WHO’s recent mission to Afghanistan

Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday.

Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. 

“This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said.

Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”.

It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. 

“Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.”

The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients.

“WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated.

“With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.”

Polio is still endemic in Afghanistan, while measles is on the increase.

  

 

Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012.

Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades.

Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends.

Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN.

But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance.

Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness.

Boycotts and controversy

“The issue of landlessness and land grabbing is not on the agenda of the UNFSS.  Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC).

Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday.

“After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. 

However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment.

Food policy activists protest against ultr-processed food in South Africa.

Desperate need for food policy change

Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. 

“In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program.

Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people.

“The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program.

Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”.

Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin.

Taxes, warning labels and marketing restrictions

Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats”

They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. 

Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. 

“We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds.

“There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.”

Most Mexican kids had sodas for breakfast

Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight.

Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. 

A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population.

South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year.

Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. 

Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food.

These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item.

“Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.”

Safe, nutritious food for all

UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks.

Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”.

“We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman.

She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. 

Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”.

Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling.

 

 

Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media.

Members of Physicians for Human Rights join other NGOs to call for vaccine equity.

Vaccine equity and booster debates are shadowing the lead-up to US President Joe Biden’s planned COVID-19 Summit on Wednesday, with the US reportedly poised to donate another half a billion Pfizer vaccines to the world. 

Israeli scientists reported that people over age 60 who received a third dose of the Pfizer vaccine were five times less likely to become severely ill if they had their first shots at least five months earlier. The findings were published last Friday in the New England Journal of Medicine.

The findings were the largest yet on the outcomes of Israel’s booster campaign, which has so far seen 30% of its population triple vaccinated as the country battles one of the highest COVID-19 infection rates in the world. 

The Israeli findings were regarded as a critical factor in the recommendation by the US Food and Drug Administration’s (FDA) independent advisory panel of experts to approve a third Pfizer booster shot for people 65 years and over or at severe risk of COVID-19 and who were vaccinated at least six months or earlier. 

Last Friday, the FDA expert panel voted by 16 to 2 against booster shots for those over the age of 16, and the FDA itself is expected to announce its decision on boosters this week.

A recent review in The Lancet authored by key scientists from the World Health Organization (WHO) and other institutions argued that there was insufficient evidence to justify booster campaigns in developed countries which had already vaccinated at-risk groups with two courses of the Pfizer or Moderna vaccine. 

However, the review made its case on the serious equity issues around the relative global health benefits of directing third shots to already vaccinated group, as compared to first and second jabs to never-vaccinated people. 

It also relied heavily on a series of smaller, observational trials and laboratory analyses, and did not fully incorporate the Israeli results, which had only just been published in a pre-print format.  

Protests against ‘vaccine apartheid’ at UN

Regardless of the medical arguments for boosters, a rising chorus of politicians and global health advocates have charged that gross inequities around vaccine distribution are creating a “perfect storm” for new variants to emerge among entirely unvaccinated groups – threatening rich and poor countries alike. 

 

On Monday, protestors from a range of health organisations, including HealthGAP and Physicians for Human Rights, grouped outside of the United Nations (UN) headquarters in New York to protest against “vaccine apartheid”.

 

Meanwhile, UN Secretary-General Antonio Guterres expressed concern that the global COVID-19 response might be hampered by the poor relationship between the US and China in a Sunday evening interview with CNN. 

Guterres said there were “two divides” related to the COVID-19 pandemic. The first relates to the “north-south divide where the North took care of its own population and forgot largely about the south”, which was driving mistrust from the south.

“Then there is the geostrategic divide now centred in the relationship between the US and China,” said Guterres, who called on the two superpowers to negotiate on issues of potential commonality, namely “trade and technology”, to make “co-operation on vaccines possible”.

China has emerged as the world’s greatest producer of vaccines.

Jeffrey Sachs, chair of the Lancet COVID-19 Commission, appealed for similar global co-operation in an article for Project Syndicate on Monday.

“Governments of countries where vaccines are being produced – the United States, European Union members, the United Kingdom, India, Russia, and China – need to cooperate under UN leadership to ensure that a sufficient supply of vaccine doses reaches the poorest countries,” said Sachs.

UN Secretary General Antonio Guterres

Hopes have been expressed that a proposed US COVID-19 Summit could encourage  sweeping commitments from other world leaders to change course. 

The White House publicly announced its plans for a virtual COVID-19 summit on Friday where it hopes to secure a firm global commitment to vaccinate 70% of the world’s population by September 2022. 

“This meeting is about expanding and enhancing our shared efforts to defeat COVID-19, building out from previous gatherings of world leaders and ministers in fora like the G7, G20, and Act Accelerator to rally civil society, NGOs, philanthropists, and industry along with world leaders and align on a common vision for defeating COVID-19 together,” White House press secretary Jen Psaki said in a statement.

US President Joe Biden plans to use Wednesday’s summit to call on global leaders to make new commitments to fight the coronavirus pandemic, including fully vaccinating 70 percent of the world’s population by next September and securing billions of additional doses for the developing world, among other targets, according to details obtained by the Washington Post.

Vaccine equity has morphed from being a primarily global health issue, to one with domestic political impacts in the US. Last Friday, Congressional Democrats sent a letter to Biden, urging him to change the current paradigm where rich countries enjoy unlimited access to vaccines while poor countries can hardly get first doses. 

“So far, 5.82 billion doses have been administered globally, but less than 2% of the population living in low-income countries received even one dose,” Senators Tina Smith (D-Minn), Elizabeth Warren (D-Mass) and six colleagues wrote to Biden, citing WHO data on vaccine inequity.  “Clearly, there is an inequitable distribution of COVID-19 vaccine doses, and it is getting worse,” the letter said, calling for “additional U.S. leadership”.

More Biden donations 

Meanwhile, the Washington Post reported that the Biden administration is buying hundreds of millions more doses of the Pfizer-BioNTech coronavirus vaccine, with an announcement slated for early next week, during the UNGA.  But the terms are not finalized, people with knowledge of the deal, told the Post. 

Jeff Zients, the White House coronavirus coordinator, declined to comment on the deal but said vaccine access “will be a big topic of conversation” at the UN General Assembly.

The purchase would bring the US donation of Pfizer vaccines to over one billion – following announcement of an 80 million dose emergency donation in May, followed by a 500 million dose donation in June. mark the second major effort by the United States to distribute vaccine to the world. 

The Biden administration has been adamant that the United States has enough vaccine supply for booster shots and global donations.

“We feel it’s a false choice to suggest it’s either give to the world or not,” Psaki said last Thursday. “We are continuing to increase the supply of vaccines we’re giving to the world. We will continue to have more announcements on that because we want to be the arsenal of vaccines to the world, and we are giving more than every other country in the world combined.

Image Credits: CNN.

The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week.

This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday.

Diseases associated with long working hours accounted for almost 40% of global deaths in  2016, some 750,000 deaths.  People from South East Asia and Western Pacific, men and those over 54 were most at risk.

Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors.

Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. 

Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers.

According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). 

“It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” 

Healthy limits

This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies.

“These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. 

Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. 

Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. 

“These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO.

The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates.

 

A doctor shows Oleg Chutvatov, who receives treatment for tuberculosis at the TB hospital in Kharkiv, an X-ray of his lungs.

The Results Report published by the Global Fund to Fight AIDS, Tuberculosis and Malaria last week illustrates how COVID-19 has pushed us off track in significant ways – particularly with respect to access to tuberculosis (TB) and HIV diagnoses and treatment.  But at the same time, there is better news with respect to the battle against malaria.  And all in all, the picture would be far worse, without the rapid and determined actions that took place across the Global Fund partnership.

Devastating impact on TB access and treatment 

For TB, the new pandemic has been devastating. In 2020, the number of people treated for drug-resistant TB in the countries where the Global Fund invests dropped by 19%, with those on treatment for extensively drug-resistant TB falling by 37%. This means around one million fewer people with TB were treated in 2020 compared with 2019.

For HIV, the impact has also been significant. While it is encouraging that the number of HIV-positive people receiving antiretroviral treatment has continued to grow, the declines in prevention services and testing in 2020 were alarming. People reached with HIV prevention programs and services declined by 11%, while HIV tests taken declined by 22% compared with 2019. Because of the disruptions resulting from COVID-19, the people at greatest risk of infection have had less access to the information and tools they need to protect themselves.

Malaria services fared better

Thus far, interventions to combat malaria appear to have been less disrupted by COVID-19 than the other two diseases. Other than suspected cases of malaria tested – which fell by 4% compared with 2019 – rapid adaptation of malaria services seems to have limited the reverses. However, progress stalled: we did not see the year-on-year growth in provision of malaria services that we need to beat the disease.

 

These numbers are stark confirmation of what we feared might happen when COVID-19 struck. In many countries, COVID-19 has overwhelmed health systems, lockdowns have disrupted service provision, and critical resources have been diverted from the fight against HIV, TB and malaria to fight the new virus. The pandemic has disproportionately impacted the people most affected by existing diseases: the poor, the marginalized, those without access to health care. People avoided going to health centers for treatment out of fear of catching COVID-19 – or of being stigmatized for having COVID-like symptoms such as cough or fever, which could also be treatable malaria or TB.

Rapid action prevents worse outcomes

Yet it would have been even worse without the rapid and determined actions that took place across the Global Fund partnership to mitigate the impact of COVID-19 on the three diseases. Decades of experience in fighting HIV, TB and malaria with Global Fund support enabled many low- and middle-income countries to respond quickly to COVID-19, using the laboratories, disease surveillance systems, community networks, trained health workers and supply chains put in place to fight HIV, TB and malaria. By the end of 2020, we had invested about US$1 billion to support more than 100 countries fight COVID-19 and mitigate its impact on HIV, TB and malaria. To save lives from both the direct and knock-on impacts of COVID -19, we worked intensively with partners across the world, in countries and through the Access to COVID-19 Tools (ACT) Accelerator.

These efforts prevented an even more catastrophic impact on HIV, TB and malaria. Yet the setbacks we have seen mean that infections and deaths will inevitably rise, reversing the positive trajectory we have achieved for many years. Even more worrying is what’s been happening in 2021, with the highly transmissible Delta variant causing havoc in many countries, once again overwhelming health systems and disrupting other disease programs.

Because of this we have ramped up our investments in the fight against COVID-19. As of August 2021, we had approved a further US$3.3 billion to support 107 countries and 16 multi-country programs to respond to the pandemic with critical tests, treatments and medical supplies, protect front-line health workers, adapt lifesaving HIV, TB and malaria programs, and reinforce fragile systems for health.

COVID-19 as a catalyst

But to beat COVID-19 and protect our hard-won gains against HIV, TB and malaria, we must do more. The direct and knock-on death tolls from the COVID-19 pandemic are already staggering, and the longer it continues the deeper will be the scars – in health, the economy and society.  T

wenty years ago, the Global Fund was created to step up the fight against the three infectious diseases that were then killing most people. Working as partnership, we proved they could be beaten back – and an extraordinary 44 million lives have been saved. Now we must step up again: to arrest the new pandemic, get back on track against HIV, TB and malaria, and build resilient systems for health that can protect everyone, everywhere, from future pathogens.

Right now, COVID-19 presents a daunting challenge. But if we have the political will, commit more resources, and continue to innovate and collaborate, we can turn the tide on this virus, as we did with HIV, TB and malaria, and ultimately defeat it. We should seize this moment to make everyone safer from the deadliest infectious diseases, whether COVID-19, the earlier pandemics of HIV, TB and malaria, or future pandemic threats. Let us not just beat this pandemic, but use it as a catalyst to build a better, more equitable and healthier world.

Peter Sands is the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

Image Credits: The Global Fund / Evgeny Maloletka, Global Fund to Fight AIDS, Tuberculosis and Malaria.

Health gains of Afghanistani women and children are in danger.

Iconic places across the world will be lit up in orange on World Patient Safety Day on Friday to highlight the global campaign to reduce preventable deaths in childbirth and pregnancy and deliver safe maternal and newborn care. 

The International Alliance of Patients’ Organisation (IAPO), which I lead, and the alliance we are a member of,Fight the Fakes Alliance (FTF), will actively participate.

Afghan women, many already fearing for their lives with the return of the Taliban, may well be watching too. In the two decades of civilian rule since the Taliban were defeated in 2001, infant and child mortality has dropped by some 70% – the fastest reduction among low-income countries. The rate went down from 191 deaths per 1000 live births in 2007 to 49 in 2018, according to Dr Mohammad Razai, an Afghan doctor working in London,

What’s more, Razai says, maternal mortality was more than halved, declining from 1100 deaths per 100,000 live births to 396 as access to healthcare and sanitation rose dramatically. 

All of this is now at serious risk, as is the progress the world made in the same period to combat preventable deaths in pregnancy and childbirth, far too many of them caused by sub-standard and falsified medicines.

The COVID-19 pandemic has negatively affected the often-fragile lives of mothers and their babies, and also brought a surge in the purchase and use of falsified medicines and the promotion of fake treatments.

Ensuring mothers and babies get high-quality medicine

That is why, on this special day, we are urging the global community to back moves to provide mothers and newborns with the extra care and high-quality medicines they need. 

Every single day, approximately 800 women and 6 700 babies lose their lives around the time of childbirth, according to the World Health Organization (WHO). In addition, nearly 5,400 babies are stillborn daily, with 40% of these deaths occurring in relation to labour and childbirth. 

Most stillbirths, maternal and newborn deaths and harm can be avoided by safe, respectful and quality care during pregnancy, childbirth and in the first days of a baby’s life. Sub-Saharan Africa and South Asia, two of the epicentres of fake medicines, account for 86% of these deaths. 

Safe and quality care provided by skilled health professionals working in supportive environments is key. But there are other, smaller things we can do. One is to ensure that patients are safe and secure and, critically, can trust their local health services. 

Fake and sub-standard medicines to manage hemorrhages, pre-eclampsia, eclampsia and sepsis proliferate in low- and middle-income countries (LMIC), according to a recent article.

Almost half the samples of uterotonic medicines to induce or speed up labour failed quality tests. Three-quarters of ergometrine supplies failed, while almost 40% of oxytocin and misoprostol also failed. 

These drugs are deemed by the WHO to be “the most effective and safest drug of choice for the control, prevention, and management of postpartum haemorrhage — the leading cause of maternal mortality globally.”

Fake products undermine patient trust

In Nigeria, one of the richest countries in Africa, the likelihood of a woman receiving poor-quality or even fake oxytocin is very high, Devex reported, citing Dr Chimezie Anyakora, chief of party in Nigeria for the Promoting the Quality of Medicines. 

It also quotes a prominent local gynaecologist who recountedd how he had to go out on a Sunday and find genuine oxytocin after that which he had administered was manifestly not working.

Fight the Fakes has also reported on the experiences of Ghanaian patient Victoria Amponsah who first received fake malaria medicine while two months’ pregnant then, at the end of her pregnancy, she was deceived by a fake version of oxytocin in an official-looking package. 

“Within 30 minutes, Victoria started sweating, shaking, vomiting and bleeding. She was in the hospital for two days, nearly lost her baby and had to return to the hospital every week after the incident for some time,” according to Fight the Fakes.

In line with the WHO in its Global Patient Safety Action Plan 2021-2030, we call on the global and local communities to step up their efforts to stamp out unsafe and fake products. 

To build back better and ensure we have people-centred, accessible, acceptable, affordable, and quality healthcare and universal health coverage, we first must ensure patient safety. 

Safe care fosters trust in health systems, health professionals and medical products – but products that do not adhere to the highest standards of quality can undermine this trust Addressing fake and sub-standard medicine will require monumental effort on all our parts. But one key lesson from the pandemic is that we are all in this together.  

Kawaldip Sehmi is the CEO of the International Alliance of Patients’ Organisation (IAPO), a member of the Fight the Fakes Alliance.

Kawaldip Sehmi

 

 

 

Image Credits: Ahmadi/ UNICEF.

Panelists at the Africa Young Innovators for Health Award Ceremony, held on Thursday.

Africa has the highest entrepreneurship rate in the world, yet greater financial resources are needed to ensure that innovation can be implemented to strengthen health systems and the welfare of health workers, said panellists at an innovation award ceremony on Thursday.

The Africa Young Innovators for Health Award, co-organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and Speak Up Africa, launched its first competition this year designed to highlight and support the work of pioneering young African entrepreneurs in the field of health innovations, particularly healthcare solutions to support healthcare workers. 

Attracting over 300 entries from 33 countries, the winners had developed innovations to assist in cancer diagnosis, health worker development and patient record retrieval.

Winner Dr Conrad Tankou, CEO of Global Innovation and Creativity Space in Cameroon, developed GICMED, a suite of medical technologies that helps to screen and diagnose breast and cervical cancer in women. 

Dr Conrad Tankou, CEO of Global Innovation and Creativity Space, won first place for the Africa Young Innovators for Health Award.

Breast and cervical cancer account for 50% of all new cancers in Sub-saharan African women. Healthcare workers can be trained to use the technology to remotely screen women with real-time pathology confirmation and connect them to a point of care for treatment. 

“It is an honour to receive the first-ever Africa Young Innovators for Health Award,” said Tankou. “With the Award’s financial and business mentorship support, we can upgrade our technologies and start scaling our solution much quicker by investing in manufacturing capabilities and building more local partnerships.”

In second place was John Mwangi, CEO of Daktari Media Africa in Kenya, who established Daktari Online, which provides a professional development platform for healthcare workers. 

John Mwangi, CEO of Daktari Media Africa, won second place for the Africa Young Innovators for Health Award.

Currently 13,000 health workers use the platform and it has been accredited by the regulatory bodies for pharmacists, pharmaceutical technologists, and physician assistants.

“The practice of medicine requires continuous updating…and that’s what we seek to do,” said Mwangi. “We said why don’t we just democratize [access to information and professional development] and have this accessible to people even from remote areas.”

The third-place winner, Dr Imodoye Abioro, CEO of Healthbotics in Nigeria, developed an artificial intelligence (AI) powered electronic medical record system – Mediverse – that utilizes blockchain to help healthcare workers input and retrieve patient records. 

Dr Imodoye Abioro, CEO of Healthbotics in Nigeria, won third place for the Africa Young Innovators for Health Award.

The technology could work on any device and even in places where the internet has not yet reached.

“We do not have enough healthcare workers for the disease burden we’re battling,” said Abioro. “The first thought we had was how do we make the healthcare worker more effective, how can he or she see more patients, how can he or she be smarter or faster.”

“Mediverse is what we consider to be a solution that will be necessary for us to build a sustainable healthcare infrastructure in Africa upon,” Abioro added.

“This could really revolutionize the way that healthcare workers are able to access the data they need about their patients in real time,” said Nicole Kayode, CEO and Founder of Medixus. 

The winners take home between US$15,000 and US$40,000 and will benefit from a business mentorship program, media exposure, technical training on intellectual property protection, and expert advice from an extensive network of stakeholders working across healthcare mediums.

More investment needed

Some 22% of Africa’s working-age population are starting businesses, “yet more investment in human capital is needed for this demographic potential to reap the development rewards it should,” said Thomas Cueni, Director-General of IFPMA.

“We are confident that the winners of the African Young Innovators for health award will contribute to improving health systems and growing African economies,” added Cueni. 

“We don’t lack ideas or creativity, that’s not what’s missing,” said Dr Awa Marie Coll-Seck, Senegal’s Minister of State of Senegal and former health minister. “Among innovators, it’s often about the lack of financial resources for research…This is what stops them from concretising their ideas and developing prototypes.”

“We need to give [the young innovators] the opportunity to develop ideas and their expertise,” said Coll-Seck.

Africa is the youngest continent on the planet. By 2050, Africa’s youth population under the age of 24 will increase by nearly 50%. This presents an opportunity for rapid social and economic transformation, said the panelists. 

In 2019, sub-Saharan African countries were classified among the hundred best countries in terms of innovation.

Africa facing massive shortages in healthcare workforce

Africa bears a quarter of the global disease burden but faces a shortage of over two million healthcare professionals. Only 2% of the world’s healthcare workforce are from the continent. 

“Our world lacks about 18 million health workers globally and…Africa is the place that really suffers the most from it,” said Pape Gaye, President Emeritus of IntraHealth International, addressing the awards ceremony.

The shortage of human and financial resources invested in the African healthcare system is putting a strain on healthcare workers and the broader national and regional health infrastructure.

“COVID-19 has laid bare the underlying inequities and prejudices in existing healthcare,” said Dr Moredreck Chibi, the World Health Organization’s (WHO) Africa Advisor for Innovation. “Our young people [need to] take the bull by its horn and apply their intellectual capital to address some of these challenges.”

Dr Moredreck Chibi, WHO Regional Advisor for Innovation for the Regional Office for Africa.

“Only this approach will ensure Africa’s sustainable path for the future of health on the continent,” said Chibi. 

“As we are all aware, the COVID pandemic has been devastating and exposed the vulnerabilities of health systems across the globe, including in Africa,” said Dr Lindiwe Makubalo, WHO Assistant Regional Director for Africa. “There could be no better time to draw on the rich human capital, especially among young people, to find solutions to the problems that we are facing.”

“COVID-19 has been a wake-up call for the continent. It is inevitable that we need to think outside the box to solve these problems,” said Makubalo. 

Innovation is a central component of public health

“Innovation has always been the driving force of progress in public health, from vaccines to penicillin to the mapping of the human genome,” said Cueni. “Innovations have changed the world and this has never been more evident than with the COVID-19 pandemic.”

Vaccines and treatments for COVID-19 were developed by pharma companies in record time due to large investments in research and a lot of innovation. 

“We have seen from smartphones to drones, there’s no doubt that technology and innovation are leapfrogging Africa and future young African entrepreneurs are playing a crucial role by developing creative ideas that can resolve the various health challenges on the continent,” said Cueni.

Thomas Cueni, Director General of the IFPMA, at the award ceremony on Thursday.

The panelists called on countries to support efforts and innovations of the youth by harnessing domestic resources through advocacy for partner financing and the creation of platforms to showcase initiatives.

Partnerships with private sector are essential

“We all know that innovation is best when it is tailored to the local context and that we should think about those who need it most when we’re creating them, and how we can create the most impact,” said Yacine Djibo, Founder and Executive Director of Speak Up Africa. 

Yacine Djibo, Founder and Executive Director of Speak Up Africa.

Building science, technology, and innovation capacity, as well as stimulating the existing entrepreneurial culture in Africa should be a priority, said Djibo. 

Collaboration with the private sector will increase the opportunities for innovation and help the continent build sustainable health systems.

“Health system strengthening and the potential of Africa’s private sector are crucially important for unleashing the entrepreneurial power of Africa’s young people,” said Cueni. “This will create innovative and compelling modern businesses, increase the capacity for these businesses to compete regionally and globally, attract both domestic and foreign investment, and diversify investment profiles.”

This will contribute to job creation and economic growth across the region.

“By leveraging its resources, expertise, networks, infrastructure, and assets, the private sector can focus on innovation for new technologies, systems, and processes, [and] can influence policy and form partnerships that will have continent-wide impact on the populations,” said Cueni. 

“We are extremely impressed by the quality of the applications we received. These applications are a shining example that young Africans are bursting with creativity and are constantly looking for local-based solutions that work,” said Djibo.

With only one-fifth of applications to the innovation award coming from women, the IFPMA and Speak Up Africa have launched the Women Innovators Incubator to address the gaps in female-led innovation. Three female participants will receive financial support, mentorship, media training, expert advice on intellectual property protection, and access to a network of global health experts.

Image Credits: Africa Young Innovators for Health Award, Africa Young Innovators for Health Award.

The South African mRNA hub aims to make Moderna-like vaccine.

Countries with high COVID-19 vaccination rates have pre-purchased over two billion excess vaccine doses, limiting the supplies available for low- and middle-income countries (LMIC).

This emerged from a meeting on Thursday between the heads of the International Monetary Fund, World Bank Group, World Health Organization and World Trade Organization – the multilateral Task Force – and CEOs of leading vaccine manufacturing companies.

Meanwhile, the South African mRNA technology transfer hub set up in July to enable Africa to manufacture its own vaccines is moving ahead with plans to make a “Moderna-like” vaccine – despite a lack of co-operation from either mRNA manufacturer, Moderna or Pfizer-BioNTech.

This was confirmed to Health Policy Watch by Dr Marie-Paule Kieny, Chair of the Board of the Medicines Patent Pool in Geneva and President of the French Scientific Committee on COVID-19 vaccines.

“The mRNA hub doesn’t need direct transfer of technology from Pfizer/BioNTech or Moderna, as enough information on production process is available publicly and as there are no patent on mRNA vaccines in any African country,” said Kieny, who recently visited South Africa to work with local hub partners.

“The hub will therefore work with technical experts to recreate a new ‘Moderna-like’ vaccine,” added Kieny.

Appeal to swap doses, deliver to COVAX and AVAT

To alleviate COVID vaccine shortages in LMICs, the task force called on wealthy countries to urgently “swap their near-term delivery schedules with COVAX and the African Vaccine Acquisition Task Force (AVAT)”, meet their dose donation pledges with “unearmarked upfront deliveries to COVAX”, and release vaccine companies from options and contracts to enable these doses to be delivered to LMICs. 

Without these urgent steps, the world is unlikely to meet the WHO’s target of vaccinating 40% of the global population by the end of the year.

“Despite adequate total global vaccine production in the aggregate, the doses are not reaching LMICs in sufficient amounts, resulting in a crisis of vaccine inequity,” the task force said.

It also appealed for transparency about the supply of vaccines, calling on vaccine manufacturers to share details on month-by-month delivery schedules for all vaccine shipments, especially for COVAX and AVAT. 

It also called on all countries to urgently address export restrictions, high tariffs and customs bottlenecks on COVID-19 vaccines, raw materials and supplies.

The task team welcomed the pharmaceutical CEOs’ willingness to ‘work collectively to end vaccine inequity” and “readiness” to form a joint technical working group with the Task Force to exchange and coordinate information on vaccine production and deliveries.

However, the big pharmaceutical companies have been unwilling to work with the mRNA hub.

‘No point’ in mRNA transfer

In response to a Health Policy Watch question, Pfizer CEO Albert Bourla said that he didn’t see the point as the tech transfer “would take years”, and that producing mRNA vaccines was what Pfizer did. 

Kieny confirmed that the Medicines Patent Pool, WHO and others had reached out to the mRNA vaccine manufacturers “but up to this point, the companies have not been interested”.

Vaccine manufacturers are apparently wary of new manufacturers competing for raw materials and customers.

Shortly after the mRNA hub was announced, Pfizer revealed that it had made a deal with South African pharmaceutical company and hub member Biovac, to “fill and finish” around 100 million vaccines destined for Africa. 

Kieny described this as “an excellent step forward”, as Biovac will receive technology transfer from Pfizer for the fill-finish part of their mRNA vaccine, “especially as the Pfizer contract does not claim exclusivity”. 

“Biovac will therefore also become the first African manufacturer with a product resulting from technology transfer of the full production cycle from the hub,” said Kieny.

Image Credits: Gavi .

Björn Kümmel, deputy head of the global health division at Germany’s Federal Ministry of Health and chair of the WHO Working Group on Sustainable Finance.

For a long time, the World Health Organization (WHO) has experienced immense financial stress resulting in numerous debates on how to remedy its economic woes. A working group set up earlier this year has been tasked with finding long-term solutions.

Each year the representatives of some 194 countries make demands on what work should be carried out by the WHO, but the money needed to carry out the requests is severely lacking.

Björn Kümmel, deputy head of the global health division at Germany’s Federal Ministry of Health, and chair of WHO’s Working Group on Sustainable Funding, recalls explaining the situation to his daughter who asks what the money problem is.

“The family decides to have breakfast with lots of friends. We need to buy 20 buns from the bakery, and there’s a plan in place because we know our guests want different buns. I send my daughter to the bakery to buy 20 different buns but only give her enough money for two,” he says.

Without enough money, Kümmel’s daughter would have to beg for money on the way to the store. Some generous passersby might give her some change, but on the condition that she spends it on specific types of buns. She might be able to bring back home all 20 buns but to a large extent they will not be the ones ordered.

“It sounds absurd when we put it this way but the member states of the WHO, in the same way, do not provide the finances to fund their own priorities agreed to by these countries,” Kümmel told Geneva Solutions.

Increasingly, individual donors have been providing funding money for these “buns”, but often face criticism for financing projects that personally interest them.

Meanwhile, the funds needed to execute the activities of the ever-broadening agenda set by the World Health Assembly (WHA) are lacking. COVID-19 has revealed major discrepancies between the expectations of the WHO and its de facto ability. “The pandemic has shown that we need a strong WHO, now more than ever, and it is clear that it is not strong enough,” Kümmel said.

Sustainability lens

For years discussions have circled around WHO’s funding, prompting its Director-General, Dr Tedros Adhanom Ghebreyesus, to reflect on how these conversations have “remained rather abstract” in a report delivered to the Executive Board.

As a result, the WHO created the Working Group on Sustainable Financing (WGSF), which is tasked with finding long-term solutions to the body’s financial troubles.

Kümmel notes that although finances remain a popular topic amongst the organisation’s members, this is the first time a “sustainability” lens is being adopted. He adds that everyone shares the view that a stronger WHO is needed, which requires more stable sources of long-term funding.

The alternative, continuing with the status quo, poses a threat to global health security and the achievement of the Sustainable Development Goals.

“There needs to be a completely new approach to ensure the WHO has the right finances in place in order to fulfil the world’s expectations,” he says.

The WSFG is working on a proposal that will “enable WHO to have the robust structures and capacities needed to fulfil its core functions,” as highlighted in the meeting report. The final report and recommendations will be taken forward to the WHO’s executive board in January 2022.

Concluding their third and most recent meeting in June, the group has already explored different financing models, including other global health actors’ funding structures that could help recharge the WHO’s coffers, drawing on lessons from other health actors.

Adopting the Global Fund’s so-called replenishment model, for example, would mean raising funds in multi-year cycles. Kümmel says the WHO budget could at least be partially funded this way.

Dr Tedros addressing the WHO’s 149th Executive Board meeting

Since taking office in 2017, Ghebreyesus has made broadening the WHO’s funding base one of the organisation’s main priorities. In 2019, he announced plans to establish the WHO Foundation to secure funds from the public, individual major donors and corporate partners.

The launch of the independent grant-making body came amid controversy over former US President Donald Trump’s decision to halt funding from the US, the WHO’s single largest donor.  The move was later reversed by current President Joe Biden but it had already exposed the health organisation’s heavy dependence on a few major donors.

Approved for 2020-2021, the budget is $5.8 billion, which reflects a $1.4bn increase from the previous biennium, mostly needed for the Covid-19 response. About 16 per cent of this figure stems from mandatory payments known as assessed contributions, paid by its members, which over the last two decades or so, have remained flat at one billion US dollars.

The other way is through voluntary contributions, secured from governments, other UN agencies and the private sector, which make up the majority of the budget.

In recent years the top voluntary contributors, in addition to the US, have included the United Kingdom, Germany and the Bill and Melinda Gates Foundation.

Yet, private players such as the Gates Foundation have come under fire for having some of the most powerful and influential voices in global health, raising questions about the WHO’s independence.

Praise for ‘Big Philanthropy’ donors

Kümmel, however, believes “these voluntary generous donors should be praised because they provide the needed funding in the absence of member states”.

The vast majority of funds coming from the private sector go to the Polio Eradication Initiative, he points out.

“If the WHO didn’t receive these resources, we wouldn’t even be close to an eradication of polio because many member states just don’t put the money on the table,” he adds.

In the last 10 years, the UN health agency has depended heavily on voluntary contributions, which can include both flexible funds untied to specified causes as well as money that can only be spent on activities decided by the donor. Still, in 2018/2019, almost 70 % of the overall budget was financed by funds allocated for specific purposes.

The working group has considered whether the core mandate of the WHO should be fully funded by “un-earmarked” flexible contributions, which favours the organisation’s aspired ways of working, whilst also exploring the importance of expanding the WHO’s donor base.

Following the recommendations of the Independent Panel for Pandemic Preparedness and Response (IPPPR), who share the view that two thirds of assessed contributions should be dues paid by member states, the working group are toying with the idea of whether this figure should be at least 50 per cent, a proposal that has been put forward to the regional committees, which Kümmel expressed had been received constructively and positively.

In addition, the group has put forward to the regional committees whether member states would support and agree to the proposal on increasing assessed contributions as well as adopt an incremental implementation schedule at next May’s 75th WHA.

Contributions from all member states

For Kümmel, all member states should contribute regardless of their economic status. However, he agrees that some countries experience severe financial challenges, thus the current mechanisms in place ensure financial possibilities are accounted for.

At the moment each country is assigned a share of the assessed budget through the WHO’s scale of assessments proportional to the size of its economy, but ultimately it is up to member states to fork out the money, particularly if it is un-earmarked funding.

Coordinated efforts across regions are vital, especially when faced with health crises such as the Covid-19 pandemic. If paired with the loss of funds from major contributors, the results can be devastating.

In 2020, the US fell to the third largest donor position, providing about 8% of the overall budget in the first three quarters. Biden has since restored ties with the body and in February pledged $4bn to the WHO-backed COVAX initiative to boost the equitable distribution of COVID vaccines, however, the full effect of this is yet to be seen.

Germany has similarly reinforced its support to WHO’s work and fight against COVID. Earlier this month the WHO launched its new Hub for Pandemic and Epidemic Intelligence in Berlin. Germany has said it will make an initial $100 million investment to prop up the facility.

The Hub is said to focus on “collaborative intelligence”, where all 194 member states, scientific institutions and civil society could share information openly.

As the coronavirus has demonstrated, the world is not ready to rapidly spot and tackle potential pandemics. The working group believes preparing the health body against such future challenges with the appropriate resources is crucial.

“I think that it is quite clear that the strengthening of WHO post-COVID is a key priority for many countries including Germany. Member states who really want to strengthen WHO understand that ensuring sustainable financing to WHO is one of the key pillars of this,” Kümmel urged.

“We are very supportive of constructive multilateralism in global health. WHO is the global health forum where everyone sits at the table, all 194 Member States, it has a broad global health mandate, and it is fully inclusive.”

This article was first published by Geneva Solutions.

 

Image Credits: WHO/ Violaine Martin, WHO.

German Health Minister Jens Spahn and German Chancellor Angela Merkel have staunchly opposed the TRIPS waiver.

More than 140 former heads of state and Nobel laureates have called on the three candidates in line to be the next German chancellor to declare themselves in favour of waiving intellectual property on COVID-19 vaccines and transferring vaccine technologies.

Germany is leading the European Commission’s refusal to accept the so-called TRIPS waiver proposal put forward by South Africa and India at the World Trade Organisation (WTO).

However, German elections on 26 September could unseat Angela Merkel’s ruling Christian Democratic Union Party, which has steadfastly opposed the TRIPS waiver – apparently in support of BioNTech-Pfizer.

In the letter, addressed to Annalena Baerbock, Olaf Scholz, and Armin Laschet, sent on Wednesday, the signatories stress that German support for waiving patents is vital to overcoming vaccine monopolies, transferring vaccine technology and scaling up vaccine manufacturing around the world to prevent millions more deaths from COVID-19.

Signatories include former French President François Hollande, former UK Prime Minister Gordon Brown, former Colombian President Juan Manuel Santos, former Malawian President Joyce Banda and Helen Clark, New Zealand’s former prime minister. 

Nobel prize winners include Professor Joseph Stiglitz, Professor Francoise Barre-Sinoussi and Elfriede Jelinek.

End the pandemic

They express deep concern with Germany’s “continued opposition to a temporary waiver of the World Trade Organization’s (WTO) intellectual property rules”, at a time in which “the artificial restriction on manufacturing and supply is leading to thousands of unnecessary deaths from COVID-19 each day”. Less than 2% of adults are fully vaccinated in low-income countries compared to almost 50 % in high-income countries.

The TRIPS waiver on COVID-19 vaccines, proposed by India and South Africa in October 2020, is supported by over 100 countries including the United States and France in doing so. 

“Having helped create the most successful vaccine technology against COVID-19, by overcoming pharmaceutical monopolies and insisting that the technology be shared, Germany has the ability to help end this pandemic,” according to the letter.

It also calls on the next Chancellor to ensure that German pharmaceutical companies openly and rapidly share life-saving mRNA vaccine technology with qualified producers around the world.

Commenting on the letter, New Zealand’s Clark stressed: “Germany’s support for a TRIPS waiver in the exceptional circumstances presented by COVID-19 would send a clear signal that all peoples should be able to benefit speedily from available vaccines and therapeutics. Widespread vaccination now and further scaling up of vaccine production will play a significant role in curbing the pandemic.”

Extraordinary power

Meanwhile, Nobel laureate Joseph Stiglitz, said that the new Chancellor of Germany will “hold extraordinary power to turn the tide on this horrific pandemic”. 

“Intellectual property rules are today locking out people across the world from the benefits of life-saving science – it is time for Germany to ensure the transfer of vaccine technologies and join the rest of the world in backing a temporary waiver at the WTO,” he added.

Earlier in the week, ​​Belgian Green Sarah Matthieu, a Member of the European Parliament, said that the European Commission’s opposition to the waiver is “economic”, based on lobbying and financial support from the pharmaceutical companies. BioNTech is a particularly big donor of Germany’s ruling Christian Democratic Union Party, she added.

“We continue to see the Commission really putting big pharma over people’s health. It continues to push its own proposal, that is, if I can say it bluntly, big air. It’s not going to change anything,” Matthieu told a media briefing on Monday organised by Medecins sans Frontieres (MSF), Health Action International, Public Citizen and Third World Network.

Although the European Parliament has passed a resolution in support of starting text-based negotiations on the waiver, this is continually downplayed by commissioners, she added.

The letter was coordinated by the People’s Vaccine Alliance, a coalition of more than 70 organizations including Club de Madrid, Global Justice Now and UNAIDS.

 

Image Credits: Clemens Bilan.