Smog engulfs Lahore, Pakistan, on Thursday as air pollution levels hit record highs. Some pollutants reached nearly 100 times the World Health Organization’s recommended level, according to IQAir.

BAKU, Azerbaijan — Global and Indian experts at COP29 produced new evidence Thursday calling for clean air standards to become part of nations’ climate commitments, as cities across South Asia’s heavily polluted air corridor battled record-breaking smog.

In Delhi, authorities closed schools up to grade 5 and halted construction as pollution levels soared to almost twenty times the WHO’s safe daily limit. The crisis came just days after Lahore, Pakistan’s second-largest city just 25 kilometres from the Indian border, saw its highest-ever levels of air pollution. 

Under the clear skies of Azerbaijan’s capital, experts from the World Bank, WHO, and Indian health ministry were unanimous that air quality improvement should be included in the new Nationally Determined Contributions (NDCs), the self-determined climate targets nations set under the Paris Agreement. 

“Air quality targets and standards can be a perfect indicator of success if we are successful in targeting the causes of climate change,” Dr Maria Neira, WHO’s health and climate lead, told Health Policy Watch. “If we could select an indicator of how successful we are in achieving negotiations on climate change mitigation, I think we should use the levels of air quality that people around the world are breathing.”

Health experts hope their evidence linking air pollution and climate change will strengthen calls for action at COP29.

Supporting this call for action is a new report released by the Clean Air Fund that shows how tropospheric ozone – a little-discussed ‘super pollutant’ – is linked to 500,000 premature deaths and an estimated $500 billion in economic costs annually. Air pollution from all sources contributes to more than eight million premature deaths each year, with economic costs exceeding $8 trillion, the report found.

The findings aim to support the push for including air quality standards in the third generation of NDCs – binding climate commitments due before COP30 next year under the Paris Agreement. Only a small fraction of countries currently include air pollution safety in their climate plans despite the health threat to millions worldwide.

Clean Air Fund’s founder and CEO, Jane Burston, said tackling super pollutants provides “huge opportunities” for improving climate, health, economic development, and equity.

“We know that developing countries are some of the few that have included things like black carbon in their nationally determined contributions, and that’s because a lot of these deaths and this exposure is happening in countries least able to afford action on it,” she added.

Super-bad for children

Protest by ‘Warrior Moms’, a group for clean air, in Delhi outside India’s health ministry, as air pollution turned ‘severe’ on 14th November, which is celebrated as Children’s Day in the country.

Tropospheric ozone and its super-pollutant siblings – including methane, black carbon, nitrous oxide and fluorinated gases – are collectively responsible for nearly half of global warming to date.

Unlike other pollutants, tropospheric ozone isn’t directly emitted but forms when sunlight interacts with pollutants from aviation, shipping, agriculture and other sectors. Its health impacts can be severe, from reduced lung function to complications in type 2 diabetes and cardiovascular disease. For children, this pollution poses an especially severe threat.

“Young children have smaller lungs,” Dr Soumya Swaminathan, an advisor to the Indian health ministry and former chief scientist at the WHO, explained. “They breathe much faster than adults, and they are shorter, so they’re closer to the ground, where there are more pollutants, and get more respiratory infections.”

Dr Valerie Hickey, who leads the World Bank’s environment department, also placed children at the centre of her argument.

“Your kid got up coughing so bad they couldn’t go to school does not lead on CNN,” she said. “Though if there are huge floods in Valencia, it does. Both are terrible, but [air pollution] is a public health emergency.”

Like climate change itself, air pollution’s threat isn’t only visible in extreme events such as Delhi’s current crisis, where PM2.5 levels have reached almost 300 micrograms per cubic metre.

“Every unit you go above five, you actually have a health impact,” explained Swaminathan, who co-chairs Our Common Air. “Even at 20, 30, 40 you start getting effects on the heart, respiratory system, and brain. So we need to take action to keep it as low as possible.”

“We have to be pragmatic and set interim targets and do a stepwise plan to reduce it,” she added. “That’s what the NDCs are all about.”

‘Smog diplomacy’

Delhi and Lahore, just 400 kilometres apart, face the world’s highest air pollution levels.

Half of the ten most polluted places in the world today are in four countries of South Asia – Pakistan, India, Nepal and Bangladesh. Health experts often say that air pollution knows no borders, an adage now forcing cooperation between long-standing rivals in what’s come to be known as “smog diplomacy.”

India and Pakistan, nations that have fought multiple wars since independence, are finding themselves pushed toward dialogue over their shared air crisis. This week, as their major cities Delhi and Lahore traded places as the world’s most polluted, officials in Punjab, Pakistan’s most populous province, drafted a letter to India seeking talks on air pollution. 

“This is an area of the world where there isn’t always great experience with international diplomacy,” Hickey said. “Countries don’t always like each other, but they’re actually seeing that smog diplomacy is something that can bring them to the table.” 

The outreach comes as hundreds of millions in both countries face severe health risks borne from common problems plaguing both nations: farmers burning agricultural waste, coal-fired power plants, heavy traffic, construction and windless days trapping emissions.

The World Bank has launched a “multi-hundred billion dollar” to address this cross-border crisis, targeting the vast northern plains of South Asia, known as the Indo-Gangetic Plains, Hickey told Health Policy Watch.

The Bank has already committed to several regional projects in India, including a $350 million clean air management initiative plus $5 million grant for Uttar Pradesh, reportedly approved by the state cabinet and a pending $300 million loan plus $5 million grant for Haryana.

Similar programs are planned for Nepal, Pakistan and Bangladesh to address pollution that readily crosses borders due to the region’s geography and wind patterns.

“We need climate diplomacy, as a regional and global issue,” Raja Jahangir Anwar, Punjab’s Secretary for Environment and Climate Change, told CNN. “We are suffering in Lahore due to the eastern wind corridor coming from India. We are not blaming anyone, it’s a natural phenomenon.”

Image Credits: https://x.com/ThePeerAli/status/1856985454072963085/photo/1.

Thail lab technicians train in surveillance of antimicrobial resistance (AMR) in food-producing animals in Southeast Asia – an driver of AMR that was neglected in the recent UN High Level Meeting declaration.

With plans underway for a new “Independent Panel” on Antimicrobial Resistance, endorsed at September’s UN High-Level AMR Meeting, the new body must become a strong scientific authority. It should have the power to “challenge” the agencies that create it and address both human and animal health factors driving drug-resistant pathogens.

That was a key message from AMR experts in the lead up to the Fourth Ministerial Meeting on Antimicrobial Resistance, which begins Friday in Jeddah, Saudi Arabia. 

The Independent Panel “needs to be an inclusive process… listening to scientists… civil society, to industry and other actors. But you also need to make sure that that panel, even though hosted by a Quadripartite, can actually challenge the Quadripartite,” declared John Arne Røttingen, CEO of the UK-based Wellcome Trust, of the panel’s central importance to providing evidence on future AMR policies.

The ‘Quadripartite’ includes the World Health Organization, as well as the global environment, food and animal health agencies, which are now formally collaborating to confront the AMR threat.

John-Arne Røttingen, CEO of Wellcome Trust.

Røttingen was among the more than two dozen experts convened for two high-level AMR sessions at Berlin’s World Health Summit in mid-October to discuss next steps for the battle against drug resistant pathogens in the lead-up to the Jeddah meeting.

“Declarations are long. It’s hard to identify the real material commitments that have been made,”  Røttingen said at a panel discussion on Milestones and Challenges in Tackling AMR, hosted by the German Ministry of Health.

“So it’s great that we come to Jeddah for the ministerial meeting,” he said. “That should be a start of both countries’ [and development agencies]  coming together as well as the multi stakeholder partnership platform coming together across sectors to make sure that we are keeping our commitments.”

On the research front, meanwhile, new “pull incentives” recently developed in the United Kingdom, Italy and Canada to foster a sustainable market for next generation antibiotics are welcome, but they are not enough, industry experts asserted. Many more nations need to adopt supply-side incentives to ensure that badly-needed new drug candidates actually come to market.

Jeddah should be the start of making good on the UN’s AMR Declaration

FAO, UNEP, WHO and WOAH heads at September’s UN High Level Meeting that approved a set of new commitments for action on drug resistant pathogens.

The health ministers’ confab in Saudi Arabia (15-16 November) is supposed to lay out next steps for delivering on promises made in the Declaration on Antimicrobial Resistance approved at the UN High Level  Meeting, 26 September in New York City.  

September’s declaration was a major milestone in the battle to bring a long-ignored AMR epidemic to the forefront of global health policy. AMR is associated, directly or indirectly, a “silent, slow-motion pandemic” that could kill some 39 million people by 2050.

The mandate to create an “independent panel for evidence for action against antimicrobial resistance in 2025” is embedded in a 15-page text, with 106 clauses. But it is widely perceived as a key next move to maintain strategic momentum on AMR threats. 

The science panel should “facilitate the generation and use of multisectoral, scientific evidence to support Member States in efforts to tackle antimicrobial resistance, making use of existing resources and avoiding duplication of on-going efforts, after an open and transparent consultation with all Member States on its composition, mandate, scope, and deliverables,” the AMR  declaration stated.  

Final HLM declaration omitted target for reducing animal antibiotic consumption 

Asian meat-packing house.

The science panel is supposed to be created and administered by the Quadripartite of agencies whose role in managing the AMR crisis was also formalized by the declaration. Along with WHO, the four-member body includes the UN Food and Agriculture Organization (FAO), the UN Environment Programme (UNEP), and the World Animal Health Organization (WOAH), a non-UN member state body.

And that makes the panel’s mandate and composition a sensitive point, in light of the political pressures from big food and other interests that want to play down their role in fostering AMR risks, which some researchers say is the leading driver. 

Identified AMR hotspots often align with high volumes of antibiotics sales and use in livestock.

Pressures from agri-businesses and meat producing nations  already led to the deletion of a target for reducing animal antibiotic use by 30% by 2030 from the final HLM declaration. Now, the question is whether scientists can come together to articulate the evidence and agree on science-based policy recommendations.

“Even though the declaration was positive, it also didn’t achieve agreement on things that I, from my professional background, …would say should have been agreed,” Røttingen observed. “And that speaks to the interests and the trade offs between different sectors… it speaks to agri-food businesses versus human health, and that’s why we believe a science panel is important.”

He said, “We have the target of inverting AMR-related mortality [by 10% by 2030], but we need even more targets and more ambitious targets, so we have a lot to do,” he said.  

“In the climate sector, we have the IPCC (Intergovernmental Panel on Climate Change),” Røttingen continued. “We know how … contested the climate space is, but still, we have a collective international evidence base… We need authoritative evidence with scientists working in the human sector and the animal sector that can come together to actually give us that evidence base and give guidance. “

For animal health, as well, the ultimate aim is to curb abuse not essential use 

Arshnee Moodley, CGIAR-Kenya

Worldwide, the overuse of such antibiotics in livestock production is widely regarded among experts as a leading, if not the leading, driver of pathogen resistance.

But ultimately, the aim of new measures should be win-wins that ensure better access to vaccines and other measures to pre-empt antibiotic use and ensure animal health, panelists at the sessions also underlined.

 “You need to be able to communicate with the people who can change that [AMR trends],” said Dr. Arshnee Moodley, a Kenya-based lead of CGIAR, which works with farmers on animal health. “And for me, it’s the smallholder famer outside of Nairobi.  I need to be able to tell him or her why they shouldn’t use antibiotics,” she said.

“And that’s really critical because livestock is also part of the solution; it’s vital food for vulnerable groups,” she continued.

“I worked every summer in my grandfather’s farm with three milk houses, from the age of 13. So I know about animal health and the need for small farmers, even in high income countries, to keep their herds healthy,” Røttingen countered.  

“When I’m concerned about the agricultural sector, it’s not really about the misuse of antibiotics among small scale farmers … it is about big food on several continents and making sure that they are … transparent and they are willing to engage in proper animal welfare, because that’s the starting point for ensuring animal health.

Too often, measures related to vaccines and hygiene are bypassed, “by using antibiotics to treat herds that aren’t necessarily requisite,” he explained.

Worst of all, is the use of antimicrobials or antibiotics “as growth promotion that has nothing to do with animal health. It’s not healthy for those who eat those animals, and it’s not healthy for the animals.

“So … animal health is an important part, but I think the hardest question lies with the big food companies.”

For human health – more prevention and better regulation are essential too

Malawi’s Minister of Health Khumbize Kandodo Chiponda with Tamas Koncz, Pfizer Germany

Much as with animals, infection prevention, appropriate access to drugs and better regulation need to be the operative goals for humans as well, panelists at a second high-level session on AMR agreed.  

That includes clean water, sanitation and hygiene that many communities and health facilities still lack, as well as stronger laboratory networks, and quality control of antimicrobials in settings were fake and substandard formulas often circulate.  

“Unfortunately for countries like us, we face challenges, because in terms of manufacturing…  we have to get them [products] from outside. So in terms of the quality…. you cannot be 100% sure that what you’re getting really is the very, very good quality,” said Khumbize Kandodo Chiponda Minister of Health, Malawi, speaking at the panel hosted by the global non-profit antibiotic accelerator CARB-X and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

Changing community behaviours and patterns can be a major lift, in light of the ease with which people can get antibiotics through more informal channels as well as the expense people might face in seeing a healthcare professional – who will in turn face challenges determining if antibiotics are needed or not – without adequate diagnostics equipment.  

Access to antibiotics is improving – but Africa is also becoming an AMR hotspot

Buying antibiotics in India. Prescriptions are required but the rule is not always enforced.

“Access to antibiotics [in LMICs] is improving and that is a good thing,” said Tamas Koncz, a vice-president of Pfizer’s operations in Germany. He pointed to data citing a 114% increase in antibiotic use in low- and middle-income countries between 2000-2015.  Pfizer’s 2022 Accord for a Healthier World,  which committed to providing all of its patented medicines and vaccines to 45 lower-income countries on a not-for-profit basis, has been one enabler of better access to common antimicrobials, he said. At the same time, weak enforcement of prescription drug rules, as well as a lack of health provider knowledge about which drugs to prescribe, are drivers of drug resistance.   

“If physicians are not using [the drugs] appropriately, then it’s going to lead to problems. So we need to fix the challenge of access. But I think what is even more important is the overall approach.”

Africa, where sales of antibiotics by unlicensed vendors is often widespread, is also becoming a major AMR hotspot, he pointed out – highlighting the challenges of balancing access with judicious use. 

All-age rate of deaths attributable to/associated with antibiotic resistance, 2019. (Lancet, 2022)

The landmark 2022 Lancet study that found 1.27 million deaths globally in  2019 were directly attributable to drug-resistant bacterial infections, including 860,000 in Africa. That same year, Africa saw 640,000 deaths from HIV.  

“We know from the recent communication from the African CDC and others, that it’s becoming probably the one of the biggest, if not the biggest, healthcare burden, superseding now HIV AIDs, maybe even malaria and tuberculosis,” said Koncz.  

‘Pull’ incentives 

Florence Séjourné, Aurobac and Kevin Outterson, CARB-X.

On the supply side of the equation, meanwhile, “more pull incentives” that can incentivize pharma developers of newer, pathogen-resistant antibiotics is a long-neglected topic now finally rising to the top of health ministers’ agendas.  

The challenge lies in the fact that new antibiotics capable of beating drug-resistant infections also need to used sparingly – to ensure that they, too, don’t fail prey to AMR. But that means companies that develop the drugs can’t count on revenues from blockbuster sales to pay back years of investment in clinical trials. 

“AMR innovation is in a broken business model right now, needing incentives.” said Florence Séjourné. She is the CEO of the Aurobac Therapeutics, a joint AMR R&D venture created by two leading European pharma firms as well as the founder of the BEAM Alliance association of AMR-focused biotechs.  

Products risk death in the pipeline 

While there are now 20 “highly innovative” antibiotics in the early stages of development globally, the number will have dwindled by 75% within eight years if the business model doesn’t change, warned Dr Kevin Outterson, head of CARB-X.  “Within four years, we’ll have less than 10 in clinical development globally. And four more years after that, we’ll have less than five.” 

The of human capital” he added as large companies shut down programmes, and research is concentrated in underfinanced biotech startups. 

“There is absolutely no interest in private investors in the antibacterial field, which is complex,” added Séjourné. Of the startups, 60% of the BEAM Alliance members have less than a year of cash to fund their activities; 40% are firms of less than 9 employees.  

“The world is relying on micro companies, companies with less than 10 employees…That’s a very fragile base,” for developing urgently needed new drugs, Outterson added. 

On the cusp of a solution? 

Bacterial culture prepared for testing new antibiotic candidates.

But, there are also some glimmers of hope on the horizon. 

The first was the launch of the United Kingdom’s new “subscription model” in May for antimicrobial drugs that need to be held in ‘reserve’ for drug resistant pathogens. This aims to guarantee innovators a return on new drugs, regardless of the quantities used, that can guarantee a market incentive for new drugs, even if they are carefully rationed. 

Séjourné praised the UK decision as “something to highlight has a good example for others to follow” – although she warned that until a larger number of countries get on board with such changes, “the broken business model will remain.” 

More recently, at the 10 October meeting of G7 health and finance ministers in Ancona, Italy’s  Minister of Health, Orazio Schillaci announced a series of new “pull incentives” aimed at stimulating R&D and ensuring biotech firms a payback on their investment. Canada is also piloting an incentive programme, while other European Union members, as well as Japan, are considering similar moves. 

In light of those new developments, CARB-X’s Outterson sounds a note of cautious optimism. 

“At the G7 meeting, I made the economic case for a small, reasonable investment and push and mostly pull incentives, together, yields an amazing return on investment, both on the health side as well as the economic side,” Outterson said. “It was a rare opportunity to be able to speak not just to the health people, but also the finance people,” he said, noting that the issues raised at the meeting appeared to resonate with both sectors. 

“And so we have a problem, and we know that it’s desperate, and companies are filled with innovation, but not enough capital to move things forward. But we really are on the cusp of the solution as well.”

IFPMA Director David Reddy

“The UN meeting finished only a few weeks ago,” said IFPMA director David Reddy. “We’re moving towards the meeting in Saudi Arabia, which is the fourth AMR high level event.

“I think one thing that is really important is that we are getting a common understanding of where we need to go, and what the challenges are,” he added. “We do need to make progress on the business model. The UK, Japan have already made good moves towards pull incentives, and a pilot has been put in place by Canada. There are a lot of remaining challenges, but I think the key message coming out of this is there is a real thirst to maintain momentum as we head into the meeting in Saudi Arabia.” 

But “it’s not just about financing,” he added, “it’s also about people and competencies.” 

“Access but having a really firm understanding of community needs on the ground is essential, because without that, we won’t make progress in the fight against AMR and in bringing antibiotics to those who need them.” 

Image Credits: USAID Asia/Flickr, USAID Asia , Health Policy Watch , Van Boeckel, Pires et al, 2019, WHO, The Lancet, 2022, AMR Industry Alliance.

WHO senior technical advisor on measles Dr Natasha Crowcroft

Inadequate immunisation is driving the global surge in measles cases, with an estimated 10.3 million cases in 2023 – a jump of 20% since 2022.

This is according to new estimates from the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC). 

A total of 57 countries experienced large outbreaks in 2023, in comparison to 36 countries in the previous year. 

Europe’s measles cases increased by 200% – from 100,000 cases to just over 300,000 cases.

An estimated 107,500 people, mostly children under the age of five, died of measles in 2023, an 8% decrease from the previous year.

“This slight reduction in deaths was mainly because the surge in cases occurred in countries and regions where children with measles are less likely to die due to better nutritional status and access to health services,” according to Dr Christine Dubray, CDC Measles Elimination Team Lead

But Dr Natasha Crowcroft, WHO senior technical advisor on measles, said it is “very hard with the level of data we have” to be able to say why this had happened.

“Vaccine hesitancy plays a part in all regions of the world, so we know that’s in there somewhere,” said Crowcroft.

However, she said that deaths were in vulnerable communities with high rates of malnutrition, poor health services and often also conflict. 

“In the African region, the number of deaths increased by 37%,” she said. Africa had  4.5 million cases in 2023, and 71% of global deaths.

At least 95% of children need to be vaccinated with two doses of the measles vaccine to prevent outbreaks of one of the world’s most contagious viruses.

CDC and WHO are founding members of the Measles & Rubella Partnership (M&RP), a global initiative to stop measles and rubella.

Sudan
UN chief António Guterres has called the situation in Sudan “a nightmare of violence”.

The death toll in Sudan’s civil war is likely far higher than reported as violence, hunger and disease devastate Africa’s third-largest nation, a new study shows.

More than 61,000 people have died in Khartoum state, the capital region where fighting began 14 months ago, according to research from the London School of Hygiene & Tropical Medicine. Among the dead, over 26,000 were killed by violence – surpassing the United Nations’ nationwide count of 20,178 violent deaths reported by crisis monitor ACLED.

The death count in Khartoum, just one of Sudan’s 18 states, suggests official figures severely undercount the number of lives lost in what the UN and aid groups call the world’s worst humanitarian crisis.

Researchers found starvation and disease are the leading causes of death across most of the country, while violence claims the most lives in Kordofan and Darfur, where ethnically targeted attacks and intense fighting continue.

“Our findings reveal the severe and largely invisible impact of the war on Sudanese lives, especially preventable disease and starvation,” said Dr Maysoon Dahab, lead author of the report and infectious disease epidemiologist at LSHTM. “The overwhelming level of killings in Kordofan and Darfur indicate wars within a war.”

The war has transformed Sudan from Africa’s largest agricultural producer and regional breadbasket into a nation where 750,000 civilians now face famine conditions, driving 11 million people from their homes in what the UN calls the world’s largest displacement crisis. Half of Sudan’s population – 24.8 million people – now depends on aid to survive.

“Sudan is trapped in a nightmare,” Rosemary DiCarlo, UN Under-Secretary-General for Political Affairs, told the Security Council on Wednesday. “The people of Sudan need an immediate ceasefire.”

Healthcare collapse fuels rising death toll

pollution
Khartoum, Sudan.

The war’s deadliest long-term impact may be its destruction of Sudan’s health and sanitation services. Disease and starvation now account for about half of all deaths in Khartoum amid an acute health crisis sweeping the country, the study found.

Eight in ten hospitals in conflict zones have shut down, leading to a sharp rise in deaths from infectious, non-communicable, maternal, neonatal and nutritional diseases that researchers called “significant, unrecorded and largely preventable.”

An unusually heavy rainy season has fueled a severe cholera outbreak, with contaminated water driving more than 28,000 cases across 11 states, and a surge in dengue fever that has resulted in 12 confirmed deaths since July, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). 

Disease counts, like death tolls, represent only a fraction of the crisis, OCHA said. Millions remain cut off from care as outbreaks spread undetected beyond the reach of Sudan’s devastated health surveillance systems.

Half of Sudan’s population needs humanitarian assistance, yet aid remains out of reach for most. Aid groups “remain unable to reach the vast majority of people in conflict hotspots,” UN emergency coordinator Ramesh Rajasingham told the Security Council on Wednesday.

“Some areas are completely cut off,” Rajasingham said. “We urgently need the parties to ensure the safe, rapid, unimpeded movement of both relief supplies and humanitarian personnel via all available routes.”

‘Invisible’ deaths go uncounted

Aid arrives in Sudan as over half the country faces dire humanitarian needs.

Sudan’s ability to count its dead has long been fragile, with no national census conducted in over a decade. Even Khartoum, the capital region, captured just 3-6% of COVID-19 deaths during the pandemic, researchers estimate.

The war has shattered this already weak system. Morgues and hospitals that typically record deaths are now inaccessible or offline, while military factions have weaponized telecommunications, implementing blackouts that further obstruct data collection.

More than 90% of deaths documented in the new study went unrecorded in official tallies. Sudan’s Health Ministry claims just 5,565 war-related deaths have occurred to date.

Dahab said while the team could not estimate mortality levels beyond Khartoum or determine total war-linked deaths nationwide, their assessment offers the first systematic mapping of death patterns during the conflict. 

“The number might even be more,” Abdulazim Awadalla, program manager for the Sudanese American Physicians Association, told Reuters. “Simple diseases are killing people.”

Foreign powers ‘enabling the slaughter’

As disease, hunger and violence claim more lives, evidence mounts that foreign powers are intensifying and prolonging Sudan’s humanitarian catastrophe.

French weapons have been identified in the hands of the Rapid Support Forces (RSF), Amnesty International revealed Thursday, adding to a complex web of international involvement in the conflict.

“Our research shows that weaponry designed and manufactured in France is in active use on the battlefield in Sudan,” said Agnès Callamard, Amnesty International’s Secretary General. The weapons reached RSF through France’s defence partnership with the United Arab Emirates, which has emerged as a key backer of the paramilitary group.

“To put it bluntly, certain purported allies of the parties are enabling the slaughter in Sudan,” DiCarlo, the UN Under-Secretary-General for Political Affairs, told the Security Council. “Both warring parties bear responsibility for this violence.” 

A UN fact-finding mission released in September found both the RSF and government forces have committed potential war crimes and crimes against humanity. The RSF and allied militias face additional accusations of genocide and using mass rape as a weapon of war, particularly in Darfur.

Despite a UN arms embargo, weapons continue flowing to both sides through neighbouring countries, several of which, including Libya, Chad and the Central African Republic, are major arms trafficking hubs, UN experts say. 

While Egypt and Saudi Arabia back government forces, the UAE, Libya and Russian-linked Wagner Group support the RSF. The UAE has invested over $6 billion in Sudan since 2018, viewing the resource-rich nation as key to expanding its regional influence.

“All countries must immediately cease direct and indirect supplies of arms and ammunition to the warring parties,” Callamard said. “They must respect and enforce the UN Security Council’s arms embargo regime on Darfur before even more civilian lives are lost.”

Image Credits: @UNHCR, State of Air Quality and Health Impacts in Africa .

Testing for mpox will soon be done using tests made in Morocco.

African countries will soon use a PCR test for mpox developed by Moroccan company Moldiag that is cheaper than the Gene Xpert tests currently being used, according to the Africa Centres for Disease Control and Infection (Africa CDC).

“This test was approved after a number of tests were done in the [Democratic Republic of Congo] to ensure that it is sensitive to clade 1b and other clades in Africa,” Africa CDC Director General Jean Kaseya told a media briefing on Thursday.

“The cost is $6 per test, very comparable with [test] kits that are coming from Korea and China,” said Dr Yenew Kebede Tebeje, Africa CDC’s head of laboratory systems.

“But Morocco has also offered that if we can buy in large quantities, they can bring down the cost to $5 per test. As compared to Gene Xperts, this is very, very cheap, even twice as cheap.” 

Dr Yenew Kebede Tebeje, Africa CDC’s head of laboratory systems.

Africa CDC’s Diagnostic Advisory Committee (DAC) recommended the Moldiag test after it has “reviewed the evidence about this test based on set criteria, including independent evaluation data from the  National Institute for Biomedical Research in the DRC and concluded that it fulfilled all the major criteria”, according to a statement from Africa CDC.

Moldiag CEO Nawal Chraibi stated that her company is “dedicated to supporting Africa’s health resilience through the development of locally manufactured diagnostic tools. 

“We believe that strengthening local production is key to empowering the continent in its epidemic preparedness and response, allowing us to respond rapidly and effectively to public health challenges,” added Chraibi.

With 2,836 new cases and 34 deaths confirmed in the past week, Kaseya warned that mpox “is not under control in Africa”. 

The Africa CDC once again highlighted its concern about Uganda’s mpox outbreak, with 184 new cases in the past week.

While mpox vaccination campaigns in the DRC and Rwanda have met or surpassed targets, Nigeria has postponed the start of its vaccinations until 18 November.

Meanwhile, the LC16 vaccines from Japanese company KM Biologics have not yet arrived as agreement has yet to be reached on who assumes liability for adverse events, said Kaseya.

“As you know, every time that a new vaccine is introduced in the country, somebody has to sign for the insurance to be able to take care of possible side-effects,” he added. “I think that’s the issue that is now being discussed with the Japanese government to find someone that will take care of the liability issues. I think that is the only issue that is left.”

Unlike Bavarian Nordic’s MVA-BN mpox vaccine, the LC16 vaccine is licensed for children under the age of 12. Around 38% of those infected with mpox are children.

No new Marburg cases

Rwandan Health Minister Dr Sabin Ntsanzimana

Meanwhile, Rwanda has not had any new Marburg cases for almost two weeks, no deaths in a month and the last patients who were being treated were discharged a week ago, according to Health Minister Dr Sabin Nsanzimana.

While the country has to wait 42 days before it can declare that the outbreak has ended, Nsanzimana said the country has “made very good progress”.

Rwanda also effectively contained the outbreak and no Marburg cases have been detected outside its borders.

Nsanzimana revealed that the index case – a miner who contracted Marburg from fruit bats in a cave outside Kigali – has survived, but his wife and newborn child were killed by the deadly virus.

Rwanda, a small country the size of Haiti, has expanded its surveillance of bats to “all caves in the country”, the health minister added.

“We are now monitoring the movements of these fruit baths with different technology and a different combination of teams, from animal and human health using the One Health framework,” added Nsanzimana. “It’s an opportunity for us to expand our preparedness capabilities.”

Of the 66 people infected with Marburg, 51 have recovered – a comparatively low case fatality rate of 22.7%. There will  also be “continuous” follow-up of the survivors, said Nsanzimana.

Image Credits: Africa CDC.

A patient with diabetes has his blood pressure tested. Integration of care is important for patients’ wellbeing.

ISLAMABAD – Muhammad Waqas is an engineer at a private telecom company. He still remembers the day six years ago in 2018 when he was diagnosed with diabetes at the age of 30. It completely changed his life.

The diagnosis was particularly shocking for Waqas as neither of his parents had the disease, and he had always been physically fit and participated in all kinds of sports since his school days.

“It was September 2018 when I started feeling the need to urinate frequently and experienced weakness and fatigue. I consulted my doctor, who pricked my finger to take a blood sample and checked it with a glucometer. He was also prescribed an HBA1C test,” said Waqas.

Muhammad Waqas was shocked to get a diabetes diagnosis at the age of 30.

The next day, when the test report came, and Waqas’ diabetes was confirmed. Initially, he tried to control the disease through oral medication, but it didn’t work and eventually his doctor put him on insulin.

“I have been on insulin for the past six years, which has completely changed my life. Now, I have to constantly worry about my blood sugar levels and stay in touch with my doctor. I have to carry my insulin bag with me wherever I go,” he said.

World’s highest prevalence of diabetes

Some 33 million Pakistanis – or 26% of the adult population – are living with diabetes, according to the International Diabetes Federation (IDF) citing data from its 2021 report. 

Along with Pakistan, high diabetes prevalence (in black) is an issue in multiple Middle Eastern and North African countries, as well as in Mexico and several Asain-Pacific Island states.

Pakistan has the world’s highest adult prevalence rate. It ranks third in absolute numbers, following China and India which each have a billion people living with diabetes. More than one-third of Pakistan’s cases are undiagnosed, the fourth highest in global rankings. 

In addition, Pakistan’s population with diabetes could nearly double to 62 million by 2045, if more preventative action isn’t taken, the IDF warns. Worldwide, meanwhile, more than half a billion people are living with diabetes. 

Pakistan leads the world in per-capita diabetes prevalence amongst adults.

Trends in the country are even more disturbing in light of Pakistan’s health history, said Dr. Zafar Mirza, former director of Health Systems at the World Health Organization (WHO) in an interview with Health Policy Watch. 

In 1990, diabetes didn’t even appear among the 25 leading causes of disability-adjusted life years in Pakistan. However, in the decade between 2009 and 2019, death and disability due to diabetes increased by 87%.

Waqas adds that people in Pakistan are generally not aware of how to prevent diabetes.

‘Physical activity is like medicine’ 

Exercise is like medicine, but many Pakistan residents don’t do enough exercise.

Zubair Faisal Abbasi, advisor at the Centre for Governance and Public Accountability (CGPA) for food, nutrition, and public health programs, believes that the challenge of diabetes in the ciuntry is the challenge of failed food governance, failure of adaptation to new urban lifestyles, and patchy availability of standard treatments.

Food governance means that Pakistan has been unable to formulate and execute best-practice policies to control dietary risk factors such as free sugars and industrially produced transfatty acids at the population levels, according to Abbasi.

“[The government] has failed to create public awareness that physical activity is like a medicine, which is required for everyone in every age group. In addition, since fiscal allocations for health are low, the country is not able to provide standard treatments such as screening for the pre-diabetic, and treatments for diabetes-related ailments,” said Abbasi.

Mirza attributes the high burden of diabetes in Pakistan to co-existing environmental and genetic factors, with environmental factors as a major reason.  Sedentary lifestyles along with carb- and sugar-heavy diets are considered to be the main causes behind Pakistan’s high prevalence of diabetes, a trend he described, tongue-in-cheek, as “bittersweet”.

Mizra added that genetic factors become more significant due to repeated marriages among close relatives in Pakistan, which has increased the chances of diabetes.

 The burden

Mirza said the vast majority of people with diabetes have Type 2 diabetes associated with lifestyle, while Type 1 or insulin-dependent diabetes, affects a relatively small number of people.

Dr Zafar Mirza

In Type 1 diabetes, the pancreas no longer produces insulin, and patients diagnosed with this type are completely dependent on insulin. Meanwhile, Type 2 diabetes prevents the body from using insulin properly, which can lead to high levels of blood sugar. Type 2 leads to serious physical damage, especially to the feet, eyes, kidneys and heart.

According to official data obtained by Health Policy Watch, around 53% of deaths in the country are the result of non-communicable diseases (NCD), with diabetes being one of the major causes.

Official data said 41.4 % population (53.7% of females and 24.7% males) do not meet the physical activity standards recommended by WHO for the prevention of NCDs including diabetes.

Treatment challenges

Taskeen Arshad, 55, is a housewife who has been fighting diabetes for the last 10 years. Her mother also had the disease, and she died of it at the age of 69. Arshad pays monthly visits to the Pakistan Institute of Medical Sciences, a government-run tertiary care hospital in the federal capital, to get free medicines for diabetes.

She cannot afford to purchase diabetes medicine from a private pharmacy and is dependent on the government’s social security program for her treatment.

“Not every time I get free medicine from this government hospital. Sometimes it’s not available for three to six months. The hospital administration tells us the medicine was not procured because of shortage of funds,” said Arshad.

The non-availability of medicines from the government hospital makes her reliant on relatives to pay for the medicines at private pharmacies.

Noor Mahar, the president of Drugs Lawyers Forum, a watchdog for medicine pricing, said the availability and pricing of diabetes medicine is a serious issue: “Federal government has removed the pricing cap from the medicine which resulted in the price hike of insulin and other medicines up to 400% now.”

 He alleges that sometimes pharmaceutical manufacturers and importers create artificial shortages in the market to increase prices, which results in the suffering of those who depend on the medicines.

“The shortage is not only reported in the private market but also government hospitals usually run short of medicines,” said Mahar.

But Asim Rauf, CEO of the Drugs Regulatory Authority of Pakistan (DRAP), a federal body regulating drug prices and ensuring their availability in the country, said there is no shortage of insulin or other medicines in the country.

He said the prices of medicines in the market vary because of the depreciation of the Pakistani rupee in the international market against the US dollar.

“Whether it is the raw material or the imported medicine, the Pakistan medicine market will be affected by the fluctuation of the dollar rate,” he said.

Primary healthcare focus

Sajid Shah, spokesperson for the Ministry of National Health Services Regulation and Coordination (NHSR&C), said the ministry coordinates with provinces to provide health facilities to prevent and treat NCDs at the primary healthcare level.

The mandate of provinces is to provide free-of-cost services including glucometers, medicines, and other early-detection facilities, and treatment, and also educate people about the disease at service delivery points, he added.

“Every Tehsil Headquarters Hospital (THQ) has an NCD centre for prevention and treatment of diabetes,” said Shah.

However, healthcare officials working at PHC believe that although the government established NCD centres at THQ and District level, on the ground they still lack the facilities and are not functional according to their capacity.

A senior doctor at THQ Gujjar Khan told Health Policy Watch that his facility has an NCD center but it lacks the capacity to provide a full range of services to patients visiting for diagnoses and treatment of diabetes.

“We have glucometers but insulin and medicines for diabetic patients have not been available for the past one and a half years,” said the doctor.

He also said another important issue is the shortage of staff at the PHC level, nearly half of the strength at this level leaves the country because of attractive salary packages offered abroad which impacts the working of NCD centers.

“However all the diagnoses, treatment, and medicine are provided free of cost to the people depending on their availability,” he said.

What needs to be done?

Zubair Faisal Abbasi, advisor at the Centre for Governance and Public Accountability (CGPA)

Abbasi says that the country needs to implement primordial prevention – targeting the social and environmental conditions – as a priority, and doing this involves policy coordination.

“For example, it needs to increase taxes on sugary drinks, ultra-processed foods, and tobacco and look at its patterns of urbanization to reduce the burden of NCDs,” said Abbasi.

Mirza said the current rate of NCDs cannot be dealt with at big hospitals but requires a strong primary healthcare with trained community health workers.

Early diagnosis through mass screening and proper management are vital, as is the integration of service delivery of preventive, curative, and rehabilitative health services, he added.

“Our health system is not equipped to deal with the epidemic of diabetes. It needs sustained and coordinated whole-of-government and societal efforts and the private health sector also has to be taken into the loop,” he said.

Image Credits: WHO/A. Loke, IDF Atlas 2021, IDF Diabetes Atlas 2021 .

Mukhtar Babayev, COP29 President and Dr Tedros Adhanom Ghebreyesus, WHO Director General, announce new ‘COP Continuity Coalition on Climate and Health.’

BAKU – The World Health Organization and United Nations Climate Conference (COP29) host, Azerbaijan, issued a joint call to countries on Wednesday to adopt more  “healthy'” Nationally Determined Commitments (NDCs) in their next set of plans for climate action. The next NCDs are due to be submitted in early 2025. 

But as carbon dioxide (CO2) emissions from burning fossil fuels continued to increase this year over last, reaching record highs, it remains to be seen how this year’s conference appeals, hosted by an oil-flush central Asian nation, might resonate among countries.  

The “health argument” for climate action also was a popular political refrain at COP28 in Dubai. In the year since, global carbon emissions from fossil fuels reached a record high, according to new research that was released Wednesday by the Global Carbon Project. 

Emissions in 2024 are set to rise 0.8% over last year, for a total of 37.4 billion tonnes, stated the Global Carbon Budget, a peer-reviewed analysis of trends involving some 80 research institutions, and hosted by the University of Exeter. Including increased-drought related deforestation and wildfires, emissions are projected to be 41.6 billion tons in 2024, up from 40.6 billion tons last year.

CO2 emissions in 2024 will outpace every other year on record.

That includes a projected increase of 2.4% in gas emissions, 0.9% for oil and 0.2% for coal. They contribute 21%, 32% and 41% of fossil fuel emissions respectively.

The world’s remaining carbon budget is almost exhausted – and time left to meet the 1.5°C target and avoid the worst impacts of climate change – has almost run out, the report stated. 

“The impacts of climate change are becoming increasingly dramatic, yet we still see no sign that burning of fossil fuels has peaked,” said Prof Pierre Friedlingstein of Exeter’s Global Systems Institute, who led the study.

 New ‘Continuity Coalition’ issues the call to make NDCs ‘Healthy’

COP 29 in Baku, Azerbaijan
WHO Director General Dr Tedros Adhanom Ghebreyesus at COP29

The current set of NDCs upon which global climate action is hinged expire at the end of this year. They are already failing by a wide margin to meet the 2015 Paris agreement goal of limiting global warming to 1.5° C. Data released last week by the World Meteorological Organization suggested that the world had already exceeded the 1.5° C limit this year. 

Against that background, the call to adopt more health-focused NDCs will be integral to a new COP29 health initiative that aims to ensure continuity between promises and action on commitments made at this COP and future climate events. 

The initiative, called the Baku COP Presidency’s Continuity Coalition on Climate and Health, was announced by the WHO and Azerbijan’s COP29 presidency at a high-level event on Wednesday. 

“This initiative unites the visionary leadership of five COP Presidencies that span this critical time for action, underscoring a commitment to elevate health within the climate agenda,” said WHO Director General Dr Tedros Adhanom Ghebreyesus.

“With air pollution taking the lives of 7 million people each year, it’s clear that reducing emissions is a fundamental matter of public health,” he said.

‘Continuity Coalition’ aims to enable more coordinated action on health between climate conferences

The “Continuity Coalition” aims to help enhance ambition and enable more coordinated action on health and climate from year to year, asserted Azerbijan’s COP29 president, Mukhtar Babayev, the country’s ecology minister and a former oil executive, at Wednesday’s event. 

“COP26, COP27 and COP28 all added to global efforts on health,” he said. “First, the coalition will bolster ambition by supporting the implementation of existing initiatives and improving synergy between them. It will then ensure continuity from COP to COP by providing a platform for dialogue among presidencies and stakeholders from all parties of the society for climate and health growth. And it will ensure we fulfill past promises and maximize their impact.”

The coalition will be formally launched on 18 November in the presence of the countries that have held COP presidencies over the past three years (the United Kingdom, Egypt and the United Arab Emirates), as well as Brazil, which is hosting COP 30 in 2025 in Rio.  

Days before COP29 opened, Azerbaijan’s Deputy Energy Minister and COP29 CEO, Elnur Soltanov, was filmed surreptitiously by an NGO promoting SOCAR‘s oil and gas projects, saying “We have a lot of pipeline infrastructure. We have a lot of gas fields that are to be developed. We have a lot of green projects that SOCAR is very interested in.”

Babayev declined comment on the remarks to Reuters.

‘Climate Crisis is a Health Crisis’

Despite such headwinds, WHO and other health-focused research and civil society organizations have sought for years to build up a stronger drumbeat around their core message that the climate crisis is a health crisis. 

WHO’s Special Report on Climate Change and Health, issued just last week, estimates that as many as 1.9 million premature deaths annually could be averted by scaling up five interventions: early warning systems for extreme heat, powering health facilities with solar power, water, sanitation and hygiene, cleaner household energy, and reducing or removing fossil fuel subsidies.

A rapid transition to renewable energy, as well as keeping temperatures below the 1.5°C benchmark is critical to avoiding a spiralling death count from climate change in coming decades, the global health agency, backed by hundreds of other scientists, has long maintained.

But few countries so far have heeded those warnings, despite a rising toll of deaths from extreme heat, flooding and other climate-related weather events, as well as drought-threatening food security, wildfires and other visible climate impacts, according to the recent Lancet Countdown Climate and Health report card.

Lancet’s Climate and Health Report Card: Governments, Oil and Gas Companies ‘Fuelling the Fire’ of Cascading Impacts

‘No country can say we didn’t know’

WHO’s Director of Climate, Environment and Health, Maria Neira, at COP29 presentation of the Coalition of COP Presidencies for Health.

Along with changing weather patterns, increased infectious and non-communicable diseases, as well as mental health, are just a few more amongst the long list of health impacts from global warming that countries need to address in their NDCs, said Dr Maria Neira, WHO’s Director of Public Health, Environmental and Social Determinants of Health.

A new guidance document by WHO explains to countries how they can  incorporate health at the heart of their NDCs, she said. The document is called the “Quality criteria for integrating health into Nationally Determined Contributions (NDCs).”

Neira also pointed to the low levels of funding available to the health sector for climate action.

“We have less than 1% of the global funds from climate finance going to health. Governments can divert the finance from fossil fuels subsidies to this,” she said.  

That’s hardly been the case, to date, particularly in Africa, Latin America and Southeast Asia, where investments in clean energy remain comparatively small.

Renewable energy investments (dark blue) as compared to fossil fuels (light blue). Africa, Latin America and South-East Asia lag far behind China, the United States and the European Union.

And although some 1 billion people worldwide lack access to health facilities with reliable energy services, the first health sector project to be approved by the Green Climate Fund in Africa, fails to address critical energy shortages in its investment plan.   

Improving water and sanitation access is a priority for the first-ever Green Climate Fund project in the health sector – but electricity access is ignored.

The initiative, co-sponsored by Save the Children Australia, will help Malawi establish “early warning systems for climate-sensitive diseases,” said GCF Africa Department specialist, Patrick Gitonga, in a video promotion.

“It brings much needed climate resilience building to the health care establishment through the establishment and dissemination of climate-informed health  surveillance and early warning systems for a range of climate sensitive disease, including malaria, diarrhoeal disease, and extreme heat-related diseases,” he said.

While the project aims to improve water and sanitation infrastructure in Malawi’s health facilities, it makes no mention of renewable energy access for energy-starved African health facilities, where one-half of hospitals lack reliable electricity and 15% of clinics have no electricity at all.

Overall, energy-starved Sub Saharan Africa is among those regions of the world to have seen the least investment, public or private, in renewables, even while fossil fuel expansion, which is more expensive and less efficient in terms of expanding electricity access, continues apace.

–Elaine Ruth Fletcher contributed to reporting on this story.

Image Credits: Global Carbon Project , WHO, IEA , Green Climate Fund .

Activists at the World Conference of Lung Health in Bali, Indonesia demand a drop in the price of TB test GeneXpert.

Dozens of tuberculosis (TB) activists took to the stage during the opening of the annual World Conference on Lung Health in Bali, Indonesia, to demand that the price of GeneXpert tests to detect TB is slashed to $5 in low- and middle-income countries. ​

Medical test maker Cepheid and its parent corporation Danaher were asked to reduce the price of GeneXpert tests to US$5 in low- and middle-income countries. ​

While Danaher reduced the price of the standard TB test by 20% in September 2023 from $10 to $8, the test used to detect extensively drug-resistant TB, remains very high at $15.

Research commissioned by Medecins Sans Frontieres (MSF) in 2019 shows that GeneXpert cartridges could be produced and sold at a profit for less than $5 each, said MSF in a statement on Tuesday.

“For the majority of their tests, Cepheid and Danaher continue to charge triple the $5 that they could be selling each test for and still make a profit. This is unacceptable profiteering by the corporations, especially considering Cepheid and Danaher received $252 million in public funding to develop these tests,” said MSF Access Campaign’s diagnostics advisor Stijn Deborggraeve.

“The corporations have also not kept their promise to share an annual audit of their prices that they committed to more than one year ago. Cepheid and Danaher, it’s really time to do the right thing – it’s time for $5 for each GeneXpert test.” ​

The price of the test is important as TB is once again the world’s leading infectious disease killer after a few years of trailing COVID.

Impact of climate change

Climate change and migration are exacerbating the prevalence of TB while “poverty has made it very difficult to reach all patients who may have tuberculosis,” Marian Wentworth, CEO of global non-profit Management Sciences for Health (MSH) told Health Policy Watch. “Connected to that is weak health systems that contribute to the problem as well,” she added.

Some studies have shown that TB infections are rising as temperatures rise, but more research is needed.

Around 3,900 people from about 150 different countries are attending the lung conference organized by The Union, a global health organization that works to eliminate TB.

The world is far from meeting the World Health Organization (WHO) targets for 2025 and 2030, according to its End TB Strategy.

In 2023, there were around 8.2 million new TB cases, according to this year’s World TB report, and 1.25 million deaths.

While there has been improvement since 2015, the TB incidence rate and deaths remain high.

Survivors demand person-centric care

Chapal Mehra, convenor of Survivors Against TB, said that there is a big gap between what the health system thinks is good quality person-centered care, and what a patient believes is good quality person-centered care.

Patients are often less worried about the side effects of TB than pressures like poverty or caregiving responsibilities, he explained.

While survivors get invited to panel discussions they are not involved in policy and decision-making, he added.

“There are a lot of new plans and ideas on how to work with TB-affected communities, but there isn’t enough [patient] involvement in research, in product development. Because what happens is that they develop a product first, and then they come to us and say: Can you make it acceptable to communities?” he said.

This is something the organizers are trying to bridge, they said.

“TB is a social disease. Without community, you cannot cure TB,” said  Zahedul Islam, Chair of The Union’s Community Advisory Panel, who is coordinating an initiative called the Community Connect at the conference.

“With Community Connect, we are trying to bring in the scientific community and build collaboration and foster partnerships with the community,” he told Health Policy Watch.

Gendered impact of TB

Women make up around a third of all TB cases but often lack the social support or access to resources that male patients might have. They are also less likely to seek care for themselves and face delayed diagnosis even when they do.

“We work in Afghanistan, so that’s a very obvious challenge when women can only seek care through other women, right? And it’s difficult to actually strengthen the capacity of women in a country that doesn’t really encourage women working,” said Wentworth.

Women in Afghanistan have been banned from working in aid organizations including the United Nations by the Taliban. The rules are also rapidly changing and being updated making it hard to reach women in the country.

Mehra says that women need different care and a different setting to men, as TB treatment can affect women’s fertility while the stigma can affect their marriage prospects, and a care provider has to be sensitive to those needs.

He added that trans people with TB often get ignored, and this is an issue that a panel he is a part of at the conference would be shining a spotlight on.

Joegene Mangilaya shares an emotional account of battling TB and the challenges the community faces including long treatments at The Union conference in Bali, Indonesia.

Mental health and climate change on the agenda

“We have special sessions on climate change and its impact on TB and the delivery of TB services,” said Carrie Tudor from The Union who is coordinating the development of scientific programme of the conference.

“People with TB suffer depression, stigma and other mental health issues, so making sure that that is more recognized and raising awareness about mental health and TB,”  said Tudor.

The conference is taking place in Indonesia, which accounts for 10% of the world’s TB burden. India (26%), China (6.8%), the Philippines (6.8%) and Pakistan (6.3%) are the other four countries with high TB burdens. These five countries together account for 56% of the world’s TB cases.

Wentworth of MSH is hopeful that greater engagement will help countries to learn from each other’s scientific research and technologies.

“Given all the new technologies and resources to combat TB, I don’t think there’s been a more important time to have a meeting like this to try and figure out what those technologies mean in terms of real-world action,” she said.

Image Credits: MSF , World TB report 2024, The Union.

In Thailand, a patient with multi-drug resistant TB receives his daily treatment.

This week, experts and policymakers are convening at the Union’s World Conference on Lung Health to discuss tuberculosis (TB), the world’s deadliest and most neglected infectious disease. Since the turn of the 20th century, over one billion people have died from TB – a death toll greater than that from malaria, smallpox, HIV/AIDS, cholera, plague and influenza combined.

The official UN target to reduce TB deaths by 75% between 2015 and 2025 is now out of reach. Many commentators believe that the 2030 target of reducing TB by 90% will prove elusive too – unless we see an urgent increase in investments in new tools that will make a dent in the curve of the epidemic.

Promising TB vaccine pipeline

TB scientific advances over the past five years are dramatically improving the way the disease is treated and, just as importantly, they are moving the needle on a long-awaited vaccine, which history suggests will be needed to effectively end TB as a public health crisis.

The 100 year-old BCG (Bacillus Calmette-Guérin) vaccine is still the world´s only vaccine against TB. It is mainly given to babies and young children to prevent more serious forms of TB, such as TB meningitis which affects the brain. However, the vaccine is essentially ineffective for the more than nine million adults and adolescents who develop TB each year.

This could all change in the coming years if one of the three preventative vaccines now in Phase III trials – the IAVI and Biofabri-sponsored MTBVAC, the Gates Medical Research Institute supported M72/AS01E vaccine, and the Serum Institute’s VPM1002 candidate – demonstrates safety and efficacy. 

However adequate funding will be needed to make this a reality. Unfortunately, adequate funding is not something TB – a disease that disproportionately affects the world’s poorest populations – has ever had.

The science has brought us this far and now it’s time to finish the job – we can’t afford to wait another hundred years to finally deliver a broadly effective vaccine. As we await results from clinical trials, we also need to begin preparing now for the rollout of successful vaccine candidates.

Avoiding TB vaccine inequity

A clear understanding of the scale of demand for TB vaccines will be essential to ensure adequate manufacturing capacity is built and sustained to deliver required doses once a new TB vaccine is licensed by regulators and recommended by public health authorities. This is new terrain for the TB response and will be a costly endeavour, requiring significant lead time.

The COVID-19 response provided some valuable insights as to what could be accomplished with adequate investment in clinical development, de-risking of manufacturing scale up, and broad delivery of vaccines. At the same time, it shined a spotlight on inequities in supply across vaccine-producing and non-producing countries and spurred a movement for sovereign regional manufacturing.

TB Vaccine Accelerator Council

The TB Vaccine Accelerator Council – announced last year by the World Health Organization (WHO) in partnership with Ministers of Health from several high-burden countries, investment banks, and leading philanthropic organizations – could help lay the groundwork in the years to come for the effective rollout of new TB vaccines, principally to people living in countries where the prevalence of the disease is highest. It must deliver this goal with the urgency of the COVID response, but with an unwavering commitment to equity that the COVID response lacked.

The efforts of the Council were boosted earlier this year when Gavi, the Vaccine Alliance, decided to include TB vaccines as part of its Vaccine Investment Strategy. Gavi financing will provide a critical lifeline to ensure TB vaccine availability in the 54 Gavi-eligible countries. 

Gavi support will be instrumental, not only in securing the resources these countries need to finance vaccine procurement, but will also support the establishment of delivery pathways to reach adult and adolescent populations who are critical in stemming the tide of new TB infections but fall outside of routine childhood immunization programs.

Challenges facing high-burden countries

 In parallel, however, strategies are needed to support access to TB vaccines in those middle-income countries (MICs) that have transitioned, are transitioning, or were never eligible for Gavi support but face the greatest burden of TB disease.

These strategies must include investment in vaccine delivery platforms and mechanisms for countries to pool purchasing, including regionally, to leverage their collective volumes for better negotiating power. All of us convening at the Union Conference this week should also think about policy solutions that would indirectly allow MICs in invest more in health systems and vaccine delivery, including sovereign debt forgiveness and relief.

According to WHO, accelerating the scale up of vaccines would prevent up to 76.6 million cases, while producing between $372 billion in economic benefits by 2050.  But more importantly, as TB survivor and advocate Kate O’Brien has reminded us—the most important resources are human lives. Each year we stall, each year we fail to muster the investment and political will that TB deserves, more than a million lives are lost. Working together, we can and must stop this from happening.

Shelly Malhotra is Vice President for External Affairs and Global Access at IAVI. She has over two decades of experience in global health focused on harnessing public-private partnerships to facilitate access to innovations.

Mike Frick is a Co-Director of the Tuberculosis program at the Treatment Action Group (TAG). He has been advancing access to preventive options for tuberculosis for over a decade.

 

 

 

 

 

 

 

 

 

 

Image Credits: USAID Asia.

INB co-chairs Anne-Claire Amprou and Precious Matsoso with WHO principal legal officer Steven Solomon.

The pandemic agreement will not be adopted at a special World Health Assembly (WHA) next month as countries still need “more time” to conclude the complex talks.

Co-chairs of the World Health Organization’s (WHO) Intergovernmental Negotiating Body (INB) Ambassador Anne-Claire Amprou and Precious Matsoso broke this news at a media briefing on Monday evening.

The INB is midway through its 12th meeting after 32 months of negotiations. While some member states and stakeholders have cautioned against sacrificing content for haste, the Africa Group in particular was keen for an early adoption of the agreement.

“Member states have made progress on the text to reach a consensus on all the key elements of the pandemic agreement,” said INB co-chair Ambassador Anne-Claire Amprou.

But they “think that there are still work to do, and they want to use the coming weeks of discussions to continue making progress.” she added.

“Today, member states agreed we need to conclude the agreement as soon as possible and continue negotiations into 2025 with the goal of concluding the agreement by the next WHA scheduled in May 2025, so we are moving in the right direction with a strong political commitment by member states.”

Co-chair Precious Matsoso added that negotiators “are actually closer on some issues than we think” and that “broad principles had been agreed on but need more work, especially on some of the final details”.

Matsoso continued: “A clear opportunity exists for a middle ground and a place where there can be political will, trust and commitment so that the world can be better prepared for the threats today and also in future. I’m confident that we’ll reach that.”

Impact of Trump election?

Last week’s US election victory by Donald Trump cast a shadow over extending the talks.  As president, Trump withdrew the US from the WHO in 2020 and has promised to do the same if re-elected, describing the WHO as a “corrupt scam paid for by the US but controlled by China”.

However, when asked about the impact of Trump’s election on the process, WHO principal legal officer Steven Solomon said that the US was but one of the global body’s 194 member states.

“WHO is the UN agency for health. We are an international intergovernmental organization composed of 194 member states. The question relates to the national political decisions of one of WHO’s member countries, and permit me to refer you to the representatives of that country to respond.”

WHO principal legal officer Steven Solomon

‘Complex’ issues

Amprou stressed that member states were trying to create something new and many issues – such as the proposed Pathogens Access and Benefit Sharing (PABS) system – were “complex”.

Negotiators have discussed adopting a framework agreement with annexes on PABS (Article 12) and pandemic prevention (Article 4), the details of which would be decided on later.

However, Amprou said discussion on this is still ongoing: “The question is, how much detail do we need to operationalise the PABS and to operationalise prevention? Should we include everything in the pandemic agreement or in annexes, other instruments, appendices, whatever? 

“How to find the good balance? That’s why there is the option to have a parent agreement and further instruments.”

One of the most practical benefits of the proposed pandemic agreement is that a certain percentage of pandemic products – particularly vaccines and medicines – would be assigned to WHO for distribution during a pandemic.

This percentage started at 20% but has been halved in recent negotiations – but Amprou stressed the percentage was still being discussed.

“What we heard in the room is that there is a very strong commitment from member states to have a meaningful percentage allocated to to the system. So we will see at the end of the discussion.”

Matsoso added that, once that agreement is adopted, it means real work begins “because we must have the Conference of Party, countries must ratify the pandemic agreement, but you also have to ensure that there is operational elements that can help us.”

‘Abject failure’

INB observer Nina Schwalbe , CEO of Spark Street Advisors, described the decision not to call a special WHA in December “an abject failure of the international system”.

Former New Zealand Prime Minister Helen Clark submitted a statement to the INB earlier on Monday saying that the agreement – and its implementation – are “urgent”. 

“As you gather today, a teenager in western Canada has been hospitalized with H5N1. Mpox continues to infect and kill people in central and east Africa. Rwanda is doing its utmost to contain a Marburg outbreak. There are either no, or not nearly enough vaccines, diagnostics or treatments to equitably contain any of these pathogens,” said Clark, who was co-leader of the Independent Panel for Pandemic Preparedness and Response.

“The world is changing rapidly. Deadly pathogens are not waiting for a pandemic agreement to be adopted and to come into force, or for the results of elections.”