Deaths from “traditional” pollution sources like unsafe water have declined but health impacts from “modern” pollution sources associated with traffic, industry and chemicals are rising.

[NAIROBI] While deaths from some traditional pollution sources, like domestic cookstoves and unsafe water and sanitation are declining, increased exposures to “modern” sources of pollution, such as chemicals and outdoor air pollution, mean that pollution-related mortality remains steady at about 9 million a year. 

This is a key finding of a new report on “Pollution and health; a progress update”, published today by Lancet Planetary Health.

“Modern sources of pollution such as industrialisation and urbanisation are increasingly becoming major causes of deaths but there are very little responses in tackling the [menace] from players such as donor agencies and national governments,” says Rachael Kupka, a study co-author and Executive Director of the Geneva-Based Global Alliance on Health and Pollution (GAHP).

“There is also insufficient public awareness on the dangers of pollution,” she adds. 

Overall, about 16% of all premature deaths annually are due to pollution, finds the study, an update of a 2017 Lancet Commission paper on pollution and health.  This also means that pollution remains the world’s largest environmental risk factor for disease and premature death.

The estimates are based on the Institute of Health Metrics and Evaluation’s 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, which looks at a broader range of risks to health from environments, diets, lifestyles and other factors.

Outdoor air pollution sources now the most dangerous to health 

Air pollution in Mashhad, Iran. Expanding low- and middle income cities are a nexus point for risks.

Among pollution sources, air pollution remains the biggest killer by far, the report found – with about 6.7 million deaths in 2019 from both household  and ambient air pollution sources. 

However, a shift is also occurring in the balance of air pollution sources. Deaths from household air pollution, generated by the reliance of billions of people on coal and biomass cookstoves are declining gradually as households shift to cleaner domestic fuels.  

But at the same time, deaths from outdoor air pollution sources have risen sharply over the past two decades – from an estimated 2.9 million deaths in 2000, when WHO first published data on mortality from air pollution risks, to an estimated 4.5 million deaths in 2019.

Deaths attributable to key “modern” and “traditional” pollution sources for which data is available.

That increase is largely due to the continued increases in outdoor air pollution from traffic emissions, power plants and industries, in cities of the global South that are seeing explosive growth into rural areas, in  unsustainable patterns of development, researchers have said, adding: 

“The triad of pollution, climate change and biodiversity loss are the key global environmental issues of our time. These issues are intricately linked and solutions to each will benefit each other.” 

The study also notes the deep equity fault line that pollution creates – with 92% of pollution-related deaths, and the greatest burden of pollution’s economic losses, occurring in low-income and middle-income countries.

Lead pollution still a major factor in chemical risks 

Lead pollution in the Amazons a byproduct of oil extraction.

The report adds that exposure to lead, a neurotoxin that also lowers IQ in children, caused 900 000 premature deaths in 2019 while other toxic chemical exposures in the workplace, accounted for 870 000 deaths.

But the figures on deaths from chemical pollutants are likely underestimates as only a small number of manufactured chemicals in commerce have been adequately tested for safety or toxicity.

Overall, deaths from the so-called “modern” pollution sources have increased by 66 percent in the past two decades, from an estimated 3.8 million deaths in 2000 to 6.3 million deaths in 2019, according to the study’s authors.

“The total effects of pollution on health would undoubtedly be larger if more comprehensive health data could be generated, especially if all pathways for chemicals in the environment were identified and analysed,” the study’s authors say.

According to Kupka, one out of five children globally is exposed to lead contamination despite the global phase out of leaded gasoline. In some countries, up to 50% of children may be exposed to lead through water piping, leaded household ceramics, lead in spices, as well as exposures in paint, artisanal mining and oil extraction and waste scavenging, according to GAHP.  

Pollution has it’s biggest impacts on health in LMICS

Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall

Pollution remains the world’s largest environmental risk factor for disease and premature death, particularly in low- and middle-income countries where air pollution accounts for about 75% of the nine million deaths.

The authors are now calling for immediate action to address this existential threat to human and planetary health as, with a few notable exceptions, little efforts have been done to deal with this public health crisis.

“Pollution is still the largest existential threat to human and planetary health and jeopardizes the sustainability of modern societies. Preventing pollution can also slow climate change – achieving a double benefit for planetary health – and our report calls for a massive, rapid transition away from all fossil fuels to clean, renewable energy,” said Professor Philip Landrigan, another co-author and director of the Global Public Health Program and Global Pollution Observatory at Boston College.

This trend is more evident in Southeast Asia, where rising levels of urban  pollution combine with ageing populations – who are more vulnerable to the health impacts of air pollution, and related diseases, such as heart attack, hypertension, cancers and chronic respiratory diseases. 

Reduction in deaths from “traditional” pollution sources most evident in Africa

Solar-powered lights have replaced polluting kerosene lamps in many homes around the world.

The drop in deaths from traditional pollution since 2000 is most evident in Africa, the report found. Theres a decline in household air pollution as families shift away from biomass, coal and kerosene for cooking and lighting. 

Household air pollution is a leading risk for childhood pneumonia deaths – along with cleaner household fuels, better medical treatment is gradually bringing that burden down. Similarly, improvements in clean water supply, storage and sanitation have reduced deaths from diarrhoeal diseases –  traditionally another major killer of children under 5, the report found.  Even so, lack of access to safe drinking water and improved sanitation still remains responsible for 1.4 million premature deaths every year.  

Pollution prevention largely overlooked  

Despite the bright spots of progress, pollution prevention is a neglected priority both among donors as well as among top officials in many of the of the low- and middle-income countries that suffer the most – including health sector leaders. 

“Despite its enormous health, social and economic impacts, pollution prevention is largely overlooked in the international development agenda,” says Richard Fuller, lead author. 

“Attention and funding have only minimally increased since 2015, despite well-documented increases in public concern about pollution and its health effects.”

This is despite estimates that pollution-related deaths led to economic losses totalling US$ 4∙6 trillion in 2019, equating to 6.2% of global economic output.  

Comparing lost economic output as a proportion of GDP due to deaths from modern and traditional pollution sources in 2000 and 2019.

Intergovernmental Panel Report on Pollution 

The authors called for an independent, Intergovernmental Panel on Climate Change (IPPC)-style science/policy panel on pollution, increased funding for pollution control from governments, independent, and philanthropic donors, and improved pollution monitoring and data collection.

 Approval and establishment of better connection between science and policy for pollution by international organisations.

“Prioritization of this issue by policymakers, understanding the consequences of pollution is extremely important. Ministers for environment need to ensure that pollution is factored in their national strategic plans and are budgeted,” according to Kupka.

Image Credits: Mohammad Hossein Taaghi, UN Water, Lancet Planetary Health, ISGlobal – Barcelona Institute of Global Health , Uncommonthought.com, DFID, Lancet Planetary Health .

Child infected with monkeypox virus in Liberia – since smallpox vaccinations were discontinued children may be even more vulnerable.

There are now seven confirmed cases of monkeypox in the United Kingdom, and all but one case of the virus appears to have been transmitted locally in the UK, including among men having sex with men, the World Health Organization confirmed in a media briefing on Tuesday.

The smallpox-related virus, which circulates widely in central and west Africa, causes flu-like symptoms and a heavy rash of fluid-filled nodules on the limbs and other parts of the body. In some cases it can be fatal, although the west African variant that has infected people in the UK is relatively milder than the Central African strain, UK officials were quoted by British media as saying.

The virus circulates widely among animals in western and central Africa. Among humans, several thousand cases are reported every year in the Democratic Republic of Congo, although the virus is endemic in the Central African Republic, Nigeria and elsewhere in western Africa, WHO said.

WHO is investigating the sources and nature of the UK outbreak together with the UK’s Health Security Agency and the European Centres for Disease Control, said Maria Van Kerkhove in the media briefing.  The first reported UK case was in a British resident who had recently travelled to Nigeria – but some of the new cases have not been directly traceable to that single contact or others, WHO said.

Cluster of cases among men who have sex with men

Ibrahima Socé Fall, WHO Assistant Director of Health Emergencies

Typically, the virus does not spread easily among humans – but the UK cluster of locally-transmitted cases have occurred primarily among men who have sex with other men – leading to new concerns about wider transmission risks through sexual contact.

“We have reached out to our European Regional Office to raise awareness about monkeypox, looking at people with unexplained rash, particularly in communities of men who have sex with men, just to add monkeypox as a potential diagnosis to make sure that we have the right testing underway,” Van Kerkhove said.

But the expanding pace of monkeypox transmission in African rural areas is an even more fundamental concern, noted Ibrahima Socé Fall, WHO Assistant Director General for Emergencies Response. The DRC recorded some 3000 cases in 2021, “and in Nigeria we are seeing increased numbers of cases too.. Clearly the main problem we need to investigate is the expansion of… transmission in Africa.”

While smallpox vaccine is believed to prevent infection, the proportion of people today who have been vaccinated against smallpox, is shrinking every year since routine smallpox vaccination was discontinued several decades ago, when the disease was eradicated. So more young people may be at risk, WHO officials said. And the mortality risk of monkeypox, while lower than for smallpox, can still be as high as 10%, according to the US Centers for Disease Control.

“We really need to invest in the discussion and development of tools for monkeypox,” Socé Fall added. “We have so many unknowns in terms of the dynamics of transmission in the future. In terms of therapeutics and diagnostics, we have so many important gaps.”

Exportation of virus is ‘signal’

Monkeypox, was first identified in 1958 in two colonies of research monkeys – hence its  name.  The first human case was recorded in the DRC in 1970, which is the apparent epicenter for the virus, according to the US Centers for Disease Control.

Along with non-human primates that may be killed and consumed as bushmeat, rodents, which infest rural food storage facilities, are important animal reservoirs for the disease.

Gambian pouched rat – rodents are believed to be a common animal reservoir for monkeypox.

The dynamics of animal transmission means that addressing monkeypox, as well as other emerging pathogens, will require more than just vaccines and treatments, said Dr Mike Ryan, executive director of WHO Health Emergencies.

“Understanding the ecology of this virus is important,” he said. “The cases that are imported to other countries are signals that something is happening,” he said.

“We’re seeing a shift to the geographic distribution of cases. And we also see the environmental pressures that are on our ecosystem as converging threats.

Need for environmental solutions – not only vaccines and medicines

“It’s not a surprise that we’re in a zone in western and central Africa, of increasing climate stress, of changing agricultural practices, of humans trying to survive in many cases, having to adapt, but also at the same time, small animals and rodents are adapting,” Ryan added.

Non-human primates like monkeys are another reservoir for the virus.

“They’re in the same crisis…. They’re seeking the same food sources and that’s bringing the animal population and the human population into ever closer proximity as we all compete, sometimes for those same food resources.

“So we have to really understand that deep ecology.  We have to understand human behavior in those regions, and we have to try and prevent the disease reaching humans in the first place.

“And that may not be necessarily with scientific interventions like vaccines – that may be in changing social and agricultural practices, storage practices.”

Image Credits: US Centres for Disease Control , Laëtitia Dudous, Sakurai Midori/Wikipedia .

DPR Korea and Eritrea are the only countries in the world that have not launched COVID vaccine campaigns.

Nearly 1.4 million people in the Democratic People’s Republic of Korea (DPR Korea) are suspected of having been infected with COVID-19 in just the past three weeks, WHO officials said today. 

The global health agency has offered diagnostics, vaccines, medicines and other support, but with no clear response to date from the isolated Asian nation that so far has refused to vaccinate its population of 26 million.  

DPR Korea, otherwise known as North Korea has admitted only to a wave of ‘fever’– as the state media called it – the closest it has come to acknowledging a COVID outbreak since the SARS-CoV2 pandemic began in 2020.  It is one of only two countries worldwide to have not yet started a vaccination campaign – the other one being Eritrea. 

“WHO is deeply concerned at the risk of further spread of COVID-19 in the country, particularly because the population is unvaccinated and many underlying conditions put them at risk of severe illnesses,” said Dr Tedros Adhanom Ghebreyesus, the WHO Director General, at the press briefing today in Geneva. 

He added that WHO had asked government authorities to share more samples or data sequences of the SARS-CoV2 virus circulating – although some samples already shared suggest the outbreak is dominated by the Omicron BA.2 variant. 

Unvaccinated status raises concerns  

Officials with masks stand at attention in DPR Korea.

DPR Korea’s unvaccinated status has raised concerns regionally and globally that a large outbreak could also lead to the emergence of new variants – as well as imposing a heavy toll on the country itself.  

“With the country yet to initiate COVID-19 vaccination, there is risk that the virus may spread rapidly among the masses unless curtailed with immediate and appropriate measures,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, said in a press statement on May 16.

The authoritarian state has meanwhile mobilized the army, mounted an information campaign and urged patients with ‘fever’ to opt for home remedies along with the use of painkillers and antibiotics, according to one Reuters report. 

In Eritrea, meanwhile, no major COVID wave has been reported just now, but the situation remains concerning there, as well, said Tedros. 

“They still haven’t accepted our offer that we made some time ago to get [them] vaccines. So we haven’t heard from them,” he said. “I have written to the president stating that we are ready to help and we have vaccines in stock that can go to Eritrea but we haven’t heard from him either.”

‘Omicron Is Deadly, Not Mild’ 

WHO Chief Scientist Soumya Swaminathan

“..It would be a whole package which they (DPR Korea) will need now – not only vaccination that will be needed, but also the critical care and interventions for people who are already infected,” added WHO Chief Scientist Soumya Swaminathan. “We stand ready to work with the governments of both Eritrea and DPRK to ensure that people have access to the tools that are now available all over the world.” 

Meanwhile, Dr Maria Van Kerkhove, Technical Lead for the COVID-19 response rejected suggestions that the outbreak in DPR Korea would be “mild” due to the likelihood that it is dominated by the Omicron strain of SARS-CoV2.  

“This notion that Omicron is mild is false.” she asserted. “What we are seeing is that people who are vaccinated have a much reduced risk of developing severe disease and that is why vaccines are so critically important around the world, particularly among those who are vulnerable, those who are over the age of 60.” 

“We know consistently across countries that people with underlying conditions are at an increased risk of severe disease.”  Along with holdouts such as DPR Korea and Eritrea, that poses a continuing concern for some 65 other countries, mostly in the African region, which have not yet vaccinated 40% of their populations, Swaminathan also noted.

Streamlining process for amendments to International Health Regulations  

Steven Solomon, WHO chief legal counsel talks about pending resolution on International Health Regulations 

Meanwhile, a senior WHO legal official said that a draft resolution on the table at the upcoming World Health Assembly could speed up the process for amending International Health Regulations (IHR), which govern WHO and countries’ pandemic response. 

The WHA begins on Sunday, 22 May and runs until 28 May. 

However, a WHA outcome that merely amends the process for making IHR amendments – rather than actually tackling the weak points in the rules themselves –  will likely prove to be frustrating to some nations as well as observers that have argued for much faster and more dramatic changes.  

The United States, for its part, has tabled a proposal for a very detailed series of revisions to the current IHR rules. These amendments would set a strict timetable of just 48 hours for countries to report to WHO about new disease outbreaks after they are identified by a national focal point. 

That would be followed by another 48 hours period in which countries can either accept WHO offers of technical assistance – or else WHO would share on the outbreak details with all member states.  That’s in contrast to present-day practice where the global health agency sometimes waits for months to make an outbreak public. For instance, a wildpolio virus outbreak in Malawi that occurred in November 2021, was only reported publicly by WHO in February.

But with some member states, such as China and Russia, fearful of giving the IHR more teeth at all, an agreement to expedite the process for making amendments may be the best that can be achieved at this WHA session.  

With a current period of two years for any IHR amendment to take effect once something is agreed, the new rule would at least halve the delay and thus streamline the process somewhat, said Steven Solomon, WHO’s Principal Legal Officer. 

“It’s an area that the Director General  supports as helping to streamline and make more effective and more agile this important international legal instrument (IHR).” If agreed, this would be only the second time that the IHRs have been amended,” he pointed out. . 

Overall, the WHA will take up the pandemic as a major topic of discussion for the third year in a row, added Tedros, including “how to end the emergency, increasing access to vaccines, antivirals, and other life saving tools.”

Image Credits: KCN.

What are the paths health systems can take to a more disease-free world?

And related to that, why do we talk about the total “eradication” of some diseases, like polio, whereas for others, “elimination as a public health problem” or simply disease “control” that shrinks an epidemic into an endemic disease is a more realistic option?

In this episode of the “Global Health Matters” podcast, host Garry Aslanyan answers these questions and more with the help of three public health leaders who talk about experiences tackling key disease threats, including onchocerciasis, malaria and polio.

“Infectious diseases have had a profound effect on the health of millions of people,” Aslanyan says. “They also have detrimental effects on the economies of many nations, which can lead to a cycle of poverty. The ultimate goal of public health is to control, eliminate and finally eradicate diseases that pose a threat to human health.”

But only one human disease has been successfully eradicated worldwide, which means having achieved permanent reduction to zero of incidence of infection: smallpox.

In terms of disease control, Uche Amazigo shares lessons she learned during her tenure as the director of the WHO African Programme for Onchocerciasis Control.

The parasitic disease, transmitted by blackflies that live near fast-flowing streams and rivers, is commonly known as river blindness, and it infects around 18 million people each year, according to the World Health Organization, mainly in West Africa but also in parts of Latin America, leaving people with debilitating skin disorders and blindness among older people .

Today, with community-led mass administration of treatments such as ivermectin, and now recently moxidectin, which reaches over 200 million people annually, the numbers of people suffering serious side effects from onchocerciasis has shrunk, and four countries in Latin America have been certified as oncho-free.

Distribution of onchocerciasis infections

Amazigo said that to help manage disease she has learned the importance of “listening to the people” and “engaging the poor and target beneficiaries of programs, to co-design ways to implement and improve their health.”

“Today, I consider the degree of involvement or engagement of beneficiaries as the most essential ingredient of success in health,” she said.

Meanwhile, David Reddy of Medicines for Malaria Venture discusses the new and exciting innovations being tested for malaria elimination, from vaccines to new tests and treatments.

“The role of new interventions will help accelerate progress,” Reddy said. “One of the key ones is the RTS,S vaccine. It’s the first vaccine that we have had for malaria, and we shouldn’t understate the importance of that.”

He also mentioned breakthrough next-generation drug pipelines to counter drug resistance and monoclonal antibody treatments.

Finally, Aidan O’Leary, director for polio eradication at WHO, makes the case for pursuing worldwide eradication of polio, which has already been eliminated in most countries and many regions.

“The human species has been battling wild polio virus since ancient Egyptian times, so for millennia, and what we’ve basically had with the Global Polio Eradication Initiative is an initiative that started in 1988, at a time when we had almost 1,000 children per day across 125 countries across the world were being paralyzed as a result of this disease. Where we stand now, at the start of 2022, is a situation where we’ve had just six children paralyzed during the course of the past 12 months in just three countries,” explained O’Leary. “But it’s still six children too many.”

He said there are three keys to polio eradication in any country: The ability to identify and assess risk; coordination of the operational response; and accountability and oversight.

 

Join us in this discovery of what is needed to reduce or remove the risk of infectious diseases.

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

Listen to the previous podcast episode: Championing Health Equity in South Africa

Image Credits: TDR, WHO.

Needs for assistive products may be as simple as a child’s pair of spectacles – but still out of reach to billions of people worldwide.

From wheelchairs to memory aids, over 2.5 billion people in the world today need at least one assistive device either for communication, vision, mobility, as well as for certain cognitive functions, like memory aids. 

And the number is set to rise to 3.5 billion people by 2050 due to an ageing population and the prevalence of non-communicable diseases, such as heart attack and stroke, which are a major cause of disability. 

That’s the bottom line of a first-of-its kind report by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) on the needs and gaps in assistive devices that are critical to the health, safety and independence of billions. 

The report also highlights  the “vast inequalities in access to assistive technologies in high-income versus low-income countries, ranging from less than 3% in poorer countries to 90% in wealthy ones. 

“This is a stunning disparity and is one we can and must address,” Dr Tedros Adhanom Ghebreyesus said at a press conference launch today.  

Barriers – lack of awareness, affordability and supply chain challenges

Assistive technology is a broad term covering a wide range of services and devices that range from wheelchairs, protheses, eye glasses, hearing aids and other sorts of communication aids, to pill organizers and other kinds of memory aids.  

“Assistive technology is an umbrella term for the products that people with disabilities and older people need to live their lives more fully,” states the report, adding. “The global need is much larger than previously thought.” 

Indeed, the new estimate of needs globally is more than double previous WHO estimates that around 1 billion people need such devices.

According to the report, barriers to access include a lack of awareness and affordability, inadequate product quality, and procurement and supply chain challenges. 

Top 10 most needed assistive products and technologies in surveyed countries.

The report for measuring accessibility was made after surveying over 330,000 people from 35 countries in all WHO regions. The study found that the most needed assistive product is a simple pair of spectacles. Other products that were in high demand are hearing aids, canes and crutches, chairs for shower, bath and toilet; different types of wheelchairs, orthoses and prostheses.

High Costs, Low Availability, and Stigmas

Barriers to accessing assistive products, with (a) and without (b) spectacles.

The most common barriers to accessing assistive products are their high cost and low availability.

Cost barriers are further exacerbated by the fact that most individuals surveyed reported having paid for assistive technologies from their own pockets – despite the fact that the devices are critical for people to live productive and independent lifestyles.

“Without this technology, people are thrust into poverty and dependency.” Dr Tedros pointed out before calling for governments, donors and civil society to fund and prioritise these neglected but critical products as part of the country’s journey towards universal health coverage. 

The results underscore the importance of having a robust policy in place with legislation and adequate funding, along with permanent implementation systems and structures to ensure universal, rights-based assistive technology access for everyone, everywhere.

“Assistive technology can literally mean the difference between denying or providing a child with all the education or the skills training they will need someday in the workforce, or just a chance to play with friends and contribute fully to their communities,” said Catherine Russell, Executive Director of UNICEF. 

She added that such lack of access to basic assistive technologies has very “predictable results like lower rates of school completion, higher rates of unemployment, reduced household income and dependency later in life say nothing of the lasting harm of exclusion and stigma.” 

A newborn undergoing a hearing screening. Clinical screenings and early interventions are critical to detect and treat ear diseases and hearing loss.

According to the findings in the study, some countries reported that products and technologies also are not gender-friendly – and access may be skewered by gender as well. Some countries showed that men were twice as likely than women to access assistive products. The socio-cultural, financial and structural barriers that women face makes them more likely to suffer than men with need for assistive products. 

The Way Ahead 

The report also makes recommendations on how to better integrate the provision of assistive technologies within health and social care systems.

Among those, it recommends that health systems organise assistive technology services around the person and the environment in which they live, rather than around one particular disease or disability or financing flow.

Furthermore, there is a need for every country to collect and update population-based data in this domain to understand the gaps and trends in the needs as well as supply of such technologies, to  enable evidence-based strategies, policies and more comprehensive programmes. 

When it comes to humanitarian crises – and on the back of the Ukrainian crisis – the WHO has developed two lists of assistive products for children and adults with disabilities in emergencies. 

The first, and most basic list, includes wheelchairs and cushions, elbow and axilla crutches, walking frames and mobile toilet and shower chairs. The second list also includes static toilet, absorbent products and different types of catheter kits – all of which are among the devices most often needed by internally displaced people and refugees.

According to Anne Rabitte, the Irish Minister of State at the Department of Children, Equality, Disability, Integration and Youth and at the Department of Health, the timing is crucial and we need to act now to stop the gap in needs and access. “We know that one in three people require some assistive technology…This number is expected to increase exponentially the potential for innovation and development cannot be underestimated. Timing is important. And the quick key question really is if not, when?”

Image Credits: flickr, WHO/UNICEF, WHO/UNICEF , WHO/Otto Mejía.

africa cdc
Africa CDC’s Director John Nkengasong

Within the last five years, Africa CDC has grown into a “formidable” public health agency.  

But equally formidable challenges remain for the agency, which must provide advice and guidance on Ebola, cholera, measles – as well facing yet another surge in COVID cases in South Africa – the country hardest hit by SARS-CoV2, says outgoing director John Nkengasong.  He was speaking at a farewell press briefing Thursday, shortly after being confirmed by the US Senate to lead the United States President’s Emergency Plan For AIDS Relief (PEPFAR).

The continent also faces an uphill battle to increase rates of COVID immunization in a region where many people don’t see the disease anymore as a major threat.  Against a WHO goal of having 70% of Africans immunised, only about 17% of Africans have had two jabs, and only about 30% of people in South Africa, despite being the country hardest hit by the successive pandemic waves.  

Future trajectory uncertain

“The future trajectory remains very uncertain, and unpredictable, except we vaccinate up to at least 70% of our population,” Nkengasong said.

“I’m departing the Africa CDC with a lot of mixed feelings,” he added. “One is really of joy to see that for the past five years, we collectively as a continent, in partnership with close allies, have actually built a formidable Africa CDC — a public health agency agency that has become a respectable public health organization for the continent and for the world, and is contributing in the fight against COVID-19 and other global health insecurities.  

“But with the right determination, I’m very convinced that we are going to make it as a public health agency,” he said.

Reacting to Nkengasong’s new PEPFAR appointment, African leaders told  Health Policy Watch that he’ll reinvigorate the US-funded programme that has been a flagship for the global battle against the AIDS pandemic for nearly two decades.

Southern Africa’s COVID upsurge

Meanwhile, the WHO African Regional Office has expressed concerns over the upsurge in COVID-19 cases in Southern Africa, for the third week in a row. This is coming as the winter season in the region approaches.  The uptick has broken a two-month-long decline in overall infections recorded across the continent.

In the week ending 8 May 2022, there was a 32% increase in new infections over the week before in the sub-region, which recorded a total of 46,271 new cases.  That, WHO said, is largely driven by the spike in South Africa where weekly recorded cases have quadrupled in the past three weeks. 

“Deaths have, however, not climbed as quickly. South Africa recorded 376 deaths in the past three weeks, twice as many compared with the previous three weeks,” WHO stated.

Similarly, hospitalization rates in South Africa remains low, with the number of patients currently admitted testing positive for COVID-19 at around 20% of the late December 2021 peak. 

The Omicron variant and relaxed public health and social measures are fuelling the surge. Since early April, South Africa alone has recorded 1369 cases of the Omicron sub-variant BA.2, 703 cases of sub-variant BA.4, and 222 cases of sub-variant BA.5. WHO however noted that BA.4 and BA.5 remain the most concerning because they contain the largest number of mutations, and their effects on immunity remain unclear.

“This uptick in cases is an early warning sign which we are closely monitoring. Now is the time for countries to step up preparedness and ensure that they can mount an effective response in the event of a fresh pandemic wave,” said Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response at World Health Organization (WHO) Regional Office for Africa.

While TB kills more people each year than malaria and HIV, more money is allocated to malaria and HIV than to TB in the new Global Fund strategy.

With a target to raise at least $18 billion to save 20 million lives, and reduce mortality from HIV/AIDS, TB, and malaria by 64%, the Global Fund to Fight AIDS, Tuberculosis, and Malaria is gearing up to implement its ambitious new strategy to defeat these longstanding pandemics by 2030. 

However, even though TB kills more people than HIV/AIDS and malaria combined, the global body will continue allocating just 18% of its overall funding to TB, while 50% goes to HIV/AIDS, and 32% for malaria for the first $12 billion of funds that are spent spent between 2023-2026. A new split of 45% for HIV, 25% for TB, and 30% for malaria will, however, be applied as cumulative funding rises above  $12 billion in that period. 

The increased allocation for TB was welcomed by Global Fund Board Chair Donald Kaberuka as enabling a “scale up of TB programs for the most affected while protecting HIV and malaria gains.”

TB is 60% of the disease burden in comparison to HIV and malaria

But for the TB community, the new allocation formula still falls far short of the realities, in which TB has a much larger global health impact overall while TB diagnosis and treatment also suffered big setbacks during the pandemic.

“This decision does not reflect the burden, and especially the mortality,” said Lucica Ditiu, Executive Director of the Stop TB Partnership, interview with Health Policy Watch. “If you put TB, HIV, and malaria together, TB alone is responsible for close to 60% of [disease burden and mortality], and HIV and malaria closer to 40%.”

And while the allocation share has risen, proportionately, from only 16% in 2013 – 2014, “this is far away from reflecting any needs and any realities – it will not really push the end of TB,” she asserted.

An implementation plan for the new five-year strategy “Fighting Pandemics and Building a Healthier and More Equitable World”, was discussed this week at the annual Global Fund meeting.

Allocating funding similar to cutting a cake

Dr Lucica Ditiu

Ditiu likened the difficulties of trying to split funding allocation between the three diseases to the cutting of a cake.

“You try to give more to one, it means the rest get less.”

She noted that HIV and malaria communities mobilized and warned that if funding were to decrease to either disease, the gains made over the years in both HIV and malaria would no longer be sustainable.

While no one wants to pit one disease against the other, “it becomes a matter of equity,” she said. This is especially noticeable for HIV vs TB funding – as TB has never received the ‘long end of the stick’.

Answer to the gap is not the Global Fund

“Not only does HIV get the biggest chunk from the Global Fund. They also have the President’s Emergency Plan for AIDS Relief (PEPFAR), which receives a huge amount of funding from the government of the United States. They receive billions of dollars every year from external funding, while TB receives barely a billion.”

While Ditiu hopes that the Global Fund’s Seventh Replenishment Conference, hosted by the United States in September – October 2022, will increase overall funding for TB, she also suggests that new financing solutions have to be identified.

“The answer to the gap in finances is not the Global Fund.”

Looking towards the future, Ditiu hoped that events such as the G20 hosted in high-burden TB countries such as Indonesia, Brazil, and India, will raise awareness about the continued threat posed by this ancient airborne disease, which also has developed new, and even more deadly drug-resistant forms which are even harder to treat.

Disproportionate TB funding leaves millions undiagnosed and untreated

Lack of funding has resulted in about 4 million people with TB left undiagnosed and unable to receive treatment each year, as a result of outdated technology and barriers to accessing services.

“We don’t have the foundation, we don’t have the bed. What is heavily missing is access to people to get diagnosed with TB,” said Ditiu.

Many low- and middle-income countries continue to diagnose TB with the now-outdated method of sputum smear microscopy, which is not as accurate as molecular diagnostic tools In addition, TB services in many of these countries lack resources and funding to find more vulnerable groups that are unable to get diagnosed and receive treatment on their own.

“Do we really want to end TB ever? According to laboratory estimates, around 24% of the world population is infected with TB, and 20% of that will develop the active form of TB in their lifetime. So we sit on a big reservoir, and it looks like we don’t want to clean it up,” said Ditiu.

Disease split was ‘difficult decision’ but an ‘essential step’

Despite the obvious dissonance in the existing allocation formula, it’s essential to the lowest-income countries where HIV and malaria remain bigger threats, says the Global Fund. 

“The disease split is a difficult decision, but it’s an essential step that enables the Global Fund to allocate funds to the highest burden countries with the lowest economic capacity, ” said a Global Fund spokesperson in response to a query by Health Policy Watch, citing a statement by Harley Feldbaum, Head of Strategy, in November 2021, when the strategy was first released. 

“Since we allocate well over 90% of the funds we raise directly to countries, there are no easy tradeoffs in this decision; every change must balance priorities across HIV, TB, malaria and broader health needs,” Feldbaum said. 

“The decision the Board made responsibly protects HIV and malaria investments and funding to lower income countries, where there remain substantial unmet needs, while significantly increasing the proportion of funding directed to meet important TB needs with a successful Replenishment.”

New Global Fund strategy focuses on communities  

global fund
2023 – 2028 Global Fund Strategy Framework Overview

To end HIV, TB, and malaria as public health threats by 2030, the Global Fund has said it will focus more attention on community-based services in the coming years.

The strategy has three stated objectives. These include: people-centered health systems; engaging with communities so no one is left behind; and maximizing health equity, gender equality, and human rights. 

Especially important is the need to protect and advance health equity, gender equality, and human rights in the face of co-occurring pandemic and other humanitarian crises. 

“The COVID-19 pandemic, and efforts to control it, have exacerbated human rights and gender-related barriers,” said Roslyn Morauta, Vice-Chair of the Board of the Global Fund, in a statement at the close of this week’s meeting. 

“At the same time, humanitarian crises from Myanmar to Afghanistan to Ethiopia, and most recently in Ukraine, further threaten our community partners and put human rights, disease responses and lives at risk. These crises have underscored the need for strong and well-resourced community systems and responses. Planning the implementation of the 2023 – 2028 Strategy provides an important opportunity to respond strongly to the challenges we face.”

Image Credits: Stop TB Partnership, Global Fund .

More Effective Responses to Health & Environmental Emergencies through Peacebuilding panelists.

One-half of the countries facing serious climate threats also are located in conflict zones – and that single fact alone illustrates the symbiotic relationship of climate and conflict, and their inter-related impacts on health.  

This was a key message of the Geneva Health Forum panel on ‘Effective Responses to Health and Environmental Emergencies through Peacebuilding’, Thursday 5 April, on the Forum’s closing day.

Environmental degradation negatively impacts economic growth, food security, and through those drivers, public health. All of this, in turn, exacerbates conflict and impedes peace-building efforts by driving instability and displacement, once more worsening people’s health in a vicious cycle. 

“Incorporating the lens of climate risk, and how you factor it into your response is extremely important during most emergencies,” said Micaela Serafini of the International Committee of the Red Cross (ICRC), a co-host of the panel. 

Factoring in climate to humanitarian responses 

climate change
Environmental emergencies such as deforestation often overlap with conflict.

If one superimposes a map of conflict with one of environmental degradation, including drought and deforestation, there would be significant overlap, said Elhadj As Sy, Former IFCJ Secretary General noted.  

“If you take the combination of environmental degradation and demographic pressure, we are already creating the conditions for conflict because we are fighting over resources, no longer over diamonds and gold.” 

Livelihood impact diseases from wild animals and livestock devastate rural communities 

Pig farming in Malaysia. Nipah virus passes from pigs to people.

The increased competition for natural resources, such as water and pastures for animals to graze, is a major driver of the migration of people and their livestock, which in turn leads to the ‘transboundary movement of diseases’.

Many of the new diseases to have emerged in recent decades, out of environmental degradation and deforestation, are zoonoses that can also be described as ‘livelihood impact diseases’.  They include the bat-borne Nipah virus that also infects pigs and people in South East Asia, as well as rift valley fever, brucellosis, and avian influenza, which affect livestock and poultry. They impact rural communities, firstly animals and then people – both directly and indirectly.

For rural communities, the direct impacts of infections are only “the tip of the iceberg, ” said Dominique Burgeon, Director Food and Agriculture Organization (FAO) Liaison Office at UN Geneva. “The diseases are devastating to their livelihoods, which means it also has an impact on food security, and therefore on health and especially the health and nutrition of children in these communities, who are highly dependent on milk and dairy products,

Dominique Burgeon Director, FAO Liaison Office at UN Geneva

With 60% of new human diseases originating from animals, the complex relationship between animal health, environmental health, and human health needs to be considered more deeply, he and other panelists stressed.  

Burgeon referred to ‘One Health’ as a framework for understanding the linkages. One Health, is defined as an “integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.”

Both conflict and climate change have big impacts on animals, through loss of pasture land and water sources for example, Burgeon said: “When it comes to animal health, and therefore going towards human health, conflict can have a huge impact.  

Conversely, strategies for promoting better animal health can help ease conflicts, by reducing the need for people to migrate to keep their animals alive.

“We see that animal health can be a pathway for peace, because at the end of the day, what we see is that those communities are highly dependent on livestock,” Burgeon concluded.  

Humanitarian organizations need to look at their own carbon footprint

Micaela Serafini, International Committee of the Red Cross (IFCJ).

Along with promoting more sustainable environments in fragile conflict zones, the humanitarian sector’s own climate footprint also needs greater consideration, Serafini said.  

“How do you factor in climate risks in your health response?” asked Serafini. “It’s essential to construct or support a system to become resilient to climate events that can overturn whatever investment in health you wanted, or what you were able to do.

“What is it we leave behind once the emergency has finished? How conscious are we of our own [carbon] footprint?” 

Image Credits: Jami Dwyer, GHF, KeWynn Lee, GHF.

us president biden
President Biden announces licenses between the NIH and the WHO Covid-19 Technology Access Pool (C-TAP) at the US Global COVID-19 Summit.

The United States National Institute of Health (NIH) has finalized an agreement with WHO’s COVID-19 patent sharing facility (C-TAP) to share the patent rights on 11 government-funded coronavirus medicine and vaccine technologies – in what is perhaps the most significant agreement to date with WHO to share closely-guarded pharma know-how.  

The announcement was made today by US President Biden at the opening of the second Global COVID-19 Summit, co-hosted by the United States, Belize, Germany, Indonesia and Senegal which raised a total of $3 billion toward various forms of pandemic preparedness and response. 

That included a total of $960 million in commitments from the US and other developed countries toward the creation of a new Pandemic Preparedness and Health Security Fund to be housed by the World Bank.

The new $200 million US contribution comes in addition to $250 million pledged last year, said US Secretary of Health and Human Services, Xavier Becerra, speaking at the Summit. Creation of a standing fund was recommended last year by The Independent Panel, whose critical review had noted that a standing pool of finance needs to be readily available to spur faster pandemic response. 

The pledges should provide the seed money needed to formally create the new Financial Intermediary Fund (FIF), said World Bank President David Malpass, speaking at the summit.  “I’m hopeful that this will be enough to give us critical mass and we can work with the G-20 and get the steps done to take the FIF to our board in June,” he said.

‘Hope to be ready on TRIPS waiver’ by June

World Trade Organization Director General Dr Ngozi Okonjo-Iweala speaking at the Second COVID-19 Summit

But the World Trade Organization’s Director General Dr Ngozi Okonjo-Iweala said more would be needed to really operationalize the finance facility effectively.

“Today’s commitments are good but they are just a down payment on the $10 billion a year needed to seed this fund,” she said  “So we hope to see more commitments coming, while now the task remains to operationalize the FIF.”

Meanwhile, Iweala expressed hopes that the WTO would finally be ready to present a compromise draft proposal for a “TRIPS” waiver on intellectual property for COVID vaccines to the Ministerial Council (MC-12) when it convenes in June.

“We hope to have a workable compromise, that is being debated right now, and we hope it will be ready in June,” she told the Summit.

Negotiations over the long-deadlocked initiative to waive the so-called TRIPS agreement on Trade Related Aspects of Intellectual Property Rights, was originally proposed by India and South Africa in 2020, but languished for months before a breakthrough just last week, when WTO published an “outcome document“, negotiated by the four-member “Quad” leading negotiations.

Although unfinished, that text represented a significant bridging of once deeply-divided positions between developed countries led by the United States and the European Union, and developing countries, led by India and South Africa. The evolving agreement would allow countries that export less than 10% of the world’s total COVID vaccine supplies to apply the “waiver” to the generic production of vaccines for domestic use as well as for export, with minimal transaction costs.

While China, a large COVID vaccine exporter, initially objected to explicit the 10% clause, China’s WTO Ambassador, Li Chenggang suggested to an informal meeting of the TRIPS Council this week that it could voluntarily abstain from taking advantage of the waiver if explicit mention of the 10% rule was dropped – clearing away another obstacle to final approval.

Developed countries pledge $2 billion in immediate pandemic response

Tanzania, once COVID vaccine hesitant, now aspires to 70% coverage.

At the Summit, global leaders also pledged over $2 billion more in funding for immediate COVID response; much of it to be funneled into the WHO co-sponsored Act Accelerator (ACT-A), for procurement of vaccines, treatments, tests and health system capacity-building. That included a CAD 735 million donation from Canada and over $300 million from Spain, along with pledges by Australia, Austria, Sweden, Italy, South Africa and Thailand, to donate over 130 million more vaccine doses to low-income countries.

And the African Union, as well as 16 low-and-middle income countries individually, also said they would invest more domestic resources in health systems, pandemic preparedness and COVID vaccine campaigns – along with new product R&D and manufacturing. The pledges included one by Africa’s most populous nation, Nigeria, to train 10,000 more frontline healthcare workers by December 2022 on basic infection prevention and control along with supporting more laboratory capacity for genomic sequencing, and a 70% COVID vaccination goal.

Tanzania, once the most vaccine-hesitant country on the continent, pledged to vaccinate 70% of all eligible Tanzanians against COVID by fall 2022. Rwanda also pledged to reach the 70% goal by the year’s end as well as doubling booster coverage from 30-60% of those eligible.   

LMICs seeking know-how not donations 

However, it is vaccine know-how, not vaccine and medicines donations that low- and middle income countries stress that they are seeking now – and the NIH deal with C-TAP goes at least a step in that direction, long-sought by WHO.  Significantly, the new US deal opens the way for generic manufacture of at least some components of patented mRNA vaccine technology.  

Those include technologies for producing the stabilized spike protein used in the leading COVID-19 mRNA vaccines produced by Pfizer and Moderna, as well as research tools for vaccine, therapeutic and diagnostic development as well as early-stage vaccine candidates and diagnostics. 

The US deal with WHO for sharing the 11 COVID-19 technologies also includes the Geneva-based non-profit Medicines Patent Pool (MPP), which has experience in the actual negotiation of licenses with generic manufacturers to supply WHO-approved treatments to low- and middle-income countries. 

Both WHO and the MPP welcomed the agreement, which would make these technologies more accessible to people in low- and middle-income countries and help to overcome the pandemic. 

“I welcome the generous contribution NIH has made to C-TAP and its example of solidarity and sharing,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Sharing and empowering lower-income countries

Lab technicians at work in Cape Town’s Afrigen Vaccines & Biologics, part of the WHO-supported mRNA Vaccine Technology Transfer hub created in Cape Town.

“Whether it’s today’s pandemic or tomorrow’s health emergency, it’s through sharing and empowering lower-income countries to manufacture their own health tools that we can ensure a healthier future for everyone,” said Tedros, just before appearing at the Global COVID-19 Summit, hosted by The White House on Thursday. 

“We are honored to sign these public health-driven license agreements with NIH under the auspices of C-TAP with the goal of providing equitable access to life-saving health products for the most vulnerable in the world,” said Charles Gore, MPP Executive Director.

The first major donation to the C-TAP, the WHO COVID-19 Technology Access Pool came from Spain in Nov. 2021 for a serological antibody test that checks for the presence of anti-SARS-CoV-2 antibodies. 

The longstanding WHO effort to build a repository of treatments, tests and vaccines available to any country on an open license had, until now, failed to gain much buy-in from either governments, researchers or industry. 

WHO has since refocused more of its efforts on building a series of technology transfer hubs that aimed to train researchers and jump-start manufacturing of vaccines and other innovations – including a hub for mRNA Technology Transfer, based in Cape Town and a Global BIomanufacturing Workforce Training Hub in the Republic of Korea.  

US pledges to ‘do its part’ with licensing agreement 

Word that the US would be sharing COVID technologies first came in March, announced by US Secretary of Health and Human Services Xavier Becerra at a virtual meeting with other ministers of health.

“Sharing our scientific knowledge and health technologies with C-TAP to foster the development of crucial medical countermeasures is another step we are taking to assist our global partners in our shared fight against this devastating disease,” remarked Becerra. 

Said Biden in announcing the deal: “The United States will continue to do its part.”  

Image Credits: Luis Gil Abinader/Twitter , Rodger Bosch for MPP/WHO.

Testing blood pressure as part of NCD prevention.

The upcoming World Health Assembly (WHA) has the biggest focus on non-communicable diseases (NCDs) in a decade – and offers an opportunity to ensure that NCDs are integrated into future responses to pandemics and other health emergencies.

This is according to Katie Dain, CEO of the NCD Alliance, who urged attendees at a high-level NCD briefing before the WHA on 22 May, to highlight solutions in order to encourage countries that it is possible to address NCDs.

This comes in the wake of statistics from the World Health Organization (WHO) NCD Progress Monitor 2022 that show COVID-19 has pushed back countries’ gains against cardiovascular disease, cancer and diabetes in particular.

WHO’s NCD Progress Monitor

Bente Mikkelsen, the WHO’s NCD director, said that 70-90% of the 14.9 million “excess deaths” recorded during COVID-19 were likely to be people living with NCDs.

“Most governments now recognise that people living with NCDs are among the most vulnerable,” said Mikkelsen – but added that NCD treatment needed to be assured during humanitarian disasters.

“The United Nations Office for Coordination Humanitarian Affairs estimated 235 million people needed humanitarian assistance and protection last year, and we know that there it is as much as two to three times more common to have heart attacks and strokes in humanitarian emergencies than in pre-emergency circumstances,” said Mikkelsen.

The WHO is supplying NCD kits to 10,000 people in Ukraine, and the NCD team was now part of the daily coordination of the response in that country, she added.

“There is no health security without including NCDs into primary health care, into universal health care,” she concluded.

NCDs as part of new pandemic instrument

Precious Matsoso, Co-Chair of the Intergovernmental Negotiating Body on a pandemic instrument

Dain said that the current negotiations in Geneva on an instrument to address future pandemics offered the opportunity to “link NCDs to health security and pandemic preparedness”.

She called for a broader definition of health security that took into account the underlying burdens caused by NCDs.

Precious Matsoso, who is co-chair of the Intergovernmental Negotiating Body that is negotiating the WHO’s new pandemic preparedness instrument, appealed for simpler implementation guidelines for countries.

Matsoso said that there were at least five major conventions relating to NCDs as well as a number of high-level agreements – and it was “not practical” for countries to implement all of these.

“We need one instrument to integrate all these into a comprehensive response,” said Matsoso, who is South Africa’s former Director-General of Health.

She cited five main pillars to ensure a comprehensive response to NCDs, including proper governance, NCD prevention, adequate financing, and meaningful community engagement.

New Presidential Group offers political leadership

Kwaku Agyemang-Manu, Ghana’s Minister of Health

Political leadership to address NCDs was gathering momentum, following the launch last month in Ghana of a Presidential Group and NCD Compact, Ghana’s health minister, Kwaku Agyemang-Manu, told the briefing.

“The compact is expected to provide the framework for the successful management and control of NCDs,” said Agyemang-Manu, who also outlined Ghana’s $110million plan to address NCDs.

“The compact is a turning point in our fight against NCDs. It will galvanise action to ensure the support from heads of state have committed to closing the implementation gap to address the prevention and control of NCDs,” said the minister.

Agyemang-Manu, Dain and the University of Washington’s David Watkins stressed that it was still possible for low- and middle-income countries to reduce the burden of NCDs by one-third by 2030.

Watkins and colleagues recently published a paper in the Lancet outlining how this could be achieved.

“There’s a widespread belief in the global health and development community that tackling NCDs is too expensive and that it isn’t feasible in countries with very limited resources. Our report thoroughly debunks this idea,” says Watkins.

The paper focuses on 21 interventions – both clinical and policy-based – to reduce NCD-related mortality, which is the United Nations Sustainable Development Goal 3.4.

Image Credits: NCD Alliance.