Delegates at the CBD Geneva talk.

Two weeks of negotiations in Geneva over a critical new agreement to protect and conserve some 30% of the planet’s land and oceans spaces by 2030 have yielded only halting progress – with the parties to the UN Convention on Biodiversity (CBD) agreeing to meet again in Nairobi in late June. 

The Nairobi meeting, 21-26 June, will be the last, critical session before the Convention on Biological Diversity’s (CBD) 15th Conference of the Parties (COP15) in Kunming, China – where a new, landmark agreement on is supposed to be finalized, following a two year delay due to the pandemic. The new framework has been billed as the biodiversity equivalent of the 2015 Paris Climate deal, but the delay in talks and negotiations have not helped its profile.  

Some 91 countries and the European Union, have publicly supported incorporating a “30×30” agreement into the CBD – as part of the “High Ambition Coalition for Nature and People”. Observers said a number of new countries from the Caribbean, the Middle East, Asia and Latin America also had expressed support for the target at the Geneva meeting, which ended on Wednesday.  

But with the exception of India, the influential BRICS bloc, including Brazil, Russia, China, and South Africa, have refrained from supporting the goal.  Nor are the BRICS among the 72 members of the Global Ocean Alliance (GOA), which has publicly supported a 30×30 target for the world’s oceans. 

The proposed 30×30 framework has been portrayed by biodiversity advocates as equivalent to the 2015 Paris Climate deal in terms of its significance. 

The Convention on Biodiversity, however, lacks the high political profile of its sister climate agreement, the UN Framework Convention on Climate Change (UNFCCC).  A two-year delay in convening the recent negotiations, due to the pandemic, have not helped.  

“There is an emerging consensus in support of the science-based proposal to protect at least 30% of the planet’s land and ocean by 2030, which is encouraging,” said Brian O’Donnell, Director of Campaign for Nature, one of the groups that has been lobbying for the 30x 30 proposal. 

However, he said that the progress with the negotiations had been “painfully slow”, and the level of ambition with financing is “woefully inadequate”.

“Unfortunately, the negotiations in Geneva have not reflected the urgency that is needed to successfully confront the crisis facing our natural world,” O’Donnell said.  

One million species at risk of extinction 

Delegates at the negotiations meeting, UN CBD, Geneva.

Scientists warn that without more assertive action by the nations of the world, rapid overdevelopment will lead to the extinction of another one million species within decades.

Rapid deforestation and consequent losses of natural habitat, coupled with climate change, have already pushed major species like giraffes and koalas into the ‘endangered’ category. Currently, there are 17 critically endangered animal species while over two-dozen species are considered “endangered”, according to the World Wide Fund for Nature (WWF). That has made it imperative that the 30% target be achieved as the absolute minimum amount of conservation needed to curb global biodiversity loss, according to a recent paper in Science Advances. 

In January 2021, a group of scientists from around the world issued a stark warning that “humanity is causing a rapid loss of biodiversity, and, with it, Earth’s ability to support complex life.”

This year, an Intergovernmental Panel on Climate Change report further underlined the urgency of addressing the biodiversity crisis which is deeply interrelated with climate change. The number of endemic species subject to “very high extinction risks” in biodiversity hotspots is projected to at least double from 2% between 1.5°C and 2°C global warming levels and to increase at least tenfold if warming rises from 1.5°C to 3°C. 

For instance, according to another recent study of satellite imagery of the Amazon forest, deforestation and climate change, via increasing dry-season length and drought frequency, may already have pushed the Amazon close to a critical threshold of rainforest regeneration. When forests dies, so do the animal and insect species living in them – or else they relocate to areas inhabited by humans, bringing new pathogens with them. 

Increased risk of disease outbreaks

In terms of health, environmental health experts have also pointed to the increased risks of disease outbreaks, such as the recent COVID-19 pandemic, as the loss of biodiversity also means the loss of the natural system of checks and balances that keep many diseases under control. 

Notably, continued ecosystem destruction along with unsafe and unsustainable patterns of food production are bringing more and more people into closer contact with viruses and pathogens harboured by animals in the wild – from SARS-CoV2 that may have spread to humans via the sale and slaughter of wild animals in Chinese wet markets, to Ebola virus in Africa, which infects humans via bushmeat slaughter and consumption, among other factors. 

Square brackets, late nights and talks in circles

In the two-weeks of Geneva meetings, talks sometimes went up to 3 a.m with inconclusive endings, followed by new suggestions for the text. Some paragraphs had up to 30 square brackets, which implies that governments were yet to agree on the language. 

The final draft text showed a large portion of the framework’s 21 targets still in square brackets which pimples a lack of formal agreement, said those who saw the agreement. Continued areas of disagreement also included specific goals for reducing pesticide use and goals for removing billions of dollars in national government agricultural subsidies that incentivise farmers to destroy habitats. 

The COP 15 in Kunming is seen as an important stage for finalising new targets, more ambitious than the previous CBDs.

In 2002, the CBD convention in Montreal committed to achieve a significant reduction of the current rate of biodiversity loss by 2010, but failed to meet the targets. Targets that were set for 2020 in the 2010 Aichi Convention– which included protecting 17% of the planet’s land surfaces and 10% of the ocean– were also missed. This makes the Kunming summit even more important in drawing a line in the sand over the rapid loss of habitat and species loss, by setting new targets for 2030. 

Among the 2030 targets, the proposal to protect or conserve at least 30% of the planet’s land and oceans is a flagship initiative. Even so, it would not be binding on any single nation;  countries would determine their contributions in accordance with their national circumstances.

However, another note of progress at the meeting in Geneva was an agreement by countries to add the term ‘equitably governed’ to the text, in response to requests from indigenous leaders, as well as adding the phrase ‘giving effect to the rights of indigenous peoples and local communities’ to underscore the that implementation of the 30×30 dovetail with human rights protections. 

“There is growing recognition of the need to better safeguard the rights of Indigenous Peoples and Local Communities, who must be central to achieving the world’s biodiversity goals,” said O’Donnell.

Image Credits: UN CBD Twitter .

WHO Director General Dr Tedros Adhanom Ghebreyesus at press conference on 30 March 2022

In some of his most forceful remarks to date, WHO Director General Dr Tedros Adhanom Ghebreyesus and other senior WHO officials slammed both Russia’s invasion of Ukraine and Ethiopia’s blockade of Tigray for both withholding vital health and humanitarian aid – as well as deliberately targeting civilians or putting them in harms way.

Speaking from Doha, Tedros called Russia’s war in Ukraine and invasion and slammed its continuing attacks on health facilities, saying, “We are outraged that attacks on health care are continuing. Since the beginning of the Russian Federation invasion there have been 82 attacks on health care facilities, leading to at least 72 deaths and 43 injuries, including patiens and health workers.  Attacks on health care are a violation of international humanitarian law and must stop immediately.”

As for Ethiopia’s warn in Tigray, he added that while WHO had welcomed last week’s declaration of a humanitarian truce in Tigray, between Tigrayan rebel forces and the Ethiopan government, “a week has passed and no food has been allowed into Tigray.

“Every hour makes a difference when people are starving to death. No food has reached Tigray since mid-December and almost nothing has been delivered since August. of last year. “The siege of 6 million people in Tigray by Eritrean and Ethiopian forces for more than 500 days is one of the longest in modern history,” Tedros said.  

WHO Executive Director of Health Emergencies, Dr Mike Ryan

“What’s so unusual about situations like we see in Ukraine like we see in Tigray, is that this is not is this is not people caught up in the fog of war. It is people being directly targeted, directly used as strategic implements, as chess pieces in horrific murders,” added Dr Mike Ryan, WHO Executive Director of Health Emergencies, Dr .  The world needs to look at why we end up with so many groups of people being used as pawns of war.”

Ryan added that the situation in Ukraine and Tigray, are both “a world of difference between that and a conflict situation where we struggle to get aid and assistance and because of conflict and all sides are trying to help in a way – and we struggle just because of conflict.

“That’s a very big difference between that situation, and the situation of access is being actively denied for the population – where actually cutting off of people is part of part of the tactics. It’s part of the military strategy.”

Tedros also called out the Taliban leadership in Afghanistan for the sudden turnabout last week that led to the banning of girls from secondary school classrooms – just hours after they had arrived to resume their studies for the first time since the fundamentalist Islamic group seized control of the government last August.

“Women and girls are especially at risk from lack of access to health services and lack of access to education,” Tedros said. “Last week’s decision by the Taliban leadership to ban girls from school is very troubling.”

Beseiged Mariupol remains blocked to WHO relief workers

Ian Clarke, WHO Incident Manager for Ukraine

In terms of recent relief efforts, WHO’s Incident Manager for Ukraine, Ian Clarke, said that over the past few days WHO had been able to dispatch more than 21 metric tons of medicines and other health supplies to eight locations in disputed parts of Ukraine, adding “We tried to get into Mariupol.  We have been unsuccessful today, together with our interagency partners, but we have been able to access places like Kherson”. Mariupol has been under a prolonged Russian seige that has also prevented aid groups from bringing in food and medical supplies, while Kherson already fell to Russian control several weeks ago.

Clarke added that a $57 million fund-raising drive to support short-term healthcare needs of Ukranians in the country as well as those who have abroad had nearly reached its goal.

“We’re now in the process of working with our health partners, both in Ukraine and the hosting countries to come up with a comprehensive strategic response plan that will cover the healthcare needs for Ukrainians regardless of where they are located, both in Ukraine or in hosting countries. And that will provide a longer term outlook,” Clarke said.

Remains committed to 70% COVID vaccination target – as virus continues to evolve

In other remarks, the WHO Director General said that he remains committed to a 70% goal for vaccinating people low- and middle-income countries against COVID-19, despite current trends that reflect a sharp decline in infections and less lethal variants. This, despite an undercurrent of criticism from both countries and some donors that a strategy of vaccinating the most high-risk groups like older people and health care workers might be preferable to such a broad goal.

“Even as high income countries roll out fourth doses, one third of the world’s population has yet to receive a single dose, including 83% of the population in Africa,” said Tedros.””This is not acceptable to me, and it should not be acceptable to anyone.” 

WHO is launching it’s third COVID response strategy since the pandemic began, he added, in which COVID vaccination of under-covered groups would remain a key priority along with better access to treatments, and continued testing and surveilance.

“This is our third plan and it could, or should be our last plan,” Tedros said, explaining that the plan etches out three scenarios for how the pandemic will evolve – from best to worst cases. As part of that, he said WHO is also launching a new strategy to scale up genomic surveillance globally for pathogens with epidemic and pandemic potential.

“Based on what we know now, the most likely scenario is that the virus continues to evolve. But the severity of disease it causes is reduced over time as immunity increases due to vaccination and infection. Periodic spikes in cases may occur as immunity wanes, which may require very early boosting for vulnerable populations,” he said.

“In the best case scenario, we may see less severe variants emerge, and boosters or new formulations of vaccines won’t be necessary. In the worst case scenario, a more violent and highly transmissible variant emerges. Against this new threat, peoples’ protection against disease and death either from prior vaccination or infection will wane rapidly. Addressing this situation would require significantly altered vaccines, and making sure that they get to the people who are most vulnerable.”

Tedros was speaking from Doha where he was meeting with Qatari officials, shortly after delivering an address to the World Government Summit, taking place in Dubai. 

 

A man at a protest in Geneva to demand the TRIPS waiver.

A compromise proposal on a World Trade Organisation’s (WTO) waiver on intellectual property for the production of COVID-19 vaccines is ‘problematic’, ‘largely insufficient’, and WTO members should not be politically pressured into adopting the  text, several dozen civil society organisations said in an open letter published today. 

The letter, addressed to European Commissioners, European members of Parliament, and WTO Ambassadors, and signed by 42 European and International civil society organisations, called on the European Union and WTO Director General Dr Ngozi Okonjo-Iweala to “refrain from rushing WTO members” to rapidly adopt what the civil society groups termed as an “unsound proposal”.  

The draft compromise text, was brokered in mid-March with United States support between the European Union, which had until then opposed any IP waiver at all for COVID health products, and the initiative’s sponsors, India and South Africa – referred to in some quarters as “the Quad”.  However, the draft agreement still needs to be put to all 164 WTO members, which typically decide by consensus. 

To make the compromise possible, South Africa and India had to make major concessions in narrowing the waiver to only vaccines, as well as narrowing the list of countries that would be eligible to take advantage of the waiver on patents and other IP.

In their letter, the civil society critics charged that “The text under consideration by some WTO members contains problematic and contradictory elements (see Annex) and remains largely
insufficient as an effective pandemic response.

Exclusion of therapeutics and burdensome requirements among the complaints

The main innovation of the proposed waiver is that most low- and middle-income countries that decide to produce their own generic versions of vaccines would be also allowed to export their products to other low- and middle-income countries in deed – providing that the country historically produces less than 10% of the global COVID vaccine supply – effectively excluding China from the waiver provisions.  Bulky and complex requirements around export of generic products are a key complaint of the current WTO Agreement on Trade Related Intellectual Property (TRIPS).

Among the main civil soceity complaints about the new agreement, detailed further in an annex, are the exclusion of COVID diagnostics and treatments from the IP waiver.  Those products, proponents say, are even more critical now in the battle by low- and middle-income countries against the pandemic in light of the comparatively higher costs of such drugs and lower vaccination rates.

Critics also say that the compromise would require new “burdensome, unecessary, TRIPS-plus requirements for countries seeking to issue a compulsory license” for the generic production of a vaccine – in terms of notification procedures.

While patents are part of the waiver, “the draft text also does not address barriers arising from confidential information/trade secrets held by corporations or contained in documentation submitted to regulatory authorities,” the critics say.

“And eligibility requirements still exclude too many low- and middle-income countries from either “producing, supplying, export and importing” even vaccines, they add.

Ultimately, the measures create “more legal uncertainty compared to the existing TRIPS flexibilities due to textual ambiguity and a confusing structure,” the critics further charge.

Final decision set for June

A final decision on the IP waiver is expected is to be taken at the 12th WTO Ministerial Conference, now set to take place during the week of 13 June in Geneva. 

But until then, the civil society groups said that there is a need for “further negotiations are needed to ensure an effective outcome in a multilateral manner.

“Throughout the COVID-19 pandemic, the EU has repeatedly ignored evidence of the effects of restrictive licensing practices on access to COVID-19 medical tools and resisted meaningful negotiations on a proposal for a temporary TRIPS waiver at the WTO to address limited production and shortage of supply,” the letter said. 

The critics charge that the terms of the waiver, as stated now, would also cast legal doubts around the work of the mRNA tech-transfer up recently set up by WHO in South Africa, and which the European Commission has suported.  The mRNA hub recently announced that scientists there had duplicated the Moderna version of a COVID vaccine.

“We find it hard to comprehend how the EU would endorse a so-called compromise that could hamper the functioning of the mRNA tech-transfer hub that the European Commission and some Member States strongly support. It’s hard to see countries in the Global South believing in the promise of equity that the European Council assures guides its push for a pandemic preparedness treaty,” Health Action International Senior Policy Advisor Jaume Vidal said in a press release.

The current compromise reached, however, now has good chances of being approved by consensus insofar as EU countries have been the major opponents to the proposal by South Africa and India, submitted in October 2020.  The original proposal called for a blanket waiver on all IP related to COVID-19 vaccines and other pandemic-related health products for the duration of the pandemic. 

According to organisations, including Amnesty International, Human Rights Watch, Oxfam, the People’s Vaccine Alliance and others that signed the letter today, the compromise text is a “reiteration of existing TRIPS flexibilities with a narrow export waiver and additional cumbersome requirements” and that a large number of WTO members whom these proposals affect were not a part of the negotiations. 

Image Credits: Aishwarya Tendolkar.

A mother and her newborn baby at Karenga Health Center, Uganda.

Between childbirth and six weeks is the most dangerous time for mothers and babies and when most deaths occur, and the World Health Organization (WHO) issued a new guideline called ‘Recommendations on maternal and newborn care for a positive postnatal experience‘ on Wednesday aimed at guiding all role-players during this period.

One of the key recommendations is that women and their babies remain at health facilities for at least 24 hours after the birth, and have check-ups at least three times over the next six weeks. At present, around 30% of mothers and newborns don’t get health care during this crucial period, according to the WHO.

“A positive postnatal experience is defined as one in which women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers, and where a resourced and flexible health system recognizes the needs of women and babies and respects their cultural context,” says the WHO.

In total, the new guidelines bring together over 60 recommendations that help shape a positive postnatal experience for women, babies and families. Some of the key proposals include:

  • Identifying and responding to danger signs needing urgent medical attention in the woman or the baby
  • Treatment, support and advice to aid recovery and manage common problems that women can experience after childbirth, such as perineal pain and breast engorgement  
  • Screening of all newborns for eye abnormalities and hearing impairment, as well as vaccination at birth
  • Support to help families interact and respond to babies’ signals, providing them with close contact, warmth and comfort 
  • Exclusive breastfeeding counselling, access to postnatal contraception and health promotion, including for physical activity
  • Encouraging partner involvement, for example by being part of checkups and attending to the newborn
  • Screening for postnatal maternal depression and anxiety, with referral and management services where needed.

Image Credits: UNICEF/Zahara Abdul 2019.

A Ukrainian wheat field

Food price hikes, hunger and instability are predicted globally – but particularly in North Africa and the Middle East, which are already in the midst of serious droughts and heavily dependent on Russia and Ukraine for wheat.

Bread is the staple food in Tunisia, Morocco and Egypt, and the price of wheat had already increased by 70-80% over the past year – even before Russia’s invasion of Ukraine – according to the International Monetary Fund.

Around 10 million tonnes of wheat, 10 million tonnes of corn, as well as sunflower oil and barley have been unable to leave the Black Sea area (Ukraine and Russia), according to Gro Intelligence..

Meanwhile, wheat crops in the US and Canada have also been affected by drought with an estimated 20 million tonnes lost, and available wheat stocks are the tightest since 2007/8, according to Gro Intelligence.

Food production is down 21%

The World Food Programme (WFP) warned this week of “destabilization, migration and starvation” if climate change is not addressed.

“If emissions are not reduced, the risk of food supply shocks will greatly increase with harvests failing simultaneously in multiple major food-producing countries, leading to shortages and price spikes. Food productivity growth is already down 21% because of global heating,” said the WFP in a statement on Monday.

The WFP added that 2021 was the third-costliest year on record for climate-related disasters, totalling $329 billion in economic losses, with “more frequent and intense droughts, floods and storms” which had led to “widespread food insecurity, crippling agricultural production, devastating livelihoods and forcing people from their homes”.

Fragile states face political instability

Morocco, a major wheat-producing area in North Africa, is likely to have to import wheat for domestic use because of severe drought, while similar conditions are being experienced by wheat-growing countries in the Middle East.

Australian and Indian imports might ease the stresses faced by the region, but are unlikely to be able to meet all the demands of North Africa and the Middle East.

Meanwhile, the fragile economies of Yemen, Tunisia and Lebanon – which are heavily dependent on wheat from Ukraine – are already facing food shortages in tense political environments that could lead to instability, according to reports.

Climate action failure

Climate action failure was ranked as the most severe risk in the World Economic Forum’s Global Risks Report 2022, with the most severe threat in both the medium term (2-5 years) and long term (5-10 years).

The WFP has appealed for more climate finance to be directed to fragile states to limit their  climate-related risks, and for urgent funds to be channelled to “integrated adaptation programmes at scale”, rather than simply confined to humanitarian aid to address crises.

“Climate action requires integrated approaches, which combine nature-based solutions with access to climate and early warning information and financial safety nets,” said WFP.

It advocates for early warning systems to anticipate climate crises and “trigger pre-positioned financing for preventative action”, the restoration of ecosystems so that they can act as  “natural shields against climate impacts”, and safety nets and insurance against climate extremes to protect those most vulnerable.

Image Credits: Polna Rytova/ Unsplash.

A microbiologist extracts COVID-19 from a sample at the Pennsylvania Department of Health Bureau of Laboratories.

The World Health Organization (WHO)’s first pilot biohub facility in Spiez, Switzerland, has been able to provide laboratories around the world with biological materials with epidemic or pandemic potential in under nine days, according to a consultative meeting convened last week.

The Spiez Biohub was set up according to an agreement between Switzerland and the WHO in May 2021 to serve as a centre for the safe receipt, sequencing, storage and preparation of biological materials for distribution to other laboratories as part of global pandemic preparedness.

It is the first of a number of biohubs that the WHO intends to set up as part of a biohub system to encourage the speedy sharing of pathogens  with epidemic or pandemic potential to characterise these and provide an informed review of the risk under the International Health Regulations.

So far, Luxembourg, South Africa, and the UK have voluntarily shared different variants of the SARS-COV-2 strain with the Spiez BioHub facility, while Italy, Japan, Peru, Switzerland, Thailand, Egypt, El Salvador and Portugal have also participated in the pilot. Luxembourg was the first country in February to contribute virus samples of SARS-COV-2 to the Spiez BioHub. 

What happens at Spiez? 

The facility in Spiez was built to amplify the rapid sharing of viruses and other pathogens between laboratories and partners globally in order to better be prepared for fast and collaborative efforts against future outbreaks and to aid the public health systems in battling the pandemic. 

As per the timeline of the South Africa Omicron shipment in late-November 2021, the WHO said it took 8.75 days for the BioHub facility to procure the shipment of materials from South Africa.

WHO was notified by South Africa on 29 November that it wished to send a shipment of the material to the BioHub. The two parties then signed a Standard Material Transfer Agreement (SMTA) on 4 December, and the courier of the specimen in question was shipped on 8 December. It took one working day for the specimen to arrive at Spiez. 

After arriving at Spiez, the specimens are studied, and their genetic sequence data is shared with other agencies and stakeholders which includes legal experts and civil society.

The BioHub also provides technical consultations with relevant stakeholders on issues of intellectual property rights as well as the benefits arising from sharing of the BMEPP. 

The BioHub system is intended to replace the current bilateral state of genome surveillance data sharing with a facility that will enable Member States to share biological materials with and via the BioHub under pre-agreed conditions. These conditions include biosafety, biosecurity, and other applicable regulations along with timeliness and predictability in response activities.

Image Credits: Flickr: Governor Tom Wolf.

A woman gets her blood pressure tested. The paper suggests investment in how to deliver more effective hypertension treatment.

Despite the negative effects of the COVID-19 pandemic on health systems worldwide, it is still possible for low and middle-income countries (LMICs) to reduce premature mortality from non-communicable diseases (NCDs) by a third between 2015 and 2030.

This is the optimistic message from a new Lancet study in the ”NCD 2030 Countdown” series published Friday, which stresses that a cost-effective package of NCD prevention and treatment interventions is “feasible to implement in countries at all levels of income”.

“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 lead author Drt David Watkins from the Department of Global Health at the University of Washington’s Hans Rosling Center for Population Health.

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.

The 15 clinical interventions are weighted towards addressing cardiovascular disease as heart disease and strokes are the most deadly NCDs, and include dispensing aspirin for suspected acute coronary syndrome, chronic heart failure treatment, primary prevention of cardiovascular disease and treatment of early-stage breast cancer

The six policies focus on taxing and regulating unhealthy products such as tobacco, alcohol, salt and transfats.

Interestingly, the paper does not mention taxing sugary drinks, the consumption of which is contributing to diabetes and hypertension, or regulations to address air pollution

A key source working with the WHO on NCD policies expressed disappointment that air pollution regulation had been excluded, as the seven million people who died from air pollution each year died from NCDs including heart disease, stroke, chronic respiratory diseases and cancers. 

Taxing tobacco is one of the six key policy proposals.

Emphasis on health system delivery

Watkins says that the proposed interventions are aligned with the WHO best buys but they go further in terms of the clinical and health system interventions. 

“The best buys mostly focus on population-level policies and a very modest investment in medical treatments to prevent cardiovascular disease in primary healthcare settings,” Watkins told Health Policy Watch.

“We include these interventions but also include several more, such as long-term drug therapy for chronic heart failure and treatment of acute exacerbations of asthma and chronic obstructive pulmonary disease (COPD),” he said.

In addition, Watkins’ proposals focus on the healthcare system, advocating that most of the short-term mortality gains in NCDs “could be realised through targeted investments in clinics and hospitals, especially by improving the quality of existing care”.

The paper effectively scores interventions based on their value for money, providing governments with cost-effective guidelines. In the case of hypertension – a disease that all countries are struggling to address effectively – the authors argue that resources might be better spent on researching and developing how to deliver this treatment more effectively.

“Telehealth, drone-based supply chains, and other innovations could help us do that, but we need to go all-in on R&D and public goods,” said Watkins.

Modest price tag

Implementing the most efficient package of interventions across the world would require an additional $18 billion each year from 2023 to 2030. The end result would be 39 million lives, which would generate an average net economic benefit of $2·7 trillion – a return in investment of 19 to one.

By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions, asserts the paper, advising governments to raise funds through “general taxation or social health insurance, coupled with fiscal reforms”.

There have been massive increases in NCDs in LMICs. In Ethiopia, for example, deaths from NCDs increased from 19% in 2000 to 37% in 2017, and almost all adults now have at least one NCD risk factor, yet over 90% of the country’s health centres and hospitals do not have adequate staff to manage NCDs.

If the proposed package was implemented, deaths from the four top NCDs in people aged 30 to 70 years across all 123 LMICs would be reduced by 35%, and all regions except Latin America and the Caribbean and Oceania would achieve the SDG target (although several countries in each region would not be able to achieve the target).

“To my knowledge, this is the first paper to give a ‘price tag’ for achieving the SDG 3.4 target,” said Watkins. “The price tag estimates are aimed both at national governments and at the development community to give them a sense for how much more money is needed to accelerate progress—and just as importantly, exactly what to invest in.”

Katie Dain, CEO of the NCD Alliance, said that the Lancet paper “reinforces what we already knew to be true pre-pandemic and more so today: that with relatively low investment, most countries could make big inroads into their chronic disease burdens and simultaneously reach UN targets by 2030.”

stroke
COVID-19 has been the cause of strokes by blocking larger blood vessels.

No more disease silos

“Advocacy for NCD financing and collective action should not be framed as another global health initiative. The COVID-19 pandemic has shown that siloed programmes are increasingly unfit for purpose and need to be integrated within primary health care,” it argues.

“The growing burden of multimorbidity and the bidirectional relationships between communicable diseases and NCDs underscore the need to dismantle disease-specific silos, emphasising reforms and investments that improve a wide range of health outcomes. Additionally, missed opportunities to prevent NCDs have arguably increased population susceptibility to COVID-19-related mortality, a pattern that could repeat itself in future pandemics.”

Image Credits: NCD Alliance, WHO AFRO, GJBrainResearch/Twitter.

India’s Ministry of Ayush signed the Host Country Agreement with the WHO on March 25 to build a Global Centre for Traditional Medicine.

The government of India and the World Health Organisation (WHO) on Friday signed an agreement to set up a one-of-its-kind Global Centre for Traditional Medicine. India will invest $250 million in this centre which will be established in Jamnagar city in the state of Gujarat. 

The centre will work towards harnessing the potential of ‘traditional medicine’ from across the world through modern science and technology to improve the health of people and the planet, the press release said.

“Ensuring all people have access to safe and effective treatment is an essential part of WHO’s mission, and this new centre will help to harness the power of science to strengthen the evidence base for traditional medicine. I’m grateful to the Government of India for its support, and we look forward to making it a success,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General said in the press release. 

India’s Ministry of Ayush, which is the designated ministry for Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy, signed the Host Country Agreement with the WHO. The interim office will be at the Institute of Training and Research in Ayurveda in Gujarat and the onsite launch of this new global centre will take place on April 21. 

The centre will concentrate on building a solid evidence base for policies and standards on traditional medicine practices and products and help countries integrate it as appropriate into their health systems and regulate its quality and safety for optimal and sustainable impact, according to the WHO. 

Around 80% of the world’s population is estimated to use traditional medicine and 170 of the 194 WHO Member States have reported the use of traditional medicine. However, national health systems and strategies do not yet fully integrate the millions of traditional medicine workers, accredited courses, health facilities, and health expenditures.

“Through various initiatives, our government has been tireless in its endeavour to make preventive and curative healthcare, affordable and accessible to all. May the global centre at Jamnagar help in providing the best healthcare solutions to the world,” Indian Prime Minister Narendra Modi said. 

WHO defines traditional medicine as: “the total knowledge, skills and practices indigenous and different cultures have used over time to maintain health and prevent, diagnose and treat physical and mental illness and its reach encompasses ancient practices such as acupuncture, ayurvedic medicine and herbal mixtures as well as modern medicines”.

India’s Ayush ministry was established in November 2014 to revive the knowledge of ancient Indian systems of medicine and to ensure the optimal development and propagation of the Ayush systems of healthcare.

Image Credits: WHO Twitter.

Israeli couple receives fourth dose of COVID vaccine in Israel
Israeli couple receives their fourth dose of a COVID-19 vaccine in Israel

A second booster of the Pfizer COVID-19 vaccine reduced mortality rates among elderly people in Israel by 78%, according to a new study by the country’s Clalilt Health Services, Sapir College and Ben-Gurion University.

This is the largest study of its kind to date, and involved more than 560,000 people aged 60.

“The main conclusion is that the second booster [fourth shot] is lifesaving,” Dr Ronen Arbel, Health Outcomes Researcher at Clalit Health Services and Sapir College, told Health Policy Watch.

The study’s findings are in the process of being peer-reviewed by Nature Medicine journal. They were uploaded by the journal’s editor to the Research Square website so medical decision makers can have access to the data in the interim, Clalit said.

With the outbreak of the Omicron wave, the question arose as to the usefulness of giving yet another booster shot to prevent serious illness and death, especially since the Omicron appeared to cause less severe disease for the majority of people.

“The results of our study unequivocally show that the second booster vaccine is significantly associated with a reduced risk of COVID mortality, including from the Omicron strain,” said Dr Doron Netzer, head of Clalit’s Community Medical Services division.

“The results show that the Health Ministry’s decision to recommend giving an additional dose to the elderly population before the issue had been researched saved many lives in the country, with nearly a five-fold reduction in mortality risk for this population.”

Second booster offered little protection from infection – but huge protection against hospitalization 

Israel approved a fourth vaccine (second booster) for the elderly and high-risk in early January, just as a study on the fourth dose was kicking off at Sheba Medical Center, the country’s largest hospital, but before any results were available. The health ministry recommended shots specifically for people who were over the age of 60 or immunocompromised, as well as residents of retirement homes, four months after their third shot. A handful of other countries followed, including Chile and Sweden.

Since then Sheba, which ran its trial on healthcare workers, reported that the fourth shot offered “little protection, if any, from infection by COVID-19 among vaccinated young and healthy individuals in comparison to those vaccinated with only a third dose.”

That data, which included 270 people who received a fourth shot of either the Pfizer or Moderna vaccines, was published earlier this month in the New England Journal of Medicine.

“We found no differences, both in terms of igG antibody levels and in terms of neutralizing antibody levels,” said Professor Gili Regev-Yochay, who led the Sheba study, referring to the impact of the fourth jab on the study group in comparison to the control.

In contrast, Clalit’s study involved 563,465 members of its health fund between the ages of 60 and 100 (median age 73) who were eligible for the second booster shot. The patients were divided into two groups based on their vaccination status, while taking into account a variety of risk factors for mortality in order to neutralize possible biases that could result from age, gender, socio-economic status or comorbidities between the groups.

The study took place between 10 January and 20 February, the height of the first Omicron wave in Israel. Mortality due to COVID-19 among participants who received the second booster was compared with participants who received one booster dose. Death due to COVID-19 was 78% lower in the second-booster group, the study showed.

“I think it is very simple,” Arbel explained. “The Sheba study was on healthcare workers, and they were looking for infection. And we saw that a second booster shot does not stop infection. The big question is does it stop severe disease, hospitalization and death? We showed that it does.”

What about the waiting for the Omicron vaccines that Pfizer and Moderna are currently testing?

Arbel said that to his understanding those vaccines have “failed so far. Right now, we are not aware of another vaccine against COVID that is better than the original. So, what are we waiting for?”

Sheba is also taking part in the Pfizer clinical trial on the Omicron-specific vaccine shot but no official data has been released yet.

Fourth shot efficacy wanes fast

Clalit’s study was released on the same day as another smaller study conducted by Israel’s Maccabi Health Services, which also found that a second booster of the Pfizer vaccine had more than 70% efficacy in preventing COVID-19 hospitalization and death.

“The relative efficacy of the fourth versus the third dose against severe disease maintains a high level (above 73%)” for at least nine weeks,” the study, which was published on the health research sharing site MedRxiv showed. Conducted via Maccabi’s KSM Research and Innovation, it has not yet been peer-reviewed.

However, the researchers also noted that serious illness was a rare occurrence since the onset of Omicron (1%) both among those who had their third and fourth doses.

Some 10,000 Maccabi health fund members over the age of 60, who were eligible for a fourth dose, were analyzed as part of the study, which was conducted between January and March 2022.

This study looked at both infection and severe disease.

The researchers found that peak efficacy against Omicron infection occurs at around three weeks after vaccination, with a 64% relative decrease in the risk of infection for those who received a fourth shot compared to those who had only three.

However, after only eight weeks, the efficacy had already started to wane and stood at 29% at the end of 10 weeks from the fourth shot – meaning the vaccine wanes even faster between doses three and four than between doses two and three.

“More and longer-term studies are needed to determine the duration of protection given by the fourth dose over time, and how re-exposure to the same vaccine affects the efficacy of the vaccine against different variants over time,” said the Maccabi team in a statement.

Image Credits: Maccabi Health Services.

The COVID-19 pandemic has shed light on how human health and ‘planetary health’ are inextricably linked – through deforestation, urbanization and climate change, all of which increase future disease risks. This year’s Geneva Health Forum explores these and other critical global health challenges, as well as emerging solutions,  just ahead of the World Health Assembly.   

In one of the first major in-person global health gatherings since the pandemic began, over a thousand researchers, policymakers and activists are expected to descend on Switzerland’s global health hub 3-5 May for the 2022 edition of the Geneva Health Forum. 

The GHF has morphed from a modest Geneva-based event focused mostly on the sharing of clinical experiences, to one of the world’s leading global public health events, its sponsors say. 

It straddles the worlds of innovation, clinical advances, and increasingly, health diplomacy, observes GHF Executive Director Eric Comte, a staff member at the Institute of Global Health at the University of Geneva. 

Straddling Geneva’s global health hub and regional realities 

Eric Comte

“With the COVID crisis and with the environmental crisis, we are in front of really big, big challenges in terms of global health,” Compte said in an interview with Health Policy Watch.  

“We cannot continue, as usual, thinking that the health system will solve the problems.  We need a much more multilateral approach.”

But the conference also links the world of field researchers with movers and shakers in Geneva’s global health hub, home to the World Health Organization and other international organizations, with the voices of civil society – as well as the private sector. 

“We need to break the silos between the health organizations but also with other domains, and we think that Geneva can play a role to facilitate actions addressing all of these challenges,” Comte said.  

Dual theme: Covid pandemic and environmental emergency  

pandemic planetary health
‘Planetary Health’ is one of the key issues being addressed at this year’s Forum

Now in its ninth edition as a biennial event, this year’s conference has a dual theme: COVID-19 Pandemic and Environmental Emergency; Reinventing Global Health in Times of Global Changes.

The conference involves some two dozen partner organizations including: all of Geneva’s  major multilateral health organizations such as WHO, UNAIDS, GAVI the Vaccine Alliance, and the Global Fund; leading Swiss university and hospital research centers; and major non-profit organizations, such as Drugs for Neglected Disease Initiative (DNDi) and PATH. 

Since this year’s theme includes ‘Planetary Health’, and related to that the ‘One Health’ relationship between the human and animal world, other UN agencies, including the World Organization for Animal Health (OIE), the United Nations Environment Programme, and the Food and Agriculture Organization, are also playing a role.

“Working with the environmental organizations, also including the IUCN and WWF, and bringing them together with the health organizations is one way that we can make the bridge,” says Comte.

Humanitarian relief and sustainable finance   

The forum will open to a keynote address on the Ukraine war, and the related refugee crisis.

Humanitarian relief agencies, such as the International Committee of the Red Cross and Médecins Sans Frontières also play an important role in the Geneva landscape, and are also partners in the event.  And, so another stream of GHF sessions will address issues involving migrants, refugees and related humanitarian challenges –  from impact of climate change on conflict and migration to the war in Ukraine.

“We will also have a keynote address the Ukraine war, its displacement of populations, migration, and the related refugee crisis – we will open the Forum on this point,” said Professor Antoine Flahault, Director of the Institute of Global Health of the University of Geneva (UNIGE), co-organizer of the conference with Geneva University Hospitals (HUG).  

Antoine Flahault

But the current crisis also needs to be seen in proportion with other longstanding humanitarian issues that the world faces.  “Given that the war is an enormous public health problem, it’s sure it will get our attention,” he says, while at the same time bemoaning the fact that, “today no one is speaking about Afghanistan, about Ethiopia.” 

Finally, another major thread running through the conference is economics and sustainable finance – something that also comes naturally to Geneva, a global financial services center.

Collaborators span the range from the World Economic Forum and major pharmaceutical actors – many of which also are headquartered in Switzerland. Financial actors, working together under the Sustainable Finance Geneva consortium, also are contributing.  

“We [in Geneva] are a humanitarian hub, environmental hub, a health hub, but we think it’s also important to make the link to the financial world, to include more of the economic sector,’’ Comte says. 

Global Health Lab showcases affordable innovations  

Geneva Health Forum (2018) – Global Health Lab showcases affordable interventions

One more major element of the Forum is the Global Health Lab exhibit, a large space at the International Conference Centre Geneva venue (CICG), which will be showcasing more than 100 tech innovations from around the world. 

These include dozens of new breakthroughs in telemedicine diagnostics and treatment, such as a Vital signs monitor from Bangladesh, a Brazilian telecardiology tool, a Ghanaian “virtual mental health space” as well as affordable medical devices. These include  an Indian “skin spray gun” as well as a solution to tackle antimicrobial resistance in waste-water. 

The exhibits will interface with special sessions on e-health, which is being used more and more in the health sector, with exploration of what Comte describes as a comprehensive “digital pathway for a patient – from appointment to test results and treatment”. 

“The Forum has been extremely successful in taking very concrete research from the field and sharing it with practitioners… to see how to scale up the approaches,” observes Flahault, and the exhibit is a big part of that effort. 

But alongside that, he sees an increasing emphasis on “health diplomacy” linking the findings at the research level with policy-making. “In the ‘One Health’ arena in particular, there are a lot of discussions that are no longer just about clinical research, but are policy questions.”

Public avant-premiere of “Making Pandemics” 

Scene from the ‘Making Pandemics’ trailer

While understanding the “One Health” link between the animal world and human disease risks is sometimes hard to grasp – a major new film being premiered at the conference draws out the linkages in visual images and stories that are easy to understand. 

Making Pandemics (La Fabrique des Pandémies), is a film by the French documentary producer and director, Marie Monique Robin, author of an earlier documentary on the infamous pesticide Roundup, “The World According to Monsanto”. This latest film, narrated by Juliette Binoche, takes the viewer to Congo, Thailand and the site of industrial livestock production, to witness the ecosystem destruction taking place today – and to understand how that increases animal-human contacts and subsequent disease risks.  

On 4 May, the film will be aired for free at the Conference’s CICG venue before conference participants and the public alike, in an “avant-premiere” ahead of the film’s world premiere on 22 May, the International Day of Biodiversity, in 30 countries around the world.

“As we say, the Geneva Health Forum is a forum for people who are already involved. But this film gives us the opportunity to enlighten the public that we want to motivate,” says Comte. 

Looking forward to a return to an in-person event 

While GHF went virtual in 2020 as a result of the pandemic, this year’s conference will feature mostly in-person sessions, with one stream online.

In the spring of 2020, the in-person GHF conference had to be canceled at the last minute due to the pandemic and proceedings shifted to an all virtual forum.

Both Comte and Flahault are delighted that this year’s event is a hybrid that should offer the best of both worlds. 

In fast, most sessions will be exclusively face to face in order to restore more direct participation  – although the major plenary stream will also be online.   

“We are looking forward to returning to an in-person event,” Comte says. “We learned a lot from the digital Geneva Health Forum that we did the last time. It can offer us an opportunity to link to people who will never be able to come to Geneva.”

“At the same time, we see that one of the real advantages of the GHF is to facilitate networking between people and collaborations. For this, you have to have in-person meetings and deeper discussions.” 

Fostering year-round collaborations 

Geneva Health Forum Exhibition (2018)

As a conference based in Geneva, the world’s second UN headquarters, the Forum offers a special draw to UN Missions officials, and particularly their health attachés, adds Flahault. 

“A health attaché can be a very lonely post,” he says. “They may be based in smaller missions, they have a lot of duties, and health issues are complex. So they appreciate being able to come to the Forum, as a kind of preliminary to the World Health Assembly, and gain insights that will be useful when the WHA comes along three weeks later.

The Forum’s Geneva position also enjoys a natural audience from the dozens of global health organizations, large and small, already operating in the city – which bring together a very diverse array of researchers, practitioners, and policymakers. 

“There are not so many forums where you gather people from academic institutions, NGOs, international organizations, and the private sector altogether,” he observes.  

While about half of the GHF participants are drawn locally, or from nearby European countries – the other half hail from dozens of nations around the world. For both local diplomats, as well as more far-flung participants, Switzerland’s traditional position as a “neutral” intermediary – unaffiliated with the world’s big power blocs, also remains an enduring draw to the event – which is also supported financially by the Swiss Confederation.  See related story here.

Says Flahault: “It’s important for participants to have the Swiss neutral venue for debate without vested interests attached.”

Drawing from its diverse base of participants, the GHF is also now incubating a series of ongoing collaborations, which extend well beyond the biennial conference dates.  

Those included a series of webinars last year, and this year, a series of eight workshops in which researchers and clinicians are exploring key themes like a new suite of recommended Digital Health interventions, which WHO could consider; improving pediatric surgery as well as sustainable pharmaceutical distribution in Africa; and a training programme for One Health/ Planetary Health. 

“So we are no longer only a health conference,” declares Comte. “We are creating permanent activities with working groups that will foster ongoing opportunities for collaboration. This is very important for us, because it’s really a place where people can work together.” 

See the full GHF 2022 programme. Register here: Rates are tiered and early-bird fees range from CHF 300-100 for the in-person event, and CHF 200-70 for digital participation. Daily rates are also available. 

Image Credits: Geneva Health Forum , Geneva Health Forum, World Meteorological Organizations, UNICEF, Antoine Flahault, M2R Films, Geneva Health Forum.