Neglected tropical diseases (NTDs) pose a threat to more than 1.5 billion people worldwide,  making them one of the biggest health problems in the developing world. 

In sub-Saharan Africa, these diseases are found “at the end of the road” in the most rural and poor communities where an estimated 600 million people are at risk of contracting one or more NTDs. 

These diseases have detrimental effects on school attendance and child development. They cause irreversible damage and stigmatizing disability with reduced quality of life and hence reduced productivity. They imprison afflicted communities in a vicious cycle of poverty and disease, which creates a significant barrier to achieving the UN Sustainable Development Goals (SDGs). 

An estimated 90% of the NTD burden in Africa can be controlled or eliminated through mass drug administration of preventive chemotherapy to treat five key NTDs, onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma . 

This ambitious goal is feasible thanks to strong public-private partnerships, including the commitment and generosity of several pharmaceutical companies to provide free drugs, and the volunteers and teachers from endemic communities who distribute the drugs to millions – often without remuneration. 

Improved productivity

A study published in PLOS NTDs estimated that eliminating these five NTDs with preventive chemotherapy would increase productivity by $11 billion annually on a global scale. Increased investment in NTD control and elimination is imperative to improve development, end suffering for millions, and achieve the SDGs.

The Mectizan Donation Program (MDP), is the longest-running pharmaco-philanthropy initiative established in 1987 by the pharmaceutical company MSD (known as Merck and Co. Inc in the USA and Canada) to facilitate access to its drug, Mectizan (ivermectin), for the elimination of river blindness. 

In 1998, MSD joined forces with GSK through their donation of albendazole to be co-administered with Mectizan to eliminate lymphatic filariasis. 

Today, the Mectizan Donation Program is no longer alone. Many other initiatives have since been created to facilitate access to NTD medications. MDP is a proud partner of the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), a special program of World Health Organization (WHO) AFRO with the mission to accelerate elimination of the five PCT NTDs in Africa.

The COVID-19 pandemic resulted in disastrous socio-economic consequences worldwide. As resources become scarce, there is a need for greater innovation and efficiency. This includes high-quality disease mapping, programme planning and implementation, and timely monitoring and evaluation, which will enable countries to demonstrate progress. 

Data-sharing is key

During the COVID-19 pandemic, the communication channels, data collection tools, and health care infrastructures established by NTD programmes have been re-purposed for training and capacity building for COVID-19 risk mitigation. 

NTD programmes will continue to serve as well-established grassroots platforms to implement NTD interventions along with other preventive health interventions for those living at the end of the road.

Assessing strengths and weaknesses to improve strategies based on quality data collection and analysis will be critical to success. 

ESPEN has a strong commitment to the improvement of data quality and use in the African member states, which includes ESPEN’s data portal, a central repository for NTD data across all diseases and treatments.

 The portal is being designed to facilitate transparency and data sharing among stakeholders. ESPEN partners now have access to 10,000 maps and data sets from 45 countries. Countries and other stakeholders have access to a source of historical and current information on NTD endemicity including disease-specific epidemiological surveys, treatment coverage, and other programmatic data.

COVID-19 has further exacerbated the socio-economic consequences such diseases can have worldwide, and there is an even greater need for more resources to be channelled towards NTD programmes. 

Improving access to quality data to effectively fight disease should be at the top of the WHO AFRO agenda. Ultimately, data tools such as ESPEN data portal will be our winning strategy in the fight against NTDs.

 * Dr Yao Sodahlon is Director of the Mectizan Donation Program.

Dr Yao Sodahlon
Hypertension cases have increased to 1.28 billion in 30 years and millions of people are living with untreated hypertension.

The number of adults around the world with hypertension has almost doubled from 650 million to 1.28 billion in 30 years – and nearly half these people don’t know they have hypertension, a new study published in The Lancet has found.

The study, which is the first comprehensive global analysis of trends in hypertension prevalence, detection, treatment, and control also found that more than one billion people with high blood pressure  — 82% of hypertension patients in the world — lived in low- and middle-income countries in 2019.

The international study, led by researchers from Imperial College London and the World Health Organization (WHO), analysed blood pressure measurements from 104 million people in the 30 to 79 age group and was taken over three decades in 184 countries. 

“Despite medical and pharmacological advances over decades, global progress in hypertension management has been slow, and the vast majority of people with hypertension remain untreated, with large disadvantages in low- and middle-income countries,” lead author of the study Professor Majid Ezzati, Imperial College London, UK, said.

“Our analysis has revealed good practice in diagnosing and treating hypertension, not just in high-income countries but also in middle-income countries. These successes show that preventing high blood pressure and improving its detection, treatment, and control are feasible across low- and middle-income settings if international donors and national governments commit to addressing this major cause of disease and death.”

Hypertension is defined as systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or taking medication for high blood pressure. It is directly linked to more than 8.5 million deaths worldwide each year and is the leading risk factor for strokes, ischaemic heart disease, other vascular diseases, and renal disease.

Lowering blood pressure can cut the number of strokes by 35%-40%, heart attacks by 20%-25%, and heart failure by around 50%. 

The study found that globally, the number of adults aged 30 to 79 with hypertension jumped from an estimated 331 million women and 317 million men in 1990 to 626 million women and 652 million men in 2019. 

Increase mostly seen in low- and middle-income countries

The data further pointed to regional disparities in treatment and control of high blood pressure despite the easy diagnosis and low cost of medicines.

Dr Bin Zhou, a research fellow at the School of Public Health at Imperial College London, who led the analysis said: “Although hypertension treatment and control rates have improved in most countries since 1990, there has been little change in much of sub-Saharan Africa and Pacific Island nations.  International funders and national governments need to prioritise global treatment equity for this major global health risk.”

Canada, Iceland, and South Korea had among the lowest prevalence of hypertension with treatment levels greater than 70%; and control rates of over 50% in 2019. 

Encouragingly, large improvements in treatment and control rates were seen in some middle-income countries including Costa Rica, Kazakhstan, South Africa, Brazil, Turkey, and Iran over the 30 years. 

Some of the highest rates were seen in the Dominican Republic, Jamaica, and Paraguay for women and Hungary, Paraguay, and Poland for men.

“Policies that enable people in the poorest countries to access healthier foods—particularly reducing salt intake and making fruit and vegetables more affordable and accessible—alongside improving detection by expanding universal health coverage and primary care, and ensuring uninterrupted access to effective drugs, must be financed and implemented to slow the growing epidemic of high blood pressure in low- and middle-income countries,” said Ezzati about the large improvements in some of the countries.

Over half of hypertension sufferers were unaware of their condition

Hypertension is relatively easy to treat with low-cost drugs yet 720 million people were not on treatment.

Another significant finding was that about 580 million people with hypertension were unaware of their condition because they were never diagnosed and 720 million did not receive the required treatment.

Although the condition is straightforward to diagnose and relatively easy to treat with low-cost drugs, almost half of people (41% of women and 51% of men) with hypertension worldwide in 2019 were unaware of their condition, and more than half of women (53%) and men (62%) with the condition were not treated for it. Worldwide, blood pressure was controlled in fewer than one in four women and one in five men with hypertension. 

“Nearly half a century after we started treating hypertension, which is easy to diagnose and treat with low-cost medicines, it is a public health failure that so many of the people with high blood pressure in the world are still not getting the treatment they need,” said Ezzati.

The authors note that, whilst the study provides the first comparable estimates of blood pressure prevalence, diagnosis, treatment, and control in adults for all countries of the world; it may be affected by a lack of data in some countries, especially in Oceania and sub-Saharan Africa.

New WHO guideline for hypertension treatment

This week, the World Health Organization (WHO) released fresh guidelines after 20 years for pharmacological treatment of hypertension in adults to help countries manage the condition better.  

The recommendations cover the level of blood pressure to start medication, type of medicine or combination of medicines to use, target blood pressure level, and frequency of tests.

“The need to better manage hypertension cannot be exaggerated. By following the recommendations in this new guideline, increasing and improving access to blood pressure medication, identifying and treating comorbidities such as diabetes and pre-existing heart disease, promoting healthier diets and regular physical activity, and more strictly controlling tobacco products, countries will be able to save lives and reduce public health expenditures,” said Dr Bente Mikkelsen, Director of WHO’s Department of Noncommunicable Diseases.

Image Credits: John Campbell/Flickr, REUTERS/Baz Ratner, Pxhere.

Johnson and Johnson single-dose vaccine

Johnson & Johnson has joined other vaccine producers in advocating for a booster shot for its single-dose COVID-19 vaccine, which is being rolled out particularly in low-income African countries that had hoped to only vaccinate citizens once.

The company made the announcement on Wednesday, following the results of interim data from two Phase 1/2a studies in individuals previously vaccinated with its vaccine.

“New interim data from these studies demonstrate that a booster dose of the Johnson & Johnson COVID-19 vaccine generated a rapid and robust increase in spike-binding antibodies, nine-fold higher than 28 days after the primary single-dose vaccination,” according to a company statement.

“Significant increases in binding antibody responses were observed in participants between ages 18 and 55, and in those 65 years and older who received a lower booster dose,” it added, saying that it had submitted study summaries to medRxiv on 24 August.

This follows the publication in July of interim data from the trial in the New England Journal of Medicine that demonstrated neutralizing antibody responses generated by the Johnson & Johnson single-shot COVID-19 vaccine were strong and stable eight months after immunization.

“We have established that a single shot of our COVID-19 vaccine generates strong and robust immune responses that are durable and persistent through eight months. With these new data, we also see that a booster dose of the Johnson & Johnson COVID-19 vaccine further increases antibody responses among study participants who had previously received our vaccine,” said Mathai Mammen, Global Head of Janssen Research & Development, Johnson & Johnson. 

“We look forward to discussing with public health officials a potential strategy for our Johnson & Johnson COVID-19 vaccine, boosting eight months or longer after the primary single-dose vaccination,” he added.

J&J said that it was engaging with the US Food and Drug Administration (FDA), US  Centers for Disease Control and Prevention (CDC), European Medicines Agency (EMA) and other health authorities regarding boosting with the Johnson & Johnson COVID-19 vaccine. 

The African Union has ordered 400 million doses of the J&J vaccine and the US government is also in the process of donating millions of doses of the vaccine to Africa, making the J&J vaccine the cornerstone of the continent’s rollout.

At World Health Organization (WHO) meeting on vaccines two weeks ago, J&J was the only vaccine manufacturer that was not advocating for boosters citing a lack of clinical data.

 

 

 

Singaporean Senior Minister Tharman Shanmugaratnam

Global health security is dangerously underfunded, making the world vulnerable to a “prolonged COVID-19 pandemic with repeated waves affecting all countries” and future pandemics, Singaporean Minister Tharman Shanmugaratnam told a World Health Organization (WHO) media briefing on Wednesday.

Shanmugaratnam, who co-chairs the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response, urged global governments to pledge at least $10 billion more every year to address this and future pandemics.

His panel has recommended the establishment of a Global Health Threats Fund to mobilise money for pandemic surveillance and response.

“The current funding for global health is raised by individual global health organisations on a siloed basis. It is also largely dependent on discretionary bilateral aid. The result is a non-system of complex inefficient, unpredictable, and greatly inadequate funding,” said Shanmugaratnam.

“We need a new global mechanism to overcome these silos mobilise resources on the needed scale and predictability.”

He described the additional resources needed as “very small investments, compared to the costs of a prolonged COVID-19 pandemic” and “tiny investments, compared to the costs of future pandemics”.

“We have to move away from thinking about funding of global health security in terms of foreign aid towards thinking about it as a strategic investment that all nations must make not only for the good of the global community, but because it is in each nation’s self interest,” he added.

He also called for the “repurposing” of international financial agencies – the World Bank, IMF and other multilateral development banks – so that financing “resilience against climate change and pandemic security” are part of their core mandates.

WHO Director General Dr Tedros Adhanom Ghebreyesus told the briefing that the COVID-19 pandemic has stabilised over the past week, “but at the very high rate of 4.5 million cases and 68,000 deaths”.

Tedros described the next three months as “a critical period for shaping the future of pandemic preparedness and response”.

WHO believes that “whatever structures and mechanisms emerge”, they have the engagement and ownership of all countries, be aligned with the constitutional mandate of WHO rather than creating parallel structures, involve partners from across the One Health spectrum, including animal, and environmental health, ensure coherence with the International Health Regulations, and be accountable to all member states, added Tedros. 

COVID-19 origins

Members of the WHO scientific team into the origins of the SARS-CoV2 authored a report in Nature on Wednesday saying that time was running out for them to complete their work.

In response, WHO’s lead on COVID-19, Maria Van Kerkhove, said the global body was in the process of setting up the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) to “establish a standardised approach for studying where and when these pathogens emerge”.

However, Van Kerkhove said that the origins group had identified “numerous further studies” that needed to be conducted in its March report – and there were many scientists in China who could do these.

“One of the responsibilities of the SAGO would be to urgently prioritise what studies need to go forward,” said Van Kerkhove, adding that “we have heard from Chinese colleagues that studies are underway from some public statements that they have made recently”. 

“We want the origins work to remain scientific, transparent, urgent and inclusive, and we will continue to work with all member states to make sure that we better understand how this pandemic begin began so that we can be better prepared for future ones,” she concluded.

Dr Mike Ryan, WHO Executive Director of Health Emergencies, emphasized that “there is no impediment” to the studies identified by the origins team going ahead in China.

“Chinese colleagues don’t need WHO to hold their hands through this kind of process,” said Ryan. “Those studies have been laid out. They’ve been agreed between the international team and Chinese colleagues. In fact, many Chinese colleagues do report that those studies are underway, and we very much look forward to receiving data and reports.”

He added that WHO was “very willing” to deploy the international team – or smaller, more specialised teams “as needed”.

In July, China rejected further research by the origins team – particularly into whether the virus escaped from a laboratory.

“We will not accept such an origin-tracing plan as it, in some aspects, disregards common sense and defies science,” Zeng Yixin, Vice Minister of the National Health Commission,  told a press conference organized by the Chinese State Council Information Office.

“We hope the WHO would seriously review the considerations and suggestions made by Chinese experts and truly treat the origin tracing of the COVID-19 virus as a scientific matter, and get rid of political interference,” Zeng added.

COVID booster vaccines have gained traction in several countries – US, Israel, Germany, UK, and others, but low- and middle-income countries lag significantly behind in shots.

As the Delta variant spreads across Africa and with the anticipation of a fourth COVID-19 wave later this year, the World Health Organization’s Africa head has called out rich countries that are now offering booster vaccine shots – even as much of the continent’s population waits for their chance at the first shot.

WHO regional director for Africa, Matshidiso Moeti, on Tuesday warned that moves by some wealthy countries to introduce booster shots threaten the African continent’s ability to fight the devastating pandemic. Richer countries should share their vaccine supplies with low-income countries instead of hoarding the drugs, she told delegates at the 71st Session of the WHO Regional Committee for Africa’s virtual meeting on public health in Africa.

The COVID-19 vaccine roll-out had demonstrated the huge gaps in international solidarity, said Moeti. “We believe the priority should be for the most oppressed populations in all countries to be fully vaccinated. To have the greatest impact in curbing transmission, saving lives, and bringing about an end to this pandemic, as quickly as possible,” she said, adding that 75% of vaccine doses globally had been administered in just 10 countries.

The United States, Israel, United Kingdom and Germany are among a growing number of wealthy countries planning to offer COVID-19 booster shots to their populations from September. This, at a time when some of the world’s poorer nations are struggling to get even one jab of the life-saving vaccines into their peoples’ arms. 

“High-income countries have administered 62 times more doses than low-income countries, potentially worsening this divide,” warned Moeti, stressing that: “We’ve advocated for wealthy countries to share their doses.”

Moeti was echoing the call by WHO Director-General, Tedros Adhanom Ghebreyesus, who last week again fiercely denounced the booster policies. “The divide between the haves and have nots will only grow larger if manufacturers and leaders prioritize booster shots oversupply to low- and middle-income countries,” Dr Tedros said.

The director-general had previously warned that diverting global vaccine supplies to boosters could foster the spread of dangerous variants in vaccine-poor countries elsewhere.

Africa’s vaccine roll-out lagging behind

Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa

Dr Tedros, who also addressed the meeting, said he was concerned that only four countries in Africa had reached the targeted vaccination of at least 10% of their populations. Globally, some 140 countries have already reached this target.

“I don’t need to tell you that the distribution of vaccines has been terribly unfair. More than 4.8 billion doses of vaccine have been administered globally. Just 87 million doses have been administered in the African region – less than 2 % of the global total.” Dr Tedros said.

More than 44 million doses have been distributed to 40 African countries through the global vaccine-sharing facility, COVAX.

“We have also made progress towards increasing production in Africa, through the recent establishment of a technology transfer hub for mRNA vaccines in South Africa, and through our work with many countries including Rwanda & Senegal to boost local production.” Dr. Tedros said.

More than 5.4 million COVID-19 cases have been reported from the African region, and about 130,000 deaths reported.  “We know that these numbers are under-reported.” Dr Tedros added.

Currently, the Delta variant is present in 44 African countries, the Beta in 39, Delta in 30, and Gamma in four.

Africa’s COVID-19 challenges and proposed actions

Governments on the African continent have faced several challenges since the start of the pandemic last year, said WHO’s Regional Emergency Director Dr Abdou Salam Gueye.  These include the lack of multi-sectoral coordination of the pandemic response, weak health systems, limited funding, low public awareness, and low vaccination rates, and vaccine hesitancy.

Added to this was the misinformation at all levels, including political leadership, health workers, and communities, which Gueye said made “the work harder”.

Most shockingly, according to Gueye, is that many African countries are not clear about which variant they are dealing with due to, among other, poor genomic sequencing technology, gaps in surveillance, and data and information management.

“Critical data was not sufficiently shared and used and GIS capabilities are not explored,” said Gueye.

Other challenges include concerns over the negative effects of COVID-19 vaccines, low public trust in leadership, and the negative impact of social media on preventative measures.

WHO AFRO has however proposed specific action to deal with the challenges which include advocating for local vaccine production, increasing vaccine doses beyond existing programs, and ensuring that operational funding from multilateral development banks is available for vaccination programs.

Learning from the COVID-19 pandemic

Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa

On Tuesday Moeti  emphasised the need to learn from the COVID-19 pandemic and called for significant resources to be dedicated to research, development, and innovation.

“COVID-19 presents both an opportunity and a stark warning of the need to rethink systems that reinforce justices, and to invest more in building a healthier, fairer world,” she said.

Stressing the importance of sharing both the knowledge gained and the benefits to “protect the world”, Moeti said: “Promising homegrown solutions have emerged, and more needs to be done to test harness, and promote these globally, including African traditional medicines and digital technologies.”

She also called on the continent to ramp up local production of essential medical supplies, including vaccines, and for increased investment in health systems that have for decades been underfunded.

This year’s Regional Committee focuses on ways to scale up the COVID-19 response, renew the efforts to end all forms of polio, eliminate cervical cancer as well as enhance the use of health technologies. The meeting which is being held over three days until August 26 will also discuss measures to improve healthy ageing on the continent as well as reinforcing the fight against tuberculosis, HIV, sexually transmitted infections and hepatitis, and defeating meningitis by 2030 among other key health priorities.

Image Credits: Marco Verch/Flickr.

One billion children – almost half the world’s children – live in 33 countries that are at an “extremely high-risk” from the impacts of climate change including heatwaves, cyclones, air pollution, flooding and water scarcity.

This is according to UNICEF’s Children’s Climate Risk Index (CCRI) which provides the first global comprehensive view of children’s exposure and vulnerability to the impacts of climate change.

“This report examines for the first time exactly how many children live in areas that experience multiple, overlapping climate and environmental risks that trigger, reinforce and magnify each other combined with data on the availability and quality of essential services such as healthcare, education and water and sanitation to give a true insight into the impact of the climate crisis on children,” according to UNICEF executive director Henrietta Fore.

Fore added that “almost every child on earth” was exposed to at least one climate shock, but that the survival of the one billion children in high-risk countries “is at imminent threat from the impacts of climate change”.

The worst countries worst for children to live in for climate change threats.

Twelve of the 15 worst affected countries are in Africa, with the Central African Republic, Chad and Nigeria ranked the three worst-affected countries. Pakistan, Afghanistan and Bangladesh are the only non-African countries in this group.

Meanwhile, the safest three countries for children are Iceland, Luxembourg and New Zealand.

The least affected countries, which are safest places for children.

“Addressing the climate crisis requires every part of society to act,” said Fore,  appealing for greenhouse gas emissions and environmental pollutants to be reduced dramatically.

Crossing ‘key boundaries’ 

“We are crossing key boundaries in the Earth’s natural system, including climate change, biodiversity loss, and increasing levels of pollution in the air, soil, water and oceans,” according to the report.

“As these boundaries are breached, so too is the delicate natural balance that human civilization has depended upon to grow and thrive. The world’s children can no longer count on these conditions, and must make their way in a world that will become far more dangerous and uncertain in the years to come.”

According to the report, the climate crisis is creating multiple crises that threaten children’s very survival. They are more vulnerable physically to floods, droughts, severe weather and heatwaves and physiologically to pollution and climate-related diseases such as malaria and dengue.

According to the recent IPCC report, global greenhouse gas emissions need to be halved by 2030 and cut to zero by 2050 to avoid the worse impacts, but most countries are not on track to meet these targets.

“Only with such truly transformative action will we bequeath children a liveable planet,” according to the report.

According to Nkosi Nyathi, a young climate change activist from Zimbabwe: “What keeps me on the frontline for climate justice is the notion that I don’t only represent my nation but my entire generation because climate justice concerns our future.

“I have dedicated my voice as a voice of the voiceless, to call for immediate action and there is no better time for acting than now. Take a closer look at the unpredictability and uncertainty of weather patterns, the rise in sea levels, frequent cyclones, hot temperatures and heatwaves – honestly, how am I expected to attend school under a scorching sun?”

 

 

Image Credits: UNICEF.

In a milestone event that was also long-awaited, The United States Food & Drug Administration issued a final authorization for the Pfizer-BioNTech COVID19 vaccine – the first such vaccine to receive permanent FDA approval status – following the receipt of an Emergency Use Listing on 11 December.

The definitive FDA approval is expected to bolster both public willingness to voluntarily get the jab – as well as more vaccine mandates.  As one of the first such mandates to be issued in the wake of the announcement, the US Pentagon said that some 1.4 million armed forces personnel around the world would be required to be vaccinated against COVID-19, with guidelines to be issued shortly. Private companies, health care providers and universities across the United States are also grappling with vaccine mandates.

New York City Mayor Bill de Blasio followed, announcing that all New York City school staff would be required to get vaccinated – the largest school system in the United States to have imposed such a mandate. In New Jersey, Governor  Phil Murphy announced that all state employees would have to be vaccinated by 18 October.  That follows moves by California requiring teachers to get vaccinated two weeks ago.  Dozens of private schools and colleges around the country also have instituted vaccine mandates. Some public universities and individual school boards in vaccine hesitant states like Florida are also enacting vaccine and/or mask mandates – despite attempts to bar them from doing so by state authorities.

At the same time, US health officials were clearly hoping that vaccine-hesitant people, who had expressed doubts about the speed of the emergency approvals, might be swayed to get the jab now that the authorization is permanent.

“While millions of people have already safely received COVID-19 vaccines, we recognise that for some, the FDA approval of a vaccine may now instil additional confidence to get vaccinated,” said the FDA’s Acting Commissioner, Janet Woodcock, in announcing the move.  “Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.”

For now, the final approval, however, remains limited to people age 16 and over, with vaccines for younger groups, aged 12-15, being administered under the pre-existing EUA.  Increasingly, infections are also being seen among younger adults and teens in North America and worldwide as social gatherings regain steam and schools reopen – accelerating the spread of the highly-infectious Delta variant.

Other countries slower on mandates

Teachers aged 50 years and above were among the first in Kenya to get COVID-19 vaccine in March.

Other countries are carefully eyeing the US vaccine mandate moves – even if most, including high-income Europe, have been much slower to consider mandates for civil servants and in schools – although  COVID passes for international travelers, large gatherings and high-risk groups such as health workers are being implemented more widely.

In Kenya, however, the government recently mandated that its civil servants be vaccinated by 23 August – a decision that also reflects the slowly expanding vaccine access in some parts of the continent. The move received the support of John Nkengasong, Director of the Africa Centre for Disease Control (CDC), who said “they’re saving themselves, their loved ones and protecting their community and country.”

“We’re going to move forward, making that vaccine mandatory. We’re preparing the guidance to the force right now. And the actual completion date of it, in other words, how fast we want to see it get done, we’re working through that guidance right now,” said Pentagon Press Secretary John Kirby, at a press briefing on Monday.

Approval also triggers new calls for wider vaccine access

Meanwhile, Médecins Sans Frontières, issued a renewed call to Pfizer/BioNTech and other COVID vaccine manufacturers to share their vaccine technology more widely, in order to boost global supplies – and particularly in Africa where COVID vaccine coverage continent-wide remains under 2%.

MSF called on the pharma firm to begin cooperating with a new World Health Organisation mRNA vaccine tech hub in South Africa  – which has declared that it will train LMIC professionals in the development and manufacture of mRNA vaccines on an open-access platform.

In a parallel move, Pfizer/BioNTech recently announced a vaccine production deal with the Cape Town-based firm Biovac – but the company has so far deferred from joining the WHO collaboration.

“With only 1.7% of Africa’s population fully vaccinated against COVID-19, increasing and diversifying production and supply of mRNA vaccines through additional manufacturers, beginning with those based in countries on the African continent, offers an opportunity to urgently and sustainably address vaccine inequity during this pandemic, and in the future,” said an MSF statement.

“Médecins Sans Frontières/Doctors Without Borders (MSF) called again on Pfizer and BioNTech to immediately share the vaccine technology and knowledge with manufacturers on the African continent that could help boost global vaccine supply. They should do this via the World Health Organization’s (WHO) mRNA vaccine technology transfer hub hosted in South Africa.”

Image Credits: International Monetary Fund/Ernesto Benavides, Wish FM Radio.

Some 300,000-400,000 Afghans have been forced from their homes in the past two months alone, says WHO and UNICEF.

KABUL – As the Taliban blitzed through towns and villages of Afghanistan finally capturing Kabul August 15, the war-ravaged country’s fragile health system was also crumbling, leaving the sick and vulnerable in despair. 

Over the past week, the health ministry’s previously daily updates of coronavirus infections, vaccinations and other key updates on public health have ceased to exist.

As per the last official figures, Afghanistan was grappling with mounting rates of COVID-19 infections, driven by the Delta variant, amid shortages of vaccines and oxygen. Health experts believe the situation has taken a sharp turn for the worse in the week since the Taliban took charge of the capita. 

Continuing health services a priority for the new regime 

Within days of entering Kabul, the Taliban leaders went to the Health Ministry to highlight the importance in their eyes of this key sector, and particularly the continued engagement of female doctors and health workers.

A Health Ministry official who asked not to be named told Health Policy Watch that the Taliban representatives, along with the acting Health Minister, Dr. Wahid Majrooh, were collaborating closely together in order to steer the public health sector out of uncertainty.

“They are working hard and no drastic changes have emerged in the Ministry.  It is hoped soon things will return to normalcy”, said the official. 

In a series of tweets,  Majrooh also expressed his commitment to working with WHO and other global health partners, returning basic health services to the country – stressing the importance of continued engagement with female health professionals. 

Other sources within the government, however, say that many doctors and health workers, and particularly female nurses, doctors and members of COVID vaccination teams, remain too anxious to return to their duties – out of fear of the new government. 

WHO & UNICEF call for “humanitarian airbridge 

In statements Wednesday,  WHO Director General Dr Tedros Adhanom Ghebreyesus and Dr Ahmed Al-Mandhari, Regional Director for WHO’s Eastern Mediterranean Region, also affirmed that WHO is committed to remaining in Afghanistan and working constructively with the new regime.   

But they also warned of large, looming health risks as a dire humanitarian situation continues to unfold in Afghanistan. 

This includes increasing cases of diarrhea, malnutrition, and COVID-19-like symptoms, as well as reproductive health complications being seen nationwide – and particularly among displaced populations who have fled to larger cities like Kabul, to escape conflict zones.  

On Sunday, amid the continuing airport chaos, WHO and UNICEF called jointly  “for the immediate establishment of a humanitarian airbridge for the sustained and unimpeded delivery” of much-needed medicines and supplies to “millions of people in need of aid, including 300,000 people displaced in the last two months alone.”

Said the statement: “While the main focus over the past days has been major air operations for the evacuation of internationals and vulnerable Afghans, the massive humanitarian needs facing the majority of the population should not – and cannot – be neglected. 

“With no commercial aircraft currently permitted to land in Kabul, we have no way to get supplies into the country and to those in need.  Other humanitarian agencies are similarly constrained,” said the statement. 

Even prior to the events of the past weeks, Afghanistan represented the world’s third largest humanitarian operation, with over 18 million people requiring assistance.\

Displaced populations adds to challenges in Kabul and elsewhere  

Afghan families fleeing conflict in Kunduz and other southern Afghan provinces have now crowded into Kabul

In its statement last week, WHO noted the urgent need for reproductive, maternal, newborn and child health (RMNCH) services to be provided to newly displaced people in Kabul and other cities, calling on “all parties to swiftly address disruptions to medical supplies and equipment being shipped into and across the country so as to plug gaps in needs at health facilities.” 

The Kabul capital’s iconic Shahr-e-Nau commercial district, which was once a population destination for leisure, outings and shopping for the newly-emerging middle class of Afghanistan, is now flooded with war-affected displaced men, women and children from the north and south of the country.

With no proper accommodation, hygiene and food mechanism in place, the vulnerable women and children in particular can be seen in despair in the nearby park here under scorching summer heat.

Begging for food, one mother of three minor children, who identified herself as Hajira said all of her children are ill, hungry and restless. “Where can I go? What can I do for these children? Nothing is in my control? I am hopeless!” she sighed, clearing her tears with her dusty and torn veil.

Some two million Afghan children are malnourished, The World Food Program said this week. “The combined effects of drought and the coronavirus pandemic, on top of years of conflict, look set to worsen the food security situation,” the organization said.  

For the second time in three years, the country saw a second devastating drought, destroying crops and livestock. A harsh winter could make things even worse said Mary Ellen McGroarty, WFP Afghan country director.

Over 260,000 Afghanis were displaced by drought in the country’s western provinces in 2018 – and drought has now struck again in 2021.

Questions loom over future of COVID vaccine drive 

Behind the scenes, health experts also are worried about whether the new regime will move forward aggressively in the COVID vaccination drive that had been gaining steam  recently.  They point to the long struggle the country has undergone to root out polio virus, with vaccinations – which met with chronic opposition in some parts of the country. 

Prior to the latest turmoil, Afghan officials told Health Policy Watch that the administration of vaccines had gained momentum – following the sudden rise of infections and corresponding deaths since April. Up to 40,000 people were getting the jabs on a daily basis across the country with the government aiming to take it up to 100,000 per day, health officials say.

Now, however, due to the disruptions in health services, the pace of COVID vaccines has slowed dramatically or even halted, officials say, as well as delaying other routine childhood immunizations, which could lead to secondary health emergencies. 

As per the UN estimates, vaccination rates remain extremely low in Afghanistan, with less than 4-5% of the population vaccinated overall. The virus continues to deeply affect the lives of the most vulnerable children and families across the country as they face the compounded impacts of the pandemic, conflict and longstanding drought.

Southern Afghanistan Worst Affected Region

A mother and her child in the Haji camp for internally displaced people in Kandahar, southern Afghanistan.

Dr. Kabeer Ahmad, a former health ministry official, said the country’s restive south, particularly Helmand province, as well as the Kunduz province in the far north, are currently the worst affected overall by the acute shortages of medicine supplies and public health services.

“These two provinces in particular have been literally the frontlines throughout the 20 years of war, and it got worse there (Kunduz, Helmand) in the past couple of months when the foreigners (US and NATO) left,  and fighting intensified”, he told Health Policy Watch. 

That has included various attacks on health care facilities and personnel, which humanitarian groups say continue to strain an already fragile health system. 

Provinces of Afganistan – regions in the far northern province of Kunduz, and Helmand province in the south, are among the hardest hit by conflict – and displacement.

“All parties must respect neutrality of health interventions and ensure safety of health workers, patients and health facilities”, said the WHO in its recent statements, adding unimpeded and sustained access to humanitarian assistance, including essential health services and medical supplies, is a critical lifeline for millions of Afghans, and must not be interrupted.

The WHO has called for  additional funding of US$ 6.6 million for the urgent health response following the escalation of conflict.

Image Credits: Hesamuddin Hesam, © UNHCR/Edris Lutfi, Photo: Enayatullah Azad/NRC, © UNICEF Afghanistan.

Yemen’s ruined health system struggles to cope with COVID alongside other diseases.

The Delta variant is finding fertile ground to spread – and claim lives – around the Middle East and North Africa. The New Humanitarian, a nonprofit newsroom covering crises around the world, provides a snapshot of COVID-19 across the region.

After months of relative calm, COVID-19 has again been coursing through much of the Middle East and North Africa, posing a major challenge for countries with low vaccination rates and healthcare systems that were often in bad shape even before the pandemic hit.

This is not entirely unexpected: The World Health Organisation warned in mid-July that infections were rising, with the particularly contagious Delta variant spreading fast. And that was before the Muslim holiday of Eid al-Adha, which this year ran from 19-23 July and traditionally includes large gatherings.

Since then, infections have shot up in Libya, Morocco, Lebanon, and Iran – where on Monday COVID-19 deaths hit a daily high of 665 – as well as in places like Tunisia and Algeria, where the numbers have since dropped off but have already had serious consequences.

Vaccination rates are low almost across the board, and for a variety of reasons: limited deliveries from the UN-backed COVAX facility, scepticism of the jabs, and the inability of many countries to purchase doses after their economies were hit hard by the pandemic. Israel (but not, for the most part, occupied Gaza or the West Bank) and the Gulf countries are notable exceptions.

In early August, Dr. Haytham Qosa, head of health in the Middle East and North Africa for the International Federation of the Red Cross and Red Crescent Societies (IFRC), cautioned that vaccine inequity is a serious threat in a region already dealing with a litany of problems.

“Leaving countries behind on vaccines will only serve to prolong the pandemic, not just in the region, but globally,” Dr. Qosa said. “Many countries are facing other vulnerabilities, including conflict, natural disasters, water shortages, displacement, and other disease outbreaks. This makes people even more vulnerable to the devastating impacts of COVID-19. This alone should be a reason enough for global solidarity to ensure equitable vaccine access in the region.”

Below, The New Humanitarian presents snapshots from five Middle Eastern and North African countries confronting the impacts of COVID-19.

Libya: Soaring caseload amidst supply shortages

COVID in Libya has come on top of protracted conflict, meaning that relief efforts must juggle health services with distribution of food and other essentials to vulnerable household.

COVID cases: 286,894 – Deaths: 3,956 – Vaccinations: 764,233 doses – Percentage of population vaccinated*: 5.6%

As cases soar, health workers in Libya say they’re still struggling with the same overarching obstacle they faced at the start of the pandemic: a decade of armed conflict and chaos has crippled the country’s healthcare system.

“In our hospital, we have outdated and broken medical equipment. You can find dusty ventilators locked in a room. Nobody is able to use them,” said Dr. Nasser, a physician at Tripoli Central Hospital – the Libyan capital’s second largest.

Dr. Nasser, who asked that his surname not be published, said many doctors aren’t being regularly paid by the country’s six-month-old interim government, and that 17 months on from Libya’s first confirmed coronavirus case, “there is still a severe shortage [at his hospital] of lifesaving medicine and supplies, including gloves and masks.” Libya has not yet confirmed an official case of the Delta variant, but the WHO says it is “suspected” because of its presence in neighbouring Tunisia and Libya.

Libya, which has a population of around seven million, has so far received around 2.7 million doses of vaccine, including 292,890 doses of AstraZeneca and Pfizer vaccines via COVAX, as well as a reported 900,000 doses of Russia’s Sputnik V from third countries and two million doses of China’s Sinopharm. It has administered more than 764,000 doses so far, in a country of around seven million people.

Several Libyans told The New Humanitarian they were frustrated at how the government has organised the vaccination campaign. “My family and I signed up to get the vaccine, but we never heard back,” said a recent medical school graduate from the second city of Benghazi who asked not to be named.

Dr. Tamadur Almahdi, who works for Speetar, a Libyan telemedicine platform that offers online consultations, said “a lot of people are asking about the vaccine’s safety, efficacy, effectiveness, and protection.”

COVID-19 vaccination is even harder for the more than 600,000 migrants, refugees, and asylum seekers in Libya, with discrimination in accessing healthcare services a longstanding barrier for this population, who also face detention, torture, rape, and other abuses.

Mohammed Mussa, a Sudanese refugee from Darfur who lives in Surman, a town in northwestern Libya, said getting vaccinated is just not his top priority. “If I look at my situation, I don’t see where the importance of the vaccine fits in,” he told The New Humanitarian. “Right now, I don’t even have enough money for food, rent, or medical care.

Sara Creta, long-time reporter on Libya, currently in Darfur/The New Humanitarian

Lebanon: Lights out, economic worries

Nurse takes tempature of child suspected of COVID symptoms in a Lebanese public health centre

COVID cases: 584,896 – Deaths: 7,988 – Vaccinations: 2,221,656 – Percentage of population vaccinated*: 16.4%

With its economy in tatters and some hospitals now running out of electricity and medications because of subsidy cuts, Lebanon is barely able to respond to new COVID-19 cases, which have been increasing at a fairly steady rate since late June.

Two weeks ago, Dr. Abdulrahman Bizri, the head of Lebanon’s COVID-19 vaccination committee, said the new Delta variant had been identified in 60 percent of new cases.

Lebanon’s financial crisis, which began before the pandemic but was worsened by it, has been disastrous: The local currency has lost 90 percent of its value since September 2019, and food prices are up 400 percent, among the highest worldwide. Today, about half the population lives in poverty.

That may be among the reasons the country’s COVID-19 policy has mostly focused on mitigating the economic effects of the pandemic: Unemployment skyrocketed following its first lockdown in March 2020, and there have been few subsequent lockdowns despite rising cases. The government largely allowed the country to stay open in the summer and winter of 2020, when tourists poured in, and restaurants, nightlife, and hotels were allowed to function at almost full capacity.

This temporarily helped breathe life into the economy, but it also allowed for intermittent surges in cases, including this one – the largest since December 2020. “We never put into place an effective long-term strategy,” Dr. Jade Khalife, a Lebanese physician who specialises in health systems, told The New Humanitarian. “You have repetitive cycles of surges every five or seven months… with yo-yo partial or full lockdowns.”

Doctors and hospital administrators have cautioned that they would be unable to cope with a full-on Delta variant wave, should current trends continue. When cases skyrocketed last January, some hospitals treated patients on stretchers used as makeshift beds, and had to reallocate other wards for coronavirus cases. Due to the lack of capacity and oxygen shortages, patients with less severe symptoms were sent home.

Lebanon’s vaccine rollout has been slow, and one vaccination drive was postponed due to electricity issues, but rates are relatively high for the region: Just over 32 percent of the population registered for the vaccine, and less than 21 percent of the population is fully vaccinated (other sources put this number closer to 16 percent). According to data from UNICEF, Lebanon’s cash-strapped government has secured a total of 2.64 million vaccine doses, including 292,800 of the AstraZeneca vaccine from COVAX, and 588,510 doses of Pfizer. Some of the Pfizer doses have come from COVAX and most thanks to money from the World Bank, which reallocated $34 million in emergency funding from an existing healthcare project to pay for them.

Meanwhile, Russia’s Sputnik V vaccine is available through a private distributor, which has mostly been selling them to businesses. There may be more Sputnik V available soon: A Lebanese pharmaceutical company announced in early August it had signed a deal to produce the vaccine locally.

Dr. Khalife says Lebanon can’t just rely on travellers and sick people self-isolating, especially as mass vaccination hasn’t happened yet. “The weakness of over-relying on vaccines has been exposed already, because our access to vaccines was already quite weak, and we started later than other countries,” he said. “We need to focus on preventing cases, and adopt a policy of containment and move towards elimination.”

Kareem Chehayeb, Beirut, Lebanon/The New Humanitarian

Tunisia: A deadly wave abating?

Tunisia faced dire shortages of COVID supplies, as it hit its catastrophic third wave – which now seems to be abating after massive national and international mobilization.

COVID cases: 626,750 – Deaths: 22,025 – Vaccinations: 4,690,354 – Percentage of population vaccinated*: 20.3%

Tunisia’s dramatic third wave of COVID-19 became so catastrophic by late July that it sent protesters into the streets, with the country’s president dismissing the country’s then-prime minister and suspending parliament in a move denounced by critics as a coup.

President Kais Saied said his actions were necessary to fix the country’s faltering economy, and to put a stop to a coronavirus death toll and caseload that had soared to new heights: Morgues had been filling up, hospitals were overwhelmed and running out of oxygen, and grave-diggers were working around the clock.

While cases have since dropped off, Tunisia has the highest recorded death rate per capita in the Middle East and North Africa, with 22,025 deaths in a country of around 12 million. In early August, the WHO said more than 90 percent of the country’s infections were due to the Delta variant, and “being fuelled by low adherence to public health and social measures, as well as low vaccination coverage”.

Since then, the country has kicked off a massive vaccination drive, having received – or been promised – several million doses from Saudi Arabia, the United Arab Emirates, Turkey, and Algeria (which has been struggling with its own wave). Tunisia has also received 1.9 million doses of Pfizer, AstraZeneca, and Moderna vaccines from COVAX.

Tunisia and neighbouring Algeria have also been forced to allocate limited resources to fight devastating wildfires in soaring summer temperatures. “Climate change is here. It impacts people across the globe every day,” Anne Leclerc, from the International Federation of Red Cross and Red Crescent Societies, said in a statement last week. “Combined with the recent surge of COVID-19 cases in the region, we are tackling multiple crises simultaneously. The combination of these is stretching already strained healthcare systems to their limits.”

-The New Humanitarian

Iraq: A third wave, and concern for the next one

A doctor at Baghdad’s Medical City health complex analyses COVID-19 test results, on 1 August 2021.

COVID cases: 1,793,372 – Deaths: 19,815 – Vaccinations: 2,102,550 – Percentage of population vaccinated*: 2.7%

In Iraq, health workers told The New Humanitarian they had been taking major risks to treat the sick throughout multiple waves of the virus, and that even the start of vaccinations hadn’t necessarily reduced their fears.

That’s because its public healthcare system – marked by dilapidated infrastructure, chronic underfunding, a shortage of medical staff, and a serious lack of trust – was recently hit by two deadly fires at facilities treating coronavirus patients. An April fire at a Baghdad hospital killed at least 82 people, and the death toll from a July hospital blaze in a COVID-19 isolation ward in the southeastern city of Nasiriyah is at least 92.

Iraq has received 2.9 million vaccine doses from COVAX, including 1.1 million doses of AstraZeneca and 500,000 Pfizer via COVAX, plus 550,000 more doses of Pfizer from other countries or agreements. It also has 750,000 of Sinopharm. Vaccination campaigns are mostly taking place in major cities and hospitals, which has raised some concern about crowding and the possibility of infection at these centres.

Noor Hazem, a nurse in Baghdad, told The New Humanitarian she has been constantly terrified about bringing the virus home. “I’m in direct contact with the infected, so since the start of the pandemic I’ve been preparing myself to say goodbye to my family forever.”

While Hazem said “the vaccine saved my life”, she added that the April and July disasters had raised new worries for her: “I now wonder about how to avoid getting burned in the hospital where I work.”

Not everyone has been as willing as Hazem to take the vaccine. Ali Kareem, 30, a doctor at Baghdad’s al-Yarmouk hospital, told The New Humanitarian that a worrying number of people have declined to be vaccinated. “We are still facing the height of the third wave, due to people refusing to be vaccinated,” he said. “The situation will get worse,” he added. “We don’t have enough beds for patients, and we’re unlikely to be able to provide them with oxygen or care” as the wave progresses.

The situation is not helped by rumours that the vaccines cause infertility and are a way for Western countries to spy on the population. However, the recent increase in infections and the government’s insistence that people entering official institutions show a vaccine card appears to have increased uptake.

One aid worker, who requested anonymity to speak freely, said the aid community was trying to immunise the more than 248,000 refugees and asylum seekers and 1.3 million internally displaced people in Iraq; but she said refusal rates had been high (although it’s hard to know the actual vaccination rates among these groups because they can’t register independently for the jabs). “We are working hard through awareness sessions about the virus,” the aid worker said. “The infection inside the camps is considered a time bomb… [because] people share cooking tools, food, and bathrooms.”

Health workers were also concerned they would see more cases of the Delta variant because of Muharram, a month that has particular significance for Shia Muslims and began this year on 10 August. This period sees tourists flock to Iraq from Iran and Pakistan, a millions-strong pilgrimage to the southern city of Karbala, and gatherings elsewhere in the country.

Sanar Hasan, Baghdad, Iraq/The New Humanitarian

Yemen: A divided country and COVID denial

Makeshift COVID treatment centre in Aden, Yemen, operated by the International Committee of the Red Cross (ICRC)

COVID cases: 7,308 – Deaths: 1,405 – Vaccinations: 311,483 – Percentage of population vaccinated*: 0.5 %

Yemenis have suffered at least two serious waves of COVID-19, with treatment options extremely limited by a healthcare system that has been decimated by six years of war, and fear of seeking help compounding the problem.

Officially, infections and deaths in both the Houthi rebel-run north (including the capital city of Sana’a) and the internationally recognised government-run south are relatively low and stable at the moment. But recent reports say the Houthis have opted to keep the real case numbers secret (they suggest that releasing this information would generate unnecessary fears), and when vaccines arrived in the country – 360,000 doses of the India-produced Covishield (licensed by AstraZeneca) via COVAX in March – they allowed only 1,000 doses into the part of Yemen they control.

Dr. Abdurrahim al-Murri, who works at the COVID-19 isolation centre at Sana’a’s al-Kuwait hospital, said what appeared to be a second wave had slowed by the end of Ramadan – on 12 May – but had begun to rise again by the start of Eid al-Adha, on 19 July. He said it’s hard to know exactly how many people have died because the Houthis haven’t released any data, but “we think it’s higher than at this time last year”.

The centre where he works closed temporarily in October because admission rates were so low, but now it is full. Dr. al-Murri said it has enough supplies, and that the “main challenge now seems to be the virus’ mutating nature”.

Still, he said, the local community doesn’t trust isolation centres, in part because of widespread rumours last year that Houthi-run hospitals were killing patients on purpose with a lethal injection.

“Most patients arrive too late; we can’t help them survive [at that point],” said Dr. al-Murri, adding that when he asks patients why they waited so long to get help, they mention the lethal injection rumour.

In the south of the country, where in April and May 2020 Aden was believed to be one of the cities with the highest infection rates in the world, cases also appear to have been rising since Eid al-Adha. Dr. Yaser Alwai, director of the COVID-19 isolation centre at Aden’s al-Sadaqah hospital, said that while he has more cases than this time last year, “the team is a bit more organised and prepared.”

Still, he’s concerned about another wave, what the Delta variant will mean for Yemen, and an ongoing shortage of ICU supplies. As in the north, he said, patients often “arrive too late for treatment”.

Dr. Alwai said that when vaccinations began – targeted at health workers and people who need to travel outside Yemen – people were reluctant to get their jabs. “The common person, even some medical staff, were concerned about possible side effects and complications [from the vaccine]. A lot panicked.” Uptake increased, he said, when Saudi Arabia began requiring people who work in the country to show proof that they had been vaccinated.

Still, Dr. Alwai said, misinformation and rumour remains a problem: “A significant portion of the population is denying that COVID even exists. They also have a great deal of fear of seeking treatment at isolation units, until they experience it firsthand.”

​​Shuaib Almosawa, Sana’a, Yemen/The New Humanitarian

Edited by Annie Slemrod.

__________________________

This article was originally published in The New Humanitarian, a non-profit newsroom covering crises around the globe.

*Numbers for percentage of population vaccinated use the assumption that every person needs two doses.

Data source for reported infections, deaths, and vaccinations.

Image Credits: Sanar Hasan/The New Humanitarian, ReliefWeb, The protracted conflict in Libya had forced thousands of people to leave their home, where ICRC distribute food and other essential household items to the most vulnerable. Credit: Fares ELABEID/ICRC, UNICEF , World Bank Group , ICRC.

A young man stands outside a row of buildings destroyed by a 7.2 magnitude earthquake in Haiti followed by a storm surge from Tropical Depression Grace

COVID cases across most countries of South America are now declining,  after months in which the region was the epicenter of the pandemic. 

But in the seesawing trends that the pandemic continues to see, infections are rising again throughout central and North America – as well as the Caribbean – where earthquake torn Haiti faces special risks. 

Haiti has only vaccinated about 21,000 people – after receiving its first shipment of COVID vaccines only last month, said PAHO’s assistant director, Jarbas Barbosa, speaking at a PAHO press briefing: “We are working with the ministry of health to expedite the process, despite all the challenges that Haiti is facing,” he said.

Risks of COVID transmission are rising as thousands of displaced people in Haiti’s southwestern pennisula crowd shelters or seek refuge with extended family members. Two dozen health facilities in the area have been damaged and are struggling to regain services in the hardest hit provinces of Grand’Anse, Nippes and Sud, the PAHO officials said at a Wednesday press briefing. Those factors, combined with already poor COVID testing capacity, will make case reporting and tracking even more difficult in the wake of the natural disaster.   Over 1.5 million people, including 540,000 children have been impacted by the earthquake, according to UNICEF.

On a brighter note, in Brazil, hospital occupancy has dropped by an average of 80% across all states for the first time since November, said Dr Carissa Etienne, Director of the Pan American Health Organization, which is responsible for WHO’s Americas Region, at the briefing.

But at the same time, COVID infections are now rising across Mexico and the United States, fueled by the highly infectious Delta variant.   

 “In Mexico, more than two thirds of states have been deemed at “high” or “critical” risk as hospitals fill with COVID patients,” she said.

Cases and deaths also are rising in Central America, including countries such as in Costa Rica, where vaccine drives have been fairly successful.  Likewise, infections and deaths are increasing across the Caribbean, including in Cuba. Dominica, Guadalupe, Jamaica, Martinique, and Puerto Rico, where cases rose by 49% and deaths increased by 70%. In Trinidad and Tobago, weekly deaths continued to rise, said PAHO officials.

Appeal for aid to earthquake-struck Haiti

Epicentre of 2021 Haiti earthquake

Meanwhile, groups ranging from USAID to the European Union were rushing aid to Haiti, where at least 1,300 people have been killed by the 7.2 magnitude quake that struck early Saturday morning.  Another 5,700 people have been injured, said Médecins Sans Frontières, which said that a complete mapping of the disaster in remote areas remained challenging.

“Many patients are outside or in tents, not to mention all the Haitians who have lost their homes, said Michael Olivier Lacharité, MSF head of emergencies.  Heavy rains from tropical storm Grace and landslides damaging access roads were further challenging relief workers – who were resorting to helicopter and sea travel when feasible.

WHO Appeals to International Community for Aid

People search through the rubble of what used to be the Manguier Hotel after the earthquake in Les Cayes. Haiti, 14 August, 2021.

Etienne called on the international community to meet the country’s “immense” need for medical aid, including health workers, medicines, equipment and transport vehicles. 

“What we need is health personnel, supplies and equipment to treat patients with trauma, injuries, acute illnesses, chronic diseases and mental issues,” she said at a Wednesday briefing. “There is an urgent need to restore health services mainly in the most affected areas and to ensure adequate water and sanitation to prevent increases of diarrheal, respiratory, and skin diseases.”

“Our hearts go out to the people of Haiti, and rest assured that we are doing everything possible to assist Haitians in these difficult and hard times,” added Etienne, paying special homage to PAHO public health emergencies specialist, Dr. Ousmane Touré, who perished in the earthquake. 

‘Moment in history of extreme fragility’

Her comments were echoed in Geneva by Dr Tedros Adhanom Ghebreyesus, noting that on the occasion of World Humanitarian Day, observed Thursday August 19, world was facing unparalleled challenges from health and humanitarian response efforts in corners of the world as diverse as Haiti and Afghanistan – compounded by the overarching challenges of the COVID pandemic.

“I can honestly say that I have never seen so many emergencies happening simultaneously. This moment in history is one of extreme fragility,” Tedros said.

The Haiti earthquake was the latest in a series of natural and political disasters to have struck the island nation, also one of the poorest in the world.  The earthquake hit along the same fault lines that triggered another 7.0 magnitude earthquake in 2010 killing as many as 300,000 people in and around the capital city of Port-au-Prince.  

While this time the capital city escaped relatively unscathed, the tremor’s epicenter in remote rural regions also made relief and rescue operations more difficult. And it was a particularly traumatic blow for people who had relocated to the penninsula just a decade ago in order to get away from earthquake risks – only to find themselves homeless once again, the New Humanitarian noted. 

Image Credits: UNICEF/Georges Harry Rouzier, US Geological Survey/Google Maps, Médecins sans Frontières.