obesity
Obesity is most common for both men and women in the WHO Americas region.

By 2030, 20% of women and 14% of men, or over 1 billion people, will be living with obesity globally, according to the new World Obesity Atlas 2022 published Friday.  

The new Atlas, launched on World Obesity Day, predicts that by that time, the number of people with obesity globally will have doubled since 2010.

The Atlas presents new projections on obesity and severe obesity among men and women as of 2030, as well as revisiting projections for children. Two years into the pandemic, obesity was also found to be closely  correlated with COVID-19 associated mortality, with death rates ten times higher in countries where over 50% of the population are overweight.

“This has shown clearly that an unhealthy population, without concerted action in anticipation of the next pandemic, will result in even more lives lost needlessly,” said World Obesity Federation President John Wilding and CEO Johanna Ralston, in the Atlas’s Foreword.

Katie Dain of the NCD Alliance called obesity a “slow-burn pandemic, one that has the health of a billion people sitting on a precipice. 

Missing WHO global targets 

Given current trends, chances of meeting the WHO global targets to halt the rise in obesity by 2025 also have likely passed, the report acknowledges.  

The WHO targets called for no increase in the prevalence of adult obesity between 2010 and 2025.

Authors of the Atlas – the World Obesity Federation – said that they are “hopeful”, nonetheless, in the fact that public and policymakers’ understanding about obesity has increased, and there has been more recent momentum to take action.

“As we reflect on the COVID-19 pandemic, it is essential that lessons are learnt…and that governments take the difficult but necessary steps – with obesity treatment and obesity prevention – to reduce the prevalence of obesity in this and future generations,” said both Wilding and Ralston, in the Foreword. 

Obesity in Africa to triple by 2030 

Mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but too much of it can lead to obesity and related diseases later in life.

While the highest rates of obesity are still found in the WHO Americas region for both men and women, the numbers in Africa are expected to triple by 2030.

Countries in the Americas are projected to see a 1.5- fold increase in obesity between 2010 and 2030, while Africa is predicted to experience a rise from 34 million obese people in 2010 to 101 million in 2030, 75% of which would be women.  That, while the African continent continues to struggle with undernutrition, leading to the wasting and stunting of many children. 

Worldwide, obesity is higher among women than men and the gender gap will continue to rise in all regions by 2030.

Across all regions, obesity is expected to impact women more than men.

Trends are also very geographically defined. Currently, one-half of all women with obesity live in just 11 countries: United States, China, India, Brazil, Mexico, Russia, Egypt, Indonesia, Iran, Turkey and Pakistan. 

At the same time, one half of all men with obesity live in 9 countries: US, China, India, Brazil, Mexico, Russia, Egypt, Germany and Turkey.

Especially concerning are the countries that feature in both the top 20 rankings for prevalence and number of people living with obesity projections; namely US, Egypt, Turkey and Saudi Arabia.

High BMI causes loss of 160 million years of healthy life

Years of life lost due to high BMI has huge financial implications.

Over 160 million lost years of healthy life were due to high body-mass index (BMI) in 2019 globally, accounting for more than 20% of all lost years of healthy life caused by preventable chronic ill-health, the atlas also finds. 

The greatest proportion of years lost, or disability adjusted life years (DALYs) and deaths that result from high BMI can be found in the Eastern Mediterranean region and in higher income countries. 

The Atlas warns that the years of healthy life lost due to high BMI and increasing obesity will hold back economic development and will lead to high levels of stress on the health services of many countries.

“A failure by governments to act to reduce the high prevalence of obesity in populations have high financial implications on health systems, as more people require support to manage and treat obesity and comorbidities,” authors say.  

They project that countries such as Mexico and the US will suffer a total economic impact of $160 billion by 2060. For India, that impact is $479 billion; for Brazil, $181 billion.  

Obesity-NCD Preparedness Ranking shows variability in preparedness across regions  

The report also introduces a new “Obesity-NCD Preparedness Ranking” which takes into account countries’ current health system responses to NCDs and wider commitment to the implementation of prevention policies, giving an indication for how well, or poorly, countries are prepared to address the rise in obesity. 

The findings highlight that many countries ranked lowest in preparedness to prevent and treat obesity are low- and middle-income countries, especially in Western Africa, as well as in WHO’s Western Pacific and Eastern Mediterranean (Middle East) regions. 

In contrast, the WHO European Region appears best-equipped to prevent and respond to obesity trends, with a population-weighted average preparedness score of 37 out of 183 – with Switzerland, ranking as Number 1 – as the most prepared.  

But even within the European region there was some variability – in countries such as Kyrgyzstan, Azerbaijan, and Uzbekistan. 

“It is clear that the preparedness ranks are not distributed uniformly around the globe, but vary markedly across national income levels, and across geographical regions,” notes the Atlas. 

Overall, African region countries scored poorly in the global preparedness rankings, with only Algeria, Seychelles, and Mauritius scoring better than the global average of 87. 

Western Africa appears to be the least prepared – with conflict-ridden Central African Republic, Nigeria, and Niger, ranking 179, 180, and 183 respectively. 

Another conflict zone, Somalia and Pakistan in WHO’s Eastern Mediterranean region also rank poorly in preparedness, with scores of 181 and 172 respectively. 

For the Western Pacific region, Pacific Islands countries such as Papau New Guinea, Vanuatu, adn Kiribati, were among the lowest-scoring. They also have some of the highest obesity prevalence levels globally. 

‘Double burden’ of obesity and undernutrition  

A malnourished child is weighed at a clinic in Abu Shouk camp for Internally Displaced Persons, North Darfur.

With the majority of people with obesity living in LMICs, where obesity rates are rising fastest and health systems capacity is lowest, countries also are ill-equipped to tackle the double burden of both malnutrition and undernutrition, as well as obesity. 

Health service budgets in these countries also are unlikely to be able to cover advanced forms of obesity treatment, such as bariatric surgery.

This reinforces the need for a comprehensive approach to managing and treating obesity, says the Atlas.  

“Countries have a major challenge to halt the rise in obesity and reduce obesity across all age groups.” 

Global action plan should replace ‘disjointed global response’ 

Responding to the report, the NCD Alliance called upon the WHO to advance a new Global Action Plan on Obesity in time for review at the upcoming World Health Assembly, which takes place 22 – 28 May 2022 . 

The plan would bring together all existing actions, including the WHO’s recent draft recommendations on obesity, which were considered at January 2022 Executive Board meeting.  But an action plan would also expand the ambition and scope of WHO’s work to accelerate action on obesity in priority countries.

“A disjointed response, lack of ambition, and inaction is hurting the most vulnerable, and the impact couldn’t be more striking than it is today,” said Margot Neveux,  a Senior Policy Manager at World Obesity Federation. 

“We need more from our leaders; we need governance that puts the health and well-being of its people first.” 

Image Credits: Malingering/Flickr, Jen Wen Luoh, World Obesity Federation, Flickr – UN Photo, World Obesity Federation .

A nurse in rural Mozambique consults with a 32-year-old woman about her family planning needs, pre-COVID. Many such services remain disrupted, two years after the pandemic began.

Women in Africa will feel the disruptive force of the pandemic for many years to come – with upticks in maternal deaths and prolonged disruptions in maternal, child and reproductive health services issues the continent must grapple with now. 

About 40% of African countries are reporting continued disruptions to sexual, reproductive, maternal, newborn, child and adolescent health services, said Dr Matshidiso Moeti, Director of the World Health Organization’s Regional Office for Africa, in a WHO briefing on Thursday, just ahead of International Women’s Day, 8 March.   

Matshidiso Moeti,of the World Health Organization Regional Office for Africa,

Even more worrisome, some countries have seen a prolonged increase in maternal deaths since the pandemic began, she said.

“One survey from 11 countries showed that more than half saw a 16% increase in maternal deaths between February and May 2020 compared to the same period in 2019,” Moeti said.

“That statistic decreased slightly last year [2021] to 11%. But the number could be much higher because home births were excluded from this data,” she said.

Overall, Africa has fared worse than other regions in terms of gender-related health services, according to the data reported by WHO in its latest Global Pulse Survey on health services continuity. 

On top of that, nutrition-relation services like counseling on infant feeding and management of wasting, which also deeply affect women, have been even more severely disrupted, the WHO data reveals.  

Teen pregnancies and violence against women

Health Education - Family Planning
Moeti added that teenage pregnancies and incidents of violence against women also increased exponentially, with the situation exacerbated by pandemic-related school closures. 

According to one recently published study, the COVID-19 pandemic “deleteriously affected the sexual and reproductive health of girls and amplified school transfer and dropout in Kenya. 

“Adolescent girls who couldn’t attend school for six months were at twice the risk of falling pregnant, and three times more likely never to return to class,” Moeti added. 

She called on African governments to consider ​​gender inequality as a determinant that needs to be woven into the design and delivery of interventions to improve health.

“Investing in human economy participation, livelihoods and health is an investment in the health of future generations of Africans. Our continent cannot afford any further reversals of the fragile gains made in the pursuit of equitable care for women and girls,” Moeti warned.

Need for gender-based approaches to pandemic preparedness

Dr Francine Ntoumi, President and Director-General of the Congolese Foundation for Medical Research.

In other remarks at the WHO briefing, ​​Dr Francine Ntoumi, President and Director-General of the Congolese Foundation for Medical Research noted that women, especially pregnant women, often have to wait before they can benefit from interventions because they were not included in clinical trials.

“All of the trials exclude pregnant women, which means that pregnant women can only benefit from scientific progress very later, which is the case for vaccines as well. So we call for urgent actions to ensure pregnant women have privileged and early access to new interventions including vaccination,” she said. 

Corroborating Ntoumi, Dr Eleanor Nwadinobi, President of the Medical Women’s International Association added that the circumstances surrounding the global COVID-19 response necessitated the need for gender-based approaches to pandemic preparedness.

The experts also called for more studies targeting African women on a number of issues including pregnancy, mental health, obesity, co-morbidities and others.

“We need to ensure there’s prevention education, and dedicated funding to address violence against women and girls,” Nwadinobi concluded.

Image Credits: Dominic Chavez/World Bank, © Evolving Communications/The Global Financing Facility.

covid technologies
US NIH will offer some of its COVID-19 technologies to WHO’s C-TAP patent pool.

The United States National Institutes of Health (NIH) will offer certain government-funded coronavirus technologies to WHO’s COVID-19 Technology Access Pool (C-TAP), top US officials said on Thursday. 

The  announcement by US Secretary of Health and Human Services Xavier Becerra at a virtual meeting Thursday with other ministers of health, could help bolster support for the WHO effort to build a repository of treatments, tests and vaccines available to any country on an open license – an effort that has failed to gain much buy-in from either governments, researchers or industry so far. 

WHO welcomed the move saying it would help the agency and countries to more quickly overcome the COVID pandemic. 

“This is a strong example of innovation and collaboration coming together to expand access,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, who also spoke at the virtual ‘COVID-19 Dialogue – Potential Opportunities for Innovation and Collaboration, convened by Becerra with over 20 health ministers and senior health officials from Europe, Asia, Africa, the Middle East and Latin America.  

“Voluntary sharing of technologies through non-exclusive agreements will not only help us put the pandemic behind us; it will also empower low- and middle-income countries to produce their own medical products and achieve equitable access,” Tedros added in a follow-up statement.  

US Secretary of Health and Human Services, Xavier Becerra

The NIH technologies will also be sub-licensed to the United Nations backed Medicines Patent Pool (MPP) – in an effort to amplify the impact of certain American scientific breakthroughs to better fight the pandemic, said Becerra.

Sharing technologies behind NIH-devised coronavirus diagnostics, treatments and vaccines will help other nations and developers to move innovations to the manufacturing phase more quickly, Becerra said. 

The HHS secretary also hinted that the move to share NIH technologies with C-TAP could set the stage for further policy changes around how NIH innovations are used and shared, noting that: “moving forward, HHS will work with manufacturers to promote global access to public health emergency products in future purchase agreements”.

‘Push the envelope where the law allows’

Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease (NIAID), also confirmed the plan to share the NIH know-how on a call with US media later Thursday. But he declined to offer details on exactly what technologies will be shared, saying the plan is “still being ironed out.” 

However, both Fauci and Becerra hinted that they would try to push for the inclusion of powerful innovations like the Moderna mRNA vaccine in the patent pool – if the NIH were to win a bitterly-contested patent dispute with the company over the ownership of a patent critical to the vaccine recipe.

“We’re still in early stages,” Becerra quoted as saying. “This latest announcement is an effort to try to let low and middle-income countries know that we want them to have capacities as well.”

But he added that HHS would “push the envelope where the law allows us.”

The NIH and Moderna are locked in a battle around patent ownership for key technologies related to the Moderna vaccine. 

WHO – NIH move will help ‘put pandemic behind us’

“We will be honored to sign public health-driven transparent non-exclusive license agreements with NIH under the auspices of C-TAP when the negotiations have concluded, with the goal to provide access of these innovative technologies to people in need around the world and help put an end to the pandemic,” said MPP Executive Director Charles Gore in the joint WHO-MPP statement. 

In Nov. 2021, Spain announced that it would share the technology behind a coronavirus antibody test to the pool, known as C-TAP, the first significant donation. However, few other takers have surfaced, and WHO has since refocused more of its efforts on building a series of technology transfer hubs that aimed to train researchers and jump-start manufacturing of vaccines and other innovations – including one based in Cape Town and another, announced last week, in the Republic of Korea.  

Medecines access advocates also said they were heartened by the decision – although some took a wait-and-see attitude to see what technologies are really shared.

“HHS’s announcement is a turn towards sharing not only doses, but knowledge, which is the difference between charity and justice. It is a trajectory which if pursued with seriousness of purpose can improve resilience to future pandemics and bring a measure of justice to a terribly unjust time,” said Peter Maybarduk, who oversees the global medicine program at Public Citizen, an advocacy organization.

Entry point for US to share patents 

While the newly-announced agreement is with WHO’s C-Tap, the US announcement could also open the door for new policies on NIH funding of discovery research, some observers also suggested. 

If future funding arrangements provide an entry point for the US to explicitly preserve its right to share patents for global health objectives, that would have more long-term impacts on the ecosystem of R&D-sharing, beyond the current pandemic, said Knowledge Ecology International Director James Love:

 “In the past, the NIH has opposed such agreements or clauses in the NIH funding agreements, and we hope that attitudes are changing,” he said.  

Becerra’s announcement followed  Wednesday’s release of a new White House plan for US COVID-19 preparedness, which also emphasises the importance of “vaccinating the world” to prevent future pandemics.

Image Credits: wasajja_j/Twitter, Twitter .

The world’s nations have agreed to negotiate a landmark treaty by 2024 to curb plastics pollution which is choking oceans, killing fish and wildlife and polluting water, soils and foods with toxic chemicals. 

The agreement by some 175 UN member states was reached Wedneaday evening at the United Nations Environment Assembly in Nairobi. It offers a bright light of international cooperation at a time when Europe is at war and climate change signals are ever more alarming. 

“Today marks a triumph by planet earth over single-use plastics. This is the most significant environmental multilateral deal since the Paris accord. It is an insurance policy for this generation and future ones, so they may live with plastic and not be doomed by it.” said Inger Andersen, Executive Director of UNEP.

“Against the backdrop of geopolitical turmoil, the UN Environment Assembly (UNEA-5) shows multilateral cooperation at its best,” said Norway’s Minister for Climate and the Environment, Espen Barth Eide, who presided over the UNEA event. “Plastic pollution has grown into an epidemic. With today’s resolution we are officially on track for a cure.”

Waste from single-used plastics has increased exponentially from just two million tons in 1950, to 348 million tons in 2017, as part of a global industry valued at $522.6 billion, according to the  United Nations Environment Programme.  

In a business-as-usual scenario, volumes of plastics pollution would double again by 2040, said the UN agency. 

Plastics pollution: Twin health and climate crisis

Plastics production use and disposal are all major, unrecognized contributors to climate change – beginning with the petro-chemical products used as inputs to the CO2 emissions generated by the high-tech incineration of plastic in high-income countries – and crude open-burning of plastic waste in lower-income nations.  

By 2050, greenhouse gas emissions associated with plastic production, use and disposal, would account for 15% of climate emissions – providing that countries succeed in limiting those to levels that meet the 2015 Paris Agreement goal of keeping global temperature rise, UNEP says. 

But from a health standpoint, the silent infiltration of toxic microplastics into food, water supplies, soils, fisheries and wildlife is creating an equally insidious epidemic.  A growing number of scientific studies point to a wide range of health impacts ranging from fertility to endocrine disorders due to the ingestion of microplastics associated with food package, plastics plates and other food-related sources, as well as consumption of micro-plastics contaminated fish and wildlife.  Emissions of health-harmful dioxins, furins and other toxic particles from open burning has further health impacts, which can contribute to respiratory illnesses and cancers.  Plastics contamination of soils, and related to that, soil fertility and food production is another growing concern. 

Agriculture Plastic Residues Are Poisoning Soils, Food Systems & Threatening Human Health, Says FAO 

With regards to water sources, a WHO study from 2019 did not find significant evidence of widespread plastics contamination yet – but it acknowledged that the evidence remains limited and more research is needed.

The historic UNEA resolution, entitled “End Plastic Pollution: Towards an internationally legally binding instrument”, was adopted with the conclusion of the three-day UNEA-5.2 meeting, attended by more than 3,400 in-person and 1,500 online participants from 175 UN Member States, including 79 ministers and 17 high-level officials.

20 fossil fuel companies responsible for most plastics pollution 

Single-use plastics, such as bottles, bags and food packages, are the most commonly discarded type of plastic. Made almost exclusively from fossil fuels, these “throwaway” plastics often end their short lifecycle polluting the oceans, being burned or dumped into landfills.

Last year, a study by the UK-based Plastic Makers Index found just 20 companies were the source of more than half of single-use plastic items thrown away globally.

The research found that 20 petrochemical companies were responsible for 55% of the world’s single-use plastic waste, with US  ExxonMobil topping the list with 5.9 million metric tons contribution to global plastic waste, closely followed by U.S. chemicals company Dow and China’s Sinopec.

The health sector is a major consumer of single use plastics for countless medical procedures – and those uses have only exploded further during the COVID crisis with the swelling global demand for masks and other protective gear for health care workers as well as people moving about infected communities. 

Although the United Nations Environment Programme has led the charge on plastics waste, WHO has published warnings that 1 in 3 healthcare facilities globally do not safely manage healthcare waste. 

However, after years of encouraging health care facilities to adopt throw-away medical devices – from tubing to syringes as an infection prevention measures – disposing of them by burning or landfilling – finding new technologies that use less toxic plastics, and better ways to separate and reprocess contaminated health care waste remains an uphill challenge.  

Image Credits: WHO/European Pressphoto Agency (EPA).

hearing
Speech and hearing testing in Karnataka, India. Over one billion people aged 12 – 35 are at risk of hearing loss.

Ahead of World Hearing Day 2022, WHO has issued a new international standard for safe noise levels and hearing at public venues and events.  It aims to combat the growing problem of hearing loss from exposure to excessively loud music and other recreational noise. 

Over 1 billion people aged 12 – 35 risk losing their hearing due to prolonged and excessive exposure to loud music and other recreational sounds, which has devastating consequences for their physical and mental health, education, and employment prospects. 

“Millions of teenagers and young people are at risk of hearing loss due to the unsafe use of personal audio devices and exposure to damaging sound levels at venues such as nightclubs, bars, concerts and sporting events,” said Dr Bente Mikkelsen, WHO Director for the Department for Noncommunicable Diseases.

The Global standard for safe listening at venues and events highlights six recommendations under the theme, To hear for life, listen with care!. The six recommendations in the new WHO report to limit the risk of hearing loss are: 

(1) a maximum average sound level of 100 decibels

(2) live monitoring and recording of sound levels using calibrated equipment by designated staff

(3) optimizing venue acoustics and sound systems to ensure enjoyable sound quality and safe listening

(4) making personal hearing protection available to audiences including instructions on use

(5) access to quiet zones for people to rest their ears and decrease the risk of hearing damage; and

(6) provision of training and information to staff.

More about the safe standard

Image Credits: Trinity Care Foundation/Flickr.

Molnupiravir
Molnupiravir

Molnupiravir, an oral COVID-19 antiviral medication, has just been added as a conditional recommendation to the World Health Organization’s living guidelines on COVID-19 therapeutics. 

The pill, created by Merck, had already been approved by the Medicines Patent Pool (MPP) in January to be distributed and supplied in 105 low- and middle-income countries (LMICs). 

In comparison with Pfizer’s Paxlovid, Monulpiravir emerged with lower efficacy ratings and more potential adverse effects, in the FDA’s final review of clinical trial results.

Even so, the Merck drug is still regarded as an important new tool in countries’ arsenals, as it can be administered to certain patients unable to tolerate Paxlovid. WHO recommends molnupiravir to non-severe COVID-19 patients with the highest risk of hospitalizations, including people who have not received a COVID-19 vaccination, older people, people with immunodeficiencies, and people living with chronic diseases.  WHO has not yet made a recommendation 

See more about monulpiravir: WHO

Image Credits: Merck .

The World Health Organization (WHO) on Wednesday appealed for a “humanitarian corridor” to enable it to deliver emergency medical supplies to sick and injured Ukrainians – particularly oxygen, insulin and equipment needed to treat battle wounds. 

The WHO appeal at a media briefing Wednesday came just hours before the UN General Assembly overwhelmingly approved a resolution that “deplores” Russia’s “aggression against the Ukraine” – on a day when Russia ramped up its bombing and shelling of major Ukranian urban centres, including Kharkhiv, Kherson and Mariupol, leading to evermore mounting casualties, by the hour.   

Meanwhile, over 870,000 people have already fled Ukraine, WHO European officials disclosed – several hundred thousand people than estimates from just 24 hours ago, as numbers grow exponentially. Their arrival will create more knock-on impacts for stressed health systems in neighboring countries.

As for humanitarian supplies destined for the beseiged country, “the first shipment will arrive in Poland tomorrow, including six metric tonnes of supplies for trauma care and emergency surgery,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing. 

But getting the supplies to thousands of critically injured and ill people is yet another matter, he said.

“There is an urgent need to establish a corridor to ensure humanitarian workers and supplies have safe and continuous access to reach people in need to support our response,” added Dr Tedros. 

Grim list of equipment

Ukrainian child with his dog -displaced by war to a refugee camp on the border with Moldova.

Dr Mike Ryan, WHO Executive Director of Health Emergencies, recited a grim list of some of the equipment in the shipment: “sutures, skin graft equipment, equipment for doing major surgery and unfortunately equipment for doing amputations, for bone grafting, for bone wiring.

“These are ordinary civilians being broken and the health system is going to have to put them back together again and they need this very specialised equipment,” said Ryan.

WHO also has a large stock of supplies in the country, concentrated in the Ukrainian capital city of Kyiv, Ryan added.  But those stores, right now are “blocked” by the constant bombardments and tightening Russian blockade around the city. 

He appealed for  “humanitarian access, corridors, moments of peace – anything that can be done … where we can move supplies, move patients.”

‘You can’t wait for oxygen’

Dr Mike Ryan

An estimated 2000 COVID-19 patients remain seriously ill in hospital and in need of high-flow oxygen, Ryan added. WHO had warned earlier this week that oxygen was in short supply for those people and others with chronic conditions. But there are now soaring needs for more oxygen to treat the war-wounded, children struck with pneumonia, as well as mothers and newborns birthed in desperate conditions. 

“Oxygen is lifesaving, full stop. And when you need it, you can’t wait until tomorrow,” Ryan said, warning that without a replenishment of supplies soon “people will die needlessly in the dark. They are dying needlessly to start with, but there is a secondary level of needlessness”.  

“When you see nurses mechanically ventilating infants in basements of hospitals, even the toughest of us struggle to watch those heroes… taking care of those kids.

“It’s really important that we don’t just break this down into supplies and commodities that we have to deliver,” he stressed. “This is people’s bodies. People’s bones are broken, people’s lives are being lost.”

WHO training in mass casualty management

Ryan also disclosed that the WHO had been conducting training in “mass casualty management and major surgical training” in hospitals all over Ukraine over the past few months – in anticipation of a possible Russian invasion. 

However, when asked why the WHO never mentioned Russia in its statements, Ryan said that the WHO stood for peace and did not want to get involved in the politics of the conflict.

“Our primary purpose is to sustain and preserve the health system in Ukraine that may serve the people of Ukraine and we will do everything in our power to make that happen,” said Ryan.

Attacks on health facilities violate international law

COVID-19 patient in severe state in Chernivtsi, Ukraine
COVID-19 patient in severe state in Chernivtsi, southwestern Ukraine. As the SARS-CoV2 pandemic wanes, a health emergency – created solely by human forces.

The senior leadership was more outspoken about attacks on health facilities and health workers are, which Dr Tedros described as a violation of international law.  He said that the WHO had confirmed one such report, which killed four people, and was in the process of verifying reports on several other incidents. The Ukrainian army claimed yesterday that a hospital had also come under attack in Kharkiv after Russian forces landed in the city.

“We have received several unconfirmed reports of attacks on hospitals and health infrastructure and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers,” said Dr Tedros.

“The sanctity and neutrality of health care, including of health workers, patient supplies, transport and facilities, and the right to safe access to care, must be respected and protected.”

Maintaining COVID-19 care during a war

Dr Jarno Habicht, WHO Ukraine

Dr Jarno Habicht, head of the WHO’s Ukraine Country Office, said that while there was a protocol in place to move goods from Poland to Ukraine, this was only possible where direct military offensives are not taking place.

“So there is certain access, but as the situation evolves, that access is decreasing and the challenge is that where the major needs are for the surgery, trauma care, there we don’t have access,” said Habicht.

He added that an Omicron-driven COVID-19 outbreak had peaked in Ukraine in mid-February and although this wave had been milder, many elderly people had been hospitalised.

The mass movement of people throughout the country to try to avoid the war is now likely to exacerbate the spread of the virus once more, he warned.

“Infectious diseases ruthlessly exploit the conditions created by war: the increase the transmission of these diseases from the crowding, the conditions. More people are vulnerable in the settings and there’s less care available for them. It’s as simple as that. What can we do about it? Number one, stop the war,” said Dr Bruce Aylward, a WHO special adviser.

Over 870,000 refugees from among Ukraine’s 44 million people, have already entered surrounding countries, which also are battling COVID-19, Dr Heather Papowitz, the WHO’s incident manager for Europe, reported. This inflow also will strain their health systems, she predicted. 

UNICEF and UNHCR also issue warnings 

WHO’s briefing came just hours before the UN General Assembly voted overwhelmingly to “deplore” the Russian invasion. The vote came in a resolution supported by 141 of the Assembly’s 193 members, at an emergency session called by the U.N. Security Council. 

Meanwhile, UNICEF also called for an immediate suspension of hostilities, and the UNHCR warned that the humanitarian crisis being seen now, on day seven, of the crisis, is only the beginning. 

“As we speak there are 520,000 refugees from Ukraine in neighboring countries. This figure has been rising exponentially, hour after hour, literally since Thursday.” said High Commission Filippo Grandi, in a Tweet Tuesday. And indeed, 24 hours later, WHO estimates were that more than 800,00 people had fled.  

Meanwhile, heavy fighting continued in the strategically-located Black Sea port city of Kherson, while Russia claimed that it had taken control of the city, following hours of continuous air strikes and bombardment  that has destroyed thousands of homes, and forced hundreds of thousands of people to flee – if they could. 

Russia meanwhile continued shelling and bombing other key cities, including Kharkiv and Mariupol, in its efforts to subdue the country that has shown unusually stiff resistance, despite the overwhelming imbalance of weaponry in favour of Moscow. 

Mariupol was near a “humanitarian catastrophe,” after more than 15 hours of continuous bombardment, its mayor told BBC. He said water and power to parts of the city had been cut off, a densely populated residential district nearly flattened, and hundreds of people were dead – with no way to even retrieve the bodies.

Speaking to Health Policy Watch, diplomatic sources in Europe warned of a pending Russian attack on Kyiv, around which a massived columns of tanks and armored personal carriers have been grouping over the past few days, despite stiff Ukranian resistance on the roads. The next stage of Russian attack could likely involve “precision guided missiles,” aimed at the key government buildings of the city center.

“Don’t know how precise it will be, there will certainly be lots of casualties,” said one source.  

“We see hospitals are being bombarded, people have nowhere to go.  They have bombed out whole cities and there are no green zones for non-combatants.  People don’t have bomb shelters because Ukraine hasn’t fought anyone since World War II. It’s like Canadians fighting Americans, no one could have imagined it could go to this level of barbarity and cruelty,” said one former resident of Kyiv, who spoke with Health Policy Watch.

–Elaine Ruth Fletcher contributed to this story

Image Credits: Elena Mozhvilo/ Unsplash, UNICEF/UN0599222/Moldovan, Mstyslav Chernov/ Wikimedia Commons.

WHO NCD Director Dr Bente Mikkelsen

As streams of Ukrainians leave their country to escape from Russian attacks, the World Health Organization (WHO) is concerned that they, and other migrants and refugees, are not being included in programmes to treat critical non-communicable diseases (NCDs), like diabetes, that can be deadly if treatment is not maintained.

WHO’s NCD Director Dr Bente Mikkelsen said that she had been approached on Tuesday to assist with diabetes treatment for ill Ukrainian refugees.

Addressing the launch of a new WHO review on ensuring NCD care and treatment for migrants on Tuesday, Mikkelsen said that “international migrants, including refugees, may face extreme poverty and inadequate access to food and health care already in their own countries, and then during the migration process, and in the country of destination, they may be exposed by economic inequalities, social exclusion and discrimination.”

“As we speak, unfortunately, we see a new big wave of migration happening due to the horrible situation in Ukraine. This morning, I was contacted by people really concerned about diabetes care in already sick patients, and how we could best support this,” she added.

Meanwhile, WHO Deputy Director-General Dr Zsuzsanna Jakab, said that the 2030 Agenda for Sustainable Development and Sustainable Development Goals emphasised the principles of “leaving no one behind, including refugees and migrants”. 

“Refugees and migrants have specific health needs and vulnerabilities, which in practice, may all too often fail to be recognised and addressed and which may have been exacerbated during the pandemic,” added Jakab. 

“It is imperative that has the health needs of these vulnerable groups is addressed by transmitting and receiving countries using human rights principles and with careful coordination across sectors,” said Jakab, adding that more research was needed to better understand the global trends, magnitude and implications of migration and health as well as how to address migrants’ NCD-related needs

Almost three-quarters (74%) of global deaths are caused by cancer, diabetes, cardiovascular diseases and lung diseases, said Mikkelson and that the lack of investment in NCD care was “dire”, particularly since COVID-19.

The review looks at “academic and grey literature published between 2010 and 2021” that identified major challenges for NCDs in refugees and migrants because of the multifaceted dynamics of the migration processes. 

Migrant-specific barriers in accessing NCD services include cultural and language differences, social exclusion, discrimination and legal status, according to the review.

It calls for strengthened governance and policies, research and data monitoring, and health service delivery to ensure inclusive NCD prevention, treatment and care to meet internationally agreed goals and targets.

EU – AU Summit, February 2022

Two years after the COVID-19 pandemic started, the leaders of the European Union (EU) and African Union (AU) met in Brussels. By then, six million people including 200,000 healthcare workers had died. Yet only one in five healthcare workers in Africa had been vaccinated. This is not good enough.

The rollout of COVID-19 vaccines was neither inclusive nor adequately planned. Of more than nine billion doses produced, Africa – with a population of 1.3 billion – only received approximately 540 million and administered 309 million. In other words, some 1.2 billion Africans have not received a single dose. 

Correcting this injustice as fast as possible is required for the benefit of all. So how can we make it happen? What are some of the urgent and longer-term structural actions needed to get to the other side of this pandemic and, crucially, be better prepared for the next one? It’s only a matter of time. What actions can Africa and Europe take together, at a global level?

I will focus on three main topics. First, is the need to localize production, procurement and supply of pharmaceutical products in Africa, including the most recent mRNA vaccines. Second, the importance of ‘rebooting’ health-related research in the public interest, with more public health professionals and data management for health. And third, we need to move towards a more meaningful and equal partnership between Africa and Europe.

Localizing production, procurement and supply of pharmaceuticals

South Africa’s mRNA hub, Afrigen

When the pandemic, and rush to develop vaccines and treatments, accelerated from February 2020, we already knew certain things. We knew this situation would require a different approach. We knew the entire world would need personal protective equipment (PPE), diagnostics and vaccines, ideally everywhere at the same time. We needed to boost production and make the cake big enough to share.

We also knew that Africa only produced 1% of the vaccines that it uses and that most supplies are procured by global entities in the northern hemisphere. We knew that if the cake wasn’t made bigger fast, richer countries would help themselves as a priority: a “me first” approach.

What I didn’t know was that the G7 Countries would monopolize access and purchase quantities in advance that would be far larger than needed for their own populations. However, when COVID-19 started in March 2020, I had written a proposal for a planned  African-EU summit arguing for localization of production and supply of pharmaceuticals, with a close partnership between Africa and Europe to rapidly invest in Africa’s ability to produce tests, vaccines and therapeutics.

The summit never took place. However, my proposals were strongly echoed by the AU and Africa Centers for Disease Control and Prevention (ACDC) some months later, in October 2020. 

In April 2021, Africa developed an ambitious strategy for the manufacturing of vaccines to move from producing only 1% locally to producing 60% locally by 2040. By the end of last year, enough African countries had ratified the African Medicine Agency for it to be set up as a specialized agency of the AU and set up the start of a co-operation with the European Medicines Agency (EMA).

At the end of 2021, the EU announced its support for some manufacturing sites in Africa. Of course, donations had arrived from the G7 countries and from China, Russia and India. But not enough, not fast enough, and not always with the predictability needed to prepare. Hence the fact that, as I write, 1.2 billion Africans remain unvaccinated.

This is not looking back with the benefit of hindsight. I have repeatedly argued that if the world had moved earlier, if donors and investors had made investments in local manufacturing, if pharma companies had transferred technologies, we would not be in the shocking situation that we find ourselves today.

My pitch to the 2022 Africa-Europe summit was this: it needed to clarify just how ambitious EU initiatives to support localization of production are, how these initiatives align with plans prepared by the AU, how they will go further than focusing on the final stages of filling and packaging, and go beyond voluntary licensing, as so far this has been scarce.

I was also keen to hear how producers on the African continent will be protected from potential patent infringement claims when they produce vaccines while the waiver on intellectual property rights is still on hold unless the EU and Africa could come to a mutual understanding during the summit.

If done properly, localization will benefit Africa, Europe and the rest of the world. I also believe that Africa and Europe can do more to work together to resolve policy issues at a global level. 

Because many donations and the procurement of vaccines in general, and COVID-19 specifically, are organized in Geneva or Copenhagen, this poses a challenge for local producers in Africa to be sustainable – unless the market and procurement are moved to Africa. A change in global health architecture is needed involving Gavi, Unicef and Covax.

Science preparedness and health professionals

Inside Biovac – which is to be the first manufacturing spoke for the mRNA products produced by the South African Hub.

Effective emergency responsiveness now and in the future also requires science preparedness. Africa’s share in the global production of research has more than doubled in the last 20 years, from 1.5% to 4%. Indeed, European-African university collaboration is a longstanding tradition. 

Specifically, epidemic-related research in Africa has been valuable to Africa and the world. A recent example is how, in December 2021, South Africa’s genomic sequencing was instrumental in alerting the world to an unusual profile in samples tested for coronavirus. The African Pathogen Genomics Initiative includes locations in many African nations.

At the same time, ACDC has attempted to co-ordinate research to promote synergies and resource optimization, and to disseminate and translate emergency research outputs rapidly. In general, Africa contributes regularly and significantly to the development of vaccines and treatments for Ebola, malaria and COVID-19 – however, some of the countries that hosted Covid vaccine trials received fewer doses per capita than did higher-income countries. Is this fair and proper?

While the AU recognizes that the EU-AU co-operation in research and innovation has gained momentum, more is still needed. One critical step towards strengthening Europe-Africa science collaboration is a shift from time-limited project-based funding to long-term commitments. Clusters of excellence in certain fields will strengthen the research and innovation capacity of African universities significantly and sustainably, while also benefiting Europe.

Indeed, science preparedness should be embedded within a wider scientific capacity-building agenda to be developed in partnership. A policy area that we can improve on, together at a global level, is reconsidering the relationship between public and private R&D. 

The issue to resolve is whether governments can negotiate differently when signing one purchase contract after another and transfer value from taxpayers to investors in pharma companies. Knowledge and technologies crucial to Covid-19 vaccine development and production were created with the contribution of the public purse; patents filed by pharma companies do not protect the public interest arising from such earlier research.

In addition, the Covid-19 pandemic demonstrated how reliable epidemiological data are often unavailable in resource-limited settings in sub-Saharan Africa, and this knowledge gap is aggravated further by a serious shortage of skilled personnel in epidemiology and biostatistics to efficiently monitor, analyze and interpret these data to inform policy and decision making.

Health professionals need to play an important part in this refreshed narrative. Yet the World Health Organization’s Global Strategy on Human Resources for Health Workforce 2030 has estimated that by 2030, the shortfall in the health workforce in Europe will have reached 1.4 million – and 6.1 million in Africa The situation in Africa has worsened due to COVID-19; a lack of public health professionals and epidemiologists could seriously hamper efforts to equip Africa for outbreak preparedness and response, and for the Africa-Europe partnership to succeed. The Africa CDC has already developed a framework for public health workforce development, and this requires strong support from Europe.

 African health data is a game-changer

The pandemic also accelerated digital transformation, for some at least. And as we know from various commercial and public arena, power and impact today is all about data: who controls it, how data can be accessed, and how it can be harnessed to inform planning and more positive outcomes. I am therefore arguing for a pathway towards an African Health Data Space.

The creation of a European Health Data Space is already one of the European Commission’s priorities for 2019-2025. An African Health Data Space would promote more robust exchange and access to different types of health data including electronic health records, genomics data, data from patient registries, to support healthcare efforts, health research and policymaking.

Europe’s contribution to such efforts might include pioneering the ethical and human rights-based legal frameworks for effective and secure digital health and data management. Indeed, there will be best practices and lessons learned of interest for the AU in designing and developing its own data frameworks.

The successful planning and launch of an African Health Data Space in partnership with a similar European initiative could be a game-changer. Indeed, there is a global policy interest: if Africa can establish a similar space, the two data spaces could provide a strategic gateway for Europe and Africa to collaborate on mutually beneficial research.

The global level opportunity arises if both data spaces are aligned to goals for interoperability and promoting open standards, personal data protection and privacy. The result would be to foster and build a vibrant approach to digitalization for health, including the development of telehealth to reach and benefit the most vulnerable citizens while protecting healthcare personnel. Such outcomes are well worth pursuing.

No more ‘me first’

Throughout this and previous pandemics, the strength of regional co-operation, the national health systems of individual countries, and community healthcare workers have been critical success factors. But that is not enough.

True pandemic preparedness requires speed, agile systems, trust, the highest levels of ambition, efficient regional institutions, and enlightened political leadership that shuns a “me first” attitude. European and African leaders need to take bold decisions and pursue ambitious actions to correct the scandal of vaccine inequity, to strengthen Africa’s systems to deliver vaccines, to support African research and manufacturing capacities, and together to reshape the global health architecture to be better prepared.

The good news is that Africa recognizes the need to emancipate itself from “the global north”. This itself might help the continent to become more resilient and not create new dependencies. Countless examples exist that demonstrate how global health structures are about the north giving the south what the north thinks it needs. Not what it actually wants. Together, we can make health about the global good — and not about the north’s priorities alone.

 

Lieve Fransen

Dr Lieve Fransen is a global health expert who advises several think tanks. She is a former senior director at the European Commission, lead the creation of the Global Fund for HIV/AIDS, Malaria and TB and is a medical doctor with a PHD in policies and long experience working in Africa and Asia. The article is based on the keynote speech that she delivered at the European Union-African Union Summit, at a session on Critical Issues For AU-EU Collaboration On Health And Science

Image Credits: Kerry Cullinan.

Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter.

Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats.

The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year.

Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control.

It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating  in the Huanan market in the early days of 2020 alongside its sequel, Lineage B.

That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market  – whereas Lineage A was the first to spread among people in the city of 10 million.

China study corroborates findings of University of Arizona researchers

Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues.

The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak.

While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held.

The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by  bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2.

Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report

Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020.  Around one-third were lineage A and two-thirds were lineage B.

“We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B.  The patterns in the phylogeny are the giveaway,” according to Worobey.

The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include:  a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold.  And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed.

In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more…

“It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus.

Market is epicentre

The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported.

According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.”

Based on these maps, “Huanan market sits right in the highest density region,” he adds. 

“This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. 

In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market.

Chinese paper also points to the market

In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported.

The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported.

Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study.

But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”.

Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC.

This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base.  And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak.

-Elaine Ruth Fletcher contributed to this story.

Image Credits: Arend Kuester/Flickr.