A New Pandemic Treaty, Revised International Health Regulations, or Both? What is the Actual Roadmap?

02/10/2021 Gian Luca Burci

WHO Headquarters in Geneva, Switzerland.

The World Health Assembly is set to make a fateful decision in November over whether to negotiate a new international ‘Pandemic Treaty’ to improve future pandemic preparedness and response. However, major players like the United States, backed by some civil society groups, have suggested that revisions of the existing International Health Regulations (IHR) would be a better path. Amidst the hyperbole of oft-heated debate over which route might be easier, quicker or more effective, it’s important to understand that either option will require careful, systematic planning and execution of a process that is oft-misunderstood.

At the same time, there are some important technical points that must be kept in mind. WHA agreement to adopt a Pandemic Treaty may have a much more sweeping historical sense, than mere revisions of the existing IHR. But a new treaty will only be enforceable among those member states that have ratified it in what is typically a prolonged process – while any IHR revisions that are agreed to would be applicable to all 196 WHO member states immediately.

Ultimately, it is reaching political consensus on the often-charged content of proposed treaty/IHR reforms that matters the most. But to do that, the process also needs careful consideration – and demystification. WHO former legal counsel Gian Luca Burci, Adjunct Professor of international law at the Geneva Graduate Institute, takes apart the procedural issues, and what they mean, ahead of the third working group meeting of member states on the issue, next week.

Pandemic Treaty or IHR revisions – exploring the pathways & process

In May, the World Health Assembly tasked a Member States’ working group with the critical mission of assessing “the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response.”

The Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR) is now tasked with coming up with a recommendation in time for a WHA special session in November on whether the WHA should establish an intergovernmental process “to draft and negotiate such a convention, agreement or other international instrument on pandemic preparedness and response.”

Just two months from the deadline, we understand that discussions in the WGPR are moving towards negotiating a new “pandemic treaty” and revising the International Health Regulations (IHR) in parallel after the November WHA – rather than forcing a choice between them.

While this would be a welcome compromise, there seems to be some confusion, as well as contradictory positions, about the procedural steps required to pursue either option.

Debate is particularly intense over the question of whether amending the IHR or concluding a treaty would be “easier and quicker,” and which option would incentivize more participation and commitment.

While the process will eventually depend on a number of, as yet, unpredictable factors, international law and practice point to some likely steps and procedural requirements, which are reviewed here. This is without reference to the potential content of a pandemic treaty or amended IHR – closely related to questions of speed and difficulty of negotiations. This review also does not purport to be exhaustive; more information can be found in the Geneva Graduate Institute’s “Guide to a Pandemic Treaty.”

Pandemic Treaty – from negotiation to adoption, ratification & entry into force

Launch of the negotiating process

Under Article 19 of the WHO Constitution, the WHA can adopt “conventions or agreements with respect to any matter within the competence of the Organization.” The process leading up to a WHO treaty (“treaty,” “convention,” “agreement” are different denominations but do not change the substance) would therefore be launched by a WHA resolution. The resolution could shape negotiations, for example by requesting that certain issues be included in the treaty or given priority. However, that level of prescriptiveness is infrequent in contemporary treaty practice to leave flexibility to the negotiators.

Negotiating forum

The Health Assembly would establish a dedicated intergovernmental body open to all WHO member states to draft and negotiate the future convention. This step can be articulated in many different ways and there is no single model in international practice. In the case of the WHO Framework Convention on Tobacco Control (FCTC), for example, the process was subdivided into two parts: 1) a working group was firstly established to discuss possible building blocks of the convention before committing to treaty negotiations and 2) after a green light from WHA, an intergovernmental negotiating body was established. However, in many other cases, a single body (labelled for example an “intergovernmental negotiating committee”) was responsible for the whole preparation and negotiation of the treaty. This occurred, for example, with the UN Framework Convention on Climate Change (UNFCCC) and later its Kyoto Protocol.

WHO Director-General Dr Tedros Adhanom Ghebreyesus delivering the closing speech for the 72nd World Health Assembly in 2019, prior to the COVID-19 pandemic.

Negotiating bodies of this nature are invariably open to participation by all member states. In addition, the European Union is a likely invitee with full rights of participation under the rubric of “regional economic integration organizations” (a category that so far includes only the EU). And indeed the EU has already been one of the most vocal advocates of a pandemic treaty.

Participation of other non-state actors

Beyond member states and possibly the EU, one can expect participation to be extended to other actors identified in the 2016 Framework of Engagement with Non-State Actors, most importantly NGOs, international business associations and philanthropic foundations (the fourth group, academic institutions, are not entitled to participate but are sometimes invited ad hoc as experts).

All these actors would participate as “observers” with limited privileges, rather than full negotiators. For example, they usually can only participate in public meetings but are excluded from closed negotiating sessions that often prevail at crucial stages of the process. However, what matters is physical presence at the negotiations to lobby and brief delegates and network with like-minded organizations.

Unlike more technical questions such as “one health” and access to pathogen samples, we can expect substantial civil society mobilization and lobbying behind issues such as equity, human rights and access to countermeasures. These considerations are especially relevant if negotiations resume in person; if the sanitary situation still requires online meetings, the process will have to be adapted and the recent sessions of the WHA and the Executive Board offer a blueprint for that. Virtual negotiations of course are less than ideal for all participants.

Methods of work – geopolitical representation and the demands of consensus decision-making

The body or bodies established by the WHA will have to elect their officers, typically following WHO’s breakdown into six regions. The Assembly can prescribe the make-up of the bureau, as in the case of the WGPR. Appointing the bureau can be a delicate process depending on geopolitical circumstances or competing ambitions. The role of the bureau is not cast in stone but can be decisive for the progress and outcome of work, in particular by working informally behind the scenes to explore options and foster consensus.

The bodies concerned will operate under the WHA rules of procedure, but in practice they enjoy considerable discretion in organizing their work. It is customary, and practically a dogma within WHO, that decisions be only taken by consensus without a formal vote. This increases the importance of the process that has to be perceived as fair, legitimate and inclusive to lead to a result that is at least not unacceptable to any state. The requirement of consensus decision-making carries a lot of inertia all the way to the WHA; even though any state can break consensus by formally objecting and requesting a vote, it is in fact a heavy responsibility to do so and it hardly ever happens.

Negotiations of long and complex instruments usually require dividing the text, or particularly difficult issues, among subcommittees that work in parallel, formally report to the plenary on their progress and are often coordinated by the bureau. Small delegations have understandable difficulties in managing multiple meetings, and there is an established practice within WHO to avoid more than two parallel meetings. Available UN-system practice, however, shows much flexibility to adapt the organization of work and the mix of formal and informal meetings.

Dr Tedros Adhanom Ghebreyesus, WHO Director General, discussing a pandemic treaty in September 2021.

Complex WHO intergovernmental negotiations have often been supplemented by intersessional consultations, either on a regional basis or on specific topics. Regional consultations can be particularly effective in reaching common positions and strengthening the negotiating leverage of groups of countries that could otherwise be overpowered individually.

Duration and frequency of negotiations are difficult to predict

The duration and frequency of treaty negotiations are difficult to predict. The duration of negotiations will depend on a number of factors including the complexity of the issues at hand, the attitude of key countries, the sense of urgency, the diplomatic ability of the bureau, and the intended outcome. A general “framework convention” without detailed and highly prescriptive obligations may be relatively quicker to achieve, but practice shows that even negotiating such instruments requires on average no less than two years. By way of reference, negotiating the UNFCCC took about two years, the FCTC took three years and six negotiating sessions, while its protocol on illicit trade took four years and five sessions. In contrast, negotiating the two IAEA conventions concluded on the heels of the 1986 Chernobyl nuclear accident took just a few months. It is common for the responsible governing body, in our case the WHA, to request progress reports and set a deadline for the conclusion of the negotiations. Even though there are no draconian consequences for not meeting it, it helps focus the negotiations and keep momentum.

The frequency of formal meetings usually depends on available financial resources, the capacity of delegations and the secretariat to manage the workload and the calendar of other intergovernmental meetings. One can usually expect no more than two negotiating sessions of 1-2 weeks per year as a maximum.

How to get to the initial draft?

The initial draft of the treaty is politically and psychologically very important because it inevitably shapes the dynamics of the subsequent negotiations, even for countries opposing it. Even though it is possible for one or more states to come forward with a zero draft text, this is a relatively uncommon step because questions about the motives of the proposing states could affect or derail negotiations. The responsibility to propose a full zero draft therefore can either fall on the chair of the negotiating body (e.g. the FCTC), on the secretariat (e.g. the revised IHR, or in the environmental field the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal, drafted by the UNEP Secretariat).

An important point in this regard is that a zero draft does not come out of thin air, but is the result of previous consultations or preparatory work. In the case of the IHR, the draft proposed by the secretariat was the culmination of many years of technical work and consultations, thus the text was submitted promptly to negotiations after a round of regional consultations. In the case of the pandemic treaty, so far there has been no real open discussion on its scope and content either in the WHA or the WGPR, and it is unlikely that this will occur before the WHA special session. Consequently, it is foreseeable that the body established by the WHA will devote an initial period to discuss or seek expert input on the possible building blocks of a treaty and their challenges and implications. Given the uncertainties and questions surrounding the recent proposals, it would be counterproductive to try to short-circuit an inclusive and bottom-up process for achieving a quick result at all costs.

Adoption of the treaty and next steps

The final draft text would be submitted to the WHA for consideration. As noted above, the Assembly will almost certainly adopt the treaty by consensus. In the unlikely event where consensus could not be reached, Article 19 of the Constitution requires a two-thirds majority (calculated on the basis of valid votes excluding abstentions).

The virtual World Health Assembly nerve center at WHO’s Geneva headquarters in May 2020. The upcoming WHA Special Session will likely take a similar form.

Other steps that can be taken by the WHA will depend on the nature of the treaty and the conclusions of the negotiations. A pandemic treaty will in all probability be a normative instrument establishing its own governance. Relying on precedents including the FCTC, this will include at a minimum a conference of the parties and a secretariat. Initial work on the institutional aspects will require drafting rules of procedure for the conference of the parties and, depending on the institutional arrangements contained in the treaty, financial regulations and a budget. Even though a treaty is a self-contained instrument and its governance will not be part of WHO’s, the latter may end up providing or hosting its secretariat. For all these reasons, the WHA may establish upon the adoption of the treaty a new intergovernmental body to prepare all the foregoing steps and facilitate the work of the first session of the conference of the parties.

Signature, ratification and entry into force

Multilateral treaties are customarily opened for signature for a defined period of time. What matters for the entry into force of the treaty, however, is reaching the required number of ratifications (or adherence, accession, formal confirmation depending on the final clauses of the treaty) and how fast that will occur. The threshold for entry into force has varied wildly in previous treaties, anywhere between 20 and 60 as an average (it was 40 for the FCTC and its illicit trade protocol). The number agreed upon will in practice depend on a compromise between an early establishment of the new legal regime and the critical mass of states required to make it credible and effective.

A review of UN-system treaties shows on average a time gap of between two and four years between adoption and entry into force; the FCTC protocol on illicit trade took six years, probably reflecting its complexity and demands at national level, but the FCTC took only 21 months. A related consideration for the credibility of the treaty will be the attitude of key states, whether and how quickly they will ratify it and whether they will actively oppose it should they choose to remain outside it.

A device occasionally used when it is urgent to start applying a treaty is the so-called “provisional application”, whereby contracting parties indicate in the treaty itself or in a separate act (e.g. the WHA resolution adopting a treaty) that they will provisionally implement the treaty pending its entry into force. A classic but atypical example is the General Agreement on Tariffs and Trade (GATT), provisionally applied from 1947 until 1995. I mention this for the sake of completeness, but it is not a common arrangement for self-intuitive sovereignty concerns.

Most of the foregoing considerations also apply to the negotiation and conclusion of protocols to the treaty, should it be drafted as a framework convention requiring separate instruments to spell out its obligations. Albeit linked organically to the “mother convention”, protocols are separate treaties in their own right. Certain steps of the negotiations will probably go faster than for the original convention since the latter provides an applicable legal framework. However, the experience of the FCTC protocol – 10 years from beginning of negotiations to entry into force and only 63 parties so far – should induce caution and deter over-optimism about “quick wins” or “low-hanging fruits.” Strategic reflection is required on whether to make the implementation of a possible pandemic treaty depend heavily on the conclusion of separate protocols.

A comparison of the processes required for the creation of a pandemic treaty and revising the International Health Regulations.

Amending the International Health Regulations – what is similar or different?

The step-by-step process for amending the IHR is spelled out in Article 55. Amendments can be proposed by any state party or the WHO Director-General (DG). Given the direction that the WGPR seems to be taking, it is likely that any amendment process will be launched directly by the Assembly, thus shortening this initial step.

The possibility of amending the IHR has arisen, and been controversial within WHO, well before the COVID-19 pandemic. With the exception of a highly-technical 2014 amendment extending the recognised lifetime of yellow fever vaccines, successive IHR Review Committees [expert bodies appointed by the WHO DG] have advised against amendments, and the WHO Secretariat has also traditionally been reluctant to move in this direction.

This is due partly to the perceived risk of opening up the entire Regulations to unpredictable and potentially counterproductive revisions that may end up decreasing their credibility and effectiveness. This concern is understandable and legitimate, but, firstly, it applies to any legislative instrument where the risk of unforeseeable outcomes has to be weighed against the need to improve its design and content.

Secondly, the WHA can narrow the scope of the amendments by instructing the negotiating body to only deal with specific issues. While this conditionality is infrequent and probably undesirable in the case of treaties, it would be more plausible with regard to the IHR since the Assembly is their parent body and exercises direct oversight functions over them.

Similar procedural considerations – but requiring a less steep “learning curve”

Most of the procedural considerations involved in the negotiation of a pandemic treaty would apply mutatis mutandis to the amendment of the IHR – and thus are not repeated here.

A possible difference concerns the preparatory work preceding and leading to an initial draft of the amendments. The learning curve for a pandemic treaty could be steeper and longer given the absence of an intergovernmental discussion thus far and the lack of familiarity of many delegations. The IHR and its complexities are better known to the public health and foreign affairs officials following WHO affairs, and it is likely that delegations may be willing to move quickly into drafting and negotiations.

IHR-specific requirements

Article 50 of the IHR provides that the Review Committee shall “make technical recommendations to the Director-General regarding amendments to these Regulations.”

The main consideration, time-wise, is whether involving the Review Committee is a compulsory step, since the procedural requirements in the IHR and the way in which they have been implemented by the secretariat so far, are formal and cumbersome and may lead to delays.

The second and related consideration is at which stage of the amendment process would the Review Committee intervene? Would it make its recommendations before amendments are drafted, on an initial draft, or rather towards the end of the process? The political implications of those different approaches for the negotiations may be considerable.

There are few precedents from which lessons may be learned. The IHR have been amended only once, in 2014, adjusting the requirements for yellow fever vaccination required by some state parties (eg. India) for international travelers arriving from yellow-fever endemic countries (Annex 7). The amendment extended the validity of a well-accepted vaccine from 10 years to lifetime in line with new evidence about the vaccine’s efficacy.

An IHR Review Committee was not created for that occasion, setting a precedent. At the same time, the yellow fever vaccine amendment was limited and very technical. It was recommended by the Strategic Advisory Group of Experts on immunization, a dedicated expert group convened by the WHO secretariat, and the WHO Executive Board proposed the amendment to the WHA.

In contrast, a broad and substantial amendment of multiple, substantive provisions of the IHR, which might cover sensitive issues around the early warning of outbreaks and WHO’s mandate to investigate and enforce IHR provisions, may be seen as something different legally and politically – warranting the creation of an IHR Review Committee.

The possibility of amending the IHR has arisen but the WHO Secretariat has traditionally been reluctant to move in this direction.

The main legal consideration is that the Review Committee is an expert body providing its recommendations to the DG at his request rather than a governance organ partaking of the normative functions of WHO. There can be situations like the one just mentioned, in which that technical input is not necessary or can be provided through different and less time-consuming channels. Moreover, a process initiated by the Executive Board or the WHA is different from a proposal by a member state or the DG.

In my view, convening a Review Committee may be politically but not legally necessary. It is indicative in this connection that Article 55 does not mention the Review Committee, which suggests that its participation is not compulsory.

Adoption of the amendments and entry into force

Article 55 requires that amendments be communicated to state parties at least four months before the opening of the WHA, which may influence the schedule of the negotiating body. As noted above, consensus is the norm in WHO, and that will apply to the adoption of the amendments. In the unlikely event of formal objections, a vote would require a simple majority instead of the two-thirds required for a treaty.

The main difference between a pandemic treaty and amendments to the IHR concerns entry into force. Pursuant to Article 22 of the Constitution and Article 59 of the IHR, the latter enter into force for all member states 24 months after the DG’s notification of adoption, except for those member states that either reject the amendments or file a reservation within 18 months from that notification.

In case of a reservation, Article 62 provides for a rather complex process to determine whether the reservation is compatible with the object and purpose of the Regulations and can be accepted. The Article 62 procedure makes it very difficult in practice to reject a reservation and, historically, the sole objection that I am aware of was by Australia to the 1969 version of the IHR. Opting out of a regulation (or amendments thereof) is a drastic, highly visible and politically heavy decision that states would probably take only for the most serious reasons.

Still, both rejections and successful reservations are possible and would undesirably fragment what should be instead a uniform legal and coordinating framework to achieve global health security. Objections could also create impossibly complex situations, e.g. in case of amendments changing the functions of WHO, because objecting states would remain bound by the different functions enshrined in the original IHR. For these reasons and as noted above with regard to a pandemic treaty, the inclusiveness, fairness and legitimacy of the process are of crucial importance to keep states in the fold even if they are not entirely satisfied of the outcome.

Conclusions – both exercises can be more or less difficult, depending on the political atmosphere

Among the preliminary conclusions that can be drawn is the fact that the two processes, when compared side-by-side, would be substantially similar. However there are some significant differences which will need careful consideration as well.

Significantly, amending the IHR may be faster because: 1) modifying an existing text is presumably easier than negotiating one from scratch, 2) the WHA can define and narrow the scope and purpose of the amendments, and 3) WHO member states are relatively familiar with the Regulations. The need to consult the Review Committee, however, must be clarified – as well as what this might mean for achieving consensus.

The timeline for entry into force of a treaty or any IHR amendments may be similar for either of the two options, but the amendments to the IHR would enter into force for all 196 WHO member states. In the case of a new treaty, a subset of countries will be bound by it once it enters into force, but the timeline for all WHO member states to ratify such a new instrument could be much more protracted – and remains unknown.

Politically, both exercises can be more or less difficult depending on the political atmosphere, the proposals on the table, the ability of the bureau to build consensus and the myriad other factors characterizing any major multilateral negotiation. In both processes, there is great importance in reaching a real and sustainable consensus.

At the same time, joining consensus in the WHA to adopt a pandemic treaty is not necessarily predictive of future ratifications since governments as well as circumstances may change.

In both cases, finally, it will be important to maintain momentum but avoid imposing unrealistic timelines for the negotiations. The Independent Panel’s call for concluding a pandemic treaty in six months is an example of an unrealistic goal in this connection.

Opting into a treaty requires political will and action, which can be highly appealing to politicians. On the other hand, remaining bound by a revised IHR could also be the positive outcome of political inertia and inaction – that is a country’s reluctance to be seen as opting out. The key questions are what is more politically feasible, and what will build more genuine, sustained political commitment to any improved set of international rules that aim to better govern future outbreaks and reduce pandemic risks.

Gian Luca Burci is adjunct professor of international law at the Graduate Institute of International and Development Studies. His areas of expertise are global health law and governance, global health security and the law and practice of international organizations. Between 2005 and 2016 he was Legal Counsel of WHO.

Updated on 07.10.2021 with a description of the 2014 IHR amendment on requirements around yellow fever vaccines.

Image Credits: Flickr – Guilhem Vellut, Flickr – US Mission Geneva, WHO / Antoine Tardy, WHO, Gian Luca Burci, Wikimedia Commons.

Tuberculosis is Here to Stay if We Don’t Mobilise Resources for Diagnoses and Double Fundings, New Data Shows

01/10/2021 Aishwarya Tendolkar

Global efforts to eliminate TB have been set back by the COVID-19 pandemic.

The COVID-19 pandemic and the consequent diversion of resources toward battling SARS-CoV2 has also set back global efforts to eliminate the world’s second most deadly infectious killer: Tuberculosis, by 2030.

Only a doubling of investments next year can pave the way to attainment of the 2030 United Nations Sustainable Development Goals to eliminate the disease, experts and panelists at the Stop TB Partnership said Tuesday.

The panel session coincided with the release of new data from a study conducted by the Stop TB Partnership that showed COVID’s impact on TB response this year continues to be as devastating as last year, with 1.2 million fewer people projected to be diagnosed and treated for TB this year, in comparison with 2019.

The new estimates, developed in collaboration with USAID, Johns Hopkins University, Avenir Health and Imperial College, are based on data from 27 countries that account for 75 percent of the global TB caseload.

That means TB investments for this coming year need to be doubled, in order to meet a 2018-2022 target for diagnosing and treating 40 million people (or 10 million a year), within that four year time frame, the Partnership says.

TB kills 4,000 people a day

The airborne disease still kills 4,000 people every day, with nearly a quarter of the world’s population estimated to have been infected. Despite being curable and preventable, only an estimated 5.7 million people received treatment for TB in 2020, a decline of 21 percent from the previous year—leaving an estimated 4.3 million people with untreated TB and implying all but certain death for probably half that number, the report showed.

A lack of attention to the disease, lack of funding, and a dearth of proper diagnostic tools are responsible, Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership said at a Stop TB briefing Tuesday.

“COVID showed that if the government and people are scared, money is not an issue. We are in the middle of a disaster but our attention seems to be in a very wrong place.”

Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership.

The “orphan disease” does not receive political priority or funding, Obiefuna Austin Arinze, Executive Director of Afro Global Alliance and incoming Vice-Chair of the Stop TB Partnership Board said.

At current levels of funding, the world will miss the target set by the United National High-Level Meeting on TB that took place in 2018 for diagnosing and treating 40 million people with TB by 2022. With just 400 days to reach 2022 goals, the diagnostic figure is even more grim for children with TB, Ditiu said.

However, with mobilisation of resources⁠⁠ – including funding, digital diagnostics and more government-sponsored community interventions – the world could reach the target’s 90% mark⁠ – treating some 36 million people, Ditiu said.

Annual resource needs and available funding for TB in USD.

So why is investing in TB diagnosis and elimination imperative?

In simple words, it saves more lives than you would think. “Investing an extra dollar in TB is one of the best dollars spent to help the world,” Dr Bjorn Lomborg, President of the Danish think tank, Copenhagen Consensus, said at the teleconference.

According to him, it would only cost US$8.1 billion dollars annually, between now and 2030, to eliminate TB. This investment translates to benefits worth US$348 billion dollars, pegging the benefit-cost ratio at 43. This means that every dollar invested in TB prevention and care yields a return of US$43.

But currently, only US$6.5 billion is available annually for TB response globally. Moreover, TB funding has stagnated over the last five years – meaning there are big gaps that need to be overcome now.

That’s why, at the UNHLM on TB in 2018, states and non-state actors pledged to commit a total of US$13 billion annually until 2022 to overcome past shortfalls – unfortunately COVID intervened the following year and those pledges were not honored.

Some US$13 billion in funding is needed for TB care and prevention per year.

TB is traditionally a low GF funding priority – despite a high dependency on Global Fund services in LMICs

Despite being curable, preventable, and easily diagnosable, TB sees more deaths (over 1 million annually) than HIV/AIDS and Malaria combined.

At the same time, The Global Fund channels only 18 percent of its resources to TB diagnosis and treatment. The remaining 82% is invested in fighting HIV/AIDS, malaria, and more recently, COVID-19 tests and treatments.

Although 85% of national TB budgets, on average, are financed by low- and middle-income countries themselves, they remain highly dependent on the Global Fund to Fight AIDS, Tuberculosis, and Malaria to fill vital gaps in services. And that adds weight to the Global Fund’s appeals, panelists pointed out.

In terms of how those funds should be spent, the World Health Organisation along with the UN Secretary General have outlined priority recommendations to ramp up the TB response, Tereza Kasaeva, Director of WHO’s Global TB Programme said. “Efforts need to be intensified to make these recommendations a reality.”

Diagnosis still reliant on less accurate sputum smear microscopy

According to WHO, the diagnosis of TB and drug-resistant TB remains a challenge with one-third of people with TB and two-thirds of people with drug-resistant TB not being detected globally. While WHO recommends highly accurate rapid molecular assays as the initial test to diagnose TB, less reliable sputum smear microscopy remains the dominant diagnostic tool.

Only 28 percent of people were diagnosed with MTB using a rapid molecular test in 2019, Ditiu said. This means that nearly three quarters of diagnoses are done using the “clinical” smear microscopy. Smear microscopy, while cost-effective, has a poor track record in diagnosing extra-pulmonary tuberculosis, paediatric tuberculosis, and TB in patients co-infected with HIV and tuberculosis, a paper pointed.

“Why don’t we allow people proper diagnostic tools?” she asked, pointing out that an untreated person with TB can transmit the bacteria to nearly 15 people every year. “Now think about this in countries like India with a population of 1.2 billion.”

Less reliable sputum smear microscopy remains the dominant diagnostic tool for TB, despite the existence of highly accurate rapid molecular assays.

COVID devastated TB diagnostics

To make matters worse, the COVID-19 pandemic devastated the diagnostics investments in TB – whereby existing resources were diverted, and tools like the highly accurate GeneXpert molecular diagnostic platforms were repurposed to diagnose COVID, in the pandemic’s early days.

Since then, new rapid COVID diagnostic tests have become widely available, but there has been no significant recovery plan for TB diagnostics put into place, Obiefuna said.

The COVID-19 pandemic was not the first time that the health infrastructure for TB was used to tackle other health crises, and particularly those related to airborne diseases, pointed out Cheri Vincent, Chief of USAID’s TB Division, at the meeting.

“We saw it [being diverted] for Ebola and airborne influenza,” she said, adding, “If we can’t solve TB, we can’t solve the next airborne pandemic,” she highlighted.

In fact, TB doctors were the first to be diverted to tackle the COVID-19 breakout, Ditiu said.

The Zambia story, and what it teaches us

But not all has been downhill in the fight against TB.

Zambia offers an example of a country that has been able to sustain its TB programmes through a combination of domestic funding, government-community partnerships, and diagnostic tools – despite the COVID pandemic. It can provide inspiration for countries battling both diseases at the same time.

Already today, Zambia has achieved 89% of its 2022 UNHLM diagnosis and treatment target. Over the past five years, the country invested US$45 million of domestic resources in TB response. “[TB] commodity security is key to achieving our goals,” said Dr. Patrick Lungu, National TB and Leprosy Control Program Manager in Zambia.

A ‘TB Situation room’ was created to review TB programmes on a weekly basis to identify issues that may be negatively impacting performance.

“We were able to offer more technical support to different levels of the health system – which translates to Zambia envisaging to achieve the UNHLM target in at least two-three key indicators,” Lungu said.

Zambia has achieved nearly 89 percent of its UNHLM target so far.

Will India achieve its ambitious 2025 TB elimination target?

When it comes to countries like India – which bears the heaviest TB burden in the world, the pandemic has slowed-down and diverted efforts to eliminate elimination of TB by 2025 -a huge goal set by the government.

According to the Indian Health Ministry’s 2021 Annual Report on Tuberculosis Elimination, reports and notification of confirmed TB diagnoses tumbled 38 percent in March-April 2020 owing to the lockdown.

Furthermore, a majority of the country’s TB elimination resources were repurposed for Covid-19. Then just as services were beginning to recoup, a massive second COVID wave hit the country in spring 2021; it remains unclear what dents that made in the progress India had seen toward the end of 2020.

In its 2021 official report, the Indian Health Ministry nonetheless suggested that the dedicated Infectious disease hospitals that were established for Covid will contribute “significantly” to future TB Care and management.

Despite being scheduled to be a part of Tuesday’s Stop TB Partnership panel, the Indian Health Ministry did not make an appearance – leaving a lack of clarity on trends and progress in 2021.

But on a global level, the warning signs are clear.

Says Ditui: “we have erased 10-12 years of progress, and are back to 2010-11 levels of TB detection and cases. This becomes all the more alarming with the fact that TB is not a new disease but one that has been around for decades, and has a vaccine. One can only hope that TB receives the undivided effort it needs to be eliminated.”

Image Credits: The Global Fund / Evgeny Maloletka, Stop TB Partnership, Dr. Patrick Lungu.

New Social Contract and One Health Approach Critical to Resilient Recovery from COVID Pandemic

01/10/2021 Madeleine Hoecklin

Panelists at the closing session of the European Health Forum Gastein (EHFG) on Friday.

A new social contract between European governments and their citizens is needed to lay the foundation for a resilient and sustainable recovery from the COVID-19 pandemic, with health at the center, said panelists at the closing session of the European Health Forum Gastein (EHFG) on Friday.

A focus on ensuring social protection and equitable access to healthcare, employing the One Health approach in policies, and strengthening WHO would be essential to tackle the inequities and shortcomings in preparedness and response at national and global levels revealed by COVID.

“We can’t go back to the old normal, we do need a new normal for WHO, for the European Union. It’s not an option to continue with old fashioned health politics or policies. We have to rise like a phoenix,” said Clemens Martin Auer, President of the European Health Forum Gastein, referencing the theme of this year’s conference, “Rise Like a Phoenix” – Health at the Heart of a Resilient Future for Europe.

“We cannot have resilient health systems if we don’t change how our societies and our politics are operating,” said Auer.

The world must take advantage of the momentum behind health at the moment to push for investment in health systems and innovations, reform of WHO, and prioritization of equitable access to healthcare.

“The issues concerning health have now reached such a high degree of attention that it is impossible for policymakers to neglect them,” said Professor Mario Monti, former Prime Minister of Italy and Chair of the Pan-European Commission on Health and Sustainable Development. “To avoid shifts in discussions, we need institutional structures and policy processes to help keep the momentum we now have on health going ahead.”

“We have to keep health in the driver’s seat for the future,” said Auer.

Clemens Martin Auer, President of the European Health Forum Gastein.

Adopting One Health policy and improving global health governance

Putting health systems on a trajectory to be better prepared to combat future threats will require a One Health approach and the global coordination of health policies, said the panelists on Friday.

Developing a One Health-based understanding of health is critical to preparing for and addressing future health threats in the animal, human and environment interface, said Monti.

One Health means the design and execution of programmes and policies in which multiple sectors work together to achieve better public health outcomes. Examples include working with the food, agriculture and livestock sector to prevent zoonotic diseases from leaping to human populations; and working with transport and energy sectors to curb health-harmful air pollution and climate change.

Operationalizing the concept of One Health at national, regional, and global levels was one of the main objectives from the recent Pan-European Commission on Health and Sustainable Development report published in early September.

The report reflects on the WHO European region’s response to COVID and makes a series of recommendations for the 53 WHO member states in the WHO European region.

“Our recommendations design a new strategy for health and sustainable development. This requires awareness of the interconnections between human, animal and plant health and their impact on emerging zoonotic diseases; of the links between climate change, biodiversity and human health; and of the need to reinvigorate and extend our national health services,” said Monti.

Professor Mario Monti, former Prime Minister of Italy and Chair of the Pan-European Commission on Health and Sustainable Development.

National governments are encouraged to establish structures to develop cross-government One Health strategies; international agencies, such as WHO, the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the UN Environmental Programme (UNEP), are urged to strengthen mechanisms for collaboration; and coordinated action at all levels to reduce environmental risks to health is advised.

Empowering WHO to assess national emergency preparedness more rigorously

This should be accompanied by efforts to strengthen the WHO – empowering the organization to conduct periodic assessments of national health systems and assess their emergency preparedness and response capacity.

At the regional level of WHO, a Pan-European Network for Disease Control is proposed to provide rapid and effective responses to emerging threats and to improve health governance in the European region.

In addition, the report recommends that a Pan-European Health Threats Council is established to enhance and maintain political commitment and to ensure cooperation and accountability between governments.

“We believe that this will be quite a powerful response in terms of adapting our institutions to the huge transnationality of health phenomena that we have seen in the course of this pandemic,” said Monti.

“At the global level, we need to keep all the responsibilities for health with the WHO and strengthen and make WHO more accountable and independent,” said Monti.

Global coordination of health, economic, and financial policies would be improved by the establishment of a Global Health Board under the G20 – an intergovernmental forum comprising 19 countries and the European Union.

The proposed Global Health Board could support the development of health risk assessment tools and the mobilization of financial resources, ultimately enhancing the “systematic coexistence of the world of health and the world of finance,” said Monti.

“Unless health policy is put more at the center of, let’s say, the table of the Council of Ministers of national governments and global institutions, then we will not make much progress,” said Monti.

Image Credits: EHFG.

MSF Urges Sanofi to Share Technology and Know-how with WHO’s mRNA Vaccine Hub

01/10/2021 Editorial team

Sanofi faces calls for technology sharing after deciding to abandon its promising mRNA COVID-19 vaccine candidate.

Following news that Sanofi, a French pharma company, will abandon its promising mRNA COVID-19 vaccine candidate, Médecins Sans Frontières (MSF) called for the corporation to transfer the vaccine technology and know-how to the WHO-led COVID-19 mRNA vaccine technology transfer hub in South Africa.

Despite the existence of two approved mRNA vaccines and 13 candidates in advanced stages of development, the WHO mRNA hub has yet to receive any technology transfers.

Any mRNA know-how shared with the WHO hub could save time and help the hub’s efforts towards developing a safe and effective mRNA vaccine for low- and middle-income countries, said MSF.

In spite of publishing positive Phase 1/2 study interim results for its vaccine candidate, Sanofi announced on Tuesday that it would not pursue its development due to the dominance of the mRNA COVID-19 vaccine market by Moderna and Pfizer/BioNTech.

“Transferring Sanofi’s mRNA platform to the WHO hub could boost and accelerate the hub’s R&D efforts by giving access to the technical and clinical data generated by Sanofi thus far,” said MSF’s statement. “If successful, the hub would then assist multiple able manufacturers in low- and middle-income countries to start production of COVID-19 and other mRNA-based vaccines for the current and future pandemics.”

“Less than one percent of mRNA vaccine deliveries has reached the poorest half of the world, while willing and able producers in low- and middle-income countries are desperately requesting to access the needed technology and know-how from corporations in high-income countries, to no avail,” said Alain Alsalhani, Vaccines and Special Projects Pharmacist at MSF’s Access Campaign.

The transfer of technology could allow low- and middle-income countries to no longer be entirely dependent on the vaccines produced in high-income countries and would enable their populations to be protected from vaccine-preventable diseases at the same time as people living in high-income countries.

Image Credits: Sanofi.

Childhood Vaccinations Remain High Despite COVID Pandemic

01/10/2021 Editorial team

An infant receiving the RTS,S malaria vaccine in Ghana in 2019. Childhood vaccination campaigns continued to protect against preventable diseases during the pandemic due to healthcare workers.

New statistics from Gavi, the Vaccine Alliance show that routine immunisation programmes have been hit hard by the COVID-19 pandemic. However, the latest data shows that there is extraordinary resilience in immunisation systems, with governments’ efforts to keep childhood vaccinations going despite the impact of the pandemic paying dividends.

In the face of the pandemic, routine and childhood vaccinations held fairly strong, with routine immunisations dropping only 4% over the course of 2020.

Vaccination rates in 2020 were characterised by a significant drop from March to May, but were followed by a strong rebound due to the work of governments and healthcare workers in lower-income countries.

Gavi’s Annual Progress Report shows that there are now 13.7 million “zero-dose” children in the 68 Gavi-supported countries receiving no immunisations. Many of whom live in marginalised communities in rural areas, urban slums, or conflict settings.

“COVID-19 represented a major challenge to childhood vaccination – with parents afraid to venture out to clinics and health care system capacity stretched to deal with a major influx of patients,” said Dr Seth Berkley, CEO of Gavi. “That Gavi countries saw such continuing strength in their vaccination systems is testament to an unprecedented effort from governments, Gavi, WHO, UNICEF and other Vaccine Alliance partners to shelter immunisation programmes from the worst effects of the pandemic.”

See full story here.

Image Credits: WHO.

New WHO Essential Medicines List Includes Controversial Insulin Analogues; Recommends Action on High Medicines Prices

01/10/2021 Raisa Santos

Insulin, a lifesaving treatment for those with diabetes, remains difficult to access and afford in low- and middle-income countries

The World Health Organization published the latest edition of its Model Lists of Essential Medicines (EML) on Friday, making a sweeping move this time to include long-lasting insulin analogues as essential drugs that national health systems should incorporate into their services.

The decision reverses the EML Expert Committee’s 2019 decision, rejecting the inclusion of insulin analogues – on the basis that these higher-priced formulations could negatively affect access to lower-cost human insulin products.

The EML, first developed by WHO in 1977 and updated every two years in consultation with experts worldwide, provides a baseline of guidance to national health authorities on the products and services that should be made most widely available.

Although the prevalence of diabetes has nearly doubled over the past 30 years, rising faster in low- and middle-income countries, high prices have kept many from accessing essential treatments, traditionally involving human insulin, produced by only three firms worldwide.

This led industry as well as some access advocates to propose WHO’s incorporation of newer “insulin analogues” an altered form of human insulin that can be used to treat Type 1 diabetes, to drive competition and lower prices. The proposals drew controversy even prior to their rejection in 2019.

Scientific experts, civil society, and patient groups had met the proposal to include analogues in 2019 with stiff resistance, fearing that mainstreaming the newer drugs, which are more expensive, into the EML, could ultimately drive up prices for developing countries.

But two years later, the use of analogues has expanded much more, while prices have decreased, with treatments no longer under patent protection in many countries. In settings where cost containment and efficient negotiations with insulin producers are in place, prices for insulin analogues are decreasing and aligning with those of human insulin.

This year’s EML decision reverses the 2019 recommendation

That laid the groundwork for the EML expert committee to reverse their position in this year’s edition of the EML, which is issued every biennium, for almost exactly the same reason – to make insulin more affordable by promoting more insulin alternatives.

WHO Director-General Dr Tedros Adhanom Ghebreyesus noted that the inclusion of insulin analogues is a ‘step’ in the right direction towards ensuring affordable access to a lifesaving treatment that only about 50% of an estimated 100 million people requiring insulin, are able to receive, according to a 2017 study led by Health Action International.

“Too many people who need insulin encounter financial hardship in accessing it or go without it and lose their lives,” said Tedros. “Including insulin analogues in the Essential Medicines List, coupled with efforts to ensure affordable access to all insulin products and expand use of biosimilars, is a vital step towards ensuring everyone who needs this life-saving product can access it.”

Prior rejection of analogues due to high price concerns

Echoing Tedros’ statement, the EML committee stressed that further price containment measures still need to be pursued to make insulin of all types more widely available:

The Committee noted the ongoing concerns of some access groups on the effects of including insulin analogues into the EML, stating:

“[The similar clinical benefits of long-acting insulin analogues and human insulin] make the large price differential between insulin analogues and human insulin difficult to justify…“The Committee was unequivocal that affordable access to human insulin remains a critical priority, globally.”

Another First – EML thrusts high drug prices to forefront of essential medicines debate

The Committee’s inclusion of long-acting insulin analogues also comes with another unprecedented move – the recommendation of establishing a standing EML Working Group on highly-priced essential medicines, fulfilling long-standing aspirations of medicine advocacy groups that wanted prices to be highlighted more in the EML.

“[The EML] has never been so explicit about pricing,” said Thiru Balasubramaniam, Geneva Representative for Knowledge Ecology International (KEI), in an interview with Health Policy Watch

“They usually just list medicines and then talk about the reasons for inclusion for each one, but I can’t remember a time when there was a section that basically highlighted the effect of highly-priced medicines.”

One of the tasks of the Working Group is to be: “the development of a strategy to monitor price and availability trends of essential but unaffordable medicines, to be proposed as part of the next WHO General Programme of Work.”

For over a decade, advocacy groups such as Knowledge Ecology International (KEI), have pushed the EML to include a section on essential, but unaffordable medicines, making this new recommendation from the Committee a strategic success.

“[KEI] has asked several times to create a category in the EML, of products that would be essential, if affordable. Now, as someone who has worked on this for over a decade, this is it,” Balasubramaniam said.

KEI had recently advocated for the new category back in June, during the two-week meeting of the Committee.

Prioritizing cancer treatments and new indicators for cancer

Cancer medicines were also a priority for this updated EML

In addition to including insulin analogues, the Committee also recommended 20 new medicines to the EML and 17 new medicines for the Essential Medicines List for Children (EMLc), prioritizing treatment for various cancers.

Four new medicines for cancer treatment were added to the EML:

– Enzalutamide, as an alternative to abiraterone, for prostate cancer;

– Everolimus, for subependymal giant cell astrocytoma (SEGA), a type of brain tumour in children;

– Ibrutinib, a targeted medicine for chronic lymphocytic leukaemia; and

– Rasburicase, for tumour lysis syndrome, a serious complication of some cancer treatments.

Enzalutamide, also known as Xtandi, was part of a lawsuit from the University of California against generic production in India in 2019.

UCLA, which originally developed the treatment in 2006, later sold and licensed rights to manufacture and market the drug to for-profit pharmaceutical firms, with those rights eventually acquired by the US-based Pfizer and the Japanese-based Astrellas.

The listing for imatinib was extended to include targeted treatment of leukemia. Additional childhood cancer indicators were also added for 16 medicines already listed, including low-grade glioma, the most common form of brain cancer in children.

The updated list also has new formulations of medicines for common bacterial infections, hepatitis C, HIV, and tuberculosis, to meet dosing and administration needs of both children and adults.

Médecins Sans Frontières calls for even more action from WHO and pharma companies on insulin access

While Médecins Sans Frontières/Doctors Without Borders (MSF) welcomed the addition of more insulin products to the EML, the group urged WHO and insulin companies to take an even stronger stance on ensuring access to these medicines.

“We hope that the WHO and companies manufacturing insulin will waste no time in ensuring the availability of more affordable quality assured biosimilar insulins to meet people’s growing need for this life saving medicine,” said Candice Sehome, Advocacy Officer in the MSF Access Campaign.

“It is preposterous that this medicine discovered 100 years ago still remains inaccessible to half of the people who need it.”

“Unless the price of all types of insulin and the medical supplies required to inject and monitor this treatment comes down, governments will continue to struggle to manage this controllable disease and people with diabetes will keep dying.”

Image Credits: WHO, WHO.

New UK COVID Travel Policies that Discriminate Against African Vaccine Recipients Condemned – Leaders Call for Clarifications

30/09/2021 Paul Adepoju

International passengers arriving at London’s Heathrow Airport border control – quarantine rules now based on where they were vaccinated, and not what vaccine they received.

IBADAN – Following new travel policies that discriminate against vaccinated travellers from African countries, as compared to their European, Asian and Middle Eastern counterparts, African health officials have demanded clarifications, and accused the UK government of potentially festering vaccine hesitancy on the continent.

A British government’ plan to drop a 10-day quarantine requirement for fully-vaccinated travelers arriving from Europe, North America, and a handful of Asian, Middle Eastern and Caribbean countries – but excluding vaccinated Africans, Indians, Latin America and other low- and middle-income nations – has been met with confusion and condemnation alongside calls for calm and clarification.

The new rules, set to take effect Monday, 4 October, will discriminate between the recipients of COVID-19 vaccines, not based on the vaccine received, but on the region in which these vaccines were received — a development which the Africa Center for Disease Control and Prevention (Africa CDC) described as deeply concerning.

“We are deeply concerned that policies and rules such as this carry a risk of deepening vaccine hesitancy across Africa and creates distrust in the community,” Africa CDC said in a statement.

World Health Organization – Still Seeking Clarifications

Richard Mihigo, Immunisation and Vaccines Development Programme Coordinator at WHO’s Regional Office for Africa.

Dr Richard Mihigo, WHO’s Program Area Manager for Immunisation, said the global health body is still seeking clarifications regarding the issues.

“We are still consulting to find out what the real issue is. It looks like the issue is not the vaccine itself but the documentation around the vaccine,” Mihigo told Health Policy Watch, in response to a question at an WHO African Region briefing Thursday.

The imbroglio is proving to be a major embarrassment for the UK, which is a leading contributor to the COVAX global vaccine facility, a crucial source of vaccine doses for African countries.

COVAX is receiving 80% of the 100 million doses of COVID-19 vaccines that the UK is donating to low- and middle-income countries, mostly in the African region.

But the new ruling now means that recipients of its donated vaccines, won’t be recognized as vaccinated if they travel to the United Kingdom.

“The UK is one of the countries that have provided vaccine donations to countries in the region. So it cannot tell those countries that are using vaccines from the UK that those vaccines are not valid,” Mihigo told Health Policy Watch. He added that the UK policy casts aspersions on Africa’s vaccination programme – even though the continent has been successfully vaccinating its people long before COVID.

“We’ve eradicated wild polio virus on the continent, many diseases have been controlled with a very vaccination programme. The issue is not about the reliability of our vaccination programme so we are trying to understand very well what the circumstances around that are,” he added.

‘Phased Approach’ to recognising vaccine certificates in absence of WHO global policy

Absence of a single WHO policy has left to each country to decide for itself which country’s vaccine certificates to recognize.

Mihigo stressed the importance of ensuring that Africans are not discriminated against nor are prevented from moving freely.

“Indeed anything that can prevent free movement of people, particularly in this time where countries are struggling to put the economy back on track is something that we should avoid,” Mihigo concluded.

But so far, the WHO has also rejected the creation of any unified vaccine certification programme for international travelers – on the grounds that vaccine certificates shouldn’t be used at all in travel, until more of the world is immunized. And that has left countries to fend for themselves in terms of determining the validity of other country’s vaccine certificates.

In the absence of a global policy, UK, officials told media that they were taking a “phased approach” to recognising vaccine certificate of other countries that are not on the UK “red list” – from which international travellers may not enter at all, unless they have UK citizenship or residency.

So far, vaccinated travellers entering just 18 countries, along Europe, can have their vaccine certificates recognised officially, and thus avoid the 10-day quarantine. Those include Australia, Antigua and Barbuda, Barbados, Bahrain, Brunei, Canada, Dominica, Israel, Japan, Kuwait, Malaysia, New Zealand, Qatar, Saudi Arabia, Singapore, South Korea, Taiwan, and the United Arab Emirates (UAE).

Discrimination fuels vaccine hesitancy in Africa

African public health experts worried that as news of the UK government policy gets more attention, it will also worsen vaccine hesitancy on the continent; the general public may wrongly believe that the policy directions of the UK government imply that vaccines being administered in Africa are not effective or are different from the ones being given to people in the UK and other developed countries.

“They are making it very difficult for us to do our job when they issue those conflicting policies,” Taiwo Abayomi, a community health worker in Nigeria, said in an interview with Health Policy Watch.

Even as health officials strive to convince Africans that the vaccines are safe, such restrictions make it easier for fake news and misinformation to quickly spread, she said.

But it is not only African countries that should be worried officials stressed; developed countries will still be at risk if vaccination efforts falter in Africa due to policies in the global north.

Fortunate Bhembe, the Kingdom of Swaziland’s Deputy Director of Pharmaceutical Services told Health Policy Watch that the UK and other foreign governments need to be reminded that as long as the pandemic does not get in control everywhere, their country would also be at risk.

“If other countries are not doing well with vaccination, no one is safe. So we have to help each to ensure we vaccinate as many people as possible so as to ensure the safety of everyone. We are liaising with our partners including the UK government in this regard,” Bhembe said.

Forging ahead

Despite the concerns that the UK government’s travel restrictions could impact Africa’s vaccination plans, and in spite of unavailability of enough doses of the vaccine, the continent continues to expand its vaccination approaches.

On Thursday, the WHO announced that 15 African countries representing nearly a third of the continent’s 54 nations, have fully vaccinated 10% of their people against COVID-19 — meeting the global goal of fully vaccinating 10% of every country’s population by 30 September, the goal was set in May 2021 by the World Health Assembly.

Seychelles and Mauritius have fully vaccinated over 60% of their populations, Morocco 48% and Tunisia, Comoros and Cape Verde over 20%. However, most of the African countries that have met the goal have relatively small populations and 40% are small island developing states.

However, meeting the more ambitious 40% vaccination goal set by WHO for 31 December remains a challenge.

“The latest data shows modest gains but there is still a long way to go to reach the WHO target of fully vaccinating 40% of the population by the end of the year. Shipments are increasing but opaque delivery plans are still the number one nuisance that hold Africa back,” Mihigo said.

Image Credits: @HeathrowAirport/capt_saini, @HeathrowAirport/AndrewFell .

African Drug Discovery Group Clinches Partnership with Pharma Body to Expand Continental Capacity

29/09/2021 Editorial team

African drug innovation will get a boost with new partnership.

CAPE TOWN – A drug discovery and development centre based at the University of Cape Town (UCT) has joined forces with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) to strengthen health innovation in Africa.

The three-year partnership announced this week will focus on driving capacity-strengthening for drug discovery and development in Africa by scaling existing initiatives and identifying new opportunities for young and mid-career African scientists.

“The University of Cape Town Holistic Drug Discovery & Development (H3D) centre is the only integrated drug discovery and development platform in Africa,” said Professor Kelly Chibale, who heads both H3D and the H3D Foundation (H3D-F).

“Over the last 10 years, H3D has proven itself as a platform to develop world-class infrastructure, talent, and health innovation that will contribute to improving lives not only in Africa, but all over the world. We are ready to take our work to the next level through partnership and collaboration with key organisations like IFPMA, strengthening capacity far beyond H3D.”

Chibale, who is a professor of organic chemistry at UCT, is leading research on treatment solutions designed for, and tested on, Africans – rather than western-developed medicine tested on Caucasians that may not be optimal for people with different genetic make-up.

Sweeping Reforms Needed – And Survivor Support

At Tuesday’s presser, Tedros pledged an overhaul of the current policies – saying that the investigation would lead to sweeping reforms in the process of staff recruitment and sensitization around sexual abuse issues.

Along with terminating the contracts of four alleged perpetrators still employed by the organization, WHO is pursuing investigations of still unidentified perpetrators, and would refer allegations of rape to national authorities in DRC or elsewhere, he added.

It’s a “sickening betrayal of the people we served… a dark day for WHO,” Tedros said. “But we want the perpetrators to know that there will be severe consequences for their actions. We will hold all leaders accountable for any suspected incident.“

“We will undertake wholesale reform of policies and processes to address sexual exploitation and abuse,” Tedros added. “But we must go further to identify and address any shortcomings in our culture or leadership that failed to adequately protect the people we serve.”

Gaya Gamhewage, WHO director of Prevention and Response to Sexual Exploitation and Abuse

Gaya Gamhewage, WHO’s Director of Prevention and Response to SEA, said that the organization also would seek funds to help rehabilitate vulnerable women and the children born to them, as a result of the abuse.

“We need funds on the ground for victim & survivor support,” Gamhewage said, noting that as of now: “There is no provision in the UN system for financial reparations to the SEA victims. But that does not stop us from making sure funds are allocated for support & assistance as we move forward.”

Until now, that is support has been far from forthcoming, Coulibaly observed, saying:

“In spite of poignant narratives of the SEA victims, most perpetrators denied the facts & even stated that the sexual relations were consensual. Everything contributed to increased vulnerability of the alleged victims – they did not benefit from aid and assistance.”

Image Credits: WHO/Chris Black, Twitter/@OMSDRCONGO, WHO.

WHO Launches First Global Strategy to Eliminate Bacterial Meningitis by 2030

28/09/2021 Kerry Cullinan

Mothers take their babies to receive vaccinations at a mobile unit in Molumbo district, Mozambique.

The World Health Organization (WHO) aims to eliminate bacterial meningitis by 2030, primarily by increasing access to vaccinations and treatment.

This emerged at Tuesday’s launch of the first-ever global ‘roadmap’ to tackle the disease, which causes inflammation of the membranes that surround the brain and spinal cord, mainly as a result of infection from bacteria and viruses.

Around a quarter of a million people – mostly children – die from meningitis every year, while one in five of those infected suffers from long-lasting disabilities including seizures, loss of hearing and vision, and cognitive impairment.

“Wherever it occurs, meningitis can be deadly and debilitating; it strikes quickly, has serious health, economic and social consequences, and causes devastating outbreaks,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“It is time to tackle meningitis globally once and for all –by urgently expanding access to existing tools like vaccines, spearheading new research and innovation to prevent, detecting and treating the various causes of the disease, and improving rehabilitation for those affected.”

🆕! First ever global strategy to #DefeatMeningitis – a debilitating disease that kills hundreds of thousands of people each year. 👉https://t.co/wG6CqmOPH1 pic.twitter.com/0q6fkTwRHm

— World Health Organization (WHO) (@WHO) September 28, 2021

Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks.

“More than half a billion Africans are at risk of seasonal meningitis outbreaks but the disease has been off the radar for too long,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

“This shift away from firefighting outbreaks to strategic response can’t come soon enough.”

Four organisms are responsible for 50% of deaths – Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus.

Effective vaccines that protect against disease caused by the first three organisms are currently available and research is underway to develop vaccines group B streptococcus bacteria

But not all communities have access to these lifesaving vaccines, and many countries are yet to introduce them into their national programmes.

High immunization coverage, speedy diagnosis and optimal treatment for patients, data-driven prevention and control and better care of those affected are key pillars of the new strategy.

The roadmap follows the first resolution on meningitis passed by the World Health Assembly and endorsed unanimously by WHO member states in 2020.

“The meningitis roadmap provides a clear blueprint for defeating this devastating disease,” said Professor Robert Heyderman, head of infection research at University College London.

“Crucially it identifies the gaps in our knowledge and the tools required. To achieve the Road Map’s ambitious goals, a team approach will bring together countries, global policymakers, civil society, funders, researchers, public health specialists, healthcare workers and industry to generate and implement innovative new strategies.”