Pedestrians in Dhakka cover their faces to keep from breathing in air pollution, which takes 22 months off the average life expectancy in Bangladesh, according to recent data. (Photo: Rashed Shumon)

In a milestone moment, WHO today issued new guidelines for a range of health-harmful air pollutants – recommending a reduction by one-half in safe levels of fine particulates (PM2.5) – considered to be the benchmark indicator of health impacts that lead to some 7 million deaths a year. 

The new standards put most cities of the world – including in high income countries – in excess of WHO clean air standards once again – after a decade in which many cities and countries enacted strict new policies to clean up their air in line with the last set of WHO recommendations, issued in 2005.  

But reducing ambient concentrations of PM2.5 pollution, both outdoors and inside homes, even further to the new guideline limit of 5 micrograms per cubic meter (5 µg/m3) would save some 5-6 million lives a year, said WHO expert Michel Kryzanowski at a WHO press launch of the new guidelines on Wednesday. And that justifies the strict new WHO recommendations. 

New WHO Air Quality Guidelines – safe levels of key pollutants reduced by one-half or more.

“Some 80% of health impacts could be avoided if we get to these WHO levels globally,” Kyrzanowski said. “It’s not because the pollutants became more dangerous, but we know much more about how those pollutants affect human populations.” 

Altogether, the new WHO guidelines impose stricter limits on five key pollutants overall – including nitrogen dioxide, ozone and carbon monoxide, as well as small (PM10) and fine (PM2.5) particulates.

The new limits reflect new scientific evidence that has documented the even greater impacts of air pollution from respiratory and cardiovascular diseases, stroke and cancers, and the risk of severe COVID-19, said WHO Director General Dr Tedros Adhanom Ghebreyesus in his remarks. 

“Right now, the simple act of breathing contributes to more than 7 million deaths a year,” Dr Tedros said. Those health impacts extend from “the brain to a growing baby in a mother’s womb, at even lower concentrations than previously observed”.”  

And air pollution is a particular health threat in low-income countries – where millions of people routinely breathe air choked with pollutants that are many times over WHO guideline levels “due to urbanization and rapid economic development, and household air pollution in the home caused by cooking, heating and lighting.” 

WH0 Director General Dr Tedros Adhanom Ghebreyesus

Less Climate Change – More Economic Growth &  Benefits for Developing Countries  

Along with saving lives, stricter limits on air pollution emissions will translate immediately into less climate change as well as generating trillions of dollars of economic benefits, stressed Tedros, in his appearance alongside WHO European Regional officials, who oversaw the new guidelines development, and WHO’s director of Climate,, Health and Environment, Maria Neira. 

“These guidelines come at an important time ahead of the COP26 climate change conference in November. .. I urge all countries to put these guidelines to use to save lives, support healthy communities and help address the climate crisis,” Tedros said. 

Added Hans Kluge, WHO Europe Regional Director, “almost all efforts to improve air quality can enhance climate action: almost all climate change mitigation efforts improve air quality, with immediate health benefits… “This enhances return of investments into measures that simultaneously address both.”

Not only would millions of lives be saved, but some US$ 3.5 trillion a year in lost worker productivity and healthcare costs could be avoided if the new WHO guidelines were met, added Neira.  Other benefits would extend to agricultural production, whose yields are reduced by pollutants like ozone, which develops over cities and then drifts across the countryside. 

Key sources of pollution that could readily be identified and reduced range from energy and transport systems to industrial pollution, waste burning and household pollution from wood and coal fire use, she noted.  All require a “holistic approach” by policymakers to tackle and reduce.

New limits – a high bar to reach 

Hans Kluge, WHO Regional Director for Europe

But even in developed countries, with comparatively good air quality, the stricter limits will be a high bar to reach.   Many cities in Europe and North America have average annual air pollution concentrations that meet the current WHO guideline limits for the benchmark pollutant of PM2.5, or come close.  

Those cities and towns will now find themselves far out of compliance with the new WHO standards – not to mention low- and middle-income cities in regions such as South East Asia, which suffer from chronic air pollution levels that may be 10-20 times higher than WHO guidelines. 

“Almost all guideline levels are now lower than 15 years ago. We know that for many countries, this places the bar even higher than ever before,” Kluge said. “But these guidelines also provide interim targets, to support stepwise progress towards that achievement.”

Nitrogen dioxide pollution, associated with diesel vehicles, reduced four-fold 

Countries and regions with the highest levels of health-harmful air pollution.

Along with the tighter limits on PM2.5 – most closely associated with fatal health impacts – the new WHO guidelines also recommend a fourfold reduction in average annual concentrations of nitrogen dioxide – from 40 µg/m3 to just 10 µg/m3. 

Recent evidence has underlined the long-term damage that NO2 exposures can wreak on respiratory systems – from a very young to older ages. NO2 also contributes to the production of urban ozone (O3) – which is a short-lived climate pollutant (SLCP). Reducing short-lived climate pollutants, including black carbon particulates and methane, as well as ozone, would be one of the fastest ways to slow down the pace of global warming, say advocates with the Climate and Clean Air Coalition, sponsored by the United Nations Environment Programme and supported by WHO.  

But the strict new NO2 limits also strike at the heart of the diesel car industry, which had built a generation of vehicles with progressively lower emissions of PM2.5 – but still high emissions from nitrogen dioxide – which particulate filters cannot trap.  

Closer adherence by cities to the new WHO NO2 guidelines would thus almost certainly hasten the transition to hybrid gasoline and  electric vehicles – as well as other public transit, walking and cycling alternatives.    

At the same time, the new WHO guidelines also establish, for the first time ever, a limit for “peak season” concentrations of ozone, as such. Ozone contributes to chronic respiratory disease, including the prevalence of asthma, as well as inflicting considerable damage on crop production when ozone drifts from cities into surrounding rural areas.  

South East Asian cities suffer from some of the worst pollution in the world.  Pollution in Delhi (portrayed here) typically peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources.

SO2 guideline value loosened – but that was due to methods change 

Conversely, however, WHO actually raised its safe guideline for 24-hour concentrations of sulphur dioxide, SO2 – from 20 to 40 µg/m3. A key source of SO2 emissions is industry smokestacks which were among the first targets for air quality campaigns by environmental groups in the 1960s and 1970s. . 

In fact, there is “vast new evidence which was produced in the last 15 years, which confirms what we knew before about sulfur dioxide exposure -that it is producing health effects, up to the very low levels,” said Kryzanowski. 

However, he said methods changes in attributing health impacts to various pollutants still led to a higher baseline indicator for SO2 – in comparison 2005 value, as well as in comparison to the other pollutants now being measured. 

“There was a methodology of setting guidance, which was different back in 2005,” Kryzanowski said. “We tried to make the guidelines comparable between various pollutants. 

“And using the same methodology, the same protocol of defining the guideline values, this protocol ended up actually with a higher value than before. This value  is believed to count the health effects to the same extent as the guidelines for other pollutants, so we believe that it is fair to have it in this form as it is now.” 

Image Credits: Rashed Shumon, WHO, World Bank, Flickr.

US President Joe Biden addressing his COVID-19 summit.

The US is buying 500 million COVID-19 vaccines from Pfizer for low and middle-income countries, which will be shipped “by this time next year”, US President Joe Biden announced at his COVID-19 summit on Wednesday.

“For every one shot we’ve administered to date in America, we have now committed to doing three shots for the rest of the world,” said Biden, adding that the US had already shipped nearly 160 million doses to 100 countries – “more than every other country has donated combined”.

The US committed an additional $370 million to buy and deliver these shots and more than $380 million to assist in the global vaccine alliance, Gavi, to further facilitate vaccine distribution in regions of the greatest with the greatest need, said Biden.

Meanwhile, Pfizer announced on Wednesday that it would provide the 500 million vaccines “at a not-for-profit price for donation to low- and lower-middle-income countries and the organisations that support them” – but did not specify a price.

“This expanded agreement brings the total number of doses to be supplied to the US government for donation to these countries to one billion,” said Pfizer, adding that they would be shipped to  92 low- and lower-middle-income countries as defined by Gavi’s COVAX Advanced Market Commitment (AMC) and the 55 member states of the African Union.

“Deliveries of the initial 500 million doses began in August 2021, and the total one billion doses under the expanded agreement are expected to be delivered by the end of September 2022. The current plan is to produce these doses in Pfizer’s US facilities,” the company added.

Earlier in the week, Knowledge Ecology International reported that the $10 billion contract between the US government and Pfizer to purchase the initial 500 million doses “contains a clause indicating that the $20 per dose price may be a floor and not a ceiling going forward”.

Acknowledging that over 4.5 million people had already died of COVID-19, Biden said that the summit is about “supercharging” global efforts in “vaccinating the world by dramatically ramping up vaccine production, donations delivery and administering the vaccine, which is a logistical challenge”. 

New US-EU fund

The US and the European Union also announced a COVID-19 vaccine partnership to donate – not sell – vaccines to LMIC, added Biden.

Ursula von den Leyen, President of the European Commission told the summit that the EU would “work with the US and within the G20 to set up a new global health financial intermediary fund” to help pay for the donations.

US Vice-President Kamala Harris elaborated that her country wanted the fund to be based at the World Bank, and at address pandemic preparedness – not just  the current pandemic

“The United States is prepared to contribute at least $250 million to help get this fund started. We have also requested an additional $850 million from the US Congress,” Harris told the summit.

“We are issuing a call to action to countries and corporations from around the world to join us in this effort. And we have a collective goal of reaching $10 billion at the outset,” said Harris, adding that the world was still not prepared for the next pandemic.

“Our world is not fully prepared to prevent to detect and to respond to future biological threats,” said Harris, reiterating US support for a global health threats council that would monitor progress and identify gaps.

Kamala Harris addresses the COVID-19 Summit.

South African President Cyril Ramaphosa welcomed the establishment of the fund, and also expressed support for a proposed global health threats council.

However, Ramaphosa asked the summit to go further and adopt UN Secretary-General Antonio Guterres’ proposal for a “global vaccination plan”. 

“Cooperation, collective action and, above all, consensus, is our greatest strength in the current crisis, and will continue to be so into the future,” stressed Ramaphosa.

Guterres has previously expressed fears that the tension between the US and China may undermine global efforts to end the pandemic. South Africa has close relations with both countries.

Ramaphosa also urged the summit to come up with a sustainable plan “on how developing countries can be supported through technology, through finance and through various of support, not only to meet targets around vaccines, diagnostics, personal protective equipment, but also for manufacturing”.

Ramaphosa also stressed that the world “must close the financing and supply gap for COVAX, the Africa Vaccine Acquisition Task Team, and other mechanisms”. 

WHO’s recent mission to Afghanistan

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

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

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

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

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

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

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

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

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

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

  

 

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

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

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

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

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

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

Boycotts and controversy

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

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

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

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

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

Desperate need for food policy change

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

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

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

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

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

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

Taxes, warning labels and marketing restrictions

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

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

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

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

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

Most Mexican kids had sodas for breakfast

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

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

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

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

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

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

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

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

Safe, nutritious food for all

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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

Protests against ‘vaccine apartheid’ at UN

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

 

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

 

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

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

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

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

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

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

UN Secretary General Antonio Guterres

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

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

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

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

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

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

More Biden donations 

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

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

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

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

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

Image Credits: CNN.

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

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

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

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

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

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

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

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

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

Healthy limits

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

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

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

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

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

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

 

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

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

Devastating impact on TB access and treatment 

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

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

Malaria services fared better

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

 

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

Rapid action prevents worse outcomes

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

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

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

COVID-19 as a catalyst

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

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

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

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

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

Health gains of Afghanistani women and children are in danger.

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

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

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

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

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

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

Ensuring mothers and babies get high-quality medicine

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

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

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

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

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

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

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

Fake products undermine patient trust

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

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

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

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

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

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

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

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

Kawaldip Sehmi

 

 

 

Image Credits: Ahmadi/ UNICEF.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More investment needed

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

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

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

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

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

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

Africa facing massive shortages in healthcare workforce

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

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

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

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

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

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

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

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

Innovation is a central component of public health

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

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

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

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

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

Partnerships with private sector are essential

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Appeal to swap doses, deliver to COVAX and AVAT

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

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

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

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

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

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

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

‘No point’ in mRNA transfer

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

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

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

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

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

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

Image Credits: Gavi .