some progress this year,” said Simon Stiell, Executive Secretary of UN Climate Change. “But the science is clear and so are our climate goals under the Paris Agreement. We are still nowhere near the scale and pace of emission reductions required to put us on track towards a 1.5 degrees Celsius world. To keep this goal alive, national governments need to strengthen their climate action plans now and implement them in the next eight years.”

The UN Climate Change assessment covers the climate action plans – or NDCs – of the 193 Parties to the Paris Agreement. Some 24 countries have submitted new or updated NDCs since last year’s UN Climate Change Conference in Glasgow (COP26). Taken together, the plans cover 94.9% of total global greenhouse gas emissions in 2019.

Sharm el Sheikh will be pivotal moment 

Can fossil fuels give way to solar power? COP27 may provide some answers.

The UN Climate report refers to “glimmers of hope” in an otherwise gloomy picture, citing a second UN Climate Change report, also released today, on the prospects for the more robust development of long-term low-emission development strategies.

The review of 62 countries’ plans to transition to net-zero emissions by or around mid-century found that these countries’ greenhouse gas emissions could be roughly 68% per cent lower in 2050 than in 2019 if all the long-term strategies were fully implemented on time.

These countries’ long-term strategies also account for 83% of the world’s GDP, 47% of the global population in 2019, and around 69% of total energy consumption in 2019.

“This is a strong signal that the world is starting to aim for net-zero emissions,” the report notes.

However, many net-zero targets remain “uncertain and postpone into the future” and critical action needs to take place now, the UN Climate Change secretariat stated. “Ambitious climate action before 2030 is urgently needed to achieve the long-term goals of the Paris Agreement.”

COP26 in Glasgow ended on an ambivalent note with countries’ postponing more decisive action on emissions reductions that scientists say is urgently needed. That left the world with a big “to do list” for this year’s COP27, hosted by Egypt.

Climate impacts more visible – but will that really move politicians?

Pakistani floods have displaced some 33 million people, according to government and UN estimates.

Now, with climate impacts becoming more visible by the day – from the recent, massive flooding in Pakistan and Nigeria to drought and hunger in the Horn of Africa, and wildfires in the western United States, policymakers are at a pivotal moment.

However, war in Ukraine, geopolitical tensions between China and its neighbours in the South China Sea and a raft of other regional conflicts and crises, have also provided plenty of distraction to world leaders – as well as propping up fossil fuel production and exports.

In addition, developing countries are clamouring even more adamantly for more action on the “loss and damage” provisions of the 2015 Paris Accord – which are supposed to help countries in the global South adapt to the negative effects of climate change.

Oil and coal-producing countries in Asia and Africa remain keen on developing their unexplored fossil fuel reserves – despite calls from scientists and some global leaders to make a more rapid shift to renewable energy sources. 

Just last week, South Africa’s Minister of Mineral Resources and Energy Gwede Mantashe, known for his pro-fossil fuel sentiments, charged that developed economies offering green finance to African economies are using them as “guinea pigs” on which to perform energy experiments.

Such rhetoric pushes aside scientific evidence that climate change is turning all of humanity into guinea pigs with a range of escalating health impacts from weather extremes, diseases and air pollution – while Africa is amongst those regions most at risk.

At the same time, developed countries have failed to come through on a promised $100 billion for financing the Green Climate Fund, part of the landmark 2015 Paris Climate accord that aimed to help the developing world transition out of fossil fuels.

Fund-raising for climate adaptation, which also would be directed into green energy sources, has fallen way short of goals, charged Ghanian President Nana Akufo-Addo after a visit to France earlier this month.  He was protesting the outcomes of a climate summit in Rotterdam last month, where European Nations pledged only $55 million to climate adapatation- as compared to the $25 billion that is supposed to be committed by 2025, Akufo-Addo has, in the past, spoken out about the importance of Ghana developing its fossil fuel reserves.

“COP27 will be the world’s watershed moment on climate action,” said Sameh Shoukry, Egyptian Minister of Foreign Affairs and COP27 President-Designate. “The report from UN Climate Change and before that from the IPCC are a timely reminder for all of us. Raising ambition and urgent implementation is indispensable for addressing the climate crisis. This includes cutting and removing emissions faster and a wider scope of economic sectors, to protect us from more severe adverse climate impacts and devastating loss and damage.”

“The synthesis report is a testimony to the fact that we are off-track on achieving the Paris Climate Goal and keeping the 1.5 degrees within reach,” added Shoukry. “This is a sobering moment, and we are in a race against time. Several of those who are expected to do more, are far from doing enough, and the consequences of this is affecting lives and livelihoods across the globe. I am conscious that it is and should be a continuum of action until 2030 then 2050, however, these alarming findings merit a transformative response at COP27.”

Image Credits: UNFCCC , Gellscom/CC BY-ND 2.0., Rahul Rajput.

Shelves stand empty in a Wuhan supermarket in an earlier lockdown.

China administered the world’s first oral aerosol COVID-19 vaccine boosters in Shanghai on Wednesday, as new lockdown measures were imposed on Wuhan, the supposed birthplace of the pandemic.

Chinese vaccine manufacturer CanSino Biologics said in a media statement that the inclusion of its vaccine in Shanghai’s booster vaccination program marked “the start of the rollout of the world’s first inhaled COVID-19 vaccine, Convidecia Air”.

The inhaler, approved as a booster for adults last month by the National Medical Products Administration of China, “provides a non-invasive option that uses a nebulizer to change liquid into an aerosol for inhalation through the mouth”, according to the company.

“Convidecia Air is needle-free and can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” it added. The aerosol vaccine is based on Sinovac (marketed as CoronaVac).

The Chinese-developed Sinovac uses a modified version of an adenovirus to deliver inactive parts of SARS CoV2 to a person’s immune system to prime it recognise and attack the virus when it becomes infected. This is followed by a second vaccine to boost the immune system a few weeks later.

Results from a clinical trial that compared the oral aerosol vaccine to an injectable version of Sinovac, published in The Lancet in August, found that the aerosol elicited 6.7 to 10.7 more neutralising antibodies than the injection after two to four weeks.

However, Sinovac is less efficacious against COVID-19 than mRNA vaccines, and there are some early indications that it offers very little protection against the latest variants.

Nasal sprays

Meanwhile, there are other clinical trials of SARS-CoV-2 vaccines delivered through the mucosa, but these are all nasal sprays.

Researchers at Yale University in the US recently published a pre-print paper reporting early success in mice using a vaccine booster strategy, “prime and spike”.

Noting that protection offered by mRNA vaccines weakens fairly fast, particularly in the nasal mucosa and respiratory tract, in those already vaccinated (“primed”), they tested an intranasal “spike” to “elicit mucosal immune memory within the respiratory tract”. 

Their trial found that “prime and spike” induced a robust immune response in animals that protected against SARS-CoV-2 infection. 

Indian company Bharat has also developed an intranasal vaccine for Covaxin, which it says has been successful in animal studies although it has not yet submitted results for peer review.

Wuhan locks down

Meanwhile, China has locked down Wuhan’s central Hanyang district after COVID cases were found, as China persists with a zero-tolerance approach almost three years after the virus was first reported in the city, and about 900,000 residents were told to stay at home, according to Bloomberg.

This follows the re-election of Chinese President Xi Jinping – the architect of the “zero-COVID” strategy – for a third five-year term as leader of the country’s ruling communist party.

China’s zero-COVID strategy has resulted in lockdowns of entire cities. People living in districts where COVID-19 cases are detected are obliged to stay indoors for seven days and take a daily test.

The lockdowns have had a negative effect on the country’s economy, with a 1.7% contraction in sales last month largely as a result of quarantines in various parts of the country.

Meanwhile, a 14-year-old girl teenager, Guo Jingjing, died in a quarantine facility earlier this month, according to the BBC.

She apparently developed a fever two days after being taken to a facility in Ruzhou, and her family posted videos on social media of her shaking and convulsing on a bed. Her father, Guo Lele, said in a video on Douyin (Chinese TikTok) that the facility had not provided her with any help.

However, the videos and most references to the incident have since been removed.

Image Credits: Studio Incendo.