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.

Pierre Strauss

The Swiss Confederation has been a key financial backer of the Geneva Health Forum since its early days. As the GHF prepares for its 2022 edition, 3-5 May, Pierre Strauss, health attaché to the Permanent Mission of Switzerland to the United Nations, spoke with Health Policy Watch about the evolution of the Forum and its relevance to the “International Geneva’’ landscape. 

Health Policy Watch: Given the situation we have now in Ukraine and the increasing polarization we see between Russia, China and the Western world – which could lead to fall out in other big meetings Geneva will be hosting, such as the World Health Assembly, what can you say about the Geneva Health Forum. Does this forum offer opportunities for more bridge-building?

Pierre Strauss: The forum is not a political platform. The forum makes the link between scientific practices at country level, researchers, practitioners and the Geneva ecosystem. So as dramatic as the situation is in Ukraine right now and notwithstanding the worldwide consequences of the war, the issue here is really health, global health. If there are initiatives that can be taken from it to alleviate medical needs in specific countries, including Ukraine, certainly this is very positive. But this is not the objective of the forum. 

HPW: What’s your vision for the GHF’s outcomes? 

Strauss: A. For us, as the Swiss Mission to the UN in Geneva, Geneva is a “Center of Excellence” when it comes to global health, and so the Forum is a unique platform for people to come and discuss, share experience, when it comes to health. So we see the forum as a place with convening power, which brings together various stakeholders of the Geneva ecosystem and beyond.  We see this as a very important tool, not only to make the link between the researchers, but between the researchers and the international organizations – because this is what makes Geneva unique.  We have an extremely rich ecosystem of organizations, such as: the University of Geneva, the Graduate Institute, the HUG, WHO, as well as other international organizations and health-focused NGOs, so I think the Forum offers this unique perspective and opportunity to link the two worlds.

HPW: Do you have a vision for future developments? What kind of new ideas or new energies would you like to see developed in the Geneva Health Forum in the coming years?

Strauss: I should emphasize that the Federal Department of Foreign Affairs is supporting the Forum financially, but we are not part of the organizers. We are supporting the event because we think it has a role to play in the international Geneva. We think the current Forum has been extremely successful to date, in taking concrete research from the field and sharing it with practitioners – to see how knowledge can be shared or approaches can be scaled up. Alongside that, I think there is a potential for the Forum to play more of a role in health diplomacy, making the link between recent research findings and the international organizations when it comes to policy – and how all of this fits into the health agenda here in Geneva.  

Geneva Health Forum 2020 discussion on NCDs. Increasingly the Forum is focusing on the broader global health agenda, alongside sharing clinical experiences.

HPW: So it’s evolving into a kind of two-pronged effort, you could say?

Strauss: Yes, the Forum is a place where you can learn about recent clinical research and medical research. But in terms of future directions, as shown with the Planetary Health approach, we can reinforce the link between the Forum, international organizations and the broader global health agenda of International Geneva. 

HPW: The Planetary Health and One-Health theme this year might be an example of that kind of evolving focus? 

Strauss: Yes, we can see that in the One Health, for instance, we see that there are actually a lot of discussions that are no longer only about clinical research, but about policy, as well. You know, like in Geneva, you have for instance, the discussion over the Pandemic Treaty. And you have questions aligning to biodiversity, for instance, and how, nowadays, we see that biodiversity has also an impact on health. So, if you look at the theme of the Forum this year, here, looking at One Health, which reflects  the complexity of health risks, it is opening up new doors into issues of health diplomacy that the Forum can explore further in future editions.

To Register for the Geneva Health Forum click here. See more about the themes and features of the Geneva Health Forum’s 2022 edition:

https://healthpolicy-watch.news/geneva-health-forum-pandemic-planetary/

Image Credits: Geneva Health Forum.

Delegates from most of the world’s nations met in Bali this week to review progress in tackling the worldwide problem of mercury poisoning from artisinal gold mining and other environmental sources as well as in the health care industry, in line with the 2013 Minamata Convention.  The parties were meeting for the fourth time since the Convention entered into force in 2017.

Expanding the list of mercury-containing products for phase-out and discussing thresholds for mercury waste emissions in air and water, were among topics being discusssed. In addition, convention parties were reviewing national plans for the reduction  and eventual elimination – of mercury in artisanal and small-scale gold mining (ASGM), which poses particularly grave health hazards for women and children working in the sector.

In January 2022, WHO published a review of some 60 countries’ implementation strategies for tackling mercury’s environemental health risks. So far some 129 WHO member states have become parties to the Convention.  However, there was no evidence of health ministry participation in about half of the national reports – reflecting the lack of public health sector involvement in promoting awareness about the huge health risks of mercury poisoning.

Artisanal gold mining is one such major source of exposure. An estimated 4-5 million women and children are employed in ASGM, where mercury is still widely used to extract gold from ore – even though cleaner and safer alternatives exist. Metals production, waste incineration, including products like batteries, and the burning of coal, which leads to farflung environmental mercury contamination of water sources and ultimately aquatic life, are other key sources of mercury exposures to humans as well as wildlife.

Updated guidelines on the use of mercury in artisinal mining were expected to emerge from the meeting, along with an agreement on a timeline for eliminating mercury from dental products.

The health sector is traditionally a major consumer of mercury products, including devices such as thermometers as well as for dental fillings.  However, there has been a push to replace them with safer alternatives, under the guidance of the World Health Organization, which has supported implementation of the Minamata Convention since its adoption.

Among the 60 national reports reviewed, 11 countries did not even indicate a role for health authorities in implementing the Convention, the WHO report found.

Also, the health sector role, when acknowledged, was limited largely to phase out of mercury devices in healthcare settings without much attention to the need to raise awareness of mercury’s health impacts in the broader enviornment. That is despite the toxic human health impacts of environmental mercury exposures  from occupational and wildlife food sources, largely fish and shellfish.  These include serious, permanent neurological and developmental damage, as well as toixic effects on digestive and immune systems, as well as lungs, kidneys, skin and eyes, according to WHO.  See Geneva Solutions review of the challenges in phasing out the use of mercury from artisanal mining.

Image Credits: Global Environmental Facility (GEF), World Health Organization .

Nkengasong recently appeared before the US Senate regarding his nomination

The current Director of the Africa CDC is a vote away from leading PEPFAR. He unveils his vision for the US-led global HIV/AIDS response and future wishes for the Africa CDC.

Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) is on track to lead the United States President’s Emergency Plan for AIDS Relief (PEPFAR) as the Ambassador at Large and coordinator of US activities to combat HIV/AIDS globally. 

Although Nkengasong is yet to officially announce his exit plans for Africa CDC, he has already appeared before the United States Senate Committee on Foreign Relations to answer questions from senators ahead of a vote to confirm his nomination by President Joe Biden. He would fill a position that has been left vacant for two years – ever since Deborah Birx stepped away from the post to join President Donald Trump’s COVID-19 response team.

The road ahead for Africa CDC

africa cdc
Nkengasong at the Africa CDC briefing on Thursday, 24 March.

If finally confirmed to lead PEPFAR, Nkengasong’s departure from the Africa CDC is expected to raise concerns about the future of the African Center – which rose to prominence under his guidance steering a steady course in the storms of the COVID pandemic – and only recently gained the status of an independent agency. 

Asked by Health Policy Watch about his pending PEPFAR appointment in a Thursday briefing, Nkengasong refrained from speculating on how his departure might affect the agency or who would replace him at its helm.  

But he said that the next agenda for Africa CDC is to leverage the gains of its COVID-19 response in strengthening its healthcare systems across the African Union’s 55 member states, and to be better positioned to fight future pandemics.

“The continent has been extremely innovative in developing platforms that are continuously being used to fight this COVID pandemic but we need to focus our energy on developing them to fight other diseases,” he said.

He noted that initiatives such as the African Medical Supplies Platform that was set up to fight COVID can now be expanded to fight other diseases in terms of commodities and supply chain management. 

“So I’m really pleased to see the initiatives that have come out of this continent [and] my greatest wish would be that these initiatives be sustained and developed further so that they can be used in managing other diseases, including future pandemics,” he told Health Policy Watch.

Testimony before the US Senate

PEPFAR has a long history of involvement in Africa, dating back to its inception in 2003. Africa HIV/AIDS programs have largely been the beneficiaries of PEPFAR investments exceeding over $100 billion. The plan claims it has saved 21 million lives, prevented millions of HIV infections, and is supporting several countries to achieve HIV epidemic control – all while significantly strengthening global health security.

In Nkengasong’s opening testimony before the US Senate on Tuesday, March 15, 2022, the Cameroonian virologist said he will draw upon his three decades of experience with research and programmes public health and HIV to advance PEPFAR’s mission, assure its continued success, collaborate with partner governments and communities, and sustain the strong partnership it enjoys with the US Congress.

“If confirmed, I would be stepping into this role at a critical moment when the world is confronted with dual global pandemics.  We have seen how COVID-19 has affected some progress in our HIV efforts with devastating results. But we have also witnessed how the health systems and institutions built and strengthened by PEPFAR’s investments have been central to the COVID-19 response,” he told the senators.

As Director of the Africa CDC, Nkengasong said he has seen how PEPFAR’s investments in health systems over the past 19 years have strengthened—and in some cases, established—the fundamental health infrastructure, laboratories, surveillance systems, and human resources for health in the countries where it helps serve.

While noting that previous efforts around HIV prevention, treatment and control were premised upon building ‘vertical’ systems as semi-independent entities, almost from the ground up, the goal has now shifted. PEPFAR’s future efforts must now ensure that these HIV services and systems are well integrated into national health systems, sustainably financed, and resilient to prevent and respond to HIV/AIDS in the future, as well as other diseases.  

“For this to happen, it is my belief that we need to capitalize on the capacity and experience of those in the countries where we work, coming to the table with a deep respect for their perspectives and needs, taking account of their insights, their knowledge of local contexts, and their reservoirs of expertise.  For such systems to be sustainable and keep infectious disease in check, we must act collectively to support the capabilities of local leaders and regional institutions and work in respectful partnership and accountability with them,” he said.

A dual US-Cameroonian citizen  

A native of Cameroon, Nkengasong earned his undergraduate degree at the University of Yaounde, and later studied at graduate level at the Institute of Tropical Medicine Antwerp, at the encouragement of the famed Belgian-British microbiologist, Peter Piot. After completing his second master’s degree in medical sciences in Brussels, he joined the World Health Organization in 1993.

In the mid-1990s, he moved to the United States where he spent a stint at the University of California at Berkeley, as a Fogarty International Center trainee, after joining the US Centers for Disease Control and Prevention. He then took over the leadership of the US CDC’s virology lab in Abijdjan, Ivory Coast. 

Nkengasong subsequently returned to the States and rose to the role of acting deputy principal director for the CDC’s Center for Global Health in Atlanta, Georgia – the state where he also holds US citizenship. 

In early 2017, he was appointed director of the newly-created African CDC. 

“In 2014, when Ebola hit West Africa, the heads of state met again and asked the African Union commission to accelerate the establishment of the Africa CDC,” Nkengasong recalled in a 2017 interview, published by the Fogarty International Center. “For all the human and economic destruction wrought by Ebola, it ended up being the catalyst that pushed African leaders to rapidly advance the concept that they nurtured in 2013 to bolster the continent’s public health response, and Africa’s continent-wide public health agency was launched in January 2017.”

Hopefully, the COVID-19 pandemic can have a similar effect on promoting Africa CDC’s continued development – regardless of who remains at its helm. 

TB patient at Brooklyn Chest Hospital in Cape Town, South Africa

The world remains fixated on getting new TB vaccines. But expanding the circle of progress on shorter TB regimes, and more early detection, may be more important to overcoming setbacks of the COVID pandemic, says one expert on World TB Day. 

IBADAN, Nigeria – The Government Chest Hospital in the city’s Jericho neighborhood is regarded as one of the top hubs for TB testing, treatment and care in Nigeria. Even though health workers at the facility try to encourage TB patients to sustain their course of treatment until the very end, they often see patients are unwilling to do so.

“We have those that do not want people around them to know they have TB, so it’s difficult for them to meet all of their appointments. We also have those that live very far from here. They often start well but over time, as the symptoms clear, they default and drug resistance may arise,” a nursing officer at the hospital told Health Policy Watch.

So the World TB Day 2022 announcement of an updated WHO guideline recommending a shorter four-month treatment course for children with “non-severe” TB was a much-heralded development in the TB space as further highlighted the existing research gaps in TB. The latest recommendation relied heavily on the findings of the University College London’s SHINE Study that was conducted in South Africa, Uganda, Zambia and India.

Professor Diana Gibb of University College London

In an interview with Health Policy Watch, the study’s principal investigator, Professor Diana Gibb of University College London noted that the focus of TB treatment research for both adults and children now is shorter treatment plans considering its effectiveness in preventing resistance.

“That’s where the research of both adults and children is focused because you can give shorter treatment and people take it properly, you’re less likely to get drug resistance, which is of course a major issue in some parts of the world,” she told Health Policy Watch.

Estimates for total number of people who died from any form of TB in 2020.On World TB Day, WHO Director General, Dr Tedros Adhanom Ghebreyesus, revealed that the spotlight is on the urgent need to invest in the fight against TB to achieve the commitments made by global leaders.

“Tuberculosis kills more than 1.5 million people each year and affects millions more, with enormous impacts on families and communities. Ending this debilitating disease remains a priority for WHO,” he said.

Better treatment with shorter courses

With no new TB vaccines yet in site, shortening TB treatment duration is gradually becoming a more immediate goal considered to be within reach near-term, one which could provide the TB ecosystem opportunities to recoup the big setbacks seen in treatment coverage during the pandemic. 

Along with the new four-month course for children, other recent treatment gains have included a six-month regimen for TB meningitis instead of 12 months. Moreover, bedaquiline and delamanid, two of the newest TB medicines to treat drug resistant TB, are now recommended for use in children of all ages, making it possible for children with drug-resistant TB to receive all-oral treatment regimens regardless of their age.  

Currently, however, treatment regimens for adults still require a six month course. And with patients seeing improvements in the early days of the treatment, it remains  difficult to ensure adherence to the end of the regimen. That, in turn, can pave the way for resurgence and even multi-drug resistant TB. 

Gibb, for one, is hopeful that new studies targeting adults with non-severe TB could also yield similarly shorter treatment courses in the near future –  although this remains more challenging  because adult TB diagnosis is still often delayed and their symptoms are more severe at the commencement of treatment.

“I think if you get adults at an early stage, it may be beneficial,” she told Health Policy Watch.

Progress on vaccine candidates 

tb
Funding Needs for TB Program Implementation in USD

One major feature of conversations during World TB Days since the COVID-19 pandemic in 2020 has been the stark comparisons between the fact that available TB vaccines remain limited to the century-old BCG vaccine, which is only partially effective and primarily targeted to children, in comparison with the tens of new COVID-19 vaccines that have become available just one year after the pandemic – with more in the pipeline. 

However, with the huge shortfall in TB investments seen to date – including investments in R&D, money is sorely needed to bring the most promising candidates to clinical trials and market. 

In a statement for this year’s World TB Day, the World Health Organization (WHO) called for the need to build on lessons learnt from COVID-19 research to catalyze investment accelerated  development of new TB vaccines. 

An additional US$ 1.1 billion per year is needed specifically for TB research and development – aside from the $13 billion required for TB diagnostics, treatments and prevention – asks for which only one-third or less has actually been received.

“Urgent investments are needed to develop and expand access to the most innovative services and tools to prevent, detect and treat TB that could save millions of lives each year, narrow inequities and avert huge economic losses,” said Ghebreyesus. “These investments offer huge returns for countries and donors, in averted health care costs and increased productivity.”

Improving TB detection 

A patient in the waiting room of the Government Chest Hospital, Ibadan Nigeria. More funding, expanded short-course treatments and faster detection are critical to overcoming setbacks of the COVID pandemic.

Improving TB diagnosis, especially among children is another attainable goal that needs to rank high on health system agendas, Gibb said. This can be done if public health systems  channel the financial gains of shorter regimens and more affordable drugs towards improving TB testing.

She also noted the need to improve TB treatment for other forms of TB, such as TB meningitis in children in which there is TB infection around the brain. 

Taken together, new point-of-care testing kits, early detection of latent TB, and related to that, the ability to predict the transition from latent to active TB cases offer a cascade of solutions that can enable earlier detection of disease, when less of the lung is affected. And that, in turn, will lead to options for shorter treatment duration over time, she said. 

Overcoming previous side effects and limitations

Government Chest Hospital in Ibadan Nigeria – considered a top national hub for TB testing, treatment, and care in the country.

One of the major concerns that plagued the adoption of new TB treatment recommendations is the concern of serious side effects ranging from deleterious impacts on cognitive functions to impairment of liver functions.

While admitting that these were real concerns in the past, Gibb, however, noted that new regimens have been able to overcome the side effects barrier in addition to requiring fewer daily tablets, better tasting tablets, and doing away with injections.

“Actually the children tolerate the medicine very well,” said Gibb. “And we are using new medicines, in which the drugs are taken all together in one pill, which then can be dissolved in a little bit of liquid. 

“So it’s not as bad as it used to be in the old days when you had to take them more often. And we no longer use injections for children to get them as it used to be part of the old TB treatment,” she added.

Image Credits: USAID, Southern Africa/Flickr, STOP TB Partnership , Fatola Babafemi/Google Maps, Fatola Babafemi/Google Maps .