Alzheimer's Disease and dementia can lead to loneliness in old age.
Alzheimer’s disease is the most common type of dementia found in elderly people.

The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. 

The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. 

WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. 

Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. 

Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. 

The blueprint summarises the current state of dementia research across six themes including  drug development, clinical trials,  care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. 

According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. 

WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. 

“Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.”

At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. 

However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. 

In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. 

“We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. 

Image Credits: Photo by Steven HWG on Unsplash.

Bacterial culture prepared for testing new antibiotic candidates.

Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action.

We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making.

The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.”

A threat with more deadly potential than COVID-19

As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites.

This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019.

Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now.

Disproportionately affects the most vulnerable

Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes.

Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene.

Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. 

This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.”

Fixing market failures

Antibiotics being distributed at a pharmacy in India.

There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. 

First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. 

A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most.

We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative.

More ‘pull’ incentives

The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use.

I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion.

One Health and AMR

Inspecting a pig’s health in Busia in western Kenya.

Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors.

It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. 

And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined.

Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies.

Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future.

To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together.

Dame Sally Davies
Dame Sally Davies

Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009.

 

Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith.

After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare.

“The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.”

Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association.

One billion migrants

Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe.

“The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.”

Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare.

“We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says.

Separating border control and healthcare services

According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential.

“If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices.

The health journey of refugees and migrants is global health - Global Health Matters podcast
The health journey of refugees and migrants is global health – Global Health Matters podcast

Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing.

On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will.

“People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.”

Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR.

Shionogi’s ensitrelvir

The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval.

The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week.

According to the voluntary licence agreement,  the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries.

“Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP.

The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill.

Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients.

“Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada.

MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. 

MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory.

It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV.

Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates.

The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. 

Africa CDC’s acting Director General, Dr Ahmed Ogwell Ouma

Global vaccine purchasing mechanisms including Gavi and the United Nations have been urged to purchase a minimum of 30% of their vaccines from African manufacturers, according to a resolution, Call to Action: Africa’s new public health order adopted by African member states on the sidelines of the recent United Nations general assembly (UNGA).

The resolution, championed by the African Union Commission and Africa Centres for Disease Control and Prevention (Africa CDC), argues that vaccine-purchasing mechanisms can stimulate private sector investment in vaccine manufacturing.

While Africa currently produces only 1% of its routinely used vaccines, the continent has set a bold target of meeting up to 60% of its vaccine demand through regional manufacturing by 2040.

The full implementation of Africa’s New Public Health Order will drive global health security, according to Africa CDC which presented the call to governments, multilateral organizations, philanthropies, the private sector, and civil society organizations on the sidelines of the 77th UNGA.

Africa CDC’s acting Director General, Dr Ahmed Ogwell Ouma, revealed the five pillars for the order including strong African public health institutions that represent African priorities in global health governance, and expanded manufacturing of vaccines, diagnostics, and therapeutics to “democratize” access to life-saving medicines and equipment. 

Other pillars include investment in public health workforce and leadership programs to ensure Africa has the workforce it needs to address health threats; and increased domestic investment in health, including the domestic mobilization of financial resources, human capital, technical resources.

Africa’s current ratio of 1.55 health workers (physicians, nurses, and midwives) per 1,000 people is way below the WHO recommendation of at least 4.45 health workers per 1,000 people to deliver essential health services and achieve universal health coverage. 

South Africa’s President Cyril Ramaphosa described health workers as a “crucial pillar” in a well-functioning health system. Yet, they have been historically deprioritized in discussions about improving health systems. He described investing in the health workforce as good economics whose return will be “measurable and dependable”.

“Experience shows that professional community health workers who are properly paid, trained, equipped, and supervised are best prepared to provide essential health services in their communities,” said President Ellen Johnson Sirleaf.

She also highlighted that most community health workers in Africa are women who perform exceptional work but are unpaid for their efforts. “It is time to correct this injustice,” she urged.

Civilian protections
Two Malian former rebel leaders, Attaye Ag Mohamed, left, and Mohamed Elmaouloud Ramadan, right, join Geneva Call’s Director General Alain Délétroz, center, at a signing ceremony in Geneva for a Deed of Commitment on Protection of Health Care in Armed Conflict

Leaders of a coalition of former Tuareg and Arab rebels in Mali signed a written pledge on civilian protections for health and medical facilities during armed conflict, reflecting global efforts to stem attacks on health facilities, transport, and patients that have became more frequent since the onset of the COVID-19 crisis.

The two leaders with the movement seeking autonomy for northern Mali signed the Deed of Commitment on Protection of Health Care in Armed Conflict at a closed ceremony organized by the Swiss-based humanitarian organization, Geneva Call, on Friday.

Geneva Call’s Director General Alain Délétroz and the two Coordination of Azawad Movements (CMA) steering committee members, Attaye Ag Mohamed and Mohamed Elmaouloud Ramadan, affirmed their pledges to enforce civilian protections through the Deed of Commitment, which marks a milestone in Geneva Call’s humanitarian dialogue with CMA over the past four years, the humanitarian organization said in a statement.

Despite its “diversity of opinion on certain social issues, the CMA could agree on a document that comprises the main themes of international humanitarian law,” Attaye Ag Mohamed said, adding that the coalition benefited from Geneva Call’s support and expertise.

“Aware of the importance of the free movement of medical missions and their access to populations targets and vice versa, the CMA can only make its modest contribution to their protection as well as to that of humanitarian convoys in Mali and more particularly in the North of the country,” said Mohamed.

“The signing of this act of commitment thus signals a new phase of collaboration,” he said. “It is up to all of us to put it into widespread use in the field through awareness-raising and training on this important topic.”

CMA pledged to respect international laws insisting on the protection of “health care personnel, facilities and medical transports, and the wounded and sick,” and to adhere to “the principles of medical ethics.”

Geneva Call works to strengthen the protection of civilians during armed conflicts in dozens of countries. The issue of protections for health care workers and facilities has become more pressing in conflicts and wars around the world, including Syria and Ukraine.

Last year, the World Health Organization (WHO) reported that more than 700 healthcare workers and patients had died, and more than 2000 were injured in attacks on health facilities across 17 emergency-affected countries and fragile settings since December 2017. Countries at risk included Ethiopia, Yemen, Syria, Mozambique, Nigeria, occupied Palestinian territory, Myanmar and the Central African Republic.

The three-year analysis ws based on data from the WHO’s Surveillance System for Attacks on Healthcare (SSA), which monitors attacks on healthcare workers, patients, facilities, and healthcare transport, the resources that they affected and their immediate impact on health workers and patients.

Working behind the scenes on protecting civilians

Geneva Call has an unusual remit, persuading armed groups and de facto authorities to respect and apply humanitarian norms and human rights.

These include the conduct of hostilities, protections for children, education, food security, health care and cultural heritage, prohibition of sexual and gender-based violence, forced displacement and humanitarian access.

The Geneva-based humanitarian organization, which has worked in around 25 countries since 2000, also boosts civilian protections by strengthening local civil society organizations and their awareness of international humanitarian norms.

As a result, it says, some armed groups have developed their own monitoring bodies for humanitarian norms and human rights, have trained their senior leadership and field commanders to effectively implement these commitments, and facilitated international access for humanitarian aid to flow.

CMA was created in 2014 as a coalition of political-military movements composed of MNLA/MAA/HCUA, present in Mali in the regions of Timbuktu, Gao, Kidal, Taoudeni, and Menaka. In 2015, CMA signed a peace and reconciliation accord in Algiers with the Malian government.

Four years of work on civilian protections in Mali

Geneva Call began working to improve civilian protections in Mali in 2018.

Since the COVID-19 pandemic began in 2020, Geneva Call says it has worked in Mali to ensure health care access and strengthen respect for humanitarian standards and military codes of conduct.

Two armed groups in Mali previously signed commitments to the Geneva-based organization to provide health care access and to try to prevent the further spread of the coronavirus.

Délétroz told the signing ceremony that attacks on hospitals, medical transport and health workers have increased in conflict zones in recent years, paralyzing emergency services and disrupting the local population – with devastating impacts on the lives of staff and patients, both civilians and wounded combatants targeted because they are among the most vulnerable.

“Unfortunately, Mali is not spared from this trend,” he said. “The deterioration of the security situation has also been reflected in increased difficulties for populations to access health care centers and health workers being targeted on a regular basis.”

The Deed of Commitment with CMA is of “paramount importance,” he said, because it “represents an important step in the humanitarian dialogue initiated four years ago by Geneva Call and the members of the Coordination of the Movements of Azawad.”

On CMA’s side, the coalition affirmed it will improve civilian protections generally and respect and protect health structures and medical missions during armed conflicts in particular. The Canton of Geneva is legal custodian of the document, the first one signed with Geneva Call in Mali since it began working there.

And on Geneva Call’s side, there’s also commitment, said Délétroz, since the organization will continue to work with CMA to stick to its pledges under a jointly developed implementation plan.

“We also hope that this signature can serve as an encouragement to all Malian stakeholders who have a role and responsibility to ensure the protection of civilians,” he said. “For Geneva Call remains concerned about the situation of populations impacted by this conflict.”

Image Credits: Geneva Call.

Malaria control in Nigeria
Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria.

The World Health Organization (WHO) has launched a new initiative to counter the added malaria threat posed by the rapid expansion on the African continent of the mosquito Anopheles stephensi — native to parts of South Asia and the Arabian Peninsula, the organization said this week. 

The initiative comes just as the world struggles to get malaria control back on track – something that the invasive An. stephensi mosquito, which belongs to the same subgenus as  Anopheles gambiae, the primary malaria vector in Africa, expands its range.

“We are still learning about the presence of Anopheles stephensi and its role in malaria transmission in Africa,” said Dr Jan Kolaczinski, who leads the Vector Control and Insecticide Resistance unit within WHO’s Global Malaria Programme. “It is important to underscore that we still don’t know how far the mosquito species has already spread, and how much of a problem it is or could be.”

But with detections of the new vector already reported in several African countries including Djibouti, Ethiopia, Sudan, Somalia and Nigeria, WHO is sounding the alarm bell to Africa’s national malaria programmes. This is particularly the case because of the vector’s ability to thrive in urban settings – unlike An. gambiae.

Moreover, the vector has been found to be resistant to many of the insecticides used today for malaria control – thus posing an added challenge. One study projected that An. stephensi could put an additional 126 million people in Africa at risk of malaria if the mosquito vector were to spread unchecked. Another study estimated that the number of malaria cases in Ethiopia could increase by 50% if An. stephensi were to spread to all receptive areas.

Vector’s ability to spread in cities a big concern

African countries with detected spread of the An. Stephensi mosquito vector.

Of particular concern is the vector’s ability to spread in cities; as Africa undergoes rapid urbanization with 40% of people now living in cities. The WHO noted that An. stephensi is thought to have contributed to a resurgence of malaria in Djibouti City and at least one outbreak of the disease in Ethiopia —both in  2012. So while the overall contribution of An. stephensi to malaria transmission in the region today remains unclear, there is considerable potential for this highly efficient and adaptable malaria vector to undermine the gains made in reducing the burden of the disease, experts say.

For Africa then, the new WHO initiative, described in detail in a new policy brief, could be decisive in the battle to halt further spread of An. stephensi in the region, as well as determining whether it can be eliminated from areas that have already been invaded. 

Specifically, the initiative aims to: strengthen surveillance to determine the extent of the spread of An. stephensi and its role in malaria transmission; and increase collaboration across sectors and borders so as to improve information exchange on the presence of An. stephensi and the success of efforts to control it.

The initiative also will develop guidance for national malaria control programmes on appropriate ways to respond to An. stephensi, and prioritize research to evaluate the impact of interventions and tools against the mosquito vector.

Getting malaria control back on track

In 2020, malaria deaths rose by 12% as compared to the year before, as a result of pandemic-related service interruptions. Following a longstanding pattern, the vast majority of all malaria cases (95%) and malaria deaths (96%) were located in the African Region, with an estimated 80% of all malaria deaths in the region among children under the age of 5.

In June 2022, Philip Welkhoff, Director of the Malaria Program at the Bill & Melinda Gates Foundation, told Health Policy Watch that the world has lost years of progress on malaria control thanks to the COVID pandemic, with malaria mortality close to what it was almost a decade ago.

“Malaria is really unforgiving. And when there are disruptions in either access to care or some of the routine services, that malaria burden will go up. Because of COVID, we’ve gone backwards,” Welkhoff said, in an interview.

The latest, 2021 data now shows signs of recovery in malaria control programmes, according to the latest report of the Global Fund, with increased rates of testing and diagnosis in particular.

Now more than ever, however, “integrated action” that combines all available tools for vector surveillance, control, diagnosis and treatment, will be important in tackling the additional threats posed by An. stephensi to malaria control goals, said Dr Ebenezer Baba, malaria advisor for the WHO African Region.

“Integrated action will be key to success against Anopheles stephensi and other vector-borne diseases. Shifting our focus to integrated and locally adapted vector control can save both money and lives,” he said.

See the related story here:

https://healthpolicy-watch.news/tb-hiv-malaria-rebounds-pre-pandemic-level/

Image Credits: Munira Ismail_MSH, WHO .

Childhood immunisation checks in low-income countries
Doctors in Pakistan check an infant for a scar showing signs of Bacillus Calmette-Guerin (BCG) vaccination – used to protect against TB in high-burden countries. 

Routine childhood immunisation across 57 low income countries declined slightly for the second consecutive year in 2021, following massive pandemic-related interruptions in vaccine coverage in 2020, according to Gavi, the Vaccine Alliance.

Vaccine coverage stood at 77%, one percent less than in 2020. 

Preliminary data between January and May 2022, however, shows signs of improvement in childhood immunisation coverage, according to preliminary WHO data contained in Gavi’s 2021 Annual Progress Report. 

In 2021, 65 million children were immunised in the 57 Gavi-supported countries, generating economic benefits equivalent of more than $18.9 million. Gavi-supported countries also contributed $161 million in co-financing to advance national commitments to childhood immunisation, and ensure programme sustainability. 

Gavi countries also administered more than two billion Covid-19 vaccines in 2021. 

“Since 2019, we have seen the biggest sustained drop in routine immunisation in a generation, and millions of children are still missing out,” Catherine Russell, UNICEF’s executive director said. “Immunisation is one of the world’s most effective and cost-effective public health interventions.” 

This is not the first time that global health organisations have flagged this issue. In July, WHO and UNICEF sounded the alarm on the largest sustained decline in childhood vaccinations across the globe in 30 years. As per their estimate, around 25 million infants missed out on routine lifesaving vaccines due to many factors like increased conflicts that blocked immunisation access and Covid-19.

Signs of improvement in 2022

Though childhood immunisation numbers declined in 2020 and 2021 due to the Covid-19 pandemic, preliminary data from the World Health Organization (WHO) shows early signs of improvement in 2022. Data collected from January to May 2022 from 16 countries suggests a 2% increase in the basic vaccine coverage among children. 

In December 2021, Gavi also approved funding to support the world’s first malaria vaccine roll-out in sub-Saharan Africa in 2022-2025. 

Expressing disappointment over the continued decline in 2021 in childhood immunisation rates, Gavi’s CEO Dr Seth Berkley said that the early indications on the 2022 data still provides grounds for optimism. 

“There is no higher priority for the Alliance in 2022 than keeping routine immunisation progress on track,” he said. 

Focus on zero-dose children

The number of children who received no vaccine doses in the 57 low income countries increased by 570,000 in 2021, Gavi reported, pegging the total at 12.5 million children. Cumulatively, this is a 34% increase when compared with the 2019-figures – reflecting the much more massive drop in coverage that occurred in 2020, the first year of the pandemic. 

‘Zero-dose’ children are infants who have not received their first dose of the DTP1 vaccine, which protects them from diptheria, tetanus and pertussis. It is one of the first vaccines administered to infants.

In July’s report, 18 million infants out of the 25 million who missed out on lifesaving vaccines did not receive even a single dose of the DTP1 vaccine, thus increasing their risk of dangerous diseases like diptheria, tetanus and pertussis.

Prof José Manuel Barroso, chair of the Gavi Board, said that leveling out of the decline shows signs of recovery by countries’ “heroic” immunization programmes. “As we move forward, we must maintain our focus on supporting routine immunisation and reaching zero-dose children with life-saving vaccines,” he added.  

Added Russell:  “…we need to…make sure lost ground does not become lost lives.”

Image Credits: CDC Global, Public domain, via Wikimedia Commons.

Public goods
A panel discussion at the WTO’s Public Forum on “Creation and Protection of Public Goods for Health (the Experience of COVID-19)”.

At a World Trade Organization Public Forum this week, public health advocates argued for the creation of a new WTO framework to stimulate voluntary offers by countries to supply more ‘public goods’ to trading partners and the world, including investments, assets and know-how critical to protecting the world against future pandemics and other health or environmental crises.

A panel discussion at the World Trade Organization’s Public Forum on Friday took up the topic of a novel trade-based initiative that they say could help incentivize countries to share new technologies, assets and know-how more readily – not only for meeting health emergencies, but other types of health and environmental challenges.

The idea, says James Love, director of Knowledge Ecology International (KEI), is to create a new framework for recognizing ‘public goods’ within the WTO trade rules, whereby governments can make voluntary, but binding, offers to supply such goods to other WTO trading partners – including, but not limited to public health products, investments and know-how.

Examples of ‘Public Goods’ – KEI Presentation at WTO Public Forum.

The initiative on public goods is modeled on the modeled after the General Agreement on Trade in Services (GATS), a landmark deal from the Uruguay Round negotiations in 1995.

GATS is meant to provide a reliable system of international rules for trade in services, and to facilitate the progressive liberalisation of services markets.  But a unique feature of the GATS framework is the opportunity for countries to make voluntary, but binding, “offers” to liberalize domestic trade rules around services provision  – usually in exchange for another type of trade concession. For instance, a country can voluntarily pledge to drop domestic restrictions against foreign firms’ provision of any kind of services – from credit card management to hospitals administration.  But either directly or indirectly, it might obtain, in exchange, commitments from other countries for benefits or concessions – on issues ranging from agricultural subsidies to tariffs on vehicles.

Make ‘public goods’ part of the international trading environment

Excerpted from: KEI presentation at WTO Public Forum.

In a similar vein, a GATS-like framework for ‘public goods’ could allow, for instance, rich countries to pledge to share money or know-how on vaccines or medicines – in exchange for a developing countries’ pledge to reduce tariffs on electric car imports or even to conserve a biodiverse ecosystem of global significance – as part of the wheeling and dealing that anyways takes place around more conventional trade agreements.

“The idea is to make the public goods part of this trading environment,” said Love and one of the leaders in the novel effort to forge such a new WTO trading framework on such ‘public goods’.

“We’re not picking a fight with the drug companies or the energy companies or anyone else,” he added.

“The decision to supply a public good can be used to get something else you want from other countries at the WTO, or avoid something that you don’t want to do,” said Love. He says that the GATS framework has been highly successful in incentivizing trade liberalization of services precisely because it is heterogenous, but still rules-based.

“It’s not a winners versus losers situation,” Love said of his proposal. “It’s a clever hack at the WTO that has a path forward.”

Public goods debate at the World Health Organization

The question of how and if medicines, vaccines and other public health products could be redefined as ”public goods” also lies at the heart of World Health Organization talks on a proposed new pandemic accord, which began with broad agreement over the summer that a new legal instrument should complement but not repeat provisions of the existing WHO International Health Regulations, while respecting national sovereignty in terms of public health responses.

In those debates and hearings that have since followed, including a new round of public hearings on Thursday and Friday, a significant number of civil society organizations, as well as Asian, African and Latin American nations have stressed that public health responses to the pandemic and investments in R&D for countermeasures should be treated as, and accounted for as public goods- e.g. requiring more public sector investments with the resulting products then freed from profit-based constraints on pricing and distribution.

However, while the campaign to redefine essential medicines and vaccines as “public goods” has been a longstanding aim of many public health advocates – in the realities of the marketplace, it remains that private, not public investments, still drive much critical health related R&D.

Public goods
A slide shown by Antony Taubman, WTO’s director of intellectual property, government procurement and competition division, at a Public Forum discussion

Speaking at the WTO public forum panel, the French virologist Marie-Paule Kieny, a former high-ranking WHO official who now chairs the Medicines Patent Pool, argued “it is really the time to advance” the idea of public goods over “private goods and private profits.”

But making public health resources more broadly available, she said, “will need to be supported by sustainable financing.”

Against those hard realities, incentives for countries to offer up certain kinds of “public goods” in exchange for other types of trade concessions, could be an attractive proposition, panelists argued.

Antony Taubman, WTO’s director of intellectual property, government procurement and competition division, told the forum he believes “it’s a proposal that is quite fertile, in terms of making us all think.”

“More broadly it is a discussion about what it takes to deliver public goods sustainably,” he said. “But it’s also a refection … on how multilateral negotiations work.”

Taubman joked that sometimes “it’s tempting” to call WTO “the World Trade-off Organization,” because of the need to accommodate so many competing interests.

But the “concept of global public goods,” he added, “is in its own a valuable organising idea.”

–Elaine Ruth Fletcher contributed to the reporting of this story. 

Image Credits: John Heilprin, KEI .

EU

“This is really a historic meeting,” said Dr Ilona Kickbusch, co-chair of the European Health Forum at Gastein (EHFG). “Twenty years ago was the very first time there was any talk of a European global health strategy, and it took place right here at Gastein.”

“It was in 2003 that global health first became a part of the EU’s health strategy,” Kickbusch recalled. “But then it disappeared, only to come back in 2010 as the first global health strategy, and now we are working on a second one.” 

Two decades down the road, with public consultations formally closed last week, the European Union (EU) is set to release its second Global Health Strategy before Christmas this year.

“The consultations have taken us from Stockholm to Madrid, but also from Abuja to Columbia,” said Francisco Perez-Cañado, a senior expert at the EU’s Directorate-General for Health and Food Safety (DG SANTE). 

“It has been one of the widest consultations to date, not only including what our stakeholders feel in the member states, but also across the world, and in particular in the Global South.”

The EU plan aims to outline how the region will respond to future pandemics and health threats, and reflect a policy vision that embodies the bloc’s values. In light of the COVID-19 pandemic, EU officials hope to impress upon member states that ensuring more equitable global access to health products worldwide will safeguard global health.

“It is clear that no single government or institution can address this threat of future pandemics alone,” said Paul Zubeil, Deputy Director-General for European and International Health Politics at the German Ministry of Health. 

“The challenges of global health and our reality have changed dramatically since the last EU strategy plan in 2010, so it is a good sign the new European strategy is taking shape. It is absolutely necessary.”

While the draft strategy to be delivered later this year is sure to be ambitious, its  proposals will be at the mercy of the EU’s deliberative processes, and the final plan – expected sometime in the first half of next year – will reflect the views and priorities of its 27 member states.

“You will need to be very lucid that what will come out of the global health strategy will also be a composition of geopolitical agendas,” said Sandra Gallina, Director-General of DG SANTE. “My heart is with Africa, but our member states have many different geopolitical priorities.”

Nevertheless, the inclusive approach to consultation undertaken by the EU has raised hopes that the final plan will ensure that the region retains the role it assumed during the pandemic as a global health leader.

“Global leadership by the EU starts at home,” said Perez-Cañado. “The global health strategy must no longer be only about development, but a truly holistic health approach.”

North-South cooperation: partnerships, not charity 

EU
Sandra Gallina, Director-General of the EU’s DG SANTE.

While the previous EU global health strategy was crafted in European capitals, the new consultative approach has placed an emphasis on the inclusion of partners from across the Global South. 

“It’s been amazing how the EU has really consulted in a different sort of way,” said Catherine Guinard of the Wellcome Trust. “I think the values and ethos of the strategy – equity first and foremost – are so important to its salience and its ambition, and it is quite exciting to think about global health 10 years from now, where the EU has got a comprehensive, coherent roadmap for global health with this strategy as its kind of North Star.”

This inclusion of the views of stakeholders in low and middle-income countries (LMICs) in the drafting process is key to the new plan’s legitimacy, and to many, represents a watershed moment for the transition from charity dynamics to those of partnership. 

“The fact that we’re here is, in itself ,an indicator of some success,” said Dr Ayoade Alakija, member of the Africa Union’s African Vaccine Delivery Alliance and WHO Special Envoy for the Access to COVID-19 Tools Accelerator. “It’s an indicator that the world is listening, that we’re progressing from where we were, to where we should be.”

Alakija was the host of one of the consultative meetings held in the Nigerian capital of Abuja between European Commission officials and delegates from 17 African countries. 

“I remember when that invitation from the ambassador was sent out, there were gasps from some countries saying, ‘Oh my goodness, this is now fully beginning to indicate true inclusion and partnership as opposed to tokenistic participation’,” Alakija said. “Instead of inviting us to the table and saying, here’s what we made earlier, you invite us to co-create.”

Clemens Martin Auer, president of the European Health Forum at Gastein, stressed: “We must stop thinking in terms of charity, and we must begin to think in terms of empowerment.”

Health and climate

Europe’s understanding of the relationship between climate and health is key to the region’s strategic vision. 

“I would love to see the EU really step up and use this strategy as an opportunity to articulate how it will lead on climate and health,” Guinard said. “There’s real awareness across governments now that climate-health is a real issue, but I think there is a gap in leadership.”

To make progress, Guinard explained, the plan needs to push for a transdisciplinary approach in which health policy is integrated with climate, transport, energy and other associated policy areas. 

“On climate and health, this is a real chance to show how the EU can bring together its unique capabilities across policy, science, and politics to really drive effective change to populations in Europe, but also in the Global South,” she concluded.

No future without a health workforce 

Clemens Martin Auer, President of the European Health Forum at Gastein, says global health policy focus must shift from charity to empowerment.

Shortages in the health workforce are perhaps the most critical silent crisis threatening progress on global health agendas worldwide, and the EU strategy is no exception. 

For low- and middle-income economies, staff shortages in rich countries can have devastating knock-on effects for the progress of their health systems, causing medical talent to be frequently poached by high-income economies. 

“This year alone, the UK has hoovered up about 60,000 medical professionals from Nigeria – from Nigeria!” said Alakija. 

“How on earth are we going to have healthy societies in those countries? If we’re going to have a global health strategy, it has to address the difficult questions.”

“We have a lot of – I would say hoovering – of talent from Romania, from Bulgaria, that come over to Western Europe,” Gallina said. “That doesn’t work in Europe, and what we absolutely don’t want is a depletion of the health workforce in Africa.”

Furthermore, the physical and mental well-being of health workers around the world after years on the front lines of the pandemic – an oft-ignored consideration and major contributor to current and future shortages of medical staff – are reaching a crisis point. 

“The health workforce is at the end of its tether,” said Gallina. “That is the crude reality. They are very tired. There is a crisis.”

As one health worker advocate said: “We cannot magically pull a doctor out of a bag. If we are going to put an end to this endless crisis of shortage of health workforces by 2030, we have to start building the pipelines now.”

Pandemic Preparedness: “wake up”

Another essential component of the strategic vision pertains to pandemic preparedness. The status quo, Gallina remarked sharply, is far from acceptable. 

“So let me wake you all up,” she told the room. “Either our patterns change, or the next pandemic will find us in the same place that we were with COVID.

“We need to stop being in this reactive mode,” Gallina continued. “I am fed up that we in health are forced into reaction mode all the time. We wait for something to hit us in the head, and only then do we react.”

The primary mechanism the EU has selected to push for this change of posture is the World Bank’s Fund for Pandemic Prevention, a financial intermediary fund (FIF) to finance investments to strengthen pandemic preparedness and response, with a focus on low- and middle-income countries. 

With the WHO signed on as lead technical partner, the fund aims to address critical gaps in country capacities in areas such as disease surveillance, laboratory systems, and health workforce.

“Yes, we put in $450 million, and the US has put in $450 million, but the important thing will be the proof in the pudding,” Gallina said. “The World Bank must not run this as a development project. It is a health project. 

“A health project means that you listen to the health professionals that you have,” she explained. “If it becomes a development project, it’s lost. It will achieve other things, but not the things we want.”

Any successful approach to global health cooperation must also be adaptable. As crises are unpredictable, so too must world health vehicles be flexible to respond to that reality.

“At the Commission, we often don’t have real tools to push what we want to push, so sometimes we are inventing our tools [as we go],” said Gallina. “And at international level, it might have to be the same.”

Towards a better future

EU
Dr Ilona Kickbusch delivers closing remarks.

Though the final form of the new strategic plan will not be known for several months, the feeling in the room was one of optimism.

“The strategy isn’t just written for the challenges and the problems we know about now”, Guinard said. “But by embedding the science, it is also about the challenges that we don’t know about yet.”

If the plan is to succeed, global cooperation – and the interests of all stakeholders – will be critical. 

“For a collective future to be what we all want it to be, a global health strategy cannot really just be about health,” Akidja said. “We all need to begin to say ‘no!’, it’s not just health. It is education. It is the elimination of poverty. It is food insecurity. It is gender. It is about women’s rights.

“It is important if we are going to build partnerships that we talk together, because I think there is more that connects us in that which divides,” Akidja said in concluding. “Your health is my health, and your health security is my health security.”

Image Credits: Arthur Olesch, Urska Erklavec, Urska Erklavec.