A field worker in Pakistan administering polio drops

[ISLAMABAD] Despite gains made to end polio during COVID-19, Pakistan has  recently reported a resurgence of the virus after a gap of fifteen months. The sobering news comes just ahead of the start of the World Health Assembly in Geneva -which will review progress on polio eradication – including a recent polio wildvirus outbreak in Malawi; transmission of vaccine-derived polio elsewhere in Africa; and continuing challenges in war-weary Afghanistan.  

Pakistan has so far reported three wild poliovirus cases in the months of April and May from its western un-settled region of North Waziristan bordering Afghanistan and authorities fear more are to appear.

Reacting to the reports, Pakistan’s government officially reaffirmed its commitment to end transmission of the virus – and announced a new vaccine campaign. 

But senior officials attached with the polio program fear that the dream of eradicating the disease from Pakistani soil in the near future has been lost. 

Failed to maintain immunity wall created at height of pandemic

Pakistan is one of two countries where polio remains endemic.

“[The] program has miserably failed to maintain the immunity wall erected during the previous year,” lamented a senior official of Pakistan’s polio program wishing not to be quoted. 

He said the aggressive emergence of the virus in the high transmission season happening now, reflects gaps in the 2021-2022 anti-polio drive – which failed to keep up with the good record of the 2020-2021 campaign – conducted at the height of the COVID pandemic. 

Pakistan and Afghanistan were the only two countries left fighting to end the wild poliovirus from Asian region – although the outbreak in Malawi, reported by WHO in 2022, also is said to have originated in a Pakistani strain of the virus from an unknown source. The report of the wildpolio virus case in a young child in Lilongwe, has triggered a massive immunization campaign in both Malawi and neighboring states, which is still ongoing.  

Door-to-door immunizations need to maintain ‘immunity wall’ 

Children in Pakistan show proof of vaccination against polio.

In order to maintain the ‘immunity wall’, continuous immunization among vulnerable populations is needed, specifically in southern and central Pakistan, said the unnamed official, in reply to a query made by Health Policy Watch. 

“Polio authorities should have kept focus in the regions of South of Khyber Pakthunkhwa province, Central Pakistan and traditional core reservoirs of Khyber-Peshawar, Karachi and Quetta block,” he said. 

He said synchronised high quality door to door campaigns would also have to be conducted, not only across Pakistan but in Afghanistan as well.

After the COVID-19 interruption, the Pakistan programme in July 2020 restarted door to door campaigns along with enhanced outreach for essential immunisation across Pakistan. 

The efforts were undertaken in close coordination with Afghanistan through synchronised campaigns which resulted positively and the country reported zero polio cases for 15 months till April 2022. 

“Good approaches and efforts practiced during the low transmission season of August 2020 to March 2021 should have [been] replicated during August 2021 to March 2022,” he said.

Anti-polio drive for children announced 

A countrywide vaccination drive against polio has been announced in Pakistan, beginning next week.

In an effort to combat the further spread of polio, the ministry of National Health Services Regulations and Coordination (NHSR&C) has now announced a countrywide anti-polio drive beginning next week, to immunize around 43 million more children in Pakistan. 

Official statements say 340,000 polio workers will participate in the door-to-door countrywide anti-polio drive which was earlier limited to some regions. 

The ministry has also requested parents, civil society and religious clergy to cooperate with authorities in this campaign. 

Polio in Pakistan due to parents’ refusal to vaccinate 

Meanwhile, the Pakistani Medical Association (PMA) demanded stronger legislation regarding parents who refuse to immunize their children – which they say is a leading source of new cases. 

“There must be some law for those who refuse to immunize children,” said secretary general PMA Dr Qaiser Sajjad.

He also said it is the time to strengthen the screening system for polio cases along the Afghanistan border and within cities where polio samples are found, adding that such screening measures worked during COVID-19.

According to Dr. Sajjad there is also a need for aggressive media campaigns to create awareness and convince the communities to bring their children for polio drops. 

“All the hard work done to eradicate polio is on stake now,” he said.

Global Polio Eradication Initiative calls for nearly $5 billion in new funds 

To end polio, the Global Polio Eradication Initiative (GPEI) has also called for renewed commitments to meet a $4.8 billion global budget that would fund the implementation of a new strategy to eradicate the deadly infectious disease. 

However, money is not the only issue. The Pakistan polio program has been struggling for decades to overcome the social and security challenges that immunization campaigns face, especially in ‘war on terror’ areas. That is despite sponsorship of campaigns by global donors  including the Bill and Melinda Gates Foundation – whose co-founder Bill Gates visited the country only recently.

Polio campaigns in Pakistan were heavily disrupted after al-Queda leader Osama Bin Ladin was killed in an operation carried by US forces in the Khyber Pakthunkhwa province in May 2011.  Following that, al Queda groups also started attacking polio workers as perceived representatives of U.S and western influence. 

Since then, both US and Pakistan military forces also have committed to a ‘war on terror’ which has further impeded the work of polio campaigns. 

The North Waziristan region of Khyber Pakthunkhwa province, where all three recent polio cases in two boys and a girl were confirmed, was one of the hotbed ‘war on terror’ areas where Pakistan military carried operations while US forces held drone attacks. 

After the resurgence of polio cases in North Waziristan, Gates even reportedly called Pakistan Army Chief General Qamar Javed Bajwa to discuss the situation. 

In a statement, the Inter-Services Public Relations (ISPR) reported that the billionaire philanthropist had expressed his appreciation to the army for supporting the country’s polio drive and ensuring proper reach and coverage. The army chief responded that polio eradication was a national cause, adding that “credit goes to all involved in the process”.

Downsides of downsizing program 

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Minister Patel and WHO Pakistan Palitha Mahipala

Some  polio workers believe that downsizing of lower staff also brought harmful results for the program.

Anil Kumar, one polio worker interviewed by Health Policy Watch, said that around 800 Union Council Polio Officers (UCPOs) are registered across the country. But many of them were not offered contracts for the year 2022 – he among them. 

“Indeed uncertainty and job insecurity in lower staff can impact reporting and surveillance in the polio program,” he said.   

Meanwhile, the Pakistan federal health minister Abdul Qadir Patel and the World Health Organization’s representative in Pakistan, Palitha Mahipala met in the wake of the three polio cases, reaffirming their commitment to work together to end polio. 

The head of WHO’s Pakistan country office welcomed the decision of Pakistan’s health minister to visit the affected families as a move to underline the government’s support for ending the disease. 

Human cost of not eradicating polio in Pakistan 

Minister Patel meeting families affected by polio

“Every polio case is a huge tragedy,” said Patel in a statement about the outbreak.  

“Since January, Pakistan has taken emergency measures in the southern districts of Khyber-Pakhtunkhwa to save children from wild polio and these measures have been further extended and intensified,” he added.

Every child must be reached by polio vaccine 

Political map of Pakistan. The KP province has reported a resurgence of polio.

Despite the setbacks, rank-and-file officials say they remain determined to vaccinate all children in the country against the virus. 

Polio workers on the frontlines continue to reach out to children in North Waziristan in spite of  challenging circumstances in hard-to-reach areas, said Dr. Shehzad Baig, National Coordinator for Emergency Operations Centre (NEOC), adding, “We fear that more children from the same area may be affected as the virus circulates.”

Additionally, to address the challenges in Southern KP – unsettled and settled tribal areas that include North Waziristan, South Wajiristan, and Bannu, the Pakistan government and global polio partners had already initiated an emergency action plan to address the challenges in this part of the province.

Federal health secretary Aamir Asharaf Khawaja, in a statement from the health ministry, said after the first child was paralyzed [in Pakistan], “we feared that there would be more polio cases because of how infectious this virus is.”

Environmental samples of wild poliovirus in Khyber-Pakhtunkhwa have also been found in the Dera Ismail Khan and Bannu divisions of the region, he noted adding:  

“Unfortunately, there may be more until every child is reached by the vaccine.”

Image Credits: Sanofi Pastuer/Flickr, Pakistan Polio Eradication Program, UNICEF Pakistan.

who
Members of the WHO Working Group on Sustainable Finance hammer out the final agreement on increasing member state contributions in late April. Germany’s Björn Kümmel, who led the negotiations, on far left.

More stable funding for WHO, but only incremental progress on reforms in global pandemic response are expected out of the upcoming World Health Assembly, where member states also will debate and discuss over two dozen other critical health issues that don’t always make the headlines.  

The 75th World Health Assembly, WHO’s annual meeting of member states, opens Sunday with the prospect of diplomatic fireworks over Russia’s invasion of Ukraine and only incremental progress likely on reforms that critics say are urgently needed to strengthen the health agency’s hand in preparing for, and responding, to pandemic risks.

On the brighter side, a draft member-state agreement to bolster the WHO’s financial stability is expected to win approval after months of closed-door negotiations. The new formula involves a commitment to raise member state annual “assessed” contributions to 50% of WHO’s core budget by the end of the decade. 

Currently such fixed contributions only comprise about 17% of WHO’s budget, while a handful of rich countries and philanthropies cover an outsized portion of the global health agency’s costs – also exerting untoward influence over priorities, some critics say.  

The past two WHAs – held virtually during the pandemic – both saw demands for reforms at the top, tensions over the WHO’s investigation into the origins of SARS-CoV-2, calls for better global emergency and pandemic preparedness, and pleas for more funding to both WHO and low- and middle income countries to address widening health inequalities. 

The theme of this year’s WHA, which runs from 22-28 May,  is “Health for peace, peace for health”, given the emergency in Ukraine, just how much uptake there will be of the theme, in spirit as well as in name, remains to be seen.

Other core issues risk being sidelined

A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer 2021 – since then a months-long blockade on all health supplies has devastated the region even more.

Alongside that bloody conflict, there are worries that other urgent issues risk being sidelined at the conference. These range from burning health and humanitarian crises in places like Tigray and Afghanistan, but also other core health issues, from neglected tropical disease to the worldwide epidemic of non-communicable diseases, as well as longer-term plans to improve pandemic response.

Indeed,  in a moment of big expectations where delegates meet face to face for the first time in two years – actual results may be disappointing to those hoping for swift reforms in global rules around pandemic response. 

UN-wide, Russia’s invasion of Ukraine has diverted attention from the pandemic which was an overriding focus of politics and media for nearly two years. That, in turn, leaves a “closing window of opportunity” for key reforms, said Olaf Wientzek, Director of Multilateral Dialogue at the Geneva-based branch of Konrad-Adenauer-Stiftung, a German foundation, in an interview with Health Policy Watch ahead of the WHA.

Pandemic preparedness: A closing window for change

Former Liberian President Ellen Johnson Sirleaf (left) and Former New Zealand Prime Minister Helen Clark (right), co-chairs of The Independent Panel.

In a stiffly worded update, released just ahead of the WHA meeting, the former co-chairs of the Independent Panel on pandemic preparedness and response said the world is little more prepared to cope with a pandemic threat today than it was when the COVID-19 crisis began.

“Should a new health threat arise this year, the world would largely have to draw on the same tools it had at the end of 2019,” Helen Clark, former prime minister of New Zealand and co-chair of the Independent Panel for Pandemic Preparedness and Response, told a pre-assembly press briefing. 

Their scathing original report, released at last year’s WHA, levelled criticism throughout, from an “under-powered” WHO to “absent” global political leadership.

“The weak links that we identified then still exist today, and without more concrete efforts to fix them, we could find ourselves once again scrambling to protect people from a new pandemic threat,” added Clark, who co-authored the report with Ellen Johnson Sirleaf, former president of Liberia.   

Timing: Reforms could take years

At the current pace, processes likely to be initiated by the World Health Assembly this session “could take many years”, Clark and Sirleaf warned, citing as examples: 

  • The increase of assessed contributions to cover 50% of WHO’s base budget, which may not take full effect until 2030. 
  • Amendments to the International Health Regulations that govern WHO’s emergency powers, which have been proposed as a short-term fix in a broken system, “may take until May 2024 to be agreed, and then another year to come into force”, they added. (The timetable to negotiate and ratify a comprehensive new global pandemic convention or accord would be even longer. 
  • At the same time, efforts to include all pandemic reform issues into a new legal instrument, whether it turns out to be a convention or a treaty, could result in a “watered-down instrument, or none-at-all.” 

Along the way, ”critical issues, including WHO’s authority to report, and investigate health threats based on the precautionary principle, may be lost in negotiation,” the former Panel co-chairs stated. 

Real reforms in IHR unlikely before 2025

Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, addresses the WHO Executive Board meeting, 24-29 February, 2022.

Yet despite all the flashing warning lights,  the inherently slow and conservative nature of WHA assemblies, along with the still-evolving humanitarian emergency in Ukraine – will make faster action by WHO member states highly unlikely.

As just one example, the United States had in January submitted a draft WHA proposal for a series of pinpoint amendments to the International Health Regulations, the 17 year-old set of rules currently governing countries’ responses to health emergencies. Key among those was a tight 48- hour timetable for countries to report emerging threats – and another 48 hours for WHO to respond – something that can take weeks or months now.  

But final agreement on any IHR amendments is now likely to be punted to 2024, confirmed Switzerland’s Ambassador for Global Health, Nora Kronig Romero, in a media briefing on Wednesday.  

Agreement on a process for a process  

This year’s WHA is expected to agree only a process for making new IHR amendments – inviting all member states to throw their own reform proposals into the ring by 30 September, 2022.  

The proposals would then be negotiated, with hoped-for adoption by May 2024, according to the draft WHA decision, which has been leaked and circulated by civil society.  

It would be at least another year before any agreed-upon reforms actually take effect – keeping the status quo until 2025.  And that is only if this WHA session agrees to a companion measure that would reduce the waiting period in which new IHR amendments would actually come into force from two-years to one year.  

The conundrum of a pandemic treaty 

People wear face masks to prevent the spread of coronavirus as they commute inside a metro station at the height of the COVID-19 pandemic.

To make matters more complex, a separate, but related, Intergovernmental Negotiating Body (INB) operating under WHA mandate is supposed to be guiding the more comprehensive effort to  negotiate a new pandemic convention, treaty or other legal instrument. WHA agreed to take steps toward creating such a legal instrument in a special session in November 2021, and to set the stage for the INB negotiations, public hearings were held in April. 

The risk, however, is that member states may be forced to negotiate in two parallel processes, one supposedly “short-term” reforms in the IHR and the other a longer term process to create a new convention – without real clarity about how they are really related. 

That would be confusing for everyone – and particularly challenging for low- and middle income countries with more limited capacity, Dame Barbara Stocking, of the ad-hoc Panel for a Global Health Convention, told Health Policy Watch. 

“We’ve got concerns that we must not get two lines of negotiations going, because it makes it really difficult for low-income countries with limited mission staff in Geneva to keep up,” she said.  

To avoid duplication, member states need to decide firmly and soon if and how existing IHR rules, and any new amendments to the IHR, might be taken up into a new pandemic convention –  perhaps as a wholesale “protocol.” 

Leadership: Status quo at the top, and a reshuffle just below

WHO Director General Dr Tedros Adhanom Ghebreyesus is poised to be reelected for another term during this WHA session.

Against the paralysis of member states over pandemic reform, WHO Director General Dr Tedros Adhanom Ghebreyesus is expected to be re-elected for another five-year term during the WHA. Paradoxically, while Tedros is the first Director-General to be elected from an African state, his nomination to a second term was co-sponsored by Germany, France and other European states after he fell out of favour with the government in his home country, Ethiopia, due to his Tigrayan identity. 

There could, however, be changes elsewhere in senior leadership, in an effort to show major donors like the United States that the WHO is intent on becoming more “fit-for-purpose” in responding to emergencies, diplomatic sources have told Health Policy Watch. A reshuffle is likely to include the departure of Mike Ryan, who has led the agency’s pandemic response through two years. 

While supporters see Ryan as a dedicated professional, critics also say he has been unduly slow and cautious at key moments, as a loyal footsoldier to Tedros.

This has included criticism that it took too long for the WHO to declare a public health emergency for COVID-19, and then, the agency took months to acknowledge that the virus is “airborne”, leading to a very delayed recommendation for the public use of face masks.

Non-communicable diseases and more: The health crises that don’t make headlines

A draft WHO roadmap to reduce deaths from non-communicable diseases is expected to be discussed at the WHA.

Meanwhile topline issues like Tedros election, Ukraine and the COVID-19 pandemic may grab the limelight, but there are more than two dozen other core health issues before the Assembly, in what may be the heaviest agenda yet seen by the global health body.

These range from progress reports on cervical cancer elimination, polio eradication, and maternal and child nutrition, to neglected tropical diseases and ways to advance “One Health” approaches to reducing outbreak risks through better management of environmental risks. 

The WHA also will discuss a draft WHO roadmap for reducing deaths from non-communicable diseases (NCDs) by one third by 2030. Non-communicable diseases kill about 41 million people each year – equivalent to about 7 in 10 global deaths, according to the WHO.

The Sustainable Development Goal target 3.4 for reducing NCDs is already wildly ambitious in light of the world’s increasing taste for ultra-processed foods and unhealthy diets, sedentary lifestyles, as well as toxic chemical and air pollution exposures. But the roadmap, however detailed on traditional health issues like smoking cessation and screening, barely touches these other problems – mentioning air pollution, which kills 7 million people every year from NCDs, only in passing. 

There is also diminishing support from donor countries for initiatives to combat NCDs in low- and middle-income countries, where the highest proportion of deaths now occur – due to the huge drain on resources created by the Ukraine war. 

Resolution on clinical trials transparency  

Nathalie Strub-Wourgaft, Director of Neglected Tropical Diseases at DNDi.

Another initiative, being closely watched by medicines access advocates, is a resolution sponsored by the United Kingdom asking member states to require greater transparency in the reporting of clinical trial protocols and results from publicly funded research. 

Informal drafts of the resolution, which is not yet finalized, include measures asking member states that fund clinical trials to require: public posting of trial protocols in a reputable online database; and reporting of negative trial results – which often are buried. 

Civil advocates say such requirements are critical to ensuring research results can be relevant to the broad public good, and particularly low- and middle income countries. 

And to prepare for future pandemics, protocols for clinical trial reporting should also allow researchers to quickly and accurately aggregate from small trials of new treatments to better assess their impact,  Nathalie Strub-Wourgaft told Health Policy Watch, in an exclusive interview.  

DRC sexual abuse: New details

Ebola response workers in the DRC

The WHA will also review  a report from WHO Director General Tedros about the measures it has taken to respond to the sexual exploitation and abuse scandal involving WHO staff and consultants in the Democratic Republic of Congo, which was first reported in September 2020 by The New Humanitarian and the Thomson Reuters Foundation.

The update contains details of WHO’s measures taken to overhaul its culture and operations, including:

  • The WHO has funded support for 92 victims and survivors and children born as a result of abuse.
  • The WHO intends to enlist a women-led legal aid NGO to provide “full legal aid to up to 25 victims and survivors” in 2022.
  • As of February, some 13,000 staff and non-staff worldwide had completed a new, mandatory training programme on preventing sexual exploitation and abuse. 
  • There’s a new, global team of 15 people who are experts in conducting sexual misconduct investigations. About 70 percent of them are women.

An dedicated unit has been created in WHO’s Office of Internal Oversight Services (IOS) “to investigate the allegations of sexual exploitation, abuse, harrassment.” The creation of a  separate judiciary channel reporting directly to the Director General, generated some debate at the January Executive Board meeting, although EB members agreed to it exceptionally.  

The politics of procedure: Ukraine and Russia

A Ukrainian refugee family with 11 children entering Romania at the Isaccea border crossing in March 2022.

Before delegates even get to the core issues at stake at the WHA, however, they will have to get past the contentious issue of Russia’s invasion of Ukraine. 

That could rear its head on Sunday’s ceremonial opening day, when member states must approve the WHA’s “General Committee” that oversees the week’s proceedings. 

That committee was originally supposed to include Russia. But the WHO’s European member states, most of which staunchly back Ukraine, substituted Russia for Armenia at the last minute.  

Meanwhile, the General Committee will then be in charge of approving the agenda, likely to include a resolution being circulated by Ukraine, Canada, the United States, and the EU condemning the Russian invasion and calling for more WHO measures to address the health impacts. 

So if Russia objects to being excluded from the powerful committee, the assembly will face a very long roll call vote by all 194 WHA members – with African, Asian, and Latin American states forced to take sides over the geopolitical conflict on the opening day of the gathering. 

And if that is not enough, there may also be a dispute at the outset of the WHA over Taiwan’s request to be seated as an observer – a status that it was granted until 2016 at the invitation of the WHO Director General.

Since the election of a more hardline Taiwanese government, China has however opposed this ceremonial gesture, and Tedros has not dared to defy Beijing.  However, more recently a growing list of countries worried about China’s geopolitical ambitions have begun to support Taiwan’s quest for a seat.  This year, it includes the parliamentary reprsentatives of Germany’s governing coalition parties, who even made their support public.

See the links to the WHA agenda here and proceedings here: 

Image Credits: WHO, Germany's UN Mission in Geneva , UNICEF/Christine Nesbitt, @TheIndPanel, Flickr: IMF Photo/Joaquin Sarmiento, NCD Alliance, WHO AFRO, UNICEF.

kenya
President Kenyatta chairing a cabinet meeting.

[NAIROBI] Kenya is preparing to join the African Medicines Agency alongside thirty-one other African Union member states following the Kenyan cabinet’s decision to approve the ratification of the African Union Treaty last Thursday. 

The move by the cabinet, chaired by President Uhuru Kenyatta, would be a major boost to the AMA’s establishment given that Kenya is one of the leading countries in the Africa Union (AU). Her support, alongside others big countries recently such as Ethiopia, will be critical in building further momentum and swinging countries still holding back, such as Nigeria and South Africa, behind the treaty. 

 

Kenya wants to bid to host the AMA 

Dr Kanyenje Gakombe, the chairperson of the Kenya Health Federation.

The Kenya Health Federation (KHF) welcomed the Cabinet moves, with chairperson Dr Kanyenje Gakombe, saying that the pending ratification will help position Kenya to bid to the AU to host the new AMA Headquarters.  The AU is currently collecting submissions of interest from countries regarding a host country. 

“KHF, which is the Health Sector Board of the Kenya Private Sector Alliance (KEPSA), salutes the cabinet and the Ministry of Health for moving a step further towards the signing and ratification of the AMA Treaty,” Gakombe said in a press release.

KHF asked Members of Parliament to expedite the necessary legislation that will formalize Kenya’s ratification of the AMA treaty. He said he hoped that might also position Kenya to bid to hope  the new medicines authority.

“Kenya is currently well placed and resourced intellectually to act as the AMA host site of choice. The recent commitment by Moderna is a good example, and we have a good chance to scale up the commitments ten times if we push and lobby for the hosting of AMA in Kenya,” Gakombe told Health Policy Watch.

He was referring to the recent US$500 million investment commitment from the US-based pharmaceutical firm Moderna to set up an mRNA vaccine manufacturing plant in the country. 

According to Gakombe, hosting of the AMA could position the country to leverage foreign direct investment flows from the pharma sector of up to $4,8 billion in the short-to-medium term.

However, AU sources clarified to Health Policy Watch that the bidding for hosting the agency is already closed. Eight countries applied, but Kenya was not among the ones to meet the deadline for formal consideration, underway in June, 2022.

“The bid for hosting AMA has long been closed by the Commission and 8 countries that expressed interest to host have been assessed pending the final decision by Assembly to decide who hosts AMA,” the source told Health Policy Watch.

Streamlining medicines and vaccines approvals

The AMA Treaty, which entered into force on 5th November 2021, is an African continental agency that aims to improve regulation of medicines, medical products and technologies.  

Those advocating for the continent-wide approach to medicines regulation believe it will help streamline medicines and vaccines reviews and approvals for faster uptake of new treatments. 

A unified regulatory mechanism could also pave the way for more efficient bulk procurement of medicines and vaccines, through the AU or regional blocs of countries – reducing costs and curbing the infiltration of fake medicines. In addition, the AMA could be critical in ensuring more local production.

Eight African Countries bid to host the AMA

 

Reportedly, neighboring Uganda is among the countries that has reported placed a formal bid to host the agency. Others bidders are said to include Algeria, Egypt, Morocco, Rwanda, Tanzania, Tunisia and Zimbabwe, but these reports have not been formally confirmed. 

As Uganda’s President, Yoweri Museveni, said in March, his country has the required capacity to host AMA following its investments in developing and manufacturing HIV/AIDS drugs for the last decade, including by flagship firms like Cipla.

Museveni said he was meeting a team from the African Union, which was on a verification mission of countries bidding to host the AMA headquarters.

AMA good for Kenya public health  – regardless of where it is hosted  

Dr Bernard Langat, Programme Director in charge of HIV/Aids, Tuberculosis, Malaria and Noncommunicable Diseases at Amref Health Africa.

Dr Bernard Langat, Programme Director in charge of HIV/Aids, Tuberculosis, Malaria and Noncommunicable Diseases at Amref Health Africa in Kenya, also urged the Kenya parliament to “move with speed in legislating necessary legal instruments needed to make this a reality. I hope they will do that before the house takes a break soon as we have general elections coming up in August,” he told Health Policy Watch.

While supportive of Kenya’s bid to host the AMA, he said that public health in Kenya will be a winner regardless of where the agency is located.

“It is a good idea to lobby for it to be hosted by Kenya but the country is already a host to many international bodies, such as UN-Habitat and UNEP, and we should be happy to support others if it is not domiciled here,” he says.

Langata who is also the leader for supporting the Coalition for Health Research and Development hosted by Amref Health Africa in Nairobi believes that AMA will bestow huge benefits to countries ready to commit to it.

“There will be a lot of benefits,” he said, listing them as: “ harmonization of the different national medicines regulatory procedures; capacity building for medicines and vaccines reviews and approvals as countries are at different levels of maturity; ensuring availability of quality pharmaceutical products and smooth cross-border trade in health products among countries that have ratified AMA.”

 See our AMA Countdown page: 

African Medicines Agency Countdown

Updated  2 June, 2022

Image Credits: PPU, Amref Health Africa.

monkeypox
Monkeypox causes fluid-filled nodules to appear on limbs and other parts of the body.

Within a matter of days, over 50 cases of suspected and confirmed infection with the monkeypox virus have now been reported across Europe and North America, including the first reported case in the United States yesterday, said Massachusetts state officials; the case involved a man who had recently traveled to Quebec, Canada.

That adds the US and Canada to a growing list of European countries reporting monkeypox cases in an outbreak first spotted in the United Kingdom where a total of seven cases had been reported recently. Also on Wednesday, two more European countries, Spain and Portugal, reported a surge in monkeypox cases.

Suspected cases in Spain have climbed to 23, and Portugal is looking at more than 20 cases. Officials in Canada are also investigating more than a dozen cases in the eastern province of Quebec, with the Public Health Agency of Canada “collaborating closely” with international partners, including the US Centers for Disease Control and Prevention (CDC), the World Health Organization, and the UK Health Security Agency (UKHSA).

Many unknowns about linkage in the outbreak

There are many unknowns in Europe, the US, and Canada: whether the outbreaks are linked to each other or to cases in the UK; if so, whether the virus spread from the UK to Europe, or the reverse; or how long the virus has been spreading. Still, the quick accumulation of cases is ringing alarm bells.

“We have a sense that no one has their arms around this to know how large and expansive it might be,” CDC’s Jennifer McQuiston told STAT News.

Spain has already issued a nationwide alert in response to the growing number of cases, noting that the virus, typically transmitted via respiratory infection, has in fact been found to be spread through close contact during sex in cases outside of Africa.

“Monkeypox is spread by respiratory transmission, but the characteristics of the 23 suspected cases point towards transmission through mucus during sexual relations,” the Madrid regional health department was quoted as telling The Guardian.

The smallpox-related virus, which circulates widely in central and west Africa, is known to cause flu-like symptoms and heavy rash fluid-filled nodules on the limbs and other parts of the body. Although some forms of the virus have a 10% fatality rate, the west African variant which has infected people in the UK has been relatively milder than the central African strain, prevalent in the Democratic Republic of Congo (DRC).

DRC is also the country with the highest reported prevalence of monkeypox cases in Africa, with some 3,000 cases reported last year, WHO has said.

Unusual monkeypox transmission may be community-spread

While there have been previous reports of monkeypox cases outside of Africa, they were usually traced to infected travelers.

The recent exponential increase in reported cases in Europe and North America raises special concerns since many or most of those reportedly  infected have not travelled to monkeypox-endemic countries nor do they have links to prior cases. And that suggests that the virus is now being transmitted locally, reports the Center for Infectious Disease Research and Policy (CIDRAP).

“These latest cases, together with reports of cases in countries across Europe, confirms our initial concerns that there could be spread of monkeypox within our communities,” said Susan Hopkins, UKHSA Chief Medical Adviser, in a UK government statement.

Portuguese officials, likewise, have reported that among the cases identified there – all men located in or near the capital city of Lisbon – none travelled recently to Africa, nor were they in close contact with cases in the UK.

Additionally, most of the UK cases appear to have involved transmission in networks of men having sex with men, the World Health Organization confirmed in a media briefing on Tuesday.

WHO and national health agencies are thus exploring whether new forms of monkeypox transmission are emerging, such as through close contact during sex.

“We’re finding where we’re looking [in sexual health clinics],” said Maria Van Kerkhove, WHO Technical Lead on COVID-19, during WHO’s Tuesday briefing. Countries have so far been contacting sexual health clinics asking about patients with unusual rashes, but health care providers across the spectrum are advised to be on the lookout.

“We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay if they have concerns,” urged Hopkins. See below our previous Health Policy Watch report on monkeypox, it’s origins and transmission:

Seven Confirmed Monkeypox Cases in UK Includes Sexually Transmitted Cluster

 

Image Credits: Tessa Davis/Twitter .

A one-of-a-kind global study demonstrating the value of self-care will be released this week during a side event of the World Health Organization’s World Health Assembly in Geneva. The study, “Self-Care Socio-Economic Research,” was produced by the Global Self-Care Federation (GSCF).

“Given the proven benefits and efficiency gains that self-care delivers, it is clear self-care has to be given much higher priority by governments at all levels. It is currently an area that is sadly too often overlooked in health policy,” said GSCF Director General Judy Stenmark. “And that applies to both the wealthier industrialised nations and the world’s lower-income countries and regions.”

The event will explore the benefits self-care brings to individuals, communities and health systems by improving quality of life and welfare and while allowing for better allocation of resources.

Healthcare professionals, health economists, media, decision/policymakers, academia and other parties interested in Universal Health Coverage are invited to attend the event on 26 May at 18:00, which will include a moderated panel discussion and questions and answers from the audience.

Panelists include Stenmark; Dr Ritu Sadana, unit head of the Aging and Health division of Universal Health Care, WHO; Prof Uwe May, dean of Fresenius University of Applied Sciences; Lars-Åke Söderlund, vice president of FIP; and Kawaldip Sehmi, CEO of the International Alliance of Patients’ Organizations.

The session, moderated by broadcast journalist Shiulie Ghosh, will also be live-streamed.

Panelists will discuss the crucial role of self-care including current and future contribution of self-care for individuals, health care systems and communities; how appropriate self-care policies are needed to harness the benefits; the economics of health and well-being, and health as a public policy objective; the global social and economic impact of self-care across different regions; systemic, individual and societal benefits of self-care and its contribution to the achievement of UHC and the UN Sustainable Development Goals; and translating the evidence to patient centered health care policies supported by pharmacists.

“The Global Social and Economic Value of Self-Care Study very clearly demonstrates the benefits of self-care for individuals, healthcare professionals and health systems. It is now time to realize the potential of self-care, for everyone, everywhere,” Stenmark concluded.

More information or register for the event.

Part of a supported series by the Global Self-Care Federation.

Image Credits: Flickr.

Smokeless tobacco: A man uses a vape pen.

The high rate of smokeless tobacco consumption especially in low-and middle income countries is a looming global public health challenge. The unregulated sale of these products especially in South and South-East Asia has underscored the need to revamp the national regulations, according to the Seventh Edition of the Tobacco Atlas published Wednesday. 

The report  by Vital Strategies and the Tobacconomics team at the University of Illinois at Chicago, U.S, noted that tobacco usage of smokeless and smoked products together led to 8.67 million deaths worldwide in 2019, with economic damages worth approximately US $2 trillion. That’s over 500,000 deaths more annually, than WHO’s most recent estimate of 8.1 million deaths a year from smoking.  In addition to the world’s roughly 1 billion active smokers, there are also some 360 million are smokeless tobacco users, the report notes.

While globally, smoking rates declined from 22.6% in 2007 to 19.6% in 2019, recent increases in tobacco consumption rate among young people, and particularly of smokeless tobacco products, also is raising the alarm. The most popular ways of consuming tobacco continue to be through cigarettes, e-cigarettes or vaping.  In addition, however, traditional smokeless products, such as chewing tobacco and snuff continue to have a deeply-rooted customer base. The industry’s hold over its consumers becomes all the more apparent evident when you consider that that only five firms control over 80% of the world’s cigarette market. 

Deaths from tobacco consumption.

“Uneven and anaemic implementation of tobacco control measures means that richer countries are unlocking the economic and health benefits of strong tobacco control, while the industry is still preying on emerging economies in ways that will lock in harms for a generation or more,” one of the lead authors of the report Jeffrey Drope, of the School of Public Health at the University of Illinois at Chicago, told Health Policy Watch.

Traditional markets, especially in LMICs,  account for over 90% of the sale and consumption of smokeless tobacco products like khaini, gutka, pan masala, and snuff. The high level of nicotine those products include causes chronic dependency, howeveer, and thus addiction chains. With the unregulated sale and use of these products, rural consumers in LMICs are the ones who are affected the most, the report said.

Young Lives At Stake 

One of the most disturbing findings of the report is the fact that young women are now increasingly picking up tobacco products. Youth tobacco use has increased in 63 of 135 countries surveyed. According to the survey, over 50 million individuals in the 13-15-years age bracket consume tobacco products. 

The report also highlights that the countries with the highest prevalence of tobacco use among youth, as well as high consumption of smokeless tobacco products generally, have a lower human development index scores. The growing use of tobacco among young girls and women in many countries is also set to reverse historically low tobacco usage among females. 

 

E-cigarettes also a growing risk for the young

In addition to traditional smokeless products, e-cigarettes are increasingly popular among youth, and are often perceived to be ‘better than smoking.’ The use of flavours in these products make them more appealing and seem ‘less dangerous than cigarettes’. And while some reports suggest that damage from e-cigarettes may be somewhat less than conventional cigarettes, e-cigarette use also causes negative pulmonary and cardiovascular effects, and the exposure to high levels of nicotine is particularly worrisome for brain development. However, the lack of data about e-cigarette use along with the mostly-unregulated nature of this market poses a major challenge in combatting e-cigarettes, the report warns. 

Many countries don’t have the capacity to deal with strict controls of smokeless or e-cigarette products, Drope told Health Policy Watch, saying. “We were so geared towards regulating cigarettes, that it [regulating e-cigarettes] has been difficult, because there are different supply chains,” he said. “There are different ways of marketing and governments really need to take this seriously and make sure that we’re not creating a whole new generation of nicotine users.” 

More young individuals are now targeted.

Highly Targeted Advertising 

According to the report, the tobacco industry spent $8.2 billion on advertising and promoting cigarettes and smokeless tobacco in 2019 in the United States alone. The groups targeted the most are young adolescents. 

The unregulated world of digital social media platforms like Facebook, Instagram, and TikTok represent a critical marketing outlet for tobacco companies that are eager to skirt the restrictions that have gradually been imposed on more conventional forms of advertising, such as plain packaging or front of package labels warning of tobacco’s harms.  

“The advertising is now indirect,” said Dr. Nandita Murukutla, Ph.D., Vice President, Global Policy and Research, Vital Strategies. She said that Instead of brands competing with each other, tobacco producers target audiences through product placements in films, or using non-tobacco product identities. “It has migrated from traditional media to social media, which is amorphous, hard to regulate, especially across international jurisdictions.” 

The report also highlighted how the United States tobacco industry has been deliberately targeting the black community , particularly through marketing of items like menthol cigarettes. Menthol cigarettes are easier to start, harder to quit and deadlier than conventional cigarettes, said Phillip S. Gardiner, DrPH, Co-Chair of the African American Tobacco Control Leadership Council. 

Currently, over 85% of Black smokers aged 12 or above use menthol cigarettes compared to 29% of White smokers in the U.S. Although Black people smoke at similar rates to White people, they have higher associated death rates, including from cancer.

“The tobacco companies unashamedly have appropriated #BlackLivesMatter to sell their products, while simultaneously opposing policies that would actually protect Black health and lives,” Gardiner added. 

So, What Could Help? 

According to Murukutla, the best way to combat the rampant promotion of tobacco by the industry in the rural and urban markets can be solved by counter marketing. Such a marketing “that describes the harms of this habit, whether it’s through graphic health warnings or other means, is a highly effective way of reaching and shifting that narrative from traditional to help,” she told Health Policy Watch. 

Further, increasing the price of tobacco by 50% worldwide through higher taxes would save more than 27 million lives and generate US$ 3 trillion in extra tax revenue over the next 50 years, the report suggests. 

Media campaigns are cost-effective and play a major role in making users kick the habit. The report showed that a smokeless tobacco control mass media campaign in India yielded more than 17 million additional quit attempts at a cost of just US$ 0.06 per attempt. 

When it comes to cross-border marketing of tobacco products, she said that the ratification of international treaties like the Framework Convention and International Cooperation Mechanisms are ultimately the best way of addressing such issues since “it really does require countries to coordinate to stop it at source.” 

Image Credits: pixabay, Tobacco Atlas, Vital Strategies .

Deaths from “traditional” pollution sources like unsafe water have declined but health impacts from “modern” pollution sources associated with traffic, industry and chemicals are rising.

[NAIROBI] While deaths from some traditional pollution sources, like domestic cookstoves and unsafe water and sanitation are declining, increased exposures to “modern” sources of pollution, such as chemicals and outdoor air pollution, mean that pollution-related mortality remains steady at about 9 million a year. 

This is a key finding of a new report on “Pollution and health; a progress update”, published today by Lancet Planetary Health.

“Modern sources of pollution such as industrialisation and urbanisation are increasingly becoming major causes of deaths but there are very little responses in tackling the [menace] from players such as donor agencies and national governments,” says Rachael Kupka, a study co-author and Executive Director of the Geneva-Based Global Alliance on Health and Pollution (GAHP).

“There is also insufficient public awareness on the dangers of pollution,” she adds. 

Overall, about 16% of all premature deaths annually are due to pollution, finds the study, an update of a 2017 Lancet Commission paper on pollution and health.  This also means that pollution remains the world’s largest environmental risk factor for disease and premature death.

The estimates are based on the Institute of Health Metrics and Evaluation’s 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, which looks at a broader range of risks to health from environments, diets, lifestyles and other factors.

Outdoor air pollution sources now the most dangerous to health 

Air pollution in Mashhad, Iran. Expanding low- and middle income cities are a nexus point for risks.

Among pollution sources, air pollution remains the biggest killer by far, the report found – with about 6.7 million deaths in 2019 from both household  and ambient air pollution sources. 

However, a shift is also occurring in the balance of air pollution sources. Deaths from household air pollution, generated by the reliance of billions of people on coal and biomass cookstoves are declining gradually as households shift to cleaner domestic fuels.  

But at the same time, deaths from outdoor air pollution sources have risen sharply over the past two decades – from an estimated 2.9 million deaths in 2000, when WHO first published data on mortality from air pollution risks, to an estimated 4.5 million deaths in 2019.

Deaths attributable to key “modern” and “traditional” pollution sources for which data is available.

That increase is largely due to the continued increases in outdoor air pollution from traffic emissions, power plants and industries, in cities of the global South that are seeing explosive growth into rural areas, in  unsustainable patterns of development, researchers have said, adding: 

“The triad of pollution, climate change and biodiversity loss are the key global environmental issues of our time. These issues are intricately linked and solutions to each will benefit each other.” 

The study also notes the deep equity fault line that pollution creates – with 92% of pollution-related deaths, and the greatest burden of pollution’s economic losses, occurring in low-income and middle-income countries.

Lead pollution still a major factor in chemical risks 

Lead pollution in the Amazons a byproduct of oil extraction.

The report adds that exposure to lead, a neurotoxin that also lowers IQ in children, caused 900 000 premature deaths in 2019 while other toxic chemical exposures in the workplace, accounted for 870 000 deaths.

But the figures on deaths from chemical pollutants are likely underestimates as only a small number of manufactured chemicals in commerce have been adequately tested for safety or toxicity.

Overall, deaths from the so-called “modern” pollution sources have increased by 66 percent in the past two decades, from an estimated 3.8 million deaths in 2000 to 6.3 million deaths in 2019, according to the study’s authors.

“The total effects of pollution on health would undoubtedly be larger if more comprehensive health data could be generated, especially if all pathways for chemicals in the environment were identified and analysed,” the study’s authors say.

According to Kupka, one out of five children globally is exposed to lead contamination despite the global phase out of leaded gasoline. In some countries, up to 50% of children may be exposed to lead through water piping, leaded household ceramics, lead in spices, as well as exposures in paint, artisanal mining and oil extraction and waste scavenging, according to GAHP.  

Pollution has it’s biggest impacts on health in LMICS

Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall

Pollution remains the world’s largest environmental risk factor for disease and premature death, particularly in low- and middle-income countries where air pollution accounts for about 75% of the nine million deaths.

The authors are now calling for immediate action to address this existential threat to human and planetary health as, with a few notable exceptions, little efforts have been done to deal with this public health crisis.

“Pollution is still the largest existential threat to human and planetary health and jeopardizes the sustainability of modern societies. Preventing pollution can also slow climate change – achieving a double benefit for planetary health – and our report calls for a massive, rapid transition away from all fossil fuels to clean, renewable energy,” said Professor Philip Landrigan, another co-author and director of the Global Public Health Program and Global Pollution Observatory at Boston College.

This trend is more evident in Southeast Asia, where rising levels of urban  pollution combine with ageing populations – who are more vulnerable to the health impacts of air pollution, and related diseases, such as heart attack, hypertension, cancers and chronic respiratory diseases. 

Reduction in deaths from “traditional” pollution sources most evident in Africa

Solar-powered lights have replaced polluting kerosene lamps in many homes around the world.

The drop in deaths from traditional pollution since 2000 is most evident in Africa, the report found. Theres a decline in household air pollution as families shift away from biomass, coal and kerosene for cooking and lighting. 

Household air pollution is a leading risk for childhood pneumonia deaths – along with cleaner household fuels, better medical treatment is gradually bringing that burden down. Similarly, improvements in clean water supply, storage and sanitation have reduced deaths from diarrhoeal diseases –  traditionally another major killer of children under 5, the report found.  Even so, lack of access to safe drinking water and improved sanitation still remains responsible for 1.4 million premature deaths every year.  

Pollution prevention largely overlooked  

Despite the bright spots of progress, pollution prevention is a neglected priority both among donors as well as among top officials in many of the of the low- and middle-income countries that suffer the most – including health sector leaders. 

“Despite its enormous health, social and economic impacts, pollution prevention is largely overlooked in the international development agenda,” says Richard Fuller, lead author. 

“Attention and funding have only minimally increased since 2015, despite well-documented increases in public concern about pollution and its health effects.”

This is despite estimates that pollution-related deaths led to economic losses totalling US$ 4∙6 trillion in 2019, equating to 6.2% of global economic output.  

Comparing lost economic output as a proportion of GDP due to deaths from modern and traditional pollution sources in 2000 and 2019.

Intergovernmental Panel Report on Pollution 

The authors called for an independent, Intergovernmental Panel on Climate Change (IPPC)-style science/policy panel on pollution, increased funding for pollution control from governments, independent, and philanthropic donors, and improved pollution monitoring and data collection.

 Approval and establishment of better connection between science and policy for pollution by international organisations.

“Prioritization of this issue by policymakers, understanding the consequences of pollution is extremely important. Ministers for environment need to ensure that pollution is factored in their national strategic plans and are budgeted,” according to Kupka.

Image Credits: Mohammad Hossein Taaghi, UN Water, Lancet Planetary Health, ISGlobal – Barcelona Institute of Global Health , Uncommonthought.com, DFID, Lancet Planetary Health .

Child infected with monkeypox virus in Liberia – since smallpox vaccinations were discontinued children may be even more vulnerable.

There are now seven confirmed cases of monkeypox in the United Kingdom, and all but one case of the virus appears to have been transmitted locally in the UK, including among men having sex with men, the World Health Organization confirmed in a media briefing on Tuesday.

The smallpox-related virus, which circulates widely in central and west Africa, causes flu-like symptoms and a heavy rash of fluid-filled nodules on the limbs and other parts of the body. In some cases it can be fatal, although the west African variant that has infected people in the UK is relatively milder than the Central African strain, UK officials were quoted by British media as saying.

The virus circulates widely among animals in western and central Africa. Among humans, several thousand cases are reported every year in the Democratic Republic of Congo, although the virus is endemic in the Central African Republic, Nigeria and elsewhere in western Africa, WHO said.

WHO is investigating the sources and nature of the UK outbreak together with the UK’s Health Security Agency and the European Centres for Disease Control, said Maria Van Kerkhove in the media briefing.  The first reported UK case was in a British resident who had recently travelled to Nigeria – but some of the new cases have not been directly traceable to that single contact or others, WHO said.

Cluster of cases among men who have sex with men

Ibrahima Socé Fall, WHO Assistant Director of Health Emergencies

Typically, the virus does not spread easily among humans – but the UK cluster of locally-transmitted cases have occurred primarily among men who have sex with other men – leading to new concerns about wider transmission risks through sexual contact.

“We have reached out to our European Regional Office to raise awareness about monkeypox, looking at people with unexplained rash, particularly in communities of men who have sex with men, just to add monkeypox as a potential diagnosis to make sure that we have the right testing underway,” Van Kerkhove said.

But the expanding pace of monkeypox transmission in African rural areas is an even more fundamental concern, noted Ibrahima Socé Fall, WHO Assistant Director General for Emergencies Response. The DRC recorded some 3000 cases in 2021, “and in Nigeria we are seeing increased numbers of cases too.. Clearly the main problem we need to investigate is the expansion of… transmission in Africa.”

While smallpox vaccine is believed to prevent infection, the proportion of people today who have been vaccinated against smallpox, is shrinking every year since routine smallpox vaccination was discontinued several decades ago, when the disease was eradicated. So more young people may be at risk, WHO officials said. And the mortality risk of monkeypox, while lower than for smallpox, can still be as high as 10%, according to the US Centers for Disease Control.

“We really need to invest in the discussion and development of tools for monkeypox,” Socé Fall added. “We have so many unknowns in terms of the dynamics of transmission in the future. In terms of therapeutics and diagnostics, we have so many important gaps.”

Exportation of virus is ‘signal’

Monkeypox, was first identified in 1958 in two colonies of research monkeys – hence its  name.  The first human case was recorded in the DRC in 1970, which is the apparent epicenter for the virus, according to the US Centers for Disease Control.

Along with non-human primates that may be killed and consumed as bushmeat, rodents, which infest rural food storage facilities, are important animal reservoirs for the disease.

Gambian pouched rat – rodents are believed to be a common animal reservoir for monkeypox.

The dynamics of animal transmission means that addressing monkeypox, as well as other emerging pathogens, will require more than just vaccines and treatments, said Dr Mike Ryan, executive director of WHO Health Emergencies.

“Understanding the ecology of this virus is important,” he said. “The cases that are imported to other countries are signals that something is happening,” he said.

“We’re seeing a shift to the geographic distribution of cases. And we also see the environmental pressures that are on our ecosystem as converging threats.

Need for environmental solutions – not only vaccines and medicines

“It’s not a surprise that we’re in a zone in western and central Africa, of increasing climate stress, of changing agricultural practices, of humans trying to survive in many cases, having to adapt, but also at the same time, small animals and rodents are adapting,” Ryan added.

Non-human primates like monkeys are another reservoir for the virus.

“They’re in the same crisis…. They’re seeking the same food sources and that’s bringing the animal population and the human population into ever closer proximity as we all compete, sometimes for those same food resources.

“So we have to really understand that deep ecology.  We have to understand human behavior in those regions, and we have to try and prevent the disease reaching humans in the first place.

“And that may not be necessarily with scientific interventions like vaccines – that may be in changing social and agricultural practices, storage practices.”

Image Credits: US Centres for Disease Control , Laëtitia Dudous, Sakurai Midori/Wikipedia .

DPR Korea and Eritrea are the only countries in the world that have not launched COVID vaccine campaigns.

Nearly 1.4 million people in the Democratic People’s Republic of Korea (DPR Korea) are suspected of having been infected with COVID-19 in just the past three weeks, WHO officials said today. 

The global health agency has offered diagnostics, vaccines, medicines and other support, but with no clear response to date from the isolated Asian nation that so far has refused to vaccinate its population of 26 million.  

DPR Korea, otherwise known as North Korea has admitted only to a wave of ‘fever’– as the state media called it – the closest it has come to acknowledging a COVID outbreak since the SARS-CoV2 pandemic began in 2020.  It is one of only two countries worldwide to have not yet started a vaccination campaign – the other one being Eritrea. 

“WHO is deeply concerned at the risk of further spread of COVID-19 in the country, particularly because the population is unvaccinated and many underlying conditions put them at risk of severe illnesses,” said Dr Tedros Adhanom Ghebreyesus, the WHO Director General, at the press briefing today in Geneva. 

He added that WHO had asked government authorities to share more samples or data sequences of the SARS-CoV2 virus circulating – although some samples already shared suggest the outbreak is dominated by the Omicron BA.2 variant. 

Unvaccinated status raises concerns  

Officials with masks stand at attention in DPR Korea.

DPR Korea’s unvaccinated status has raised concerns regionally and globally that a large outbreak could also lead to the emergence of new variants – as well as imposing a heavy toll on the country itself.  

“With the country yet to initiate COVID-19 vaccination, there is risk that the virus may spread rapidly among the masses unless curtailed with immediate and appropriate measures,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, said in a press statement on May 16.

The authoritarian state has meanwhile mobilized the army, mounted an information campaign and urged patients with ‘fever’ to opt for home remedies along with the use of painkillers and antibiotics, according to one Reuters report. 

In Eritrea, meanwhile, no major COVID wave has been reported just now, but the situation remains concerning there, as well, said Tedros. 

“They still haven’t accepted our offer that we made some time ago to get [them] vaccines. So we haven’t heard from them,” he said. “I have written to the president stating that we are ready to help and we have vaccines in stock that can go to Eritrea but we haven’t heard from him either.”

‘Omicron Is Deadly, Not Mild’ 

WHO Chief Scientist Soumya Swaminathan

“..It would be a whole package which they (DPR Korea) will need now – not only vaccination that will be needed, but also the critical care and interventions for people who are already infected,” added WHO Chief Scientist Soumya Swaminathan. “We stand ready to work with the governments of both Eritrea and DPRK to ensure that people have access to the tools that are now available all over the world.” 

Meanwhile, Dr Maria Van Kerkhove, Technical Lead for the COVID-19 response rejected suggestions that the outbreak in DPR Korea would be “mild” due to the likelihood that it is dominated by the Omicron strain of SARS-CoV2.  

“This notion that Omicron is mild is false.” she asserted. “What we are seeing is that people who are vaccinated have a much reduced risk of developing severe disease and that is why vaccines are so critically important around the world, particularly among those who are vulnerable, those who are over the age of 60.” 

“We know consistently across countries that people with underlying conditions are at an increased risk of severe disease.”  Along with holdouts such as DPR Korea and Eritrea, that poses a continuing concern for some 65 other countries, mostly in the African region, which have not yet vaccinated 40% of their populations, Swaminathan also noted.

Streamlining process for amendments to International Health Regulations  

Steven Solomon, WHO chief legal counsel talks about pending resolution on International Health Regulations 

Meanwhile, a senior WHO legal official said that a draft resolution on the table at the upcoming World Health Assembly could speed up the process for amending International Health Regulations (IHR), which govern WHO and countries’ pandemic response. 

The WHA begins on Sunday, 22 May and runs until 28 May. 

However, a WHA outcome that merely amends the process for making IHR amendments – rather than actually tackling the weak points in the rules themselves –  will likely prove to be frustrating to some nations as well as observers that have argued for much faster and more dramatic changes.  

The United States, for its part, has tabled a proposal for a very detailed series of revisions to the current IHR rules. These amendments would set a strict timetable of just 48 hours for countries to report to WHO about new disease outbreaks after they are identified by a national focal point. 

That would be followed by another 48 hours period in which countries can either accept WHO offers of technical assistance – or else WHO would share on the outbreak details with all member states.  That’s in contrast to present-day practice where the global health agency sometimes waits for months to make an outbreak public. For instance, a wildpolio virus outbreak in Malawi that occurred in November 2021, was only reported publicly by WHO in February.

But with some member states, such as China and Russia, fearful of giving the IHR more teeth at all, an agreement to expedite the process for making amendments may be the best that can be achieved at this WHA session.  

With a current period of two years for any IHR amendment to take effect once something is agreed, the new rule would at least halve the delay and thus streamline the process somewhat, said Steven Solomon, WHO’s Principal Legal Officer. 

“It’s an area that the Director General  supports as helping to streamline and make more effective and more agile this important international legal instrument (IHR).” If agreed, this would be only the second time that the IHRs have been amended,” he pointed out. . 

Overall, the WHA will take up the pandemic as a major topic of discussion for the third year in a row, added Tedros, including “how to end the emergency, increasing access to vaccines, antivirals, and other life saving tools.”

Image Credits: KCN.

What are the paths health systems can take to a more disease-free world?

And related to that, why do we talk about the total “eradication” of some diseases, like polio, whereas for others, “elimination as a public health problem” or simply disease “control” that shrinks an epidemic into an endemic disease is a more realistic option?

In this episode of the “Global Health Matters” podcast, host Garry Aslanyan answers these questions and more with the help of three public health leaders who talk about experiences tackling key disease threats, including onchocerciasis, malaria and polio.

“Infectious diseases have had a profound effect on the health of millions of people,” Aslanyan says. “They also have detrimental effects on the economies of many nations, which can lead to a cycle of poverty. The ultimate goal of public health is to control, eliminate and finally eradicate diseases that pose a threat to human health.”

But only one human disease has been successfully eradicated worldwide, which means having achieved permanent reduction to zero of incidence of infection: smallpox.

In terms of disease control, Uche Amazigo shares lessons she learned during her tenure as the director of the WHO African Programme for Onchocerciasis Control.

The parasitic disease, transmitted by blackflies that live near fast-flowing streams and rivers, is commonly known as river blindness, and it infects around 18 million people each year, according to the World Health Organization, mainly in West Africa but also in parts of Latin America, leaving people with debilitating skin disorders and blindness among older people .

Today, with community-led mass administration of treatments such as ivermectin, and now recently moxidectin, which reaches over 200 million people annually, the numbers of people suffering serious side effects from onchocerciasis has shrunk, and four countries in Latin America have been certified as oncho-free.

Distribution of onchocerciasis infections

Amazigo said that to help manage disease she has learned the importance of “listening to the people” and “engaging the poor and target beneficiaries of programs, to co-design ways to implement and improve their health.”

“Today, I consider the degree of involvement or engagement of beneficiaries as the most essential ingredient of success in health,” she said.

Meanwhile, David Reddy of Medicines for Malaria Venture discusses the new and exciting innovations being tested for malaria elimination, from vaccines to new tests and treatments.

“The role of new interventions will help accelerate progress,” Reddy said. “One of the key ones is the RTS,S vaccine. It’s the first vaccine that we have had for malaria, and we shouldn’t understate the importance of that.”

He also mentioned breakthrough next-generation drug pipelines to counter drug resistance and monoclonal antibody treatments.

Finally, Aidan O’Leary, director for polio eradication at WHO, makes the case for pursuing worldwide eradication of polio, which has already been eliminated in most countries and many regions.

“The human species has been battling wild polio virus since ancient Egyptian times, so for millennia, and what we’ve basically had with the Global Polio Eradication Initiative is an initiative that started in 1988, at a time when we had almost 1,000 children per day across 125 countries across the world were being paralyzed as a result of this disease. Where we stand now, at the start of 2022, is a situation where we’ve had just six children paralyzed during the course of the past 12 months in just three countries,” explained O’Leary. “But it’s still six children too many.”

He said there are three keys to polio eradication in any country: The ability to identify and assess risk; coordination of the operational response; and accountability and oversight.

 

Join us in this discovery of what is needed to reduce or remove the risk of infectious diseases.

Subscribe to the podcast: Global Health Matters is available on Apple Podcasts, Spotify, Google Podcasts, Amazon Music, Stitcher or wherever you find your podcasts.

Listen to the previous podcast episode: Championing Health Equity in South Africa

Image Credits: TDR, WHO.