Four Priority Actions to Slow the Silent Pandemic of Antimicrobial Resistance 15/03/2022 Thomas B. Cueni The COVID-19 pandemic has killed 6 million people so far, but the next pandemic threat could emerge unnecessarily from pathogen resistance to life-saving antibiotics and other anti-microbial drugs. What steps do we need to take now to head off this growing threat? For decades, antibiotics have been hailed as “wonder drugs” for their ability to turn life-threatening infections into treatable conditions. By one estimate, antibiotics have extended average human life expectancy by more than 20 years since their discovery almost a century ago. But today, we are on the brink of losing this powerful tool – a warning that Alexander Fleming conveyed in his Nobel acceptance speech in 1945 for the discovery of penicillin, the world’s first broad-spectrum antibiotic: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops”. He challenged listeners with a hypothetical illustration: “Mr X has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs X dies. Who is primarily responsible for Mrs X’s death? Why, Mr X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.” Sadly, this is not an imaginary exercise. It’s a grim reality. It’s the world we’re living in today. In a biologically dictated race to survive, bacteria evolve and eventually become strong enough to defeat the world’s current arsenal of antibiotics. People acquire infections that can’t be treated. The result is the antimicrobial resistance (AMR) crisis the world faces today. AMR: The stealth and silent pandemic The most comprehensive estimate to date, recently published in The Lancet, shows that antimicrobial-resistant bacteria may have directly accounted for 1.27 million deaths in 2019. A further 4.95 million deaths were associated with AMR, making it a stealthy and silent pandemic. How have we failed to heed Fleming’s warning about AMR? There are many forces driving AMR. Perhaps one of the most important is the rampant over-prescription of antibiotics. According to the US Centers for Disease Control and Prevention (CDC), nearly one-third of all antibiotics prescribed in the US are unnecessary. In India, the consumption of antibiotics more than doubled between 2000 and 2015, in part because these drugs are widely available over-the-counter without a doctor’s prescription. But there are ways to slow the march of AMR. Beyond promoting better stewardship for the appropriate use of antibiotics, reducing the risk of AMR also requires higher awareness among both doctors and patients; better access to diagnostics to guide the prescription of the right antibiotic at the right time; better sanitation measures; responsible manufacturing; and better surveillance by governments. But along with these steps, we must restock the antibiotics R&D pipeline with novel ones that have a better chance of overcoming current resistance. Clearly, no single player or sector can tackle AMR alone. The scale of the challenge may seem daunting, but it has certainly galvanized action. As chair of the AMR Industry Alliance, the world’s largest life-sciences coalition gathering more than 100 biotechnology, diagnostics, generic and large research-based pharmaceutical companies and associations, I witness how every life-sciences industry sector contributes to co-creating solutions that make a difference. Industry’s fight against AMR In February, the Alliance released its latest Progress Report reflecting the work the life-sciences industry is undertaking to address the threat of AMR, across four different areas: research and science, access, appropriate use, and manufacturing and the environment. The report, based on independent, quality-assured research conducted by the not-for-profit policy research organization RAND Europe, analyses data from a survey of Alliance member companies. It found that about four out of five responding companies are actively engaged in promoting better stewardship of antibiotics and the appropriate use of these drugs to guard against over-prescription. An even larger proportion – 85 percent of responding companies – are making significant contributions to the responsible manufacturing of antibiotics. The report also found that the private sector remains one of the key funders of AMR-related R&D, with at least $1.8 billion invested by Alliance members. Alliance members contributed to R&D on 93 products or technologies spanning 54 antibiotics and antifungals, 12 vaccines, 13 diagnostic platforms and assays and 14 non-traditional or other products. Alliance members continue to conduct R&D on AMR priority pathogens. However, these funding levels are at risk given challenging market conditions for antibiotic development. This is where continued dialogue between industry and wider stakeholders will be needed to ensure a scalable and sustainable incentive system. Four priorities for collaborative action While industry is making progress in many areas, contributions from and collaboration among all stakeholders is needed. There are four key priorities where AMR Industry Alliance members see scope for action: First, to support research and science, the AMR Industry Alliance calls for greater public-sector investment in R&D and a clinical trial infrastructure to promote better innovation in the development of new antibiotics. Continued public-private collaboration between and among universities, hospitals and pharmaceutical companies is also essential and should be expanded to include more biotech, diagnostics and generics manufacturers. To create the market conditions needed to encourage the pipeline, particularly the later and more resource-intensive stages of clinical research, governments should implement so-called “pull” incentives. New antibiotics are typically locked away and reserved for when existing antibiotics become ineffective against antimicrobial-resistant infections. Pull incentives correct this marketplace flaw by rewarding new antibiotics according to their value to society, not merely how many prescriptions are written. This enables companies to recover their investments, drawing even more financial and scientific resources into the battle against AMR. Second, to make access more equitable, especially in low- and middle-income countries, all stakeholders should work together to improve the way antibiotics are ordered, purchased and supplied, including forecasting demand for key antibiotics, as well as the tendering process. This will strengthen manufacturing capacity and supply chains and broaden distribution channels to create a sustainable supply of quality-assured antibiotics. These efforts should be supplemented by awareness campaigns that educate patients and the medical community about substandard or fake products in the marketplace. Third, to encourage appropriate use of antibiotics and cut down on over-prescription, governments, health care providers and pharmaceutical and diagnostics companies need to work together on communications campaigns that raise awareness, reduce sales of antibiotics without prescriptions and curb the overuse of critical antibiotics by following the guidance provided by the WHO AWaRe classification. Better surveillance of AMR through improved data collection and increased public reporting of infection rates and antibiotics use is also essential. Fourth, to promote responsible manufacturing, stakeholders should also work together to develop and implement international standards for responsible antibiotics manufacturing. The Alliance and our members have been actively working towards this objective, and in the absence of such standards, in 2018, established the Common Antibiotic Manufacturing Framework (CAMF), a set of guidelines to assess risk and reduce antibiotic emissions across global supply chains, as well as a list of Predicted No-Effect Concentrations (PNECs) to serve as discharge targets for manufacturers. Our Progress Report shows that Alliance members are acting on this guidance even as we pursue standards. Silent no more We still have a lot of ground to cover. In the six years remaining until the centenary of the discovery of penicillin, we need a strong showing of collective action to spur and sustain responsible stewardship and innovation against AMR. By doing so, we can make sure that future generations can continue to rely on these life-saving tools. AMR won’t race across the world at the same speed as COVID-19, but its effects will be equally devastating. After far too much silence on AMR, the alarms bells are now ringing. We can’t afford not to respond. Thomas Cueni, director general of the IFPMA Thomas B. Cueni is chair of the AMR Industry Alliance and the Director-General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). Image Credits: IFPMA . New WHO Negotiating Body on ‘Pandemic Instrument’ Meets Amid Civil Society Appeal 14/03/2022 Editorial team Unconscious and intubated Covid-19 patients are treated in Vila Penteado Hospital’s ICU, in Sao Paulo, Brazil. The first session of the newly constituted Intergovernmental Negotiating Body (INB) to draft a “pandemic preparedness instrument” for the World Health Organization (WHO) began on Monday. The six-member body, representing all WHO regions, is made up of Precious Matsoso (South Africa), Roland Driece (the Netherlands), Ambassador Tovar da Silva Nunes (Brazil), Ahmed Salama Soliman (Egypt), Kazuho Taguchi (Japan) and Viroj Tangcharoensathien (Thailand). The two-day session will elect two co-chairs, as well as agree on the working methods and timelines of body “based on the principles of inclusiveness, transparency, efficiency, Member State leadership and consensus”, according to the agenda. TODAY (Monday 14 March)#healthgovernance Resumed first session of @WHO Intergovernmental Negotiating Body #INB for a #pandemictreaty: – Methods of work, timeline– Process to identify "substantive elements" – Engagment with "relevant stakeholders"https://t.co/WOgIl1FGej pic.twitter.com/wR45Vqz73q — Medicus Mundi International Network (@mmi_updates) March 14, 2022 Meanwhile, almost 200 civil society leaders have asked the six negotiators to protect the process from any “undue influence of the private sector and its powerful lobbyists”. In an open letter addressed the six negotiators, the leaders have asked the INB to pay attention to a number of issues including: The multiple determinants of potential future pandemics, including the inherent injustice and structural inequities exacerbated by such crises The interconnected dynamics of issues, including the unsustainable food production and livestock breeding, wildlife trading, resource-intensive lifestyles and consumption, destruction of ecosystems, antimicrobial resistance and soaring figures of cancer The state of universal public health systems and their workforce Incoherent policymaking by Member States and the lack of international cooperation Ensuring more inclusive engagement in the treaty-making process that balance the Member State-driven delicate diplomatic process and protect it from the undue influence of the private sector and its powerful lobbyists. The letter has been facilitated by the Geneva Global Health Hub (G2H2), as a service to its members involved in this process. Image Credits: Adnan Abidi/Flickr, Ninian Reid/Flickr. With Less Than 1% Vaccinated, DRC Trains ‘Rumour-Busters’ to Tackle COVID Misinformation 14/03/2022 Kerry Cullinan A member of a Community Action Cell speaks to a woman outside her home in Kinshasa about the COVID-19 vaccine. With fewer than 1% of its 90 million citizens vaccinated against COVID-19, the Democratic Republic of Congo (DRC) has resorted to training teams of “rumour-busters” to tackle misinformation about the virus in order to encourage more people to get the vaccine. David Olela, communications lead for the DRC health ministry’s vaccination programme, admits that his government had been “stuck”, with “no idea how to combat both the pandemic and the disinformation at the same time” until it got help from “infodemic experts”. Health workers, religious and community leaders and journalists spread across the DRC’s vast landmass of around 2.3 million square kilometres have been trained to help combat misinformation. “Having a local team trained in rumour management has helped us turn an anti-vaccine narrative into a pro-vaccine one,” says Olela, whose ministry is being supported by partners including the World Health Organization (WHO) and UNICEF. Rumours about pork in vaccines Imam Famba Ali Huseini, leader of the Usoke Central Mosque in Kinshasa, is one of 30 imams who has been trained in the capital city. “At the start of the pandemic, we were inundated with rumours and disinformation on COVID-19 and vaccines,” says Huseini. “In Kinshasa’s Muslim community, people feared the vaccine. Some thought Africans were being used as guinea pigs, and that the vaccines were made with pork gelatine.” Part of their training involved a doctor explaining how the vaccine was made to show that no pig gelatine was involved. But more impressive for Huseini was learning that people in Muslim countries such as Saudi Arabia and Indonesia had accepted the vaccine. Around 10% of DRC citizens are Muslim. More than 600 health workers have been trained in identifying and refuting myths surrounding the COVID-19 vaccine. Question-and-answer sessions on rumour refutation have also been organized in the national parliament, before 300 national and provincial representatives. In addition, 144 media professionals have been trained in fact-checking and source reliability. This includes Congo Check, an online fact-checking agency, which has been exposing fake news about the pandemic and vaccines. Hesitation to call out vaccine ‘hesitancy’ While none of the international agencies working in the DRC is willing to ascribe the low vaccination rate to “vaccine hesitancy”, it is evident that the country is facing a huge struggle to win people over to vaccines. A survey conducted in November involving 74,388 people found that respondents were split equally between those that supported vaccinations and those who didn’t (see above). For those who are not yet vaccinated, the main reason (28%) was that they “don’t believe in them”. The second most popular reason was that the person felt healthy (18%), followed by fear about vaccine side effects (13%). But even the survey itself was met with apathy. It had tried to solicit the views of almost two million people and only got a 4% response. In late 2020, an online survey of 4131 people conducted by researchers from the University of Kinshasa found that a quarter of respondents doubted the existence of COVID-19. However, 55,9% were prepared to be vaccinated. Among the 1821 participants not willing to receive a COVID-19 vaccine, the majority (60.6%) indicated they did not trust the vaccine. Some also believed it had been made to kill Africans (14,4%) or to sterilise people(5.9%). SMS campaign to promote vaccines A COVID-19 vaccination site in the Democratic Republic of Congo. Overall, immunisation in the DRC is low even for well-established diseases, according to WHO and UNICEF. In 2019, 57% of people were vaccinated against Hepatitis B, 73% had the BCG vaccine against tuberculosis and only 59% had been vaccinated against polio. UNICEF ascribes the low vaccine uptake to “chronic poverty, limited essential service infrastructure, disease outbreaks, recurrent armed conflict, massive displacement and the lack of a steady supply of vaccine doses”. To address this, UNICEF and partners – including the mobile network operators Orange, Vodacom and Africell – launched an SMS campaign in late 2021 to support the COVID-19 vaccination campaign. To start with, 16 million people in 15 priority provinces were sent messages encouraging them to get vaccinated by registering online by SMSing a toll-free number where they would get instructions in five main local languages. After four weeks, 54,000 people had registered and the government was able to prioritise delivery to areas where there is strong interest in getting vaccinated. Bad history with COVID vaccine supply But the DRC’s history with COVID-19 vaccines has been fraught from the start, and the supply chain problems affecting COVAX, the global vaccine access platform, did not help. Within a month of getting 1.7 million Astra Zeneca vaccines from COVAX in March last year, the DRC stopped its vaccine rollout over concerns about blood clots. Three-quarters of these vaccines were then redeployed to other African countries to prevent them from expiring. But once concerns about blood clots had been addressed (found to be a rare risk outweighed by benefits), COVAX’s supply chain had dried up as India had halted the export of AstraZeneca vaccines manufactured by the Serum Institute of India, COVAX’s main supplier. The lack of a reliable supply of vaccines made it hard for the DRC to plan a rollout or prepare people for their arrival. Now that a reliable stream of vaccines is available through COVAX, the DRC government is trying to speed up its vaccination programme but it has a lot of lost ground to catch up. “Our objective is to enable 50 million Congolese to receive the vaccine by the end of 2022 and thus be better protected against the disease,” says Elisabeth Mukamba, director ot the Expanded Program on Immunization. “This innovative SMS pre-registration initiative is welcome and allows us to communicate more quickly and effectively, even in the most remote communities.” Image Credits: Christian Mokili/ UNICEF, Gavi/2021/STARRY. Chinese Mayors are Fired Amid COVID-19 Surge, While Hong Kong Sees Infection Slowdown 14/03/2022 Aishwarya Tendolkar COVID-19 cases have surged to their highest in nearly two years in China. COVID-19 cases reached their highest level in nearly two years in China on Sunday, with 1,437 cases on the mainland, according to China’s National Health Commission. Cases have more than doubled since 10 March when 588 cases were recorded. This surge in cases, driven by the Omicron variant, has prompted the country, which has a strict zero-COVID policy, to impose fresh restrictions in provinces with a high infection rates. It has already shutdown Jilin province which reported 895 cases on 13 March, and the mayors of Jilin city and the Jiutai district of the city of Changchun have been dismissed owing to the outbreak, according to a state-run news agency. China has also imposed stricter restrictions on two other cities last week– Shenzhen and Shanghai. Shenzhen, which borders Hong Kong and is known to be a major hub for electrical manufacturing, is under a seven-day complete lockdown. The city, which has a population of 17.5 million people, has been brought to a complete standstill with businesses suspending operations, and public transportation halting their operations. According to one of China’s leading infectious disease experts, Zhang Wenhong,the domestic epidemic in China is “currently in the early stage of an exponential rise”. He wrote on China’s microblogging site, Weibo, that if China opens up quickly now, it will cause infection of a large number of people in a short period of time. “Even a low case fatality rate will cause a run on medical resources and a short-term shock in social life, causing irreparable damage to society and families,” he said. Hong Kong’s high death rate In the last 24 hours, Hong Kong reported 13,332 local cases had been diagnosed with Nucleic Acid Amplification Tests (most commonly PCR tests), while 19,095 fresh cases had been detected using the rapid antigen tests. However, Hong Kong Leader Carrie Lam told a daily briefing that there were no plans to tighten the social distancing measures owing to the limited scope offered by the current measures in place. The country has so far witnessed 263,411 cases. Hong Kong, like China, has a zero-COVID policy. Currently, it is compulsory to wear masks everywhere, no gatherings of more than two people are allowed, and schools and public venues are closed. While the former British colony has been struggling to manage an influx of patients at its hospitals, Hong Kong is slowly seeing a slowdown in the daily infection rate According to Bloomberg, Hong Kong has registered the most deaths per million people globally in the week to 10 March. Some 286 deaths were reported on Monday. This takes the death toll to 43,279. Meanwhile, Hong Kong opened its fourth community isolation facility on 13 March with over 1,000 beds and the region has also been working with the mainland authorities to build 90,000 isolation units to accommodate patients with mild or no symptoms, reports Reuters. Low vaccination to blame Lam has blamed the low vaccination rate in Hong Kong as a factor in the high rate of deaths and infections. “We have spent over one year to promote, encourage, coerce people to take the jab. But unfortunately, the entire society partly because of the low infection rate in the last year or so and partly because of anxiety and worries and so on, we have not achieved this high rate of vaccination, especially among the elderly,” Lam said at a press conference on Monday. According to Hong Kong’s Department of Health, 89% of those who died in the fifth wave of Covid-19 had not received any dose of vaccination. Wenhong said that China must start implementing more complete, smart, and sustainable coping strategies like booster shots for the elderly and improved vaccination strategies, widely available oral drugs, affordable and widely available home testing kits, effectively trained and rehearsed hierarchical diagnosis and treatment strategies, along with better home isolation process. Image Credits: Flickr. COVID mRNA Vaccines Do Not Harm Fertility – But The Virus Does 14/03/2022 Maayan Hoffman The mRNA vaccines (administered above) don’t affect fertility treatment for women or men. The mRNA-based COVID-19 vaccines do not harm in vitro fertilization (IVF) success rates, according to a recent study, countering disinformation that vaccines could negatively affect fertility. In contrast, the SARS-CoV2 virus has been found to negatively affect the quality of embryos for couples who are undergoing IVF treatments and sperm. The peer-reviewed study, published in the journal Fertility and Sterility, involved 428 women aged up to 38 years of age – some vaccinated and some not – between January and August 2021. In total, the women went through 672 embryo transfers and around a quarter (23% to 26%) of the transfers led to pregnancies in all cases, regardless of whether the women were vaccinated or had been infected with COVID-19. The study group was composed of 141 women either vaccinated with two mRNA coronavirus vaccines or recovered from the virus, and therefore all with COVID antibodies. “One of the concerns raised by women of childbearing age around the world since the introduction of the coronavirus vaccine was that it could negatively impact IVF treatments,” said Prof Raoul Orvieto, director of Sheba Medical Center’s Infertility and IVF Institute in Israel. “Many concerned women and mothers have approached us on this issue. This groundbreaking study shows that the vaccine does not affect a woman’s chance of getting pregnant using the frozen embryo transfer method.” Early on in the pandemic, studies showed that pregnant women were at higher risk of developing severe COVID-19. As such, it was recommended by the World Health Organization that pregnant women get the jab. However, many women have hesitated, likely due to lack of information or misinformation about the safety of vaccines on fertility and foetuses. “Unfounded claims in popular media linked a possible correlation between the SARS-CoV-2 vaccine and potential infertility,” the authors wrote in the study. “Such false claims by anti-vaccine activists aim to incite fear and deter public opinion from vaccination, so jeopardizing the vaccination plan and the end of the pandemic. “Our results refute such claims and strengthen the notion that the SARS-CoV-2 vaccine is safe and should be recommended to fertility-seeking couples,” the authors continued. Multiple studies, one result There has been a range of recent studies examining the impact of COVID-19 and COVID-19 vaccines on fertility in both men and women. A study published in the medical journal Reproductive Biology and Endocrinology in May 2021 proved that there was no difference in ovarian stimulation and embryological variables during IVF cycles conducted before and after receiving the Pfizer vaccine. A separate study of 129 women published in the medical journal Human Reproduction suggested that the Pfizer COVID-19 vaccine has no negative effect on a woman’s ovarian reserve. Women’s Anti-Müllerian hormone (AMH) levels were tested before they received their first shot of the vaccines. They received the second dose three weeks later and then were tested again three months after that. AMH levels were unchanged while COVID-19 antibody levels climbed. Finally, two separate studies examining the impact of the Pfizer vaccine on male sperm showed that it does not have an impact. In a study of 43 male patients undergoing in vitro fertilization between February and March 2021, the sperm of each subject was examined against itself before and after vaccination, and researchers saw no difference in the sperm parameters. A team of researchers from the University of Miami also studied semen volume, sperm concentration and total amount of moving sperm. In their study, published in the JAMA journal in June, they found no declines in any of the parameters after vaccination. “In this study of sperm parameters before and after two doses of a COVID-19 mRNA vaccine, there were no significant decreases in any sperm parameter among this small cohort of healthy men,” the study’s authors wrote. “Because the vaccines contain mRNA and not the live virus, it is unlikely that the vaccine would affect sperm parameters.” “There is nothing we have seen to suggest any negative impact on fertility at all,” Orvieto told Health Policy Watch. But COVID-19 can harm fertility Orvieto said that in his first study, he looked at IVF before and after infection. While there was no direct effect on the IVF outcome, the virus did affect the ratio of top-quality embryos for up to three months after disease. In the first three months, only around 30% of embryos were top quality compared to 60% before or after that period. “The production of eggs and sperm lasts for around three months and can be hampered by inflammatory responses, like the ones that occur as a result of a viral infection, which is the case with COVID-19,” Orvieto said. “Our study indicated that the quality of embryos producers during an IVF procedure for a couple in which one of the partners had previously contracted COVID-19 was significantly lower, and lead to a lower chance of successful implantation.” He told Health Policy Watch that he would recommend couples wait three months after one of the partners’ had contracted COVID-10 before IVF treatments. Other studies found up to a 50% decrease in sperm volume, concentration and motility in patients with moderate disease even 30 days post diagnosis. And there have been reports of up to 25% of men who have had COVID-19 having a sperm impairment from the disease. “If couples are choosing not to vaccinate it is because they are reading fake news,” Orvieto said. He added that his team has gathered what is believes to be all the information needed now to justify vaccination for fertile men and women now. The next thing would be to wait three or four years and see if there are any long-term effects of vaccination or infection on fertility. Image Credits: Wish FM Radio. Second Anniversary of COVID-19 – ´Building Back Better´ Encounters New Challenges 11/03/2022 Raisa Santos & Elaine Ruth Fletcher 2nd Anniversary of COVID-19 Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever. And at the same time, as global health leaders point out, the pandemic is not over…. yet. Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned. “This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing. Ukraine conflict ‘perfect storm’ for COVID surge The conflict in Ukraine is likely to lead to a surge in COVID cases. The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn. The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. “It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.” A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems. Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease. Low testing rates also create opportunities for new variants to spread WHO Director General Dr Tedros Adhanom Ghebreyesus Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve. Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.” He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services. “This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros. Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants. In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address. Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems. That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.” (see related Health Policy Watch story). Attempts to return to normalcy amidst rising cases in some regions Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions. “From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads. Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. “It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated. This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago. “Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing. The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again. Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10. “I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.” South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day. Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March. Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline. One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years. Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure. .COVID-19 Delta-Omicron ‘recombinant’ in Europe Dr Maria van Kerkhove Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark. “The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove. “There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants. “We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway. The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.” Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin. In Lviv, Ukrainian Volunteers Shoulder Humanitarian Response, But For How Long? 11/03/2022 Sam Mednick/LVIV, via The New Humanitarian A volunteer helping a woman at the train station in Lviv. (LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states. The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data. Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed. The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly. He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.” The volunteer response On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country. So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. “This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people. Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy. Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war. This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to. The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate. Need for a professional response While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine. Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian. HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response. “Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added. For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. “We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added. An uncertain future While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland. Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. “I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said. Edited by Eric Reidy. ______________________________________________________ This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe Image Credits: Sam Mednick/TNH. At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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New WHO Negotiating Body on ‘Pandemic Instrument’ Meets Amid Civil Society Appeal 14/03/2022 Editorial team Unconscious and intubated Covid-19 patients are treated in Vila Penteado Hospital’s ICU, in Sao Paulo, Brazil. The first session of the newly constituted Intergovernmental Negotiating Body (INB) to draft a “pandemic preparedness instrument” for the World Health Organization (WHO) began on Monday. The six-member body, representing all WHO regions, is made up of Precious Matsoso (South Africa), Roland Driece (the Netherlands), Ambassador Tovar da Silva Nunes (Brazil), Ahmed Salama Soliman (Egypt), Kazuho Taguchi (Japan) and Viroj Tangcharoensathien (Thailand). The two-day session will elect two co-chairs, as well as agree on the working methods and timelines of body “based on the principles of inclusiveness, transparency, efficiency, Member State leadership and consensus”, according to the agenda. TODAY (Monday 14 March)#healthgovernance Resumed first session of @WHO Intergovernmental Negotiating Body #INB for a #pandemictreaty: – Methods of work, timeline– Process to identify "substantive elements" – Engagment with "relevant stakeholders"https://t.co/WOgIl1FGej pic.twitter.com/wR45Vqz73q — Medicus Mundi International Network (@mmi_updates) March 14, 2022 Meanwhile, almost 200 civil society leaders have asked the six negotiators to protect the process from any “undue influence of the private sector and its powerful lobbyists”. In an open letter addressed the six negotiators, the leaders have asked the INB to pay attention to a number of issues including: The multiple determinants of potential future pandemics, including the inherent injustice and structural inequities exacerbated by such crises The interconnected dynamics of issues, including the unsustainable food production and livestock breeding, wildlife trading, resource-intensive lifestyles and consumption, destruction of ecosystems, antimicrobial resistance and soaring figures of cancer The state of universal public health systems and their workforce Incoherent policymaking by Member States and the lack of international cooperation Ensuring more inclusive engagement in the treaty-making process that balance the Member State-driven delicate diplomatic process and protect it from the undue influence of the private sector and its powerful lobbyists. The letter has been facilitated by the Geneva Global Health Hub (G2H2), as a service to its members involved in this process. Image Credits: Adnan Abidi/Flickr, Ninian Reid/Flickr. With Less Than 1% Vaccinated, DRC Trains ‘Rumour-Busters’ to Tackle COVID Misinformation 14/03/2022 Kerry Cullinan A member of a Community Action Cell speaks to a woman outside her home in Kinshasa about the COVID-19 vaccine. With fewer than 1% of its 90 million citizens vaccinated against COVID-19, the Democratic Republic of Congo (DRC) has resorted to training teams of “rumour-busters” to tackle misinformation about the virus in order to encourage more people to get the vaccine. David Olela, communications lead for the DRC health ministry’s vaccination programme, admits that his government had been “stuck”, with “no idea how to combat both the pandemic and the disinformation at the same time” until it got help from “infodemic experts”. Health workers, religious and community leaders and journalists spread across the DRC’s vast landmass of around 2.3 million square kilometres have been trained to help combat misinformation. “Having a local team trained in rumour management has helped us turn an anti-vaccine narrative into a pro-vaccine one,” says Olela, whose ministry is being supported by partners including the World Health Organization (WHO) and UNICEF. Rumours about pork in vaccines Imam Famba Ali Huseini, leader of the Usoke Central Mosque in Kinshasa, is one of 30 imams who has been trained in the capital city. “At the start of the pandemic, we were inundated with rumours and disinformation on COVID-19 and vaccines,” says Huseini. “In Kinshasa’s Muslim community, people feared the vaccine. Some thought Africans were being used as guinea pigs, and that the vaccines were made with pork gelatine.” Part of their training involved a doctor explaining how the vaccine was made to show that no pig gelatine was involved. But more impressive for Huseini was learning that people in Muslim countries such as Saudi Arabia and Indonesia had accepted the vaccine. Around 10% of DRC citizens are Muslim. More than 600 health workers have been trained in identifying and refuting myths surrounding the COVID-19 vaccine. Question-and-answer sessions on rumour refutation have also been organized in the national parliament, before 300 national and provincial representatives. In addition, 144 media professionals have been trained in fact-checking and source reliability. This includes Congo Check, an online fact-checking agency, which has been exposing fake news about the pandemic and vaccines. Hesitation to call out vaccine ‘hesitancy’ While none of the international agencies working in the DRC is willing to ascribe the low vaccination rate to “vaccine hesitancy”, it is evident that the country is facing a huge struggle to win people over to vaccines. A survey conducted in November involving 74,388 people found that respondents were split equally between those that supported vaccinations and those who didn’t (see above). For those who are not yet vaccinated, the main reason (28%) was that they “don’t believe in them”. The second most popular reason was that the person felt healthy (18%), followed by fear about vaccine side effects (13%). But even the survey itself was met with apathy. It had tried to solicit the views of almost two million people and only got a 4% response. In late 2020, an online survey of 4131 people conducted by researchers from the University of Kinshasa found that a quarter of respondents doubted the existence of COVID-19. However, 55,9% were prepared to be vaccinated. Among the 1821 participants not willing to receive a COVID-19 vaccine, the majority (60.6%) indicated they did not trust the vaccine. Some also believed it had been made to kill Africans (14,4%) or to sterilise people(5.9%). SMS campaign to promote vaccines A COVID-19 vaccination site in the Democratic Republic of Congo. Overall, immunisation in the DRC is low even for well-established diseases, according to WHO and UNICEF. In 2019, 57% of people were vaccinated against Hepatitis B, 73% had the BCG vaccine against tuberculosis and only 59% had been vaccinated against polio. UNICEF ascribes the low vaccine uptake to “chronic poverty, limited essential service infrastructure, disease outbreaks, recurrent armed conflict, massive displacement and the lack of a steady supply of vaccine doses”. To address this, UNICEF and partners – including the mobile network operators Orange, Vodacom and Africell – launched an SMS campaign in late 2021 to support the COVID-19 vaccination campaign. To start with, 16 million people in 15 priority provinces were sent messages encouraging them to get vaccinated by registering online by SMSing a toll-free number where they would get instructions in five main local languages. After four weeks, 54,000 people had registered and the government was able to prioritise delivery to areas where there is strong interest in getting vaccinated. Bad history with COVID vaccine supply But the DRC’s history with COVID-19 vaccines has been fraught from the start, and the supply chain problems affecting COVAX, the global vaccine access platform, did not help. Within a month of getting 1.7 million Astra Zeneca vaccines from COVAX in March last year, the DRC stopped its vaccine rollout over concerns about blood clots. Three-quarters of these vaccines were then redeployed to other African countries to prevent them from expiring. But once concerns about blood clots had been addressed (found to be a rare risk outweighed by benefits), COVAX’s supply chain had dried up as India had halted the export of AstraZeneca vaccines manufactured by the Serum Institute of India, COVAX’s main supplier. The lack of a reliable supply of vaccines made it hard for the DRC to plan a rollout or prepare people for their arrival. Now that a reliable stream of vaccines is available through COVAX, the DRC government is trying to speed up its vaccination programme but it has a lot of lost ground to catch up. “Our objective is to enable 50 million Congolese to receive the vaccine by the end of 2022 and thus be better protected against the disease,” says Elisabeth Mukamba, director ot the Expanded Program on Immunization. “This innovative SMS pre-registration initiative is welcome and allows us to communicate more quickly and effectively, even in the most remote communities.” Image Credits: Christian Mokili/ UNICEF, Gavi/2021/STARRY. Chinese Mayors are Fired Amid COVID-19 Surge, While Hong Kong Sees Infection Slowdown 14/03/2022 Aishwarya Tendolkar COVID-19 cases have surged to their highest in nearly two years in China. COVID-19 cases reached their highest level in nearly two years in China on Sunday, with 1,437 cases on the mainland, according to China’s National Health Commission. Cases have more than doubled since 10 March when 588 cases were recorded. This surge in cases, driven by the Omicron variant, has prompted the country, which has a strict zero-COVID policy, to impose fresh restrictions in provinces with a high infection rates. It has already shutdown Jilin province which reported 895 cases on 13 March, and the mayors of Jilin city and the Jiutai district of the city of Changchun have been dismissed owing to the outbreak, according to a state-run news agency. China has also imposed stricter restrictions on two other cities last week– Shenzhen and Shanghai. Shenzhen, which borders Hong Kong and is known to be a major hub for electrical manufacturing, is under a seven-day complete lockdown. The city, which has a population of 17.5 million people, has been brought to a complete standstill with businesses suspending operations, and public transportation halting their operations. According to one of China’s leading infectious disease experts, Zhang Wenhong,the domestic epidemic in China is “currently in the early stage of an exponential rise”. He wrote on China’s microblogging site, Weibo, that if China opens up quickly now, it will cause infection of a large number of people in a short period of time. “Even a low case fatality rate will cause a run on medical resources and a short-term shock in social life, causing irreparable damage to society and families,” he said. Hong Kong’s high death rate In the last 24 hours, Hong Kong reported 13,332 local cases had been diagnosed with Nucleic Acid Amplification Tests (most commonly PCR tests), while 19,095 fresh cases had been detected using the rapid antigen tests. However, Hong Kong Leader Carrie Lam told a daily briefing that there were no plans to tighten the social distancing measures owing to the limited scope offered by the current measures in place. The country has so far witnessed 263,411 cases. Hong Kong, like China, has a zero-COVID policy. Currently, it is compulsory to wear masks everywhere, no gatherings of more than two people are allowed, and schools and public venues are closed. While the former British colony has been struggling to manage an influx of patients at its hospitals, Hong Kong is slowly seeing a slowdown in the daily infection rate According to Bloomberg, Hong Kong has registered the most deaths per million people globally in the week to 10 March. Some 286 deaths were reported on Monday. This takes the death toll to 43,279. Meanwhile, Hong Kong opened its fourth community isolation facility on 13 March with over 1,000 beds and the region has also been working with the mainland authorities to build 90,000 isolation units to accommodate patients with mild or no symptoms, reports Reuters. Low vaccination to blame Lam has blamed the low vaccination rate in Hong Kong as a factor in the high rate of deaths and infections. “We have spent over one year to promote, encourage, coerce people to take the jab. But unfortunately, the entire society partly because of the low infection rate in the last year or so and partly because of anxiety and worries and so on, we have not achieved this high rate of vaccination, especially among the elderly,” Lam said at a press conference on Monday. According to Hong Kong’s Department of Health, 89% of those who died in the fifth wave of Covid-19 had not received any dose of vaccination. Wenhong said that China must start implementing more complete, smart, and sustainable coping strategies like booster shots for the elderly and improved vaccination strategies, widely available oral drugs, affordable and widely available home testing kits, effectively trained and rehearsed hierarchical diagnosis and treatment strategies, along with better home isolation process. Image Credits: Flickr. COVID mRNA Vaccines Do Not Harm Fertility – But The Virus Does 14/03/2022 Maayan Hoffman The mRNA vaccines (administered above) don’t affect fertility treatment for women or men. The mRNA-based COVID-19 vaccines do not harm in vitro fertilization (IVF) success rates, according to a recent study, countering disinformation that vaccines could negatively affect fertility. In contrast, the SARS-CoV2 virus has been found to negatively affect the quality of embryos for couples who are undergoing IVF treatments and sperm. The peer-reviewed study, published in the journal Fertility and Sterility, involved 428 women aged up to 38 years of age – some vaccinated and some not – between January and August 2021. In total, the women went through 672 embryo transfers and around a quarter (23% to 26%) of the transfers led to pregnancies in all cases, regardless of whether the women were vaccinated or had been infected with COVID-19. The study group was composed of 141 women either vaccinated with two mRNA coronavirus vaccines or recovered from the virus, and therefore all with COVID antibodies. “One of the concerns raised by women of childbearing age around the world since the introduction of the coronavirus vaccine was that it could negatively impact IVF treatments,” said Prof Raoul Orvieto, director of Sheba Medical Center’s Infertility and IVF Institute in Israel. “Many concerned women and mothers have approached us on this issue. This groundbreaking study shows that the vaccine does not affect a woman’s chance of getting pregnant using the frozen embryo transfer method.” Early on in the pandemic, studies showed that pregnant women were at higher risk of developing severe COVID-19. As such, it was recommended by the World Health Organization that pregnant women get the jab. However, many women have hesitated, likely due to lack of information or misinformation about the safety of vaccines on fertility and foetuses. “Unfounded claims in popular media linked a possible correlation between the SARS-CoV-2 vaccine and potential infertility,” the authors wrote in the study. “Such false claims by anti-vaccine activists aim to incite fear and deter public opinion from vaccination, so jeopardizing the vaccination plan and the end of the pandemic. “Our results refute such claims and strengthen the notion that the SARS-CoV-2 vaccine is safe and should be recommended to fertility-seeking couples,” the authors continued. Multiple studies, one result There has been a range of recent studies examining the impact of COVID-19 and COVID-19 vaccines on fertility in both men and women. A study published in the medical journal Reproductive Biology and Endocrinology in May 2021 proved that there was no difference in ovarian stimulation and embryological variables during IVF cycles conducted before and after receiving the Pfizer vaccine. A separate study of 129 women published in the medical journal Human Reproduction suggested that the Pfizer COVID-19 vaccine has no negative effect on a woman’s ovarian reserve. Women’s Anti-Müllerian hormone (AMH) levels were tested before they received their first shot of the vaccines. They received the second dose three weeks later and then were tested again three months after that. AMH levels were unchanged while COVID-19 antibody levels climbed. Finally, two separate studies examining the impact of the Pfizer vaccine on male sperm showed that it does not have an impact. In a study of 43 male patients undergoing in vitro fertilization between February and March 2021, the sperm of each subject was examined against itself before and after vaccination, and researchers saw no difference in the sperm parameters. A team of researchers from the University of Miami also studied semen volume, sperm concentration and total amount of moving sperm. In their study, published in the JAMA journal in June, they found no declines in any of the parameters after vaccination. “In this study of sperm parameters before and after two doses of a COVID-19 mRNA vaccine, there were no significant decreases in any sperm parameter among this small cohort of healthy men,” the study’s authors wrote. “Because the vaccines contain mRNA and not the live virus, it is unlikely that the vaccine would affect sperm parameters.” “There is nothing we have seen to suggest any negative impact on fertility at all,” Orvieto told Health Policy Watch. But COVID-19 can harm fertility Orvieto said that in his first study, he looked at IVF before and after infection. While there was no direct effect on the IVF outcome, the virus did affect the ratio of top-quality embryos for up to three months after disease. In the first three months, only around 30% of embryos were top quality compared to 60% before or after that period. “The production of eggs and sperm lasts for around three months and can be hampered by inflammatory responses, like the ones that occur as a result of a viral infection, which is the case with COVID-19,” Orvieto said. “Our study indicated that the quality of embryos producers during an IVF procedure for a couple in which one of the partners had previously contracted COVID-19 was significantly lower, and lead to a lower chance of successful implantation.” He told Health Policy Watch that he would recommend couples wait three months after one of the partners’ had contracted COVID-10 before IVF treatments. Other studies found up to a 50% decrease in sperm volume, concentration and motility in patients with moderate disease even 30 days post diagnosis. And there have been reports of up to 25% of men who have had COVID-19 having a sperm impairment from the disease. “If couples are choosing not to vaccinate it is because they are reading fake news,” Orvieto said. He added that his team has gathered what is believes to be all the information needed now to justify vaccination for fertile men and women now. The next thing would be to wait three or four years and see if there are any long-term effects of vaccination or infection on fertility. Image Credits: Wish FM Radio. Second Anniversary of COVID-19 – ´Building Back Better´ Encounters New Challenges 11/03/2022 Raisa Santos & Elaine Ruth Fletcher 2nd Anniversary of COVID-19 Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever. And at the same time, as global health leaders point out, the pandemic is not over…. yet. Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned. “This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing. Ukraine conflict ‘perfect storm’ for COVID surge The conflict in Ukraine is likely to lead to a surge in COVID cases. The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn. The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. “It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.” A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems. Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease. Low testing rates also create opportunities for new variants to spread WHO Director General Dr Tedros Adhanom Ghebreyesus Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve. Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.” He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services. “This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros. Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants. In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address. Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems. That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.” (see related Health Policy Watch story). Attempts to return to normalcy amidst rising cases in some regions Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions. “From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads. Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. “It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated. This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago. “Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing. The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again. Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10. “I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.” South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day. Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March. Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline. One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years. Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure. .COVID-19 Delta-Omicron ‘recombinant’ in Europe Dr Maria van Kerkhove Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark. “The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove. “There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants. “We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway. The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.” Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin. In Lviv, Ukrainian Volunteers Shoulder Humanitarian Response, But For How Long? 11/03/2022 Sam Mednick/LVIV, via The New Humanitarian A volunteer helping a woman at the train station in Lviv. (LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states. The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data. Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed. The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly. He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.” The volunteer response On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country. So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. “This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people. Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy. Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war. This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to. The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate. Need for a professional response While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine. Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian. HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response. “Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added. For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. “We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added. An uncertain future While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland. Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. “I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said. Edited by Eric Reidy. ______________________________________________________ This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe Image Credits: Sam Mednick/TNH. At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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With Less Than 1% Vaccinated, DRC Trains ‘Rumour-Busters’ to Tackle COVID Misinformation 14/03/2022 Kerry Cullinan A member of a Community Action Cell speaks to a woman outside her home in Kinshasa about the COVID-19 vaccine. With fewer than 1% of its 90 million citizens vaccinated against COVID-19, the Democratic Republic of Congo (DRC) has resorted to training teams of “rumour-busters” to tackle misinformation about the virus in order to encourage more people to get the vaccine. David Olela, communications lead for the DRC health ministry’s vaccination programme, admits that his government had been “stuck”, with “no idea how to combat both the pandemic and the disinformation at the same time” until it got help from “infodemic experts”. Health workers, religious and community leaders and journalists spread across the DRC’s vast landmass of around 2.3 million square kilometres have been trained to help combat misinformation. “Having a local team trained in rumour management has helped us turn an anti-vaccine narrative into a pro-vaccine one,” says Olela, whose ministry is being supported by partners including the World Health Organization (WHO) and UNICEF. Rumours about pork in vaccines Imam Famba Ali Huseini, leader of the Usoke Central Mosque in Kinshasa, is one of 30 imams who has been trained in the capital city. “At the start of the pandemic, we were inundated with rumours and disinformation on COVID-19 and vaccines,” says Huseini. “In Kinshasa’s Muslim community, people feared the vaccine. Some thought Africans were being used as guinea pigs, and that the vaccines were made with pork gelatine.” Part of their training involved a doctor explaining how the vaccine was made to show that no pig gelatine was involved. But more impressive for Huseini was learning that people in Muslim countries such as Saudi Arabia and Indonesia had accepted the vaccine. Around 10% of DRC citizens are Muslim. More than 600 health workers have been trained in identifying and refuting myths surrounding the COVID-19 vaccine. Question-and-answer sessions on rumour refutation have also been organized in the national parliament, before 300 national and provincial representatives. In addition, 144 media professionals have been trained in fact-checking and source reliability. This includes Congo Check, an online fact-checking agency, which has been exposing fake news about the pandemic and vaccines. Hesitation to call out vaccine ‘hesitancy’ While none of the international agencies working in the DRC is willing to ascribe the low vaccination rate to “vaccine hesitancy”, it is evident that the country is facing a huge struggle to win people over to vaccines. A survey conducted in November involving 74,388 people found that respondents were split equally between those that supported vaccinations and those who didn’t (see above). For those who are not yet vaccinated, the main reason (28%) was that they “don’t believe in them”. The second most popular reason was that the person felt healthy (18%), followed by fear about vaccine side effects (13%). But even the survey itself was met with apathy. It had tried to solicit the views of almost two million people and only got a 4% response. In late 2020, an online survey of 4131 people conducted by researchers from the University of Kinshasa found that a quarter of respondents doubted the existence of COVID-19. However, 55,9% were prepared to be vaccinated. Among the 1821 participants not willing to receive a COVID-19 vaccine, the majority (60.6%) indicated they did not trust the vaccine. Some also believed it had been made to kill Africans (14,4%) or to sterilise people(5.9%). SMS campaign to promote vaccines A COVID-19 vaccination site in the Democratic Republic of Congo. Overall, immunisation in the DRC is low even for well-established diseases, according to WHO and UNICEF. In 2019, 57% of people were vaccinated against Hepatitis B, 73% had the BCG vaccine against tuberculosis and only 59% had been vaccinated against polio. UNICEF ascribes the low vaccine uptake to “chronic poverty, limited essential service infrastructure, disease outbreaks, recurrent armed conflict, massive displacement and the lack of a steady supply of vaccine doses”. To address this, UNICEF and partners – including the mobile network operators Orange, Vodacom and Africell – launched an SMS campaign in late 2021 to support the COVID-19 vaccination campaign. To start with, 16 million people in 15 priority provinces were sent messages encouraging them to get vaccinated by registering online by SMSing a toll-free number where they would get instructions in five main local languages. After four weeks, 54,000 people had registered and the government was able to prioritise delivery to areas where there is strong interest in getting vaccinated. Bad history with COVID vaccine supply But the DRC’s history with COVID-19 vaccines has been fraught from the start, and the supply chain problems affecting COVAX, the global vaccine access platform, did not help. Within a month of getting 1.7 million Astra Zeneca vaccines from COVAX in March last year, the DRC stopped its vaccine rollout over concerns about blood clots. Three-quarters of these vaccines were then redeployed to other African countries to prevent them from expiring. But once concerns about blood clots had been addressed (found to be a rare risk outweighed by benefits), COVAX’s supply chain had dried up as India had halted the export of AstraZeneca vaccines manufactured by the Serum Institute of India, COVAX’s main supplier. The lack of a reliable supply of vaccines made it hard for the DRC to plan a rollout or prepare people for their arrival. Now that a reliable stream of vaccines is available through COVAX, the DRC government is trying to speed up its vaccination programme but it has a lot of lost ground to catch up. “Our objective is to enable 50 million Congolese to receive the vaccine by the end of 2022 and thus be better protected against the disease,” says Elisabeth Mukamba, director ot the Expanded Program on Immunization. “This innovative SMS pre-registration initiative is welcome and allows us to communicate more quickly and effectively, even in the most remote communities.” Image Credits: Christian Mokili/ UNICEF, Gavi/2021/STARRY. Chinese Mayors are Fired Amid COVID-19 Surge, While Hong Kong Sees Infection Slowdown 14/03/2022 Aishwarya Tendolkar COVID-19 cases have surged to their highest in nearly two years in China. COVID-19 cases reached their highest level in nearly two years in China on Sunday, with 1,437 cases on the mainland, according to China’s National Health Commission. Cases have more than doubled since 10 March when 588 cases were recorded. This surge in cases, driven by the Omicron variant, has prompted the country, which has a strict zero-COVID policy, to impose fresh restrictions in provinces with a high infection rates. It has already shutdown Jilin province which reported 895 cases on 13 March, and the mayors of Jilin city and the Jiutai district of the city of Changchun have been dismissed owing to the outbreak, according to a state-run news agency. China has also imposed stricter restrictions on two other cities last week– Shenzhen and Shanghai. Shenzhen, which borders Hong Kong and is known to be a major hub for electrical manufacturing, is under a seven-day complete lockdown. The city, which has a population of 17.5 million people, has been brought to a complete standstill with businesses suspending operations, and public transportation halting their operations. According to one of China’s leading infectious disease experts, Zhang Wenhong,the domestic epidemic in China is “currently in the early stage of an exponential rise”. He wrote on China’s microblogging site, Weibo, that if China opens up quickly now, it will cause infection of a large number of people in a short period of time. “Even a low case fatality rate will cause a run on medical resources and a short-term shock in social life, causing irreparable damage to society and families,” he said. Hong Kong’s high death rate In the last 24 hours, Hong Kong reported 13,332 local cases had been diagnosed with Nucleic Acid Amplification Tests (most commonly PCR tests), while 19,095 fresh cases had been detected using the rapid antigen tests. However, Hong Kong Leader Carrie Lam told a daily briefing that there were no plans to tighten the social distancing measures owing to the limited scope offered by the current measures in place. The country has so far witnessed 263,411 cases. Hong Kong, like China, has a zero-COVID policy. Currently, it is compulsory to wear masks everywhere, no gatherings of more than two people are allowed, and schools and public venues are closed. While the former British colony has been struggling to manage an influx of patients at its hospitals, Hong Kong is slowly seeing a slowdown in the daily infection rate According to Bloomberg, Hong Kong has registered the most deaths per million people globally in the week to 10 March. Some 286 deaths were reported on Monday. This takes the death toll to 43,279. Meanwhile, Hong Kong opened its fourth community isolation facility on 13 March with over 1,000 beds and the region has also been working with the mainland authorities to build 90,000 isolation units to accommodate patients with mild or no symptoms, reports Reuters. Low vaccination to blame Lam has blamed the low vaccination rate in Hong Kong as a factor in the high rate of deaths and infections. “We have spent over one year to promote, encourage, coerce people to take the jab. But unfortunately, the entire society partly because of the low infection rate in the last year or so and partly because of anxiety and worries and so on, we have not achieved this high rate of vaccination, especially among the elderly,” Lam said at a press conference on Monday. According to Hong Kong’s Department of Health, 89% of those who died in the fifth wave of Covid-19 had not received any dose of vaccination. Wenhong said that China must start implementing more complete, smart, and sustainable coping strategies like booster shots for the elderly and improved vaccination strategies, widely available oral drugs, affordable and widely available home testing kits, effectively trained and rehearsed hierarchical diagnosis and treatment strategies, along with better home isolation process. Image Credits: Flickr. COVID mRNA Vaccines Do Not Harm Fertility – But The Virus Does 14/03/2022 Maayan Hoffman The mRNA vaccines (administered above) don’t affect fertility treatment for women or men. The mRNA-based COVID-19 vaccines do not harm in vitro fertilization (IVF) success rates, according to a recent study, countering disinformation that vaccines could negatively affect fertility. In contrast, the SARS-CoV2 virus has been found to negatively affect the quality of embryos for couples who are undergoing IVF treatments and sperm. The peer-reviewed study, published in the journal Fertility and Sterility, involved 428 women aged up to 38 years of age – some vaccinated and some not – between January and August 2021. In total, the women went through 672 embryo transfers and around a quarter (23% to 26%) of the transfers led to pregnancies in all cases, regardless of whether the women were vaccinated or had been infected with COVID-19. The study group was composed of 141 women either vaccinated with two mRNA coronavirus vaccines or recovered from the virus, and therefore all with COVID antibodies. “One of the concerns raised by women of childbearing age around the world since the introduction of the coronavirus vaccine was that it could negatively impact IVF treatments,” said Prof Raoul Orvieto, director of Sheba Medical Center’s Infertility and IVF Institute in Israel. “Many concerned women and mothers have approached us on this issue. This groundbreaking study shows that the vaccine does not affect a woman’s chance of getting pregnant using the frozen embryo transfer method.” Early on in the pandemic, studies showed that pregnant women were at higher risk of developing severe COVID-19. As such, it was recommended by the World Health Organization that pregnant women get the jab. However, many women have hesitated, likely due to lack of information or misinformation about the safety of vaccines on fertility and foetuses. “Unfounded claims in popular media linked a possible correlation between the SARS-CoV-2 vaccine and potential infertility,” the authors wrote in the study. “Such false claims by anti-vaccine activists aim to incite fear and deter public opinion from vaccination, so jeopardizing the vaccination plan and the end of the pandemic. “Our results refute such claims and strengthen the notion that the SARS-CoV-2 vaccine is safe and should be recommended to fertility-seeking couples,” the authors continued. Multiple studies, one result There has been a range of recent studies examining the impact of COVID-19 and COVID-19 vaccines on fertility in both men and women. A study published in the medical journal Reproductive Biology and Endocrinology in May 2021 proved that there was no difference in ovarian stimulation and embryological variables during IVF cycles conducted before and after receiving the Pfizer vaccine. A separate study of 129 women published in the medical journal Human Reproduction suggested that the Pfizer COVID-19 vaccine has no negative effect on a woman’s ovarian reserve. Women’s Anti-Müllerian hormone (AMH) levels were tested before they received their first shot of the vaccines. They received the second dose three weeks later and then were tested again three months after that. AMH levels were unchanged while COVID-19 antibody levels climbed. Finally, two separate studies examining the impact of the Pfizer vaccine on male sperm showed that it does not have an impact. In a study of 43 male patients undergoing in vitro fertilization between February and March 2021, the sperm of each subject was examined against itself before and after vaccination, and researchers saw no difference in the sperm parameters. A team of researchers from the University of Miami also studied semen volume, sperm concentration and total amount of moving sperm. In their study, published in the JAMA journal in June, they found no declines in any of the parameters after vaccination. “In this study of sperm parameters before and after two doses of a COVID-19 mRNA vaccine, there were no significant decreases in any sperm parameter among this small cohort of healthy men,” the study’s authors wrote. “Because the vaccines contain mRNA and not the live virus, it is unlikely that the vaccine would affect sperm parameters.” “There is nothing we have seen to suggest any negative impact on fertility at all,” Orvieto told Health Policy Watch. But COVID-19 can harm fertility Orvieto said that in his first study, he looked at IVF before and after infection. While there was no direct effect on the IVF outcome, the virus did affect the ratio of top-quality embryos for up to three months after disease. In the first three months, only around 30% of embryos were top quality compared to 60% before or after that period. “The production of eggs and sperm lasts for around three months and can be hampered by inflammatory responses, like the ones that occur as a result of a viral infection, which is the case with COVID-19,” Orvieto said. “Our study indicated that the quality of embryos producers during an IVF procedure for a couple in which one of the partners had previously contracted COVID-19 was significantly lower, and lead to a lower chance of successful implantation.” He told Health Policy Watch that he would recommend couples wait three months after one of the partners’ had contracted COVID-10 before IVF treatments. Other studies found up to a 50% decrease in sperm volume, concentration and motility in patients with moderate disease even 30 days post diagnosis. And there have been reports of up to 25% of men who have had COVID-19 having a sperm impairment from the disease. “If couples are choosing not to vaccinate it is because they are reading fake news,” Orvieto said. He added that his team has gathered what is believes to be all the information needed now to justify vaccination for fertile men and women now. The next thing would be to wait three or four years and see if there are any long-term effects of vaccination or infection on fertility. Image Credits: Wish FM Radio. Second Anniversary of COVID-19 – ´Building Back Better´ Encounters New Challenges 11/03/2022 Raisa Santos & Elaine Ruth Fletcher 2nd Anniversary of COVID-19 Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever. And at the same time, as global health leaders point out, the pandemic is not over…. yet. Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned. “This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing. Ukraine conflict ‘perfect storm’ for COVID surge The conflict in Ukraine is likely to lead to a surge in COVID cases. The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn. The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. “It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.” A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems. Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease. Low testing rates also create opportunities for new variants to spread WHO Director General Dr Tedros Adhanom Ghebreyesus Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve. Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.” He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services. “This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros. Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants. In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address. Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems. That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.” (see related Health Policy Watch story). Attempts to return to normalcy amidst rising cases in some regions Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions. “From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads. Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. “It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated. This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago. “Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing. The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again. Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10. “I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.” South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day. Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March. Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline. One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years. Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure. .COVID-19 Delta-Omicron ‘recombinant’ in Europe Dr Maria van Kerkhove Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark. “The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove. “There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants. “We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway. The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.” Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin. In Lviv, Ukrainian Volunteers Shoulder Humanitarian Response, But For How Long? 11/03/2022 Sam Mednick/LVIV, via The New Humanitarian A volunteer helping a woman at the train station in Lviv. (LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states. The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data. Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed. The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly. He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.” The volunteer response On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country. So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. “This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people. Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy. Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war. This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to. The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate. Need for a professional response While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine. Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian. HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response. “Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added. For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. “We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added. An uncertain future While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland. Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. “I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said. Edited by Eric Reidy. ______________________________________________________ This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe Image Credits: Sam Mednick/TNH. At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Chinese Mayors are Fired Amid COVID-19 Surge, While Hong Kong Sees Infection Slowdown 14/03/2022 Aishwarya Tendolkar COVID-19 cases have surged to their highest in nearly two years in China. COVID-19 cases reached their highest level in nearly two years in China on Sunday, with 1,437 cases on the mainland, according to China’s National Health Commission. Cases have more than doubled since 10 March when 588 cases were recorded. This surge in cases, driven by the Omicron variant, has prompted the country, which has a strict zero-COVID policy, to impose fresh restrictions in provinces with a high infection rates. It has already shutdown Jilin province which reported 895 cases on 13 March, and the mayors of Jilin city and the Jiutai district of the city of Changchun have been dismissed owing to the outbreak, according to a state-run news agency. China has also imposed stricter restrictions on two other cities last week– Shenzhen and Shanghai. Shenzhen, which borders Hong Kong and is known to be a major hub for electrical manufacturing, is under a seven-day complete lockdown. The city, which has a population of 17.5 million people, has been brought to a complete standstill with businesses suspending operations, and public transportation halting their operations. According to one of China’s leading infectious disease experts, Zhang Wenhong,the domestic epidemic in China is “currently in the early stage of an exponential rise”. He wrote on China’s microblogging site, Weibo, that if China opens up quickly now, it will cause infection of a large number of people in a short period of time. “Even a low case fatality rate will cause a run on medical resources and a short-term shock in social life, causing irreparable damage to society and families,” he said. Hong Kong’s high death rate In the last 24 hours, Hong Kong reported 13,332 local cases had been diagnosed with Nucleic Acid Amplification Tests (most commonly PCR tests), while 19,095 fresh cases had been detected using the rapid antigen tests. However, Hong Kong Leader Carrie Lam told a daily briefing that there were no plans to tighten the social distancing measures owing to the limited scope offered by the current measures in place. The country has so far witnessed 263,411 cases. Hong Kong, like China, has a zero-COVID policy. Currently, it is compulsory to wear masks everywhere, no gatherings of more than two people are allowed, and schools and public venues are closed. While the former British colony has been struggling to manage an influx of patients at its hospitals, Hong Kong is slowly seeing a slowdown in the daily infection rate According to Bloomberg, Hong Kong has registered the most deaths per million people globally in the week to 10 March. Some 286 deaths were reported on Monday. This takes the death toll to 43,279. Meanwhile, Hong Kong opened its fourth community isolation facility on 13 March with over 1,000 beds and the region has also been working with the mainland authorities to build 90,000 isolation units to accommodate patients with mild or no symptoms, reports Reuters. Low vaccination to blame Lam has blamed the low vaccination rate in Hong Kong as a factor in the high rate of deaths and infections. “We have spent over one year to promote, encourage, coerce people to take the jab. But unfortunately, the entire society partly because of the low infection rate in the last year or so and partly because of anxiety and worries and so on, we have not achieved this high rate of vaccination, especially among the elderly,” Lam said at a press conference on Monday. According to Hong Kong’s Department of Health, 89% of those who died in the fifth wave of Covid-19 had not received any dose of vaccination. Wenhong said that China must start implementing more complete, smart, and sustainable coping strategies like booster shots for the elderly and improved vaccination strategies, widely available oral drugs, affordable and widely available home testing kits, effectively trained and rehearsed hierarchical diagnosis and treatment strategies, along with better home isolation process. Image Credits: Flickr. COVID mRNA Vaccines Do Not Harm Fertility – But The Virus Does 14/03/2022 Maayan Hoffman The mRNA vaccines (administered above) don’t affect fertility treatment for women or men. The mRNA-based COVID-19 vaccines do not harm in vitro fertilization (IVF) success rates, according to a recent study, countering disinformation that vaccines could negatively affect fertility. In contrast, the SARS-CoV2 virus has been found to negatively affect the quality of embryos for couples who are undergoing IVF treatments and sperm. The peer-reviewed study, published in the journal Fertility and Sterility, involved 428 women aged up to 38 years of age – some vaccinated and some not – between January and August 2021. In total, the women went through 672 embryo transfers and around a quarter (23% to 26%) of the transfers led to pregnancies in all cases, regardless of whether the women were vaccinated or had been infected with COVID-19. The study group was composed of 141 women either vaccinated with two mRNA coronavirus vaccines or recovered from the virus, and therefore all with COVID antibodies. “One of the concerns raised by women of childbearing age around the world since the introduction of the coronavirus vaccine was that it could negatively impact IVF treatments,” said Prof Raoul Orvieto, director of Sheba Medical Center’s Infertility and IVF Institute in Israel. “Many concerned women and mothers have approached us on this issue. This groundbreaking study shows that the vaccine does not affect a woman’s chance of getting pregnant using the frozen embryo transfer method.” Early on in the pandemic, studies showed that pregnant women were at higher risk of developing severe COVID-19. As such, it was recommended by the World Health Organization that pregnant women get the jab. However, many women have hesitated, likely due to lack of information or misinformation about the safety of vaccines on fertility and foetuses. “Unfounded claims in popular media linked a possible correlation between the SARS-CoV-2 vaccine and potential infertility,” the authors wrote in the study. “Such false claims by anti-vaccine activists aim to incite fear and deter public opinion from vaccination, so jeopardizing the vaccination plan and the end of the pandemic. “Our results refute such claims and strengthen the notion that the SARS-CoV-2 vaccine is safe and should be recommended to fertility-seeking couples,” the authors continued. Multiple studies, one result There has been a range of recent studies examining the impact of COVID-19 and COVID-19 vaccines on fertility in both men and women. A study published in the medical journal Reproductive Biology and Endocrinology in May 2021 proved that there was no difference in ovarian stimulation and embryological variables during IVF cycles conducted before and after receiving the Pfizer vaccine. A separate study of 129 women published in the medical journal Human Reproduction suggested that the Pfizer COVID-19 vaccine has no negative effect on a woman’s ovarian reserve. Women’s Anti-Müllerian hormone (AMH) levels were tested before they received their first shot of the vaccines. They received the second dose three weeks later and then were tested again three months after that. AMH levels were unchanged while COVID-19 antibody levels climbed. Finally, two separate studies examining the impact of the Pfizer vaccine on male sperm showed that it does not have an impact. In a study of 43 male patients undergoing in vitro fertilization between February and March 2021, the sperm of each subject was examined against itself before and after vaccination, and researchers saw no difference in the sperm parameters. A team of researchers from the University of Miami also studied semen volume, sperm concentration and total amount of moving sperm. In their study, published in the JAMA journal in June, they found no declines in any of the parameters after vaccination. “In this study of sperm parameters before and after two doses of a COVID-19 mRNA vaccine, there were no significant decreases in any sperm parameter among this small cohort of healthy men,” the study’s authors wrote. “Because the vaccines contain mRNA and not the live virus, it is unlikely that the vaccine would affect sperm parameters.” “There is nothing we have seen to suggest any negative impact on fertility at all,” Orvieto told Health Policy Watch. But COVID-19 can harm fertility Orvieto said that in his first study, he looked at IVF before and after infection. While there was no direct effect on the IVF outcome, the virus did affect the ratio of top-quality embryos for up to three months after disease. In the first three months, only around 30% of embryos were top quality compared to 60% before or after that period. “The production of eggs and sperm lasts for around three months and can be hampered by inflammatory responses, like the ones that occur as a result of a viral infection, which is the case with COVID-19,” Orvieto said. “Our study indicated that the quality of embryos producers during an IVF procedure for a couple in which one of the partners had previously contracted COVID-19 was significantly lower, and lead to a lower chance of successful implantation.” He told Health Policy Watch that he would recommend couples wait three months after one of the partners’ had contracted COVID-10 before IVF treatments. Other studies found up to a 50% decrease in sperm volume, concentration and motility in patients with moderate disease even 30 days post diagnosis. And there have been reports of up to 25% of men who have had COVID-19 having a sperm impairment from the disease. “If couples are choosing not to vaccinate it is because they are reading fake news,” Orvieto said. He added that his team has gathered what is believes to be all the information needed now to justify vaccination for fertile men and women now. The next thing would be to wait three or four years and see if there are any long-term effects of vaccination or infection on fertility. Image Credits: Wish FM Radio. Second Anniversary of COVID-19 – ´Building Back Better´ Encounters New Challenges 11/03/2022 Raisa Santos & Elaine Ruth Fletcher 2nd Anniversary of COVID-19 Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever. And at the same time, as global health leaders point out, the pandemic is not over…. yet. Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned. “This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing. Ukraine conflict ‘perfect storm’ for COVID surge The conflict in Ukraine is likely to lead to a surge in COVID cases. The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn. The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. “It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.” A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems. Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease. Low testing rates also create opportunities for new variants to spread WHO Director General Dr Tedros Adhanom Ghebreyesus Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve. Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.” He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services. “This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros. Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants. In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address. Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems. That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.” (see related Health Policy Watch story). Attempts to return to normalcy amidst rising cases in some regions Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions. “From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads. Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. “It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated. This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago. “Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing. The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again. Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10. “I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.” South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day. Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March. Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline. One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years. Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure. .COVID-19 Delta-Omicron ‘recombinant’ in Europe Dr Maria van Kerkhove Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark. “The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove. “There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants. “We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway. The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.” Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin. In Lviv, Ukrainian Volunteers Shoulder Humanitarian Response, But For How Long? 11/03/2022 Sam Mednick/LVIV, via The New Humanitarian A volunteer helping a woman at the train station in Lviv. (LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states. The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data. Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed. The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly. He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.” The volunteer response On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country. So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. “This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people. Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy. Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war. This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to. The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate. Need for a professional response While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine. Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian. HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response. “Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added. For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. “We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added. An uncertain future While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland. Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. “I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said. Edited by Eric Reidy. ______________________________________________________ This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe Image Credits: Sam Mednick/TNH. At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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COVID mRNA Vaccines Do Not Harm Fertility – But The Virus Does 14/03/2022 Maayan Hoffman The mRNA vaccines (administered above) don’t affect fertility treatment for women or men. The mRNA-based COVID-19 vaccines do not harm in vitro fertilization (IVF) success rates, according to a recent study, countering disinformation that vaccines could negatively affect fertility. In contrast, the SARS-CoV2 virus has been found to negatively affect the quality of embryos for couples who are undergoing IVF treatments and sperm. The peer-reviewed study, published in the journal Fertility and Sterility, involved 428 women aged up to 38 years of age – some vaccinated and some not – between January and August 2021. In total, the women went through 672 embryo transfers and around a quarter (23% to 26%) of the transfers led to pregnancies in all cases, regardless of whether the women were vaccinated or had been infected with COVID-19. The study group was composed of 141 women either vaccinated with two mRNA coronavirus vaccines or recovered from the virus, and therefore all with COVID antibodies. “One of the concerns raised by women of childbearing age around the world since the introduction of the coronavirus vaccine was that it could negatively impact IVF treatments,” said Prof Raoul Orvieto, director of Sheba Medical Center’s Infertility and IVF Institute in Israel. “Many concerned women and mothers have approached us on this issue. This groundbreaking study shows that the vaccine does not affect a woman’s chance of getting pregnant using the frozen embryo transfer method.” Early on in the pandemic, studies showed that pregnant women were at higher risk of developing severe COVID-19. As such, it was recommended by the World Health Organization that pregnant women get the jab. However, many women have hesitated, likely due to lack of information or misinformation about the safety of vaccines on fertility and foetuses. “Unfounded claims in popular media linked a possible correlation between the SARS-CoV-2 vaccine and potential infertility,” the authors wrote in the study. “Such false claims by anti-vaccine activists aim to incite fear and deter public opinion from vaccination, so jeopardizing the vaccination plan and the end of the pandemic. “Our results refute such claims and strengthen the notion that the SARS-CoV-2 vaccine is safe and should be recommended to fertility-seeking couples,” the authors continued. Multiple studies, one result There has been a range of recent studies examining the impact of COVID-19 and COVID-19 vaccines on fertility in both men and women. A study published in the medical journal Reproductive Biology and Endocrinology in May 2021 proved that there was no difference in ovarian stimulation and embryological variables during IVF cycles conducted before and after receiving the Pfizer vaccine. A separate study of 129 women published in the medical journal Human Reproduction suggested that the Pfizer COVID-19 vaccine has no negative effect on a woman’s ovarian reserve. Women’s Anti-Müllerian hormone (AMH) levels were tested before they received their first shot of the vaccines. They received the second dose three weeks later and then were tested again three months after that. AMH levels were unchanged while COVID-19 antibody levels climbed. Finally, two separate studies examining the impact of the Pfizer vaccine on male sperm showed that it does not have an impact. In a study of 43 male patients undergoing in vitro fertilization between February and March 2021, the sperm of each subject was examined against itself before and after vaccination, and researchers saw no difference in the sperm parameters. A team of researchers from the University of Miami also studied semen volume, sperm concentration and total amount of moving sperm. In their study, published in the JAMA journal in June, they found no declines in any of the parameters after vaccination. “In this study of sperm parameters before and after two doses of a COVID-19 mRNA vaccine, there were no significant decreases in any sperm parameter among this small cohort of healthy men,” the study’s authors wrote. “Because the vaccines contain mRNA and not the live virus, it is unlikely that the vaccine would affect sperm parameters.” “There is nothing we have seen to suggest any negative impact on fertility at all,” Orvieto told Health Policy Watch. But COVID-19 can harm fertility Orvieto said that in his first study, he looked at IVF before and after infection. While there was no direct effect on the IVF outcome, the virus did affect the ratio of top-quality embryos for up to three months after disease. In the first three months, only around 30% of embryos were top quality compared to 60% before or after that period. “The production of eggs and sperm lasts for around three months and can be hampered by inflammatory responses, like the ones that occur as a result of a viral infection, which is the case with COVID-19,” Orvieto said. “Our study indicated that the quality of embryos producers during an IVF procedure for a couple in which one of the partners had previously contracted COVID-19 was significantly lower, and lead to a lower chance of successful implantation.” He told Health Policy Watch that he would recommend couples wait three months after one of the partners’ had contracted COVID-10 before IVF treatments. Other studies found up to a 50% decrease in sperm volume, concentration and motility in patients with moderate disease even 30 days post diagnosis. And there have been reports of up to 25% of men who have had COVID-19 having a sperm impairment from the disease. “If couples are choosing not to vaccinate it is because they are reading fake news,” Orvieto said. He added that his team has gathered what is believes to be all the information needed now to justify vaccination for fertile men and women now. The next thing would be to wait three or four years and see if there are any long-term effects of vaccination or infection on fertility. Image Credits: Wish FM Radio. Second Anniversary of COVID-19 – ´Building Back Better´ Encounters New Challenges 11/03/2022 Raisa Santos & Elaine Ruth Fletcher 2nd Anniversary of COVID-19 Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever. And at the same time, as global health leaders point out, the pandemic is not over…. yet. Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned. “This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing. Ukraine conflict ‘perfect storm’ for COVID surge The conflict in Ukraine is likely to lead to a surge in COVID cases. The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn. The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. “It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.” A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems. Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease. Low testing rates also create opportunities for new variants to spread WHO Director General Dr Tedros Adhanom Ghebreyesus Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve. Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.” He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services. “This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros. Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants. In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address. Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems. That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.” (see related Health Policy Watch story). Attempts to return to normalcy amidst rising cases in some regions Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions. “From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads. Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. “It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated. This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago. “Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing. The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again. Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10. “I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.” South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day. Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March. Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline. One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years. Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure. .COVID-19 Delta-Omicron ‘recombinant’ in Europe Dr Maria van Kerkhove Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark. “The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove. “There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants. “We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway. The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.” Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin. In Lviv, Ukrainian Volunteers Shoulder Humanitarian Response, But For How Long? 11/03/2022 Sam Mednick/LVIV, via The New Humanitarian A volunteer helping a woman at the train station in Lviv. (LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states. The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data. Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed. The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly. He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.” The volunteer response On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country. So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. “This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people. Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy. Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war. This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to. The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate. Need for a professional response While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine. Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian. HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response. “Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added. For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. “We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added. An uncertain future While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland. Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. “I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said. Edited by Eric Reidy. ______________________________________________________ This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe Image Credits: Sam Mednick/TNH. At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Second Anniversary of COVID-19 – ´Building Back Better´ Encounters New Challenges 11/03/2022 Raisa Santos & Elaine Ruth Fletcher 2nd Anniversary of COVID-19 Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever. And at the same time, as global health leaders point out, the pandemic is not over…. yet. Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned. “This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing. Ukraine conflict ‘perfect storm’ for COVID surge The conflict in Ukraine is likely to lead to a surge in COVID cases. The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn. The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. “It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.” A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems. Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease. Low testing rates also create opportunities for new variants to spread WHO Director General Dr Tedros Adhanom Ghebreyesus Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve. Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.” He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services. “This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros. Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants. In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address. Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems. That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.” (see related Health Policy Watch story). Attempts to return to normalcy amidst rising cases in some regions Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions. “From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads. Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. “It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated. This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago. “Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing. The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again. Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10. “I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.” South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day. Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March. Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline. One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years. Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure. .COVID-19 Delta-Omicron ‘recombinant’ in Europe Dr Maria van Kerkhove Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark. “The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove. “There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants. “We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway. The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.” Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin. In Lviv, Ukrainian Volunteers Shoulder Humanitarian Response, But For How Long? 11/03/2022 Sam Mednick/LVIV, via The New Humanitarian A volunteer helping a woman at the train station in Lviv. (LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states. The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data. Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed. The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly. He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.” The volunteer response On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country. So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. “This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people. Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy. Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war. This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to. The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate. Need for a professional response While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine. Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian. HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response. “Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added. For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. “We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added. An uncertain future While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland. Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. “I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said. Edited by Eric Reidy. ______________________________________________________ This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe Image Credits: Sam Mednick/TNH. At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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In Lviv, Ukrainian Volunteers Shoulder Humanitarian Response, But For How Long? 11/03/2022 Sam Mednick/LVIV, via The New Humanitarian A volunteer helping a woman at the train station in Lviv. (LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states. The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data. Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed. The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly. He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.” The volunteer response On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country. So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. “This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people. Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy. Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war. This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to. The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate. Need for a professional response While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine. Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian. HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response. “Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added. For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. “We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added. An uncertain future While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland. Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. “I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said. Edited by Eric Reidy. ______________________________________________________ This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe Image Credits: Sam Mednick/TNH. At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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At Pandemic’s Two Year Milestone: More Investment in the World’s Nurses is Needed – Now 11/03/2022 Howard Catton Personal protective equipment was essential to protect healthcare workers during the pandemic The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses. Two years into the COVID-19 pandemic, governments need to offer better solutions. On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath. As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it. Pandemic happened during pre-existing health workforce crisis A nurse in full PPE completes patient forms at the Tehran Heart Centre Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone. The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies. Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years. Before the storm – shortage of six million nurses By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one. Findings included a global shortage of almost six million nurses, mainly in poorer countries. Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas. Nine out of ten were women. The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions. Inequalities income-driven “Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads. This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs). The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth. When the storm hit But when the pandemic hit, those longer-term strategies and plans were once again put aside. Issues that had to be faced were much more immediate. Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water. While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. Dreadful toll Nurses working at the isolation ward in Daegu, South Korea Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. There are also more nurses who intend to, or are considering leaving the profession altogether. Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses. ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years. In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone. On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. Brighter side of the crisis Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients. But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before. In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic. So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and support for nurses’ wellbeing and mental health needs. As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’ But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams. Preparing for the next pandemic – workforce investments The training of nurse anesthetists in Kenya will help to increase access to surgery. Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary. Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. But frankly, they were not enough and their goals were diverted by the immediate crisis. Nursing “offset credits” to countries that provide nurses The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain.. For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland. At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. Proportion of foreign-trained nurses – based on OECD data, as of January 2022. We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution. Nurses at the policymaking table Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found. Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve. But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now. Health and peace are inseparable Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve. We should never forget that health, peace and prosperity are inseparable. And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. ______________________________________________________ Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide. Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022. Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Africa’s Race Against Time to End Hunger and Malnutrition 10/03/2022 Paul Adepoju Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020. Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition. Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition. Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021. Two-thirds of these people lived in 10 countries, namely the Democratic Republic of the Congo (21.8 million), Yemen (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million) and Haiti (4.1 million). In his foreword for the report, António Guterres, Secretary-General of the United Nations, decried the rising number of people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. “Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. “Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade, reduces access to vital resources like water and electricity, and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.” The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable. Addressing the issues While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU. The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa. Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation. At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. “It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit. In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges. Multipronged approaches While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming. The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems. “I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch. But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.” A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. “It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas. “There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added. Interplay between the private sector and governments to promote good nutrition The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector. “The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. “I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.” Optimism despite uphill battles for nutrition While African countries are responding to multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. “I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch. “We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added. Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy. “We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030. “Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch. Image Credits: Paul Adepoju. Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Over 20 Former Global and Environmental Leaders Call For Protection of at Least 30% of the Planet by 2030 10/03/2022 Raisa Santos Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue. In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target. “We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland. HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 30×30 target is ‘necessary component’ to combat biodiversity and climate crisis In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”. Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York. Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. Conservation efforts must protect Indigenous people The Indigenous people of New Zealand – the Maori. The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” “It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” More must be done to build on progress as COP15 approaches Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. “Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ “Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. Other members of the GSC echoed these calls in separate statements. “With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. “None of our futures are certain unless we are united in this effort.” Image Credits: UNDP / Vlad Sokhin, einalem. Posts navigation Older postsNewer posts