Protesters and police clashed during a march against France’s health pass, which requires proof of vaccination against COVID-19 or a negative test to enter many public venues.

As more high income countries adopt COVID-19 passes for entry to venues like sporting and cultural events, restaurants and even workplaces, public opposition to the use of the public health tool is also growing – despite the fact that these same countries enjoy very widespread access to vaccines and rapid COVID tests. 

However, countries like France and Italy, which saw noisy demonstrations over the passes last weekend, are now registering record numbers of registrations for vaccines – suggesting that the new measures may also be effective in convincing the vaccine-hesitant to finally get their jab.

The passes are being touted by over a dozen European governments as a way to reopen economies and societies despite the sharp, recent rises in new COVID cases, driven by the steady global spread of the more contagious Delta variant.

In Europe, uptake of domestic passes follow on the European Union-wide adoption of the COVID Digital Certificate  on 1 July, to ease restrictions on international travel within the EU and beyond, but verifying an individual’s vaccination status, recent negative test result, or recovery from a COVID infection.

Some 13 EU member states have now established plans to extend the COVID pass system for domestic use. The new rules typically require digital or paper documentation of a certificate before entry into bars, restaurants, museums, indoor sports venues, and other cultural or entertainment sites.  

Denmark, Austria, Cyprus, France, Germany, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Portugal, Ireland, and Slovenia are among those who are already enforcing domestic health passes. 

Switzerland, which is part of the European Schengen free travel zone, has meanwhile, only implemented such a pass system for large scale events with over 1,000 participants and nightclubs. For smaller events, as well as restaurants, sporting, cultural, and leisure facilities, the use of a COVID pass is discretionary. 

The United Kingdom also is discussing implementing a vaccine pass system for large scale indoor events by the end of September. Israel, which abandoned virtually all COVID restrictions after a mass vaccination campaign pushed new cases to nearly zero, has now re-instituted its Green Pass programme for virtually all indoor venues in the face of new infections that now exceed 1000 people a day.   

Some US states & employers will require proof of vaccination

The Biden Administration ruled out introducing mandatory federal vaccine passes in the US in early April, but some states have decided to introduce their own measures. California and New York will require state employees and healthcare workers to show proof of vaccination or get tested weekly. Unvaccinated health workers will be required to wear a face mask.  Google and Facebook also announced Wednesday that they would require vaccines for workers at US offices. 

California plans to implement the measures in early August, while New York will adopt them in mid-September.

“It’s like drunk drivers, you don’t have the right to go out and drink and drive and put everybody else at risk, including your own life at risk,” said Gavin Newsom, Governor of California, at a press briefing on Monday. “Those non-pharmaceutical interventions like face coverings and masking were necessary in the absence of vaccines, but with these vaccines, we can extinguish this virus once and for all.”

The Department of Veterans Affairs, which runs one of the nation’s largest health systems, announced on Monday that it would mandate vaccines for healthcare personnel working in Veterans Health Administration facilities. Also on Monday, nearly 60 major health care professional organizations released a joint statement calling for all health care employers to require their employees to be vaccinated against COVID-19.

Protestors decry ‘discrimination’ – but move is incentivizing vaccination   

Switzerland, which is part of the Schengen area, has implemented a pass system for large scale events with over 1,000 participants.

Protests over the passes have erupted almost everywhere where the measure has been introduced – with particularly noisy outcries seen over last weekend in Europe, from Paris to Rome and other major cities across Italy – on city streets that were largely empty only a year ago, under a COVID-imposed lockdown.

But at least half a million vaccination appointments were made within 24 hours of the first Italian announcement of the green pass measure. The pass, to take effect on 6 August, will also be available to those who have only received one vaccine jab. 

“We registered an increase in bookings ranging from +15% to +200% depending on the region,” said Francesco Figliuolo, Italy’s COVID-19 Emergency Commissioner, on an Italian TV news show Tg5. “In Friuli Venezia Giulia we registered +6,000%.”

The new Italian pass announced last week, would be needed to enter gyms, swimming pools, museums, cinemas, theatres, sports stadiums, and indoor seating in bars and restaurants.

“The Green Pass is not arbitrary, but a necessary condition not to shut down the economy,” said Italian Prime Minister Mario Draghi at a press conference on Thursday. “Without vaccinations, everything will have to close again,” he added.

Freedom or ‘selfishness’

In France, the Senate approved a bill on Saturday to introduce mandatory vaccination requirements for certain professions, notably healthcare workers – who must be vaccinated by 15 September. As for the general public, a health pass showing proof of full vaccination or a negative COVID test would be required for adults to gain access to indoor dining and leisure spaces from the beginning of August. A pass showing proof of a negative COVID test will be required for children over the age of 12 from the end of September. 

France’s new mandatory health pass will be required to enter restaurants, bars, theatres, and museums, among other venues.

While over 160,000 French demonstrators took to the streets at the same time – it was clear that the new policy is prompting record numbers of people to book vaccination appointments. Some 1.7 million appointments were made  in just the first 24 hours following President Macron’s initial speech on the COVID pass initiative, and 3.7 million were booked in the first week after he spoke in mid-July,

“You will have understood that vaccination is not obligatory straight away, but we are going to extend the health pass to its maximum to encourage as many of you as possible to get yourselves vaccinated,” said Macron in a televised address. 

Overall, there has been a 59% weekly increase in turnout for first doses, reported one French analyst, Guillaume Rozier. 

While protestors have even cloaked their opposition to the passes in the charged language and symbols of racist Nazi exclusion during World War II, such as the yellow star, public health and government officials have stressed exactly the opposite message.

In fact, they say, COVID passes are an example of the kind of social solidarity, and mutual responsibility of one citizen for another, that is required to beat the pandemic.

“What is your freedom worth if you say to me ‘I don’t want to be vaccinated,’ but tomorrow you infect your father, your mother or myself?” French President Emmauel Macron told the press, during a visit to a hospital in French Polynesia on Saturday.

“That is not freedom, that is irresponsibility and selfishness.” 

More demonstrations are planned in towns and cities across France on Saturday 31 July, the largest of which are expected to take place in Paris. Some 3,000 police officers will be deployed to the capital, where more than 10,000 people are expected to join four protests.

Green passes could be as effective as lockdowns, says one public health expert 

Several countries have arranged to implement a domestic vaccine pass to regulate entry into certain venues.

The “extended use [of the health pass] has not yet been evaluated, but it could prove to be as effective as lockdown, since it amounts to confining all the non-vaccinated who will not have access to bars, restaurants, cultural, social, sporting and festive life, unless they present negative tests every 48 hours,” Antoine Flahault, Director of the University of Geneva’s Global Health Institute told Euronews. 

“And the extended use of the health pass is much less socially and economically punishing [compared to lockdowns],” Flahault added. “We will soon know if it keeps its promises and avoids the saturation of French and Italian hospitals.”

Debate over COVID certificates is ‘like a debate over deck chairs on the Titantic’ 

Other observers point out that the debate over the COVID passes is largely a luxury of the rich – living in societies with enough access to vaccines and tests so that they can indeed be required of every citizen.  But green passes won’t extricate the world from the pandemic – in the absence of low vaccine access in low and middle-income countries.

“I am very troubled about the widespread ignorance in Europe and Switzerland over the problem of global vaccine inequity,” Dr Sara L.M. Davis, Senior Researcher at the Global Health Center, told Health Policy Watch. Over 75% of the 3.5 billion vaccines distributed globally have gone to just ten countries, she points out.

And globally, new cases are now increasing at worrisome rates with the highly transmissible Delta variant sweeping across the world, and cases rising again in the Americas, European and Western Pacific regions, with particular hotspots in countries such as the United Kingdom, Indonesia and Brazil. 

Africa has been in the midst of its worst wave to date. And at the same time, only 1.6% of the population of Africa have been fully vaccinated, as compared to 37% of the population in Europe and North America.  With such low vaccination rates in so many parts of the world, the virus will continue to propagate and spur more new and potentially dangerous variants – no matter what measures are taken in Europe, experts such as Davis warn. 

“Under these circumstances, I think debating the use of vaccine certificates to access restaurants or nightclubs for me and my friends in Switzerland is a little like debating the arrangement of the deck chairs on the Titanic. Unless we have global vaccine justice we’ll all be underwater,” said Davis. 

Image Credits: DW News, Al Jazeera English.

Tanzanian and US officials celebrate the arrival of the first COVID-19 vaccines in the country, part of a donation from the US.

Tanzania has finally started to administer COVID-19 vaccinations, amid a 16-fold increase in vaccine deliveries to Africa in this week alone in comparison to the whole of June.

Tanzanian President Samia Suluhu publicly received the vaccine on Wednesday, a sharp contrast to her predecessor, John Magufuli, who died in March after months of denying the existence of COVID in the country.

Tanzania’s vaccine rollout is the result of a donation of 1,058,000 doses of Johnson and Johnson COVID vaccine from the US government.

After receiving her J&J dose, Suluhu urged Tanzanians to follow her example, noting that the country was not an island but is a part of the interlinked global ecosystem.

Addressing an Africa Centre for Disease Control and Prevention (CDC) press briefing on Thursday, centre director Dr John Nkengasong welcomed the development.

“I just came back from Tanzania and I had a conversation with the leadership. The president was very supportive. We spoke about the COVID pandemic very openly and freely. We are committed to working with them to roll out the one million doses of vaccine that they just received as part of US supply. We are very encouraged. The minister of health was extremely supportive and we look forward to doing our little best to support that effort,” Nkengasong said.

Burundi and Eritrea are now the only African countries that have not started to vaccinate their citizens against COVID-19.

“We continue to engage with Burundi and Eritrea. In the coming weeks, we will be intensifying our efforts there to understand the gaps and areas where we can support them,” Nkengasong said. 

Africa CDC Director Dr John Nkengasong

Leaving no country behind

Nkengasong noted that the battle against COVID cannot be won by leaving any country behind. Instead, he said efforts should be geared towards ensuring all the countries on the continent are supported to take required steps toward quickly stemming the spread of the pandemic.

Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa, told the briefing that four million doses had been delivered to the continent in the past week in comparison with just 245,000 doses in June. 

“COVAX aims to ship 520 million doses to Africa by the end of 2021. COVID-19 vaccine and deliveries from the African Union’s Africa Vaccine Acquisition Trust (AVAT) are picking up, with a projected rise to 10 million each month from September. Around 45 million doses are expected from AVAT by the year’s end,” Moeti said.

The WHO also revealed that COVAX had reached a deal with Sinopharm and Sinovac which will rapidly supply 110 million more doses of COVID vaccines to low-income countries. 

COVAX and the World Bank are also introducing a new cost-sharing arrangement through which low-income countries can purchase doses beyond the fully donor-subsidized doses they are already receiving from COVAX.

Dr Matshidiso Moeti, WHO Regional Director for Africa

Overall cases are falling but 22 countries report increases over 20%

As more vaccine doses are increasingly becoming available to African countries, the number of cases is also falling with the continent recording its second week of falling case numbers after an unbroken eight-week surge. 

According to the WHO, reported case numbers fell by 18% from over 282,000 to 230,500 in the week ending on 25 July. But 22 countries reported increases of over 20% and reported deaths rose in 17 African countries. 

“Africa is still in the throes of a third wave. The limited slowdown in cases is heartening and cause for a very cautious optimism, but we are far from out of the woods yet. We must all stay vigilant,” said Moeti.

Across the continent, the case fatality rate (CFR) is 2.5% which is higher than the global value of 2.1%. Furthermore, four African countries – Egypt, Sahrawi Republic, Somalia and Sudan – are reporting a CFR higher than 5%.

Dilemma of safely reopening schools 

While noting that reopening schools could lead to a surge in COVID cases, Moeti also noted that continual closure of schools could threaten girl child education. She described this as a dilemma for several African countries. 

To deal with this, she said countries should prioritise efforts aimed at safely reopening schools, which she said would require additional investment.

“Certainly, if young people are going to going back to school, which is a very important objective, then there needs to be a lot of investment in ensuring that this does not result in superspreader events within the classroom and children taking the infection back home where they are likely to infect parents that may be vulnerable to falling seriously ill and dying,” she said. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus

The World Health Organization (WHO) aims to reduce new hepatitis B and C infections by 90% and deaths by 65% by 2030 but to achieve this goal, the global health body needs countries to scale up hepatitis services including prevention, testing, and treatment.

On World Hepatitis Day on Wednesday, WHO Director-General, Dr Tedros Adhanom Ghebreyesus, speaking at a virtual event under the theme “Hepatitis can’t wait”, said many countries still don’t have access to these lifesaving tools and urged everyone to “get to work”.

Over 354 million people worldwide are living with chronic hepatitis; over 8000 new infections of hepatitis B and C occur every day, and more than one million deaths from advanced liver disease and liver cancer occur every year.

Despite the setback of the COVID-19 pandemic and the varying responses to the hepatitis responses, the director-general noted some success stories including the large-scale expansion of hepatitis C treatment, and the reduction of hepatitis B infections in children as well as expanded coverage of infant vaccination. 

“This means that we’re making progress in reducing the risk of liver cancer and cirrhosis, in future generations,” said Dr Tedros.

Last week WHO released the first guidelines on hepatitis C virus self-testing – an innovation that will help normalize testing and allow people to do it in the privacy of their own homes. Last month it launched the first-everglobal guidance for countries seeking to validate elimination of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection as a public health problem.

While a few countries, including Egypt, Mongolia, and Rwanda have made strides in eliminating hepatitis, many are lagging due to, among others, lack of funding, high prices, and lack of education about hepatitis.   

Hepatitis – the “silent pandemic”

Referring to viral hepatitis as the “silent pandemic”, Pan American Health Organization (PAHO) Director Carissa Etienne said the region of the Americans has strengthened its political commitment by including viral hepatitis in the PAHO elimination initiative. 

Regional plans to eliminate viral hepatitis include partnerships that will for the first time include viral hepatitis in the Caribbean framework on HIV and AIDS. Other services include all 52 countries in the Americas introducing a vaccine against Hepatitis B to all infants during the first year of life.

Etienne however noted some of the limitations to hepatitis services include limited allocation of domestic resources to finance national responses, high prices of medicines and laboratory tests, and limitations to access to generic HCV medicines.

“Despite the policy uptake and the revolution in hepatitis therapeutics, we have not observed a consistent scale-up of testing and treatment of hepatitis B and C, particularly in Latin America and the Caribbean,” she said, adding that countries like Argentina, Brazil, Colombia, and Mexico have been able to implement a sustainable national response to viral hepatitis and to accelerate access to the diagnosis and treatment, particularly for hepatitis C.

“People living with hepatitis cannot wait and we owe it to them to deliver and…to leave no one behind.” 

Mongolia’s successful ‘healthy liver’ program

Mongolia’s Health Minister Dr Enkhbold Sereejav

In Mongolia, chronic hepatitis infections and liver diseases are the leading causes of death, accounting for an estimated one in 10 deaths. Over 95% of liver cancer is associated with hepatitis B and C infections and about one in 10 people live with chronic hepatitis B, and one in 20, live with chronic hepatitis C.

To address this socio-economic and health issue, the government of Mongolia in 2017 launched a public health program called the healthy liver program offering universal screening, diagnosis, and treatment of viral hepatitis, as well as liver cancer caused by viral hepatitis. 

“As a result of this successful program to eliminate HCB and control HPV, about 65% of the target population have been screened, ” said Mongolia’s Health Minister Dr Enkhbold Sereejav. 

Destigmatize hepatitis and support those living with the infection

Dr Sue Wong, President of the World Hepatitis Alliance

While hepatitis treatment services are crucial, the stigma of living with the infection has in some instances made prevention, screening, and treatment difficult.

But that was not the case for Dr Sue Wong, president of the World Hepatitis Alliance, who found out she had hepatitis B after donating blood in college.

“I did not face the stigma and discrimination which have kept so many people from pursuing or even interrupted their careers in healthcare. I also did not face the rejection and abandonment that many experience from family members or significant others because of their diagnosis,” said an emotional Wong.

Detailing her journey with hepatitis B, Wong said her husband was able to get vaccinated and was protected. Her four children are also free of infection as they all received the hepatitis B birth dose within 12 hours of birth.

“I am so relieved that our four children are free of the infection, and we’ll have a hepatitis free future, but millions of mothers cannot say the same,” said Wong, adding that only 43% of infants worldwide get the hepatitis B birth dose, with mothers facing the burden of having passed the infection to their children because they cannot access testing, vaccines or treatment. 

Wong called on greater access to vaccines to help save lives.

“It is, after all, our lives, our families, and the future of our children…”

 

A billion COVID-19 vaccine doses should be reallocated from high-income countries to low- and middle-income countries (LMICs) by September, and of another billion by mid-next year, former President of Liberia Ellen Johnson Sirleaf and former Prime Minister of New Zealand Helen Clark, told United Nations member states on Wednesday.

The pair, who co-chaired the Independent Panel for Pandemic Preparedness and Response which evaluated the global COVID-19 response, were briefing an informal UN plenary meeting on their findings and recommendations.

These include that a Global Health Threats Council is established, the World Health Organization (WHO) is strengthened and empowered, and a pandemic treaty is adopted to guide future pandemics.

“While in some places, vaccines are blunting the worst of COVID-19’s impact, for too many countries, supplies are so limited, and prospects for access pushed so far into the future, that hope is turning to despair,” Sirleaf told the meeting.

Ongoing disaster

Describing the COVID-19 pandemic as “an ongoing disaster”, Sirleaf added that the panel believes it “could have been averted if the countries of the world had heeded the many warnings and prepared their health and surveillance systems – and then when the outbreak began if they had moved together in mutual transparency and solidarity”.

Clark reported that the Panel had found “geopolitical tensions and nationalism had weakened the multilateral system which was designed to keep the world safe”. 

“Vaccine inequity is a key factor in the wave of death we’re seeing across Africa, Asia and Latin America,” said Clark.

“It’s astonishing and self-defeating that pharmaceutical manufacturers continue not to share the technology or know-how which could help quickly scale manufacturing. Because of that, we see the temporary waiver of patents under the WTO’s TRIPS agreement as a key tool which should be at countries’ disposal and urge a swift resolution to the protracted discussion on that,” she added.

WHO Director-General Tedros Adhanom Ghebreyesus sent a message to the meeting, which was delivered by Dr Mike Ryan, Executive Director of  the WHO’s Health Emergencies Programme.

“One of the major gaps exposed during this pandemic has been the lack of international solidarity and sharing: the sharing of pathogen data, epidemiological information, specimens, resources, technology and tools such as vaccines,” said Tedros.

Expressing support for the panel’s proposal for a treaty on pandemic preparedness and response, Tedros said: “We need a generational commitment that outlives budgetary cycles, election cycles and media cycles; That creates an overarching framework for connecting the political, financial and technical mechanisms needed for strengthening global health security.”

At the World Health Assembly in May, Member States agreed to hold a Special Session of the Assembly in November to consider developing a WHO “convention, agreement or other type of international instrument on pandemic preparedness and response”, he added.

“We call on all Member States to engage in this process. We must seize the moment. In the coming months and years, other crises will demand our attention, and distract us from the urgency of taking action now.”

Image Credits: University of Oxford.

UN Deputy Secretary General Amina Mohammed

World leaders have been given clear pointers on how to transform the global food system to be more equitable, nourishing and resistant to climate change, at the end of a three-day United Nations pre-summit attended by over 17,000 delegates.

Focus now shifts to the Head of State-level summit in New York in September, but UN Deputy Secretary General Amina Mohammed stressed that “anything we do must always include those at the center of our food systems: smallholder farmers, indigenous peoples and especially women and youth”.

“Just as food brings us together as cultures and communities, it can bring us together around solutions. But what is clear is there is no one-size-fits-all solution. Our diversity is our strength and reflects the complexity of our world,” Mohammed told the closing plenary in Rome on Wednesday.

She said that the summit would focus on a ‘statement of action’ that “affirms the diversity of our food systems and the complexities, but also the central role that is played by indigenous peoples producers, women and youth”. 

A number of countries have developed “national pathways for food systems transformation” to deliver the sustainable development goals (SDGs) by 2030, said Mohammed.

“The priorities from national pathways were shared by many ministers in Rome. They point to the need for urgent, inclusive, people-centred and nature-positive systems change that is based on the best science and reflects local and national realities within a global context,” said Dr David Nabarro, senior advisor to the summit.

The three-day conference was attended by more than 500 delegates from 108 countries in person, including 62 ministers, and a further 17,000virtual delegates from 190 countries. Host nation Italy’s Minister of Foreign Affairs, Luigi Di Maio, said that the recent G20 Matera Declaration on food security, was “a prime example of how joint political action can lead to broader results on the ground.”

Katrín Jakobsdóttir, Prime Minister of Iceland, called for political leadership, saying, “We have to be brave and politically focused to eliminate harmful practices and at the same time advance what has been proven to be positive, human and nature-friendly. It takes courage to transform at the same time our value systems and our food systems.”

The United States in partnership with the United Arab Emirates and with the support of Australia, Brazil, Denmark, Israel, Singapore, the UK and Uruguay, has already set out its Agriculture Innovation Mission for Climate (AIM for Climate) initiative, to increase and accelerate global research and development on agriculture and food systems in support of climate action.

Japan, meanwhile, outlined its alignment with the European Union on the importance of innovation to transforming food systems, along with a balanced diet, while emphasising the need for solutions adapted to regional contexts.

Transforming food systems to contend with and tackle climate change was also a priority, particularly among Small Island Developing States, the countries facing the worst impacts of rising global temperatures.

“Today we are still able to consume our main traditional staple root crop, pulaka, but only very sparingly,” said Katepu Laoi, Tuvalu’s Minister for Local Government and Agriculture. 

“Our government recognises that providing sustainable, adequate food supply chains for the people of Tuvalu will be increasingly more challenging due to extreme weather events, which have been worsened by climate change.”

 

A new report calls out the animal health industry for fuelling superbug resistance as a result of uncontrolled use of antibiotics and other drugs in intensively farmed livestock.

Antimicrobial resistance (AMR), fostered by the wanton use of antibiotic-laced feed and growth-boosting supplements for livestock and poultry, could lead to the “next pandemic”, warns the first-of-its-kind report on AMR that focuses on the long-ignored global animal health sector. 

The new report, Feeding Resistance, on the growing threat of superbug risks associated with animal health products, was issued last week by a group of forward-looking investors ahead of the opening of this week’s major UN pre-summit on food systems in Rome. 

Globally, some 70% of antibiotics and other antimicrobial drugs are fed to livestock and poultry, accelerating the risk of widespread antimicrobial resistance, warns the report, released by an investor network called the FAIRR Initiative last week.

(A) Largest five consumers of antimicrobials in livestock in 2010. (B) Largest five consumers of antimicrobials in livestock in 2030 (projected). (C) Largest Increase in antimicrobial consumption between 2010 and 2030. (D) Largest relative increase in antimicrobial consumption between 2010 and 2030. CHN, China; USA, United States; BRA, Brazil; DEU, Germany; IND, India; MEX, Mexico; IDN, Indonesia; MMR, Myanmar; NGA, Nigeria; PER, Peru; PHL, Philippines. (PNAS, 2015)

Critical drugs are still being marketed by the industry, worth some US$ 47 billion annually, as growth promoters and preventative medications, leading to their misuse and overuse in the world’s 70 billion animals raised in industrial livestock complexes, charges the report.

The report analysed publicly-available data from 10 of the largest publicly-listed animal health companies that manufacture and sell antimicrobials for use among livestock, poultry and also in fish farms, and which comprise about 40% of the sector overall.  

Intensive, industrial-style livestock and poultry production comprises the majority of those animals today that eventually end up as meat in supermarkets and on restaurant menus in developed countries – and increasingly in emerging economies as well. 

“For animal health companies, antibiotics and other antimicrobials are a volume business. The overuse and misuse of these products in animal agriculture is a significant contributor to the global risk of AMR, catalysed by manufacturing, marketing and sales practices,” the report states.

“The animal health sector is failing to live up to its responsibilities to manage the risks we all face from antibiotic resistance,” said Jeremy Coller, the British philanthropist who is the chair of FAIRR. “It’s absolutely necessary for animal pharma to improve its antibiotics stewardship.”

Industry labelling of antibiotics as animal growth products contributes to AMR

Livestock applications of antibiotics in metric tons/year, among the few dozen countries reporting use. (The Antibiotic Footprint)

In particular, the FAIRR report calls out 10 of the world’s leading animal health companies, which represent roughly 40% of the sector, for failing to adequately address and reduce AMR risks. 

These include Dechra Pharmaceuticals PLC (UK), Elanco Animal Health Inc (USA), Jinhe Biotechnology Co. Ltd. (China), Merck / MSD (USA), Orion Oyj (Finland), Phibro Animal Health Corporation (USA), Vetoquinol (France), Virbac (France), Zoetis Inc. (USA) and  Zydus Cadila / Cadila Healthcare (India).

“By labelling products for growth promotion and prophylaxis, animal health companies are directly influencing how farmers administer antibiotics to their animals,” said Jo Raven, senior manager at FAIRR and co-author of the report.

Sales of antibiotics represent approximately 24% of the total animal health market, and between 7-43% of individual companies’ total revenue, with figures likely to be higher if expanded to include all antimicrobials, the report found. 

The impacts can be immediate on the farmworkers themselves – even before drug-resistant bacteria or viruses spread more widely into the population, he warned.

Assessment of industry exposures to AMR risks

Antibiotic ‘severely restricted by WHO for human use – promoted by industry for everyday, non-medicinal use in humans

Ugandan dairy farmer Tony Kidega has taken a keen interest in turning the tide of antimicrobial resistance (AMR) in his country. -as part of a pilot project under way there

Raven cited a German study that found that up to 86% of humans who work with pigs directly – mainly veterinarians and farmers – carry livestock-associated MRSA, which can be a dangerous bacterial infection in the chronically and ill, resistant to many leading antibiotics.

Data from China and Viet Nam, collected as recently as 2018, illustrates the scale of the problem. In Viet Nam’s heavily agricultural Mekong Delta region, the use of antibiotics as prophylaxis can account for as much as 84% of total antibiotic use in animal agriculture.  In China, the use of such antibiotics for growth promotion accounts for an estimated 53% of total antibiotic use in livestock.

The report found that none of the10 largest publicly-listed animal health companies have a comprehensive strategy to mitigate the impact of AMR, nor do they have responsible marketing policies for use of antimicrobials in agriculture. It suggests that this is a particular problem in emerging markets where product labels can be a farmers’ only guide around when to use drugs and what doses.

In emerging markets, in particular,  “sales, marketing and package sizing practices contribute to growing AMR… ” the report states, and companies operating in such markets “do little to change the ingrained behaviour of their routine use for growth promotion or prophylaxis.”

For instance, the report cites the example of a product called Winmyco – sold by the Indian firm Zydus Cadila in 25kg bags and described as a “growth promoter” – which contains the antibiotic tylosin, categorised by the WHO in a 2016 report as a high-priority drug “critically important” for human health.

“This antibiotic is severely restricted for use in humans, yet is being promoted for everyday use for non-medical purposes in animals,” the report warns.

WHO, FAO and OIE have failed to address industry practices – despite long-term risks to humans and agricultural production

AMR risks across the animal agriculture value chain.

 WHO cites AMR as one of the top 10 global public health threats facing humanity.  A 2019 UN report estimated that drug-resistant bacteria kills roughly 700,000 people a year –  with a prediction that it would hit 10 million by 2050 if AMR continues at its current rate.

But the World Health Organization (WHO) and the global health community have largely focused on the injudicious use, or overuse, of antibiotics in human populations. Global health policymakers have largely sidestepped the potentially bigger challenges posed by uncontrolled administration of such drugs to animals.

Many antimicrobials such as tylosin, which are used both in human and animal health, are not even mentioned in the new WHO AWaRe classifications of antibiotics that guides global health policymakers and professionals about drugs that should be reserved or restricted for only the most urgent medical uses.  So despite being noted by WHO as “critically important” to human health in its comprehensive 2016 report, there is in fact no clear, up-to-date guidance from the the global health agency about the extent that such drugs could or should be used in animal health as well.

Despite signals of change – such as the formation of a “One Health” initiative with the World Organization for Animal Health (OIE) and the Food and Agriculture Organization (FAO), none of the UN agencies are tracking data or aggressively promoting the problems associaed with unfettered antimicrobials use in animal husbandry.

The World Bank has meanwhile warned that AMR could lead to an 11% decline in livestock production in low-income countries by 2050.

A pig pokes his head out of a barn in Oosterhout, Netherlands – where air pollution produced by livestock in rural areas has been linked to higher rates air pollution – and during the pandemic, more COVID-19 deaths.

Along with being a major contributor to AMR, intensive livestock production is also a major driver of climate change – with livestock consuming some two-thirds of the world’s grain and cereals production, which in turn drives deforestation and ground water pollution.  Ruminant livestock also are major emitters of methane, a powerful climate changing gas, and residues from livestock excrement mixes with other air pollutants to form airborne particulate matter that contributes significantly to air pollution in regions such as Europe.  

“AMR cannot be solved without stewardship and cooperation from this industry which manufactures, markets and sells antimicrobial products to protein producers to treat the animals we eat,” said Coller, warning that: “An AMR crisis threatens to make even routine operations such as a hip or knee replacement life-threatening because we may no longer have effective antibiotics available to treat patients in recovery.”

Vaccines and probiotics can replace medicines – and reduce reckless antibiotic use

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

The report calls for increasing farmer/consumer, public and policymaker awareness of the risks associated with the overuse and abuse of antimicrobials in animal health products – so as to exert pressure on industry to reduce their use. 

It also calls on companies to increase their marketing to farmers of practical alternatives and measures that can reduce the need for antimicrobial products – which include antiviral and antiparasitic medicines along with antibiotics. 

Those can include: the better use of diagnostic tools; more use of vaccines; and more use of novel preventative and curative medicines. Proven treatments include: probiotics, prebiotics, immunotherapeutics, and in-feed enzymes, as well as bacteriophages (the deployment of harmless viruses that can infect and kill harmful bacteria). 

“Many of these alternatives show positive outcomes or have promise but require further development and widening of use in order to be cost-effective. Some animal health companies are recognising the commercial opportunities associated with alternatives to antibiotics,” states the report. 

New alternatives could be “extremely valuable” and could become the preferred option for farmers worldwide, it concludes.

Other sales and marketing measures, such as reducing package sizes to reduce the risk of unused or expired medicines being released into the environment, are also important, the report recommends. Labelling also should be clearer to prevent misuse of drugs.

Currently, animal health companies take an inconsistent approach to these measures.  For example, where farmers lack access to veterinarians, particularly in emerging markets, often the product label is their only guide to uses, dosage, method of application, and expiry date.

Addressing antibiotic residues in wastewater

Current manufacturing practices, including the WHO’s Good Manufacturing Practice (GMP) certification, which is the global standard for manufacture of pharmaceuticals – also fail to address antibiotics discharge in wastewater generated by factories producing animal drugs.  

“This means untreated wastewater releases antibiotic residues into the environment around factories increasing the risk of resistance,” Raven pointed out.

Encouraging meaningful industry commitments

On the more positive side, some of the large animal health companies have publicly committed to invest $US 10 billion collectively in alternatives by 2025, with the aim to develop 100 new vaccines, 20 new diagnostic tools, 20 nutritional enhancement tools, and 30 other products that will help to reduce the need for antimicrobials.

They include Boehringer Ingelheim, Ceva Sante Animale, Elanco Animal Health, IDEXX Laboratories,  Merck & Co., Phibro Animal Health Corporation, Vetoquinol, Virbac, Zenoaq and Zoetis.

Those commitments need to be fulfilled – and more, FAIRR asserts – for the well-being of industries themselves as well as the health of people the world over at risk from AMR.

“Animal health companies that do not increase their exposure to alternatives are likely to face increased financial pressures in the medium to long-term as the animal protein sector looks beyond antibiotics and towards preventive care and alternative treatment options as its first line of defence for protecting welfare and animal health,” states the report. 

“This report is a vital contribution to building the momentum needed to ensure the protection of the animal health sector from damaging practices and increasing regulatory risk,” says Coller.

Image Credits: pxfuel, Charyse Reinfelder, Global trends in antimicrobial use in food animals, PNAS 2015 , antibioticfootprint.net, Tony Kidega, Flickr: Dutchairplaneshooter, ILRI / Charlie Pye-Smith.

More affordable second-line ARVs will soon be available following an innovative pricing agreement.

People living with HIV in low-and middle-income countries will soon have access to generic second-line antiretroviral drugs at a much cheaper price following an innovative agreement between Unitaid and the Clinton Health Access Initiative Inc (CHAI).

The new pricing agreement announced on Monday will see pharmaceutical company Hetero Labs manufacture a generic combination of darunavir boosted with ritonavir (DRV/r) for $210 per patient, per year, much cheaper than the well-established but suboptimal alternative option, lopinavir/ritonavir (LPV/r).

 “It is vital that all those living with HIV who cannot stay on first-line treatment have access to a quality second-line product, and we are proud of our work with CHAI to make this happen,” said Unitaid Executive Director Dr Philippe Duneton.

Less toxic than other protease inhibitors, Darunavir is also easier to take

Darunavir (DRV) in combination with ritonavir is a best-in-class protease inhibitor. DRV has proven to be effective in patients who have never been treated for HIV and those who have experienced multi-drug resistance. Less toxic than existing protease inhibitors used in second-line treatment,  DRV is also easier to take.

Despite being available in the United States and other high-income countries for over a decade, low- and middle-income countries still lack access to an affordable, quality generic version of the drug.  Second- and third-line therapies are however critical for people living with HIV where first-line treatment may not be an option, due to medication resistance or intolerance.

Until the announcement by Unitaid and CHAI, DRV/r was too expensive for national treatment programmes in low- and middle-income countries to afford.

Best-in-class second-line HIV treatment is long overdue

Kenly Sikwese, HIV advocate and head of the African Community Advisory Board (AfroCAB), which advocates for better, more affordable HIV medicine, welcomed the announcement saying the board had been advocating for the use of DRV in second-line since 2011, and that the new agreement was a critical step in addressing the “longstanding inequity in access to this optimal HIV treatment in low- and middle-income countries”.

“We look forward to seeing policymakers across the globe move expeditiously forward to accelerate access to this very important drug for communities.”

Joy Phumaphi, CHAI Interim Co-CEO, said access to this second-line HIV treatment is long overdue and people living with HIV in low- and middle-income countries will now be able to access the same high-quality second-line medication as those in high-income countries, “enabling more patients to remain on treatment and save lives”. 

Image Credits: Commons Wikimedia.

How to support African women farmers is a key issue for the continent

As the COVID-19 pandemic and climate change exacerbate global food insecurity, African countries are committed to giving more support to small farmers – particularly women.

This emerged at the United Nations Food Systems Pre-Summit in Italy, which opened on Monday as a precursor to a formal UN summit planned for September.

Rwandan President Paul Kagame told the pre-summit that there was consensus among Africa nations that the continent’s food agenda needed to be based on five pillars: nutrition-centred food policies including school feeding programmes; local markets and local food supply chains; increasing agricultural financing (20% of expenditure); encouraging farmer cooperatives and ensuring women’s access to productive inputs and finally, expanding social safety nets and investing in climate advance warning systems.

Both UN Secretary-General Antonio Guterres and Pope Francis appealed for the world’s food system to be transformed in the face of hunger, poverty, climate change and inequality.

Guterres said the world was “seriously off track” in achieving the sustainable development goals by 2030, thanks to “poverty, inequality and high cost of food”.

About 811 million people face hunger in 2020, about 161 million more than in 2019, he added.

“The pandemic, which still assails us, has highlighted the links between inequality, poverty, food, disease and our planet,” said Guterres.

Meanwhile, Pope Francis urged the world to create food systems that “guarantee sufficient food at the global level and promote decent work at the local level; and that nourish the world today, without compromising the future.”

Women farmers lack land and support

UN Food System Summit gender champion Dr Jemimah Njuki

“There are 1.7 billion rural women and girls in the world – more than one-fifth of all humanity. It is unacceptable that they make up almost half the agricultural labour force, yet they are more likely than men to live in poverty and hunger,” said Sabrina Dhowre Elba, the UN Goodwill Ambassador for the International Fund for Agricultural Development (IFAD).

“In Ethiopia, as in many African countries, women are vital food system actors, but they face many challenges. Women, particularly in rural areas have multiple responsibilities in cooking, farming, fetching water for the household, finding firewood, childcare, food preparation while simultaneously engaging in trading of the food they produce or buy,” said Dr Lia Tadesse, Ethiopia’s health minister, addressing a session on micronutrient deficiencies.

While women performed up to 75% of farm labour, only 18,7% of agricultural land in Ethiopia was owned by women farmers, she added.

“Poverty, inequality and cultural and traditional practices limit woman’s ability to provide better plates for their families,” said Tadesse. “Malnutrition is the inevitable outcome of food systems that do not work for women. And this is also evident by women and children being the most affected in undernutrition and in micronutrient deficiencies.”

High rate of anaemia in women and children

Anaemia is as high as 24% for women of reproductive age and as high as 57% for children under five, she added.

UN Food System Summit gender champion Dr Jemimah Njuki, said that “how to support women smallholder farmers, how to make sure they actually have the productive resources that they need to transform food systems, how to ensure they actually have right to the land that they cultivate,” was one of the key issues in transforming food systems.

Elizabeth Nsimadala, President of the Pan-African Farmers Organization (PAFO) hailed the pre-summit: “It’s the first time that I’m seeing a UN process that is inclusive, diverse and open to all stakeholders.”

UN food systems pre-summit

Low productivity of small-scale farmers 

Lobin Lowe, Malawi’s Minister of Agriculture, lamented the “low production and yields” in his country “due to predominance of smallholder farmers”.

“Productivity levels remain lower than actual potential because of the smallholding land size and labour intensive production… and climate shocks such as droughts and floods,” Lowe told a summit side event on Tuesday.

Prof Amos Laar from Ghana said that a diagnostic analysis of his country, alongside community dialogues, had exposed five key weaknesses in the country’s food system.

“Number one, is consumption of unhealthy food,” said Laar. “Ghana is urbanising at a very fast pace. Currently, we have nearly 60% of our people living in urban areas in Ghana, and in these areas the food environment is not healthy.”

The second issue, said Laar, was reliance on energy-dense, unhealthy staple foods.

“Ghana must instigate a shift from actions that lead to feeding the population to actions that lead to nourishing them,” said Laar.

Sub-national disparities between different regions affected food production – as did poor infrastructure including a lack of processing and cold-chain capacity that lead to about 20% of food loss, said Laar. 

The final impediment, said Laar, was Ghana’s vulnerability to climate change, which has been exacerbated by environmental degradation – “land pollution, soil pollution, water pollution” – caused by illegal mining.

Beginning more than a year ago, the summit process has included more than 1,000 dialogues in 145 countries involving tens of thousands of people around the world. 

“The results of these dialogues have provided national governments with the most comprehensive picture to date of existing interconnected challenges – from hunger and poverty to rural livelihoods, health and youth unemployment – as well as opportunities to address these,” according to the UN.

 

Image Credits: UN.

World Trade Organization’s General Council meets in Geneva for first in-person session since COVID pandemic began – but fails to reach agreement on proposed IP waiver for COVID health products

World Trade Organization Director General Ngozi Okonjo-Iweala has ” high hopes” that the WTO Ministerial Conference (MC12) that convenes at the end of November can deliver decisions that curb harmful fisheries subsidies as well as improving access of low- and middle-income countries to COVID medicines and vaccines.  But WTO members must overcome a series of hurdles to show results by the end of a year – and demonstrate the continued relevancy of the global trade organization, officials warned Tuesday, following the opening of a two-day General Council meeting.

Two weeks ago, Iweala declared that members were “on the cusp of forging a WTO agreement to curb harmful fisheries subsidies”  – which undermine the environmental sustainability of ocean ecosystems, upon which billions of people worldwide depend for nutrition and food security.

However, as WTO General Council members huddled face-to-face for the first time in months, big decisions on both the fisheries issue as well as the thorny question of a proposed waiver on intellectual property rules for COVID-19 medicines and vaccines, were being still punted down the field to the autumn.

WTO TRIPS Council members will resume informal talks in early September in an effort to break the deadlock over the controversial proposal by India and South Africa to waive all forms of IP on COVID related health products for at least three years, said WTO spokesperson Keith Rockwell, at a press briefing. 

WTO members will also be going “line by line” over a draft text on fisheries subsidies, beginning in early September, in an effort to reach final agreement over another politically charged issue, he said.

WTO talks on the subsidies have dragged on for two decades – while unsustainable, industrial fishing operations continued apace to drain ocean fish stocks, fueled by lucrative government subsidies to powerful industrial fishing fleets and interests.

To add insult to injury, deep water industrial fishing boats often operate thousands of miles away from their own home countries – and offshore of the coasts of poor nations, depriving subsistance fishermen working shallower coastal waters of catches critical to their food security. Some three billion people worldwide depend on fish stocks as their primary source of protein, according to the WWF.

The emerging WTO agreement would ban subsidies that “contribute to unreported and unregulated fishing”. It would also prohibit subsidies for fishing overfished stocks, unless those subsidies help restore such stocks.  And thirdly, the draft text would prohibit subsidies that contribute to overcapacity and overfishing – with a detailed reference of those subsidies.

The net result  is that “non-harmful subsidies would not be prohibited – but subsidiers would have to prove that they have robust measures in place to avoid causing harm,” said Colombia’s Trade Ambassador Santiago Wills, who has been leading the negotiations. “In addition, this prohibition is complemented by other rules, limiting subsidies to distant water fishing.”

For TRIPS waiver agreement – all eyes now set to November’s Ministerial Council meeting

Reaching an agreement on fisheries as well as pandemic response is seen by Iweala as critical steps that also would demonstrate WTO’s relevance to the most pressing issues the world faces.

“A credible outcome here is critically important for the credibility of the organization,” declared Rockwell, of the various COVID initiatives now being debated at WTO.

Talks between rich and poor countries over the waiver initiative stalemated, however, in July’s round of meetings in the WTO TRIPS Council, leading only to an interim report detailing the issues over the deadlock at the two-day WTO General Council session. 

With an eye to producing results for the big November, Norwegian Trade Ambassador and TRIPS Council Chair, Dagfinn Sørli, said that he will reconvene WTO member delegations for an open-ended, informal session in early September – ahead of the next formal TRIPS Council meeting, set for October 13-14. 

Despite the current impasse between rich and poor countries over the proposal for a blanket waiver under WTO’s agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), everyone agrees on the ultimate objectives, Rockwell stressed.

That objective is to expand the supply of medicines and vaccines as fast as possible.  

‘No way they’re going to stop discussing this’

(Left-right) WTO Director General Ngozi Okonjo-Iweala and Chairperson Ambassador Davio Castillo, presiding over the General Council meeting 27-28 July.

“There’s no way they’re going to stop discussing this. It’s too important. It’s a very emotional issue, and it’s not going to stop,” Rockwell affirmed. 

“Let me  make it clear that on the broadest objective,  ramping up production, having trade in these essential products flowing smoothly.  … everyone agrees on this.” 

Key sticking points on the waiver initiative include the proposed duration of a waiver, it’s scope in terms of products that would be covered, as well as the technical TRIPS provisions that would be overridden by any waiver agreement, Rockwell said.

Under the latest formula put forward by South Africa, India and 13 other countries as well as the African Group and the Least Developed Countries group,  the waiver would cover all COVID health products and override all existing  TRIPS restrictions on the use and sharing of IP. It would remain in force for “at least 3 years from the date of decision,” subject to reassessment after that time.   

European delegations and their allies, however, continue to maintain that their proposal to streamline current TRIPS rules would achieve the same overall goal.  That proposal would ease the existing WTO IP rules, making it easier for countries to override commercial patents for urgently needed health products, by issuing their own “compulsory” licenses, including products for export. 

In mid-July, Australia, Brazil and China, as well as Canada, the European Union, and nearly two dozen other high-income and upper middle-income countries also tabled a WTO  “COVID-19 and Beyond: Trade and Health” proposal before the General Council to address critical supply chain bottlenecks related to national export restrictions, customs rules, tariffs and other technical issues – which in turn combine to limit the international movement of hundreds of inputs needed for vaccine and medicines production. 

And at Tuesday’s meeting, EU member states also pointed to their new initiative to set up biomedical innovation hubs in Senegal, South Africa and Rwanda as an example of the kinds of practical steps that need to be taken to actually implement technology transfer – so that available manufacturing capacity could be better harnessed in low- and middle-income countries – and more capacity built.  

Iweala so far sidestepped a position on the TRIPS waiver    

 

WTO Director General Ngozi Okonjo-Iweala, at the body’s General Council session, 27-28 July.

WTO Director Ngozi Okonjo-Iweala continues to seek some third way between the IP waiver initiative – backed by some 100 low- and middle-income countries – and the alternative proposal by the European Union and its allies.  

“It don’t have to be binary option” Rockwell, quoting the WTO DG.

He added that Iweala, as WTO DG, has so far “deliberately”  avoided taking a position on the TRIPS waiver issue – in light of the deep divisions between WTO members themselves. 

“But what she has said is that TRIPS alone is not enough…. We need to find a pragmatic and practical approach.

“And if you listen to the manufacturers, what they say is most important is the transfer of technology and know-how.  You need to have the equipment, the proper regulatory environment and so you need to have some technical assistance to ramp that up.”

“She has also been quite clear to [trade] ministers, that finance ministers, health ministers and development ministers will all be producing outcomes between now and the end of the year, and it would really not be a good look, i the trade ministers didn’t do the same.”

However, he suggested that despite the current impasse, sparks of progress are now apparent – and that is encouraging. 

“”She is very pleased that negotiations are underway.  I think she gets frustrated when you have a situation where people just read papers and talk past each other, and we’re beyond that now.”

Image Credits: WTO .

The tobacco industry is using deceptive advertising to promote its products, according to WHO.

While there has been significant global progress in curbing conventional tobacco products, newer tobacco and nicotine products such as e-cigarettes are evading regulation, according to the World Health Organization (WHO) 2021 report on the tobacco epidemic.

Some 5.3 billion people are now covered by at least one of the six tobacco ‘MPower’ control measures recommended by the WHO, including high taxes, bans on promotion, pack warnings and helping people to quit.

But electronic nicotine delivery systems (ENDS) such as ‘e-cigarettes’ are often marketed to children  – and escape regulation, according to the report, which was launched on Tuesday.

The tobacco industry also uses “thousands of appealing flavours and misleading claims about the products” to market these to children and teens, according to the WHO, adding that children who use these products are “up to three times more likely to use tobacco products in the future”. 

“These products are hugely diverse and are evolving rapidly,” said Dr Rüdiger Krech, WHO’s Director of Health Promotion Department. 

“Some are modifiable by the user so that nicotine concentration and risk levels are difficult to regulate. Others are marketed as ‘nicotine-free’ but, when tested, are often found to contain the addictive ingredient. 

“Distinguishing the nicotine-containing products from the non-nicotine, or even from some tobacco-containing products, can be almost impossible. This is just one way the industry subverts and undermines tobacco control measures.”

Youth are targets of the tobacco and nicotine industry

Caleb Mintz: Targetted in Ninth Grade.

Caleb Mintz, a young anti-tobacco advocate from the US told the launch that an official from a vaping company had given a ‘mental health’ talk at his high school where he cast doubt on the dangers of e-cigarettes and vaping.

“When I was in ninth grade, a speaker came to my high school under the guise of a mental health seminar. That speaker turned out to be a representative of Juul Corporation, which is one of the largest vaping conglomerates, and the speaker proceeded to send mixed messages about the safety of the [vaping] devices, saying ‘It is the safest product on the market’,” Mintz said

“As a result of the presentation, many of my peers began to question whether the product  once seen as dangerous was even harmful at all, with some of my closest friends now believing their habits are justified, due to a trusted adult telling them that.”

US anti-tobacco advocate Jasmine Hicks, told the launch that the majority of young people that her organisation, Truth Initiative, reached out to had no idea that e-cigarettes even contained nicotine.

ENDS are ‘highly addictive’

WHO Director-General Dr Tedros Adhanom Ghebreyesus, called for better regulation of ENDS, describing nicotine as “highly addictive”.

“Where they are not banned, governments should adopt appropriate policies to protect their populations from the harms of electronic nicotine delivery systems, and to prevent their uptake by children, adolescents and other vulnerable groups,” said Tedros.

Eighty-four countries don’t restrict or regulate ENDS in any way, although 32 countries have banned their sale and 79 have adopted at least one partial measure to prohibit their use in public places, prohibit their advertising, promotion and sponsorship or require the display of health warnings on packaging. 

“More than one billion people around the world still smoke. And as cigarette sales have fallen, tobacco companies have been aggressively marketing new products – like e-cigarettes and heated-tobacco products (HTP) – and lobbied governments to limit their regulation,” said Michael Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Injuries, who funds much of the global anti-tobacco work.

“Their goal is simple: to hook another generation on nicotine. We can’t let that happen.”

There are an estimated one billion smokers globally, 80% of whom live in low- and middle-income countries (LMICs), and tobacco is responsible for the death of eight million people a year, including one million from second-hand smoke, according to the  WHO.

Almost 80% of high-income countries (HICs) (78%) regulate ENDS while three-quarters of LICs do not.

“The tobacco industry’s ramped up marketing of ENDS and HTPs, especially to young people, is a real threat,” said Rebecca Perl, Vice President of Partnerships and Initiatives at Vital Strategies.

“With its intent on hooking a new generation of tobacco users, the industry is snatching young people’s opportunities, experiences and future potential by shortening their lives. Young people who use new products such as ENDS and HTPs are more likely to regularly use conventional cigarettes, as cited in the report. Yet remarkably 84 countries still have no regulations and restrictions at all on these products.”

Marathon runner Paula Radcliffe

Renowned marathon runner and clean air advocate Paula Radcliffe joined the launch to appeal for public health warnings about tobacco and e-cigarettes to be carried on social media to reach young people.

“Our bodies enable us to do so much and to achieve so much, but we have to look after them and look at the fuel that we put into them,” said Radcliffe. “There are enough stresses around in this world which are unavoidable. I think tobacco is really one that is avoidable. Respect your body and the world by what you put into it and how you live your life.”

 

Image Credits: WHO.