Climate Change Now Responsible for Nearly One Fifth of Dengue Cases in the Americas and Asia 06/12/2024 Sophia Samantaroy Mosquitoes, which can carry dengue virus, thrive at warmer temperatures. Climate change is already fueling increases in dengue cases globally. Nearly one fifth of dengue cases in Latin America and the Caribbean, or about 45 million infections a year, are attributable to climate change, in the past decade, according to a new study by researchers at Harvard and Stanford Universities. Rising temperatures combined with mosquito species uniquely suited to sprawling urbanization and deforestation are fueling the staggering increase in dengue cases, with a proportion of cases measurably attributable to climate change, according to the first ever study to “meaningfully” quantify that number. Over the past year, both Latin America and the Caribbean saw a record-breaking number of cases – and fatalities – of the so-called “break-bone” fever. Even with the recent regulatory approval of two new vaccines, Takeda Pharma’s Qdenga® and Sanofi’s Dengvaxia, slow rollout and continued challenges in production scale-up have meant the jabs made little impact so far. The researchers compiled data from 21 countries in the Americas and in Asia to identify the causal effect of climate change-related temperature increases and dengue cases. The study was presented at the Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH) 13-17 November, and is available in pre-print form. The researchers also estimated how different climate change scenarios will impact dengue burden. By 2050 under a high CO2 emissions scenario, the authors predicted a 61% increase in dengue incidence. Active climate mitigation would cut that figure to roughly 40%. At least 257 million people now live in countries where warming temperatures could cause dengue to double by mid-century in either scenario. “We can see the direct policy implications of reducing emissions at the global scale,” Dr Kelsey Lyberger, an ecologist at Arizona State University and one of the study authors, told Health Policy Watch. The magnitude of dengue cases will not increase equally, either, Lyberger noted. “Some of the highest relative increases are in places where they don’t necessarily have a high burden currently.” Countries in cooler climates are projected to have the largest increase in climate change-related dengue cases. But already now, increasing temperatures and extreme weather events are already changing the burden of infectious diseases – particularly vector-borne diseases. These temperature increases are already responsible for 45 million excess dengue cases, which the studied identified. The study, whose release coincided with the UN Climate Conference (COP29) in Baku, provides further evidence that climate action is “health action,” as termed in a recent WHO COP29 special report. Cooler regions will see largest change Dengue responds non-linearly to average daily temperature, with cases peaking at average temperatures of 28℃, and then decreasing. This creates “optimal” conditions for the two primary dengue mosquito vectors, Aedes aegypti and Aedes albopictus, where both species breed and feed faster. But in places where average temperatures are cooler – 15-20℃ on average – climate-change related warming has the largest effect on dengue caseload. As a result, projected warming will fuel dengue cases unequally across the globe. “It’s not across the board that we see this increase,” said Lyberger. Some cooler regions of Mexico, Peru, Bolivia, and Brazil, for instance, are predicted to see over 150% increases in dengue incidence due to climate change under any emission scenario, the study notes. Lack of surveillance data excludes Africa, India, Western Pacific from analysis WHO’s Western Pacific region was among those excluded from the study due to a lack of reliable surveillance data. While dengue cases continue to rise globally, including in much of the African continent, the lack of high quality surveillance systems means experts are left to guess the impact of climate change on dengue in these regions. Countries in the America, Brazil in particular, have felt the burden of dengue cases most acutely, but they often have surveillance methods in place to track infection rate fluctuations. “We needed a long enough time series of cases to estimate a baseline level of dengue,” said Lyberger. Many African countries face surveillance hurdles in detection, reporting and management, the lack of local laboratory capacity, and the misclassification of cases, noted researchers at Africa CDC. Without a solid surveillance system, countries are at a critical disadvantage–including little early warning systems for dengue surges. In India, the country’s “poor” surveillance network leads to “huge” under-reporting and a lack of public health response to outbreaks, as a Lancet editorial comments in India’s 2015 dengue season. A 2020 assessment of the country’s surveillance efforts found that dengue surveillance needs to be strengthened, and integrated into existing government initiatives. In that time frame alone, from 2015-2019, cases in the South Asian region increased by 46% according to WHO estimates. The organization attributes climate change, in addition to “high rates of population growth, inadequate water supply and poor waste management systems” coupled with the absence of effective treatment and suitable vector control to the high burden of dengue in the region. Preparing for the future With these new estimates of how climate change will increase dengue cases, researchers hope that such high-burden countries will be motivated to do more tracking and reporting, while those that historically have had few cases can prepare with funding for surveillance and integrated vector management. “Since we’ve established this relationship between temperature and cases, the next step is to see how warming, both in the past and in the future, is going to affect the number of cases that we have or will see,” explained Lyberger. This led researchers to compile data from 21 countries where dengue is endemic – including Brazil, Cambodia, Colombia, and Vietnam – and to examine other factors that could affect dengue infection rates like rainfall, seasonal changes, viral strains, economic shocks, and population density, to isolate the distinct effect of temperature. “We were able to pin down that historical warming has already increased dengue cases by about 20%,” said Lyberger. “It’s evidence that climate change already has become a significant threat to human health and, for dengue in particular, our data suggests the impact could get much worse,” said Erin Mordecai, PhD, an infectious disease ecologist at Stanford’s Woods Institute for the Environment and the study’s senior author in a press release. See Health Policy Watch’s ongoing coverage of dengue here. Image Credits: Marissa L. Childs, Kelsey Lyberger, Mallory Harris, Marshall Burke, Erin A. Mordecai, WHO. DRC Expects Diagnosis of ‘Disease X’ by Weekend; Mpox Continues to Spread 05/12/2024 Kerry Cullinan DRC Director-General of Health, Dr Dieudonné Mwamba. The Democratic Republic of Congo (DRC) expects to diagnose ‘Disease X’, which has killed at least 79 people in the Panzi district of Kwango Province by the weekend, according to the country’s Director-General of Health, Dr Dieudonné Mwamba. “The disease is characterised by fever, headaches, cough and sometimes difficulty breathing,” Mwamba told a media briefing hosted by Africa’s Centre for Disease Control and Prevention on Thursday. So far, around 376 people have been infected and the disease appears to be airborne, he added. Females are slightly more affected than males, and the majority of cases (52%) are under the age of 5. The second biggest group of patients is people aged over 25 (almost 30%). “Given that we do not have a specific diagnosis, we don’t know whether we are faced with a viral or bacterial disease, but we believe that, in under 48 hours, the results of the laboratories will help us,” he said. However, he noted that people in the impoverished rural Panzi district were “vulnerable” as there is a malnutrition rate of almost 40%, it recently experienced a serious typhoid outbreak. The DRC is also experiencing a seasonal influenza outbreak. Panzi does not have the capacity to test the specimens taken from patients with the unknown disease, so they have been sent to a laboratory in Kikwit some 500km away. The first case of the unknown illness was identified on 24 October in the largely rural south-eastern province bordering Angola. However, central authorities were only notified of a possible outbreak on 1 December, according to Dr Jean Kaseya, Africa CDC Director-General, who addressed the briefing from the DRC. “We want to reinforce the surveillance. We have a delay of almost five to six weeks, and in [that time], so many things can happen. This is why we are supporting the country to build strong capacity for surveillance,” said Kaseya. A team from Africa CDC, including an epidemiologist and laboratory and infection prevention control (IPC) experts, is being sent to Panzi on Friday to assist officials, he added. Mpox continues to spread Meanwhile, Mpox continues to spread, particularly in Central Africa, with 2,700 new cases in the past week, up from 2,618 new cases the previous week, said Kaseya. The outbreak has affected 20 African countries. After laboratory testing, Zambia and Zimbabwe have confirmed that their outbreaks are Clade 1b. “In total, we have 62,171 cases. Last week, we lost 36 people, and that brings a total of 1200 deaths since January 2024,” said Kaseya. However, only 13, 579 of the cases have been clinically confirmed as laboratory testing remains a challenge in many areas. The DRC remains the worst affected by mpox, with both clade 1a and 1b circulating. The lion’s share of the week’s new cases – 2,115 – were identified in the DRC and all 36 of the week’s deaths were in the DRC. However, testing remains a challenge in the country, with only 20% of cases confirmed by laboratories. Africa CDC also flagged the links between high burdens of mpox cases and measles cases in DRC, but has not yet established a causal link between the two diseases. Pakistan’s ‘Super Seeders’ Show Promise in Curbing Stubble Burning, But Uptake is Slow 04/12/2024 Rahul Basharat Rajput Three-wheelers and motorcyclists trapped in smog in Lahore, Pakistan in late November, 2024 LAHORE, Pakistan – Capital of the agriculturally rich Punjab Province, Lahore, has been engulfed in intense smoke for nearly a month. The government closed schools in Lahore and parts of the province on 7 November but even though they reopened a few weeks later, air pollution has remained at record, hazardous levels throughout the region. Air Quality Index scores were 218-425 in the first few days of December. Scores of 150 and above are considered a “red alert” while 300 or higher ranks as emergency conditions in the Index, which rank ozone, PM2.5 and other pollution levels in a scoring system modelled on the US Environmental Protection Agency. Along with mandatory mask-wearing for students and the public and banning outside sports and activities, the government ordered offices to reduce staffing by 50%, thus reducing workers’ exposures. Lahore was ranked fifth most polluted city in the world in 2023, with the top four slots going to Indian cities, according to IQAir. In what has become almost an annual ritual, Senior Minister Punjab Marriyum Aurangzeb, in a press conference, blamed neighboring India for the high air pollution in Lahore. Blame game or shared airshed? Air pollution levels in Pakistan’s Punjab Province, India’s Punjab State and across the Indo-Gangetic plain as far as Dhaka, Bangladesh on 3 December 2024. Aurangzeb said that as winds blow from east to west, smoke from seasonal crop stubble fires in India, where farmers burn their fields to sow winter wheat, drift into the skies of Pakistan. However, international experts point out that when winds blow the other way, around 30% of India’s pollution in Punjab may be coming from Pakistani Punjab across the border. And roughly one-third of the air pollution in Bangladesh, is blown in from India, around this time of year. The two rival countries, as well as Nepal and Bangladesh, all share an important airshed along the Himalayan foothills and Indo-Gangetic Plain and the pollution of each nation affects the others. In the late autumn and early winter, crop stubble burning plays a significant role in air pollution on both sides of the India-Pakistan frontier, according to a 2023 UN report on Sustainable Management of Crop Residues in Bangladesh, India, Nepal, and Pakistan: Challenges and Solutions. Punjab environmental officers put out fires set by Pakistani farmers in Province – an annual ritual on both sides of the border that leaves the entire Indo-Gangetic Plain shrouded in smoke. The problems typically begin in late October when farmers, in a hurry to prepare their land for winter wheat sowing, burn the rice stalks that remain in their fields. Thousands of fires visible across the region from satellite images. Experts have long said that a shift to more modern crop residue technologies is critical to reducing the harmful effects of stubble burning in both India and Pakistan, which are the world’s largest, and fourth largest, rice exporters respectively. Although across the Indo-Gangetic plains region, a wide variety of other pollution sources also play a role, from inefficient traditional brick kilns, to smoky household wood and coal fires, as well as polluting factories and diesel vehicles. Punjab Province launches ambitious smog control programme Punjab Chief Minister Maryam Nawwaz launches super seeder programme for farmers In April 2024, Punjab’s new Chief Minister, Maryam Nawaz set out to change that. She launched an ambitious new Smog Control Program, aimed at a range of far-reaching measures intended to better control the region’s heavy air pollution from a variety of sources. These included shifting brick kilns to more modern technologies, along with other industrial pollution sources, encouraging a transition to electric vehicles (EV’s) and a shift away from burning crop residue. Observers say that the transition to cleaner brick kiln technology shows signs of progress, while the introduction of EVs will take much more time. The crop residue programme, meanwhile, included a stick and a carrot. The stick was a ban on stubble burning, punishable by fines of $170 for offenders. The carrot was the offer of new generation “Super Seeder” machines subsidised by 65%. Despite the smoggy skies over Lahore, Health Policy Watch conversations with Punjab farmers and experts suggest that the new “Super Seeder” technology shows some promise, although its benefits won’t be reaped this season. Happy Seeders didn’t work well Hamza Cheema sits atop his conventional tractor – which he uses to clear rice stubble. He’s waiting to see how the Super Seeder performs. The SuperSeeders represent an upgrade from first-generation “Happy Seeders” – which were introduced in Pakistan a decade ago, but never really took off. Speaking with Health Policy Watch, Hamza Cheema, a farmer from Wazirabad District, around 150 kilometres north of Lahore, explained why. “I tried the Happy Seeder once as well, but the [wheat] seeds often remain on the surface rather than going deep into the wet soil. That yields a poor wheat crop,” he explained. The Super Seeder’s new features address this by plunging the seed deep in the earth. But even with the generous subsidies offered on new machines, they remain a hefty purchase and farmers like Cheema are still waiting to see how they perform over time. “It softens the soil, making it easier to plant seeds deep into the ground and removes the rice straw residue, but I have not used it because it costs around $5000 USD (PKR 1. 5 million) to purchase,” he said. While many of his neighbors still prefer to pay the fines for crop-burning, imposed by government regulators, Cheema’s farm of about 100 acres lies adjacent to a forest, which he doesn’t own but still cherishes, and he fears that smoke would harm the tree cover. “So I continue to level the rice stalks on my land by plowing them under with a tractor,” said Cheema. Even though that process, followed by seeding, is time-consuming. Super Seeders: cost remains a barrier Super Seeders – upgraded machine yielding better results. About 200 kilometres south-west of Lahore, farmer, Dilawar Khan Rath was an early adopter of the new Super Seeder, and he’s happy with the results despite the investment it required. Rath, who farms about 125 acres, purchased his machine in 2023. He believes that the investment will pay off in the long-term, in terms of field operations. The machine mixes the stubble into the soil, which helps increase the fertility of the land- as compared to crop-burning, which depletes soil fertility. “It also saves time, as a single pass is required for land preparation, fertiliser placement, and seed sowing,” Rath explained. The machine’s expense makes it feasible largely for larger landholders. As the owner of 125 acres of fertile land, he falls into that category but could just about afford the investment. Maintenance costs are high because trained technicians are not widely available and fuel consumption is also significant. However, if the government reduced the interest rates on purchase loans and launching a leasing programme through local farm councils, the machines would catch on much more widely, he asserts. “The Punjab government is providing Super Seeders on subsidy, which is a good initiative, but their numbers are limited,” Rath said. Meanwhile, Rath is also conscious of the health and environmental benefits of using Super Seeders. Smog remains a serious problem in his district . Super Seeders: not the only solution Vaqar Zakriya Indeed, the Punjab government intends to launch a leasing programme for the new machines, according to the office of Punjab’s Chief Minister. “There are 300 Super Seeders in the whole of Punjab, and the government is adding 1,000 more, with a total of 5,000 to be added over the next five years,” said a statement by Chief Minister Nawaz. The price of purchasing a machine outright will be set at $1,800 – with the remaining $2,800 covered by the government. “Public cooperation is essential to eliminate smog,” she added. While pollution from burning crop residue is indeed an issue, it should also not be seen as the primary cause of environmental pollution, Vaqar Zakaria, an environmental activist, told Health Policy Watch. He said that there remains a lack of data, overall, on the contribution of crop-burning to Punjab’s overall pollution load. “This technology has helped address the issue of residue burning for farmers, but that the current focus should be on increasing its availability to reach more farmers,” Pakistan’s former Federal Minister for Climate Change, Malik Amin Aslam, told Health Policy Watch in an interview. He noted that the Super Seeder technology was in fact first introduced three years ago by the previous government – and since then it has gained significant popularity among farmers, resulting in a notable reduction in residue burning in Punjab. But regional dialogue and data exchange is also essential to tackle smog effectively – as East Asian countries did successfully, he stressed. “Only through data sharing and regional cooperation, can this issue be managed, adding that he believes India might be willing to participate in such efforts.” Image Credits: Punjab Enviornment Department, IQ Air , YouTube/Business Recorder , Rahul Basharat, Engro Energy. Inadequate Laws Allow Rapists to Avoid Punishment in Many African Countries 04/12/2024 Kerry Cullinan Sudanese women, many of whom became leaders of the 2019 revolution, are being targeted by soldiers using rape as a weapon of war. Rape is common across Africa yet inadequate laws, weak implementation and cultural barriers mean that many perpetrators go unpunished, according to new research by Equality Now. “After examining rape laws across Africa, it is clear that to end impunity for perpetrators, governments urgently need to carry out comprehensive legal reform of rape laws, strengthen enforcement mechanisms, and improve access to justice and support for survivors,” said Jean Paul Murunga, a human rights lawyer and the report’s lead author. The report looked at rape laws and their enforcement in 47 African countries with an in-depth analysis of nine of these: Cameroon, Democratic Republic of Congo, Madagascar, Rwanda, Senegal, Sierra Leone, South Africa, South Sudan, and Zambia. Equality Now Africa Director Faiza Jama Mohamed says that the report identifies “key gaps in rape law that result in routine denial of justice to survivors of sexual violence”. “The gaps include laws allowing the perpetrator to walk free on reaching some form of ‘settlement’, including marrying the victim; laws framed in terms of morality rather than bodily integrity, thereby perpetuating a cycle of violence and discrimination; laws that explicitly permit rape in marriage, even of children,” notes Mohamed, writing in the foreword of the report. Narrow definition of rape Approximately 33% of women in Africa have experienced intimate partner violence or sexual violence in their lifetime, while in West, East, Central, and Southern Africa, the rate 44%, according to UN Women. The African Development Bank’s Gender Data Index 2019 reported that intimate partner sexual or physical violence ranges from 10% to 40% across the continen “It is critical for its definitions in the various jurisdictions within Africa, both in the context of conflict and peace, to be clear and based on human rights standards,” adds the report. Rape is when a person has not given voluntary, genuine, and willing consent for sexual interaction – and that this consent can be withdrawn anytime during the interaction. “True consent is impossible in situations of dependency or extreme vulnerability, for example, in educational settings, correctional facilities, or when a victim is incapacitated, such as being intoxicated or infirm,” according to the report. Several countries’ definitions of rape or legal frameworks fail to recognise all forms of unwanted sexual penetration (anal, oral, or vaginal by use of any body part or object) as rape . Some 25 African countries have penal codes that are “incomplete or ambiguous and do not meet international standards” by, for example, confining the definition to acts of violence and failing to recognise rape involving intimidation, coercion, fraud, and unequal power dynamics. Marital rape not recognised Justice for rape survivors Cote D’Ivoire, Gambia, Seychelles, Equatorial Guinea, Ethiopia and South Sudan do not criminalise marital rape. South Sudan explicitly notes that non-consensual sexual intercourse within marriage does not constitute rape. The Penal Code of Côte d’Ivoire provides for the presumption of married couples’ consent to the sexual act unless proven otherwise. Eritrea only criminalize marital rape when spouses are not living together, while Tanzania criminalizes it if the couple is not living together. Lesotho recognises marital rape under certain conditions. In Gabon, where child marriage is legal, if an abductor has married an abducted minor, he can only be prosecuted after the marriage is annulled. “International human rights standards require states to criminalise all forms of rape, irrespective of the relationship between the perpetrator and their victim,” says Murunga. “Failing to specifically criminalise marital rape ignores how consent must be ongoing and freely given, regardless of marital status. Legal recognition provides clarity to law enforcement, prosecutors, and judges that marital rape must be treated as a serious crime and prosecuted accordingly.” Harmful traditional beliefs Although 20 African countries have consent-based definitions of rape, rapists are often shielded by traditional beliefs and societal attitudes towards sex. “Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation,” according to the report. In Equatorial Guinea, for example, out-of-court settlements are legally permitted when a rape victim explicitly or tacitly forgives the perpetrator. This often results in rape survivors being pressurised to agree to this route. In several countries, officials opt not to investigate, prosecute, or convict rape cases unless there is physical evidence, especially which indicates a victim fought back. “Many jurisdictions emphasize force, morality, or circumstances and apply gender-discriminatory concepts such as ‘honour’ and ‘modesty’. This prejudices judgments over victims’ behavior and “chastity” and whether they are perceived as deserving justice for having been raped,” the report notes. Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation. Inadequate punishment Sudanese women wait for treatment at Fashir Reproductive health centre. Many women are pregnant as a result of being raped during the conflict. The African Commission on Human and People’s Rights recommends 16 years imprisonment for rape, but many countries have thresholds well below this. In Equatorial Guinea, Article 429 of the Criminal Code states that “rape of a woman shall be punished with minor confinement. Guinea Bissau includes an exemption where ‘the behavior of the victim has considerably contributed” to the rape. Even where not elaborated in the law, settlements with respect to rape are reportedly common in Benin, Cameroon, Chad, Côte d’Ivoire, The Gambia, Ghana, Guinea, Liberia, Nigeria and South Sudan. In South Africa, there is a serious backlog of rape cases and insufficient funding for the justice delivery system. In May 2022, the Minister of Justice announced that only 19% of reported cases were going through the courts. With the breakdown of the rule of law and security in conflicts, women and girls are rmore vulerable. In addition, rape is still being used as “a weapon of war to denigrate, disempower, demoralize and destroy communities”, the report notes. During conflict, reporting cases, collecting evidence and prosecution are often huge challenges. Providing justice to survivors of sexual violence and ensuring perpetrators do not enjoy impunity is critical in preventing and addressing rape With so many legal, procedural, and societal obstacles to addressing rape, very few cases make it to court, and even fewer result in conviction. Urgent reform Urgent reform is needed to ensure legal definitions of rape encompass all acts of non-consensual sexual penetration, with no exceptions for marital rape, according to the report. It also calls for adequate training of government officials to ensure laws are implemented and other measures including a register of sex offenders. “Effective legal implementation is equally crucial, requiring robust mechanisms to enforce justice and hold perpetrators accountable. Transparency and accountability are essential to building trust and ensuring fairness in how cases are handled,” the report notes. It advocates for supportive systems for rape survivors that” facilitate healing and enable them to pursue justice if they choose” Rwanda is highlighted as a positive example for promoting a “victim-centered approach to investigating and prosecuting sexual violence cases” that includes .gender-based violence recovery centers in numerous districts, providing survivors with witness protection, medical and psychosocial support, and legal aid. Image Credits: CC, Mohamed Zakaria/ UNICEF. Amid Global HIV Funding Challenges, PEPFAR Head Will Resign Before Trump Takes Office 03/12/2024 Kerry Cullinan Ambassador John Nkengasong, head of PEPFAR. As a political appointee, Ambassador John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January. “The rules that govern a transition are that all the political appointees have to resign on the 20th and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday. However, he stressed that PEPFAR has been a bipartisan programme since its inception in 2003 when it was launched by Republican President George W Bush. “It has since enjoyed the support of all administrations,” said Nkengasong, the US Global AIDS Coordinator in the Bureau of Health Security and Diplomacy. Nkengasong was appointed by President Joe Biden, confirmed by the US Senate in May 2022, and he started work the following month. PEPFAR’s achievements by 2024. Nkengasong is a Cameronian-born US citizen, who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the COVID-19 pandemic. Prior to that, he had worked for the US Centers for Disease Control and Prevention, as well as at the World Health Organization. “We should always think about PEPFAR, not the individual – 26 million lives saved over the last 21 years,” Nkengasong stressed at the briefing, although his re-appointment prospects are regarded as slim. “PEPFAR was reauthorised [by the US Congress] for one year last year. That reauthorisation expires in March, and we are hoping that we’ll get a clean five-year reauthorisation going forward,” he added. But this may not be plain sailing. PEPFAR has come under attack from US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion. This is why the programme only received a one-year extension rather than the usual five years. Trump has made cutting government spending and opposing abortion cornerstones of his election campaign, which does not augur well for the campaign to end AIDS by 2030. HIV money is drying up HIV is incurable but thanks to antiretroviral (ARV) drugs, it has become a controllable chronic disease and if people living with the virus have an undetectable viral load, they don’t transmit HIV. As many as 25 million people depend on PEPFAR and the Global Fund to subsidise their ARVs, which they need to take for life. Yet money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023. Meanwhile, donor resources for HIV dropped by 5%, UNAIDS Deputy Director Christine Stegling told the briefing. UNAIDS deputy director Christine Stegling. Global Fund executive director Peter Sands said that global overseas development assistance is under pressure, and health has lost its “prime spot” to both climate change and conflict. “There is a particular issue with funding for HIV/ AIDS, which is that we run the risk of being a victim of our own success. Because the number of people dying has dropped so much, and because HIV/ AIDS is no longer seen as that much of a threat in donor nations themselves, it’s dropped off the radar screen and seems like an old problem; one that’s largely won or gone away,” said Sands. “But HIV is a formidable adversary. We are nowhere near getting a vaccine, and we don’t have a cure for it yet.” But the single-minded focus on eliminating HIV has made “extraordinary progress”, Sands added. “AIDS-related deaths have come down by 51% since 2010 and more than three-quarters of people living with HIV are on treatment, but we still have another nine million people not on treatment and we still have 1.3 million new infections each year,” according to Stegling. Shift to domestic financing Economist Professor Dean Jamison, co-chair of the Lancet Commission on investing in health, says it is unlikely that for a better response to funding HIV globally. “So that does put greater emphasis on a transition to domestic finance where the reliance has been substantially on donors. It’s not to say that the external finance is likely to go away and then there won’t be important additions to that. I would be looking to parts of Asia for external finance, but on the domestic side, what are the range of options?” asked Jamison, who is an emeritus professor of Global Health Financing at UCSF, UCLA and the University of Washington. Poor countries would prioritise HIV spending, likely focusing on preventive interventions and treatment. Drawing on private resources, perhaps through payroll taxes, may also be a solution. Professor Dean Jamison Stegling singled out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing for HIV. “Last year in GDP term, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted. Meanwhile, sub-Saharan Africa loses about $80 billion in uncollected tax revenue. Debt relief, future financing at affordable rates and better tax revenue collection are the solutions UNAIDS is focusing on. “These are the issues of the future that we need to look into if we’re talking about self reliance, more resilient systems for health that are financed by countries, by every country themselves,” Stegling noted. With South Africa being the chair of the G20 next year, she sees “an amazing opportunity” for African leadership debt restructuring and different financing mechanisms. What lies ahead? Stegling says donors are likely to move into “gaps”, such as human rights protections for particular marginalized groups that might not immediately find support from their governments. Meanwhile, Nkengasong stressed that progress should not be confused with success. “The progress that we have made is very fragile,” Nkengasong stressed. PEPFAR did an analysis of 10 to 12 high-burden countries that it supports and found that, to maintain their programmes if PEPFAR was unable to fund them would result in debt risk increasing by 400 percentage point,. “Are we ready to live with this? We pride ourselves with the success we’ve made over the last 25 years or so against HIV. But the response to HIV is extremely fragile. It’s extremely fragile because it requires that the millions of people that are receiving treatment receive that treatment every day. “We cannot afford to leave them behind. If we do that, the billions that we’ve put into the fight against HIV AIDS will be completely wasted.” Image Credits: US State Department. UN Plastic Pollution Treaty Derailed as Fossil Fuel Nations Block Production Limits 03/12/2024 Stefan Anderson Global plastic production is set to triple by 2050, even as only 9% of plastic waste has ever been recycled. Negotiations to produce a legally binding treaty to curb the global explosion of plastic pollution fell short on Sunday as efforts to limit the production of fossil fuel-based plastics supported by over 100 countries, including the European Union, met fierce opposition from oil-producing nations. A coalition of oil and gas producers led by Saudi Arabia that included Iran, Russia, and other Gulf states under the Arab group, opposed capping plastic production, insisting the treaty should focus solely on plastics waste management. Negotiations this week in Busan, South Korea (known as INC-5), were meant to be the final round of a two-year process to create what the UN Environment Agency and environmental groups called “the most important multilateral treaty” since the 2015 Paris climate agreement. Instead, the Busan summit became the third major failure of multilateral environmental negotiations in as many weeks, following disappointing outcomes at COP29 in Baku and a total collapse of talks over new funding and enforcement mechanisms at the UN Convention on Biological Diversity’s COP16 in Cali, Colombia, which aimed to protect nature and wildlife. “A few critical issues still prevent us from reaching a comprehensive agreement,” said the chair of the negotiations, Luis Vayas Valdivieso, Sunday evening, in delivering the message there would be no final outcome at this round. Nearly 200 nations participated in the negotiations. The next round of plastics negotiations has not been scheduled or assigned a location. “Our mandate has always been ambitious. But ambition takes time to land,” Valdivieso said. “We have many of the elements that we need, and Busan has put us firmly on a pathway to success … to reverse and remedy the severe effects of plastic pollution on ecosystems and human health.” Deep fault lines unresolved Microplastics were detected in human blood for the first time this year, heightening research efforts to understand their effects on our health. Deep fault lines have persisted since talks began in Paris in March 2022. Nations remain divided over plastic production limits, bans on harmful chemicals in plastics, recycling’s role in solving the crisis, and funding for developing nations to implement the treaty’s goals. The scale of disagreement was laid bare in the previous negotiating round in Ottawa in April, which produced a near-illegible draft with 3,400 disputed sections. The final text published by the chair has whittled these down to 340 contested items, but the core disputes that have defined debates since the start remain unsolved. “It is clear there is persisting divergence in critical areas,” UNEP executive director Inger Andersen said in a statement, adding that talks had “moved us closer” to a legally binding treaty to protect “our future from the onslaught of plastic pollution.” While the failure to reach an agreement after 18 months marks a significant setback, other major UN environmental processes have faced far longer paths. It took three decades for climate negotiations to formally acknowledge fossil fuels’ role in global warming, while UN biodiversity talks reached their first binding treaty in 2022, thirty years after the 1992 Rio Earth Summit. “The world’s commitment to ending plastic pollution is clear and undeniable,” Andersen said. “More time is needed.” Ambition up Plastic waste is contaminating land, water and even food resources, with unknown health harms, experts have warned. More than 100 countries, including the EU and the United Kingdom, backed a Panama-led draft text in Busan calling for reducing plastic production to “sustainable levels”. The proposal would require nations to report their plastic production, import and export data to monitor global progress on curbing new plastics. The level of support mirrors broader backing for tough measures on plastics. WWF tallies from the third round of negotiations in Nairobi in late 2023 showed over 100 countries favouring bans or phase-outs of the most harmful plastics, with 140 pushing for a legally binding treaty. These nations argue plastic production is the root of the crisis. In the thousand days since nations first agreed to establish a binding treaty on plastic pollution, manufacturers have produced more than 800 million tonnes of new plastic, over 30 million tonnes have leaked into oceans, while millions more have been incinerated or sent to landfills. “Postponing negotiations does not postpone the crisis,” Panama’s lead negotiator, Juan Carlos Monterrey Gomez, told the closing plenary on Sunday. “When we reconvene, the stakes will be higher. This is not a drill, this is a fight for survival. We did not accept a weak treaty here, and we never will.” But the bloc known as the “like-minded” group of petrochemical producers, led by Saudi Arabia and including Russia, Iran, and other Arab states, oppose Panama’s proposal to limit production. These nations argue that including production limits oversteps the treaty’s mandate, which they say should focus solely on plastic pollution and waste. Their plan to maintain plastic production growth threatens to derail global climate goals. Scientists estimate that a 75% reduction in plastic production is needed by 2040 to keep global warming to 1.5 degrees Celsius. Without such cuts, plastic production alone could consume up to 31% of the world’s remaining carbon budget to stay within that critical temperature threshold. Health risks mount as treaty’s approach remains undecided Beyond the climate impacts, plastics pose escalating health risks through contamination of air, water, soil, and through those channels, terrestrial food chains and ocean life – all pathways for contaminants to penetrate people’s bodies. Scientists have detected plastic particles in human blood, lungs, breast milk, and unborn children. Research shows that people unknowingly consume about five grams of microplastics weekly through eating, drinking and breathing, while over 3,200 chemicals in plastics have known toxic effects and another 5,000 remain inadequately studied. Researchers have even discovered “plasticosis,” a new condition where microplastics alter cell behaviour in human and animal organs. Despite this growing evidence base, the treaty’s approach to health remains undecided. The final text presents two options: a standalone health article championed by Brazil, or strengthened health references throughout the document. With negotiations in Busan conducted behind closed doors, countries’ positions on this choice remain unclear. “Our babies are entering this world with their brains and bodies already contaminated with plastics, exposing them to toxic chemicals that can affect their ability to learn and increase their risk of endocrine disorders, reproductive harm, and cancers,” Aileen Lucero from the International Pollutants Elimination Network (IPEN) told delegates at the closing session. The financial toll on health is mounting. The Endocrine Society found just four families of plastic chemicals cause over $400 billion in annual health costs in the United States alone. Globally, the UN Environment Programme warns that inaction on chemical and plastic pollution could cost up to 10% of global GDP. “The science is clear: A treaty that protects human health and the environment needs to address the issues of plastic production and chemicals,” said Bethanie Carney Almroth, Professor at the University of Gothenburg, speaking for the Scientists’ Coalition for an Effective Plastics Treaty, a network of over 400 independent experts. Paradox for the healthcare industry There is also a paradox, however, for healthcare professionals. The healthcare industry relies heavily on plastics like PVC in essential medical equipment from IV tubing to protective gloves and masks. The COVID-19 pandemic only deepened this dependence as single-use protective gloves and masks became even more widely used by the general public, as well as health care practitioners, for infection prevention. But at the same time that a growing chorus of voices in the health sector also are calling attention to the health impacts of plastics in medical devices. Groups like Health Care Without Harm have worked to reduce use, and improve management, of plastics in health care facilities, and particularly of PVC, whose production requires large inputs of highly toxic mercury, asbestos or PFAS [per- and polyfluoroalkyl. One PVC’s main building blocks, vinyl chloride, is a potent carcinogen. They also have called out the impacts of health sector medical waste incineration – which in low- and middle-income countries may be in primitive stoves or open pit fires. This further generates community exposures to dangerous particulate pollution as well as longer-lived Persistent Organic Pollutants (POPS), such as dioxins and furans. At the same time, improving health sector management of plastics used, and eventually transition to new types of single-use materials that are both safe and environmentally friendly is not an easy process – a widely acknowledged fact of life. “There are specific considerations for the health industry due to the stringent regulatory rules that are applied to ensure that materials meet rigorous quality, safety, and efficacy standards to protect patient health. Changes require time and resources, from industry and from national regulatory agencies, to be implemented. Testing and validation of innovative packaging material can take up to 5-10 years to complete,” said the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a joint statment with the Global Self Care Federation and the International Generic and Biosimilar Medicines Association, at the start of the Busan meeting. “We believe it is possible to achieve a treaty that protects both the environment and human health, through harmonized, targeted extended compliance periods; in line with regulatory standards and timelines; and through limited exemptions where no feasible and safe alternatives exist at sufficient quality and scale,” the statement continued. “It will be critical to include such provisions in both the instrument and the annexes, as required. This will provide the approach needed to transition while new or alternative materials, processes, and formulations are established in collaboration with regulatory authorities.” Fossil fuels crash the party, again Unrecycled plastics have knock-on effects on the environment, emissions, biodiversity, and human health. Regardless of whether the concerns related to health, environment or climate, oil-producing nations maintained the treaty’s focus should be on the waste, and not the product itself. “The objective of this treaty is to end plastic pollution, not plastic itself,” Kuwait stated for the “like-minded group” of fossil fuel producers on the final day. “Attempting to phase out plastic rather than addressing the issue of plastic production risks undermining global progress and exacerbating economic inequality.” With negotiations largely behind closed doors, observer access was limited. Yet reports emerged of Saudi Arabia’s blocking tactics – from demanding unanimity on every decision to raising repeated procedural objections. The Saudi delegation even disputed a Brazilian working group leader’s authority to schedule a lunch meeting to recover lost time, the New York Times reported. The Global Partnership for Plastics Circularity, an industry group established specifically to influence the treaty talks and representing fossil fuel giants like Saudi Aramco, Chevron, Shell, and ExxonMobil, emphasised “addressing mismanaged waste” through improved recycling and waste collection systems. These arguments mirror tactics the petrochemical industry has employed since the 1960s. But decades of evidence tell a different story. Of the 8.3 billion tons of plastic ever produced, only 9% has been recycled, while 79% has ended up in landfills or the environment. The 2023 Plastics Overshoot report found that 43% of plastic produced globally is mismanaged and will likely contaminate air, water, or soil. The 2023 Plastic Waste Makers Index, meanwhile, called recycling “at most, a marginal activity” – and with increasingly complex chemical compositions in plastics, the problem is only getting worse. Industry’s strategic pivot Top 20 global producers of single-use plastics for the year 2021. The list remains effectively unchanged since 2019. The fierce resistance to production limits stems from oil-producing nations’ strategic pivot toward plastics as traditional markets decline. For the fossil fuel industry and its partners, plastics offer a horizon for continued expansion even as power grids and vehicles shift to renewable energy. Petrochemicals and plastics are projected to become oil’s primary demand driver – accounting for half of consumption by 2050, according to IEA forecasts, with plastic production set to represent 20% of oil and gas output. While Saudi Arabia led the fight against production caps in Busan, it’s part of a broader trend. Despite global pledges on climate and plastic pollution, major petrochemical investments continue across the Middle East, China, and the US, University of Lund research shows. For oil and gas producers, plastics offer a profitable sanctuary as clean energy expands. Petrochemicals yield higher margins than transport fuels – crucial as energy-sector fossil fuel demand wanes. Lost in the battles in Busan were the positions of the world’s two largest plastic producers. Both China and the United States were notably absent when treaty advocates made their case for production limits on Sunday. Though the US backed production cuts earlier this year, observers suggest this position is likely to shift following Donald Trump’s recent victory and pledges to continue expanding record levels of oil production. Beijing has put forth proposals to limit the use of harmful chemicals in plastics, but shown little interest in capping production. Plastics lobbyists swarm talks Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia. Plastic-producing nations were supported by an unprecedented industry presence at the UN talks. Fossil fuel and chemical industry lobbyists formed the largest single delegation, with 220 representatives. This group outnumbered both the European Union’s combined delegation and the host country South Korea’s representatives, according to analysis by the Center for International Environmental Law. The industry’s efforts to shape the treaty have been extensive. Over 93% of statements opposing an ambitious treaty came from chemical and petrochemical sectors, with companies like ExxonMobil, Dow Inc, BASF, and SABIC leading efforts to weaken the agreement, according to a report released during the talks by InfluenceMap. “Their strategy — lifted straight from the climate negotiations playbook — is designed to preserve the financial interests of countries and companies who are putting their fossil-fueled profits above human health, human rights, and the future of the planet,” said Delphine Levi Alvares, Global Petrochemical Campaign Manager at CIEL. The industry’s aggressive presence at the talks reflects what’s at stake. Petrochemical companies increasingly see plastics as a safe haven from carbon regulations as demand for fossil fuels declines in other sectors. This pivot to plastics production helps offset falling fuel demand, but threatens to dramatically increase plastic waste globally, research shows. “There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives (GAIA), representing local communities affected by plastic pollution, said in a statement. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.” Updated 3 December with added content on health sector plastics use. Image Credits: Photo by Hermes Rivera on Unsplash, University of Oregon, UNEP, QPhia. Pandemic Agreement: ‘Get it done’ 02/12/2024 Kerry Cullinan Dame Barbara Stocking urged negotiators to reach agreement. At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations. “The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors. “It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.” Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”. “As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros. “I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week. Handful of outstanding issues Yuan Qiong Hu of Medecins sans Frontieres (MSF) Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement. Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D. The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials. “Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. “You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked. “On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. “Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.” IFPMA’s Grega Kumer The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. “The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer. “To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting, regulatory challenges, limited absorption capacity and export restrictions,” he added. “The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added. Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring. Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday. Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. 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DRC Expects Diagnosis of ‘Disease X’ by Weekend; Mpox Continues to Spread 05/12/2024 Kerry Cullinan DRC Director-General of Health, Dr Dieudonné Mwamba. The Democratic Republic of Congo (DRC) expects to diagnose ‘Disease X’, which has killed at least 79 people in the Panzi district of Kwango Province by the weekend, according to the country’s Director-General of Health, Dr Dieudonné Mwamba. “The disease is characterised by fever, headaches, cough and sometimes difficulty breathing,” Mwamba told a media briefing hosted by Africa’s Centre for Disease Control and Prevention on Thursday. So far, around 376 people have been infected and the disease appears to be airborne, he added. Females are slightly more affected than males, and the majority of cases (52%) are under the age of 5. The second biggest group of patients is people aged over 25 (almost 30%). “Given that we do not have a specific diagnosis, we don’t know whether we are faced with a viral or bacterial disease, but we believe that, in under 48 hours, the results of the laboratories will help us,” he said. However, he noted that people in the impoverished rural Panzi district were “vulnerable” as there is a malnutrition rate of almost 40%, it recently experienced a serious typhoid outbreak. The DRC is also experiencing a seasonal influenza outbreak. Panzi does not have the capacity to test the specimens taken from patients with the unknown disease, so they have been sent to a laboratory in Kikwit some 500km away. The first case of the unknown illness was identified on 24 October in the largely rural south-eastern province bordering Angola. However, central authorities were only notified of a possible outbreak on 1 December, according to Dr Jean Kaseya, Africa CDC Director-General, who addressed the briefing from the DRC. “We want to reinforce the surveillance. We have a delay of almost five to six weeks, and in [that time], so many things can happen. This is why we are supporting the country to build strong capacity for surveillance,” said Kaseya. A team from Africa CDC, including an epidemiologist and laboratory and infection prevention control (IPC) experts, is being sent to Panzi on Friday to assist officials, he added. Mpox continues to spread Meanwhile, Mpox continues to spread, particularly in Central Africa, with 2,700 new cases in the past week, up from 2,618 new cases the previous week, said Kaseya. The outbreak has affected 20 African countries. After laboratory testing, Zambia and Zimbabwe have confirmed that their outbreaks are Clade 1b. “In total, we have 62,171 cases. Last week, we lost 36 people, and that brings a total of 1200 deaths since January 2024,” said Kaseya. However, only 13, 579 of the cases have been clinically confirmed as laboratory testing remains a challenge in many areas. The DRC remains the worst affected by mpox, with both clade 1a and 1b circulating. The lion’s share of the week’s new cases – 2,115 – were identified in the DRC and all 36 of the week’s deaths were in the DRC. However, testing remains a challenge in the country, with only 20% of cases confirmed by laboratories. Africa CDC also flagged the links between high burdens of mpox cases and measles cases in DRC, but has not yet established a causal link between the two diseases. Pakistan’s ‘Super Seeders’ Show Promise in Curbing Stubble Burning, But Uptake is Slow 04/12/2024 Rahul Basharat Rajput Three-wheelers and motorcyclists trapped in smog in Lahore, Pakistan in late November, 2024 LAHORE, Pakistan – Capital of the agriculturally rich Punjab Province, Lahore, has been engulfed in intense smoke for nearly a month. The government closed schools in Lahore and parts of the province on 7 November but even though they reopened a few weeks later, air pollution has remained at record, hazardous levels throughout the region. Air Quality Index scores were 218-425 in the first few days of December. Scores of 150 and above are considered a “red alert” while 300 or higher ranks as emergency conditions in the Index, which rank ozone, PM2.5 and other pollution levels in a scoring system modelled on the US Environmental Protection Agency. Along with mandatory mask-wearing for students and the public and banning outside sports and activities, the government ordered offices to reduce staffing by 50%, thus reducing workers’ exposures. Lahore was ranked fifth most polluted city in the world in 2023, with the top four slots going to Indian cities, according to IQAir. In what has become almost an annual ritual, Senior Minister Punjab Marriyum Aurangzeb, in a press conference, blamed neighboring India for the high air pollution in Lahore. Blame game or shared airshed? Air pollution levels in Pakistan’s Punjab Province, India’s Punjab State and across the Indo-Gangetic plain as far as Dhaka, Bangladesh on 3 December 2024. Aurangzeb said that as winds blow from east to west, smoke from seasonal crop stubble fires in India, where farmers burn their fields to sow winter wheat, drift into the skies of Pakistan. However, international experts point out that when winds blow the other way, around 30% of India’s pollution in Punjab may be coming from Pakistani Punjab across the border. And roughly one-third of the air pollution in Bangladesh, is blown in from India, around this time of year. The two rival countries, as well as Nepal and Bangladesh, all share an important airshed along the Himalayan foothills and Indo-Gangetic Plain and the pollution of each nation affects the others. In the late autumn and early winter, crop stubble burning plays a significant role in air pollution on both sides of the India-Pakistan frontier, according to a 2023 UN report on Sustainable Management of Crop Residues in Bangladesh, India, Nepal, and Pakistan: Challenges and Solutions. Punjab environmental officers put out fires set by Pakistani farmers in Province – an annual ritual on both sides of the border that leaves the entire Indo-Gangetic Plain shrouded in smoke. The problems typically begin in late October when farmers, in a hurry to prepare their land for winter wheat sowing, burn the rice stalks that remain in their fields. Thousands of fires visible across the region from satellite images. Experts have long said that a shift to more modern crop residue technologies is critical to reducing the harmful effects of stubble burning in both India and Pakistan, which are the world’s largest, and fourth largest, rice exporters respectively. Although across the Indo-Gangetic plains region, a wide variety of other pollution sources also play a role, from inefficient traditional brick kilns, to smoky household wood and coal fires, as well as polluting factories and diesel vehicles. Punjab Province launches ambitious smog control programme Punjab Chief Minister Maryam Nawwaz launches super seeder programme for farmers In April 2024, Punjab’s new Chief Minister, Maryam Nawaz set out to change that. She launched an ambitious new Smog Control Program, aimed at a range of far-reaching measures intended to better control the region’s heavy air pollution from a variety of sources. These included shifting brick kilns to more modern technologies, along with other industrial pollution sources, encouraging a transition to electric vehicles (EV’s) and a shift away from burning crop residue. Observers say that the transition to cleaner brick kiln technology shows signs of progress, while the introduction of EVs will take much more time. The crop residue programme, meanwhile, included a stick and a carrot. The stick was a ban on stubble burning, punishable by fines of $170 for offenders. The carrot was the offer of new generation “Super Seeder” machines subsidised by 65%. Despite the smoggy skies over Lahore, Health Policy Watch conversations with Punjab farmers and experts suggest that the new “Super Seeder” technology shows some promise, although its benefits won’t be reaped this season. Happy Seeders didn’t work well Hamza Cheema sits atop his conventional tractor – which he uses to clear rice stubble. He’s waiting to see how the Super Seeder performs. The SuperSeeders represent an upgrade from first-generation “Happy Seeders” – which were introduced in Pakistan a decade ago, but never really took off. Speaking with Health Policy Watch, Hamza Cheema, a farmer from Wazirabad District, around 150 kilometres north of Lahore, explained why. “I tried the Happy Seeder once as well, but the [wheat] seeds often remain on the surface rather than going deep into the wet soil. That yields a poor wheat crop,” he explained. The Super Seeder’s new features address this by plunging the seed deep in the earth. But even with the generous subsidies offered on new machines, they remain a hefty purchase and farmers like Cheema are still waiting to see how they perform over time. “It softens the soil, making it easier to plant seeds deep into the ground and removes the rice straw residue, but I have not used it because it costs around $5000 USD (PKR 1. 5 million) to purchase,” he said. While many of his neighbors still prefer to pay the fines for crop-burning, imposed by government regulators, Cheema’s farm of about 100 acres lies adjacent to a forest, which he doesn’t own but still cherishes, and he fears that smoke would harm the tree cover. “So I continue to level the rice stalks on my land by plowing them under with a tractor,” said Cheema. Even though that process, followed by seeding, is time-consuming. Super Seeders: cost remains a barrier Super Seeders – upgraded machine yielding better results. About 200 kilometres south-west of Lahore, farmer, Dilawar Khan Rath was an early adopter of the new Super Seeder, and he’s happy with the results despite the investment it required. Rath, who farms about 125 acres, purchased his machine in 2023. He believes that the investment will pay off in the long-term, in terms of field operations. The machine mixes the stubble into the soil, which helps increase the fertility of the land- as compared to crop-burning, which depletes soil fertility. “It also saves time, as a single pass is required for land preparation, fertiliser placement, and seed sowing,” Rath explained. The machine’s expense makes it feasible largely for larger landholders. As the owner of 125 acres of fertile land, he falls into that category but could just about afford the investment. Maintenance costs are high because trained technicians are not widely available and fuel consumption is also significant. However, if the government reduced the interest rates on purchase loans and launching a leasing programme through local farm councils, the machines would catch on much more widely, he asserts. “The Punjab government is providing Super Seeders on subsidy, which is a good initiative, but their numbers are limited,” Rath said. Meanwhile, Rath is also conscious of the health and environmental benefits of using Super Seeders. Smog remains a serious problem in his district . Super Seeders: not the only solution Vaqar Zakriya Indeed, the Punjab government intends to launch a leasing programme for the new machines, according to the office of Punjab’s Chief Minister. “There are 300 Super Seeders in the whole of Punjab, and the government is adding 1,000 more, with a total of 5,000 to be added over the next five years,” said a statement by Chief Minister Nawaz. The price of purchasing a machine outright will be set at $1,800 – with the remaining $2,800 covered by the government. “Public cooperation is essential to eliminate smog,” she added. While pollution from burning crop residue is indeed an issue, it should also not be seen as the primary cause of environmental pollution, Vaqar Zakaria, an environmental activist, told Health Policy Watch. He said that there remains a lack of data, overall, on the contribution of crop-burning to Punjab’s overall pollution load. “This technology has helped address the issue of residue burning for farmers, but that the current focus should be on increasing its availability to reach more farmers,” Pakistan’s former Federal Minister for Climate Change, Malik Amin Aslam, told Health Policy Watch in an interview. He noted that the Super Seeder technology was in fact first introduced three years ago by the previous government – and since then it has gained significant popularity among farmers, resulting in a notable reduction in residue burning in Punjab. But regional dialogue and data exchange is also essential to tackle smog effectively – as East Asian countries did successfully, he stressed. “Only through data sharing and regional cooperation, can this issue be managed, adding that he believes India might be willing to participate in such efforts.” Image Credits: Punjab Enviornment Department, IQ Air , YouTube/Business Recorder , Rahul Basharat, Engro Energy. Inadequate Laws Allow Rapists to Avoid Punishment in Many African Countries 04/12/2024 Kerry Cullinan Sudanese women, many of whom became leaders of the 2019 revolution, are being targeted by soldiers using rape as a weapon of war. Rape is common across Africa yet inadequate laws, weak implementation and cultural barriers mean that many perpetrators go unpunished, according to new research by Equality Now. “After examining rape laws across Africa, it is clear that to end impunity for perpetrators, governments urgently need to carry out comprehensive legal reform of rape laws, strengthen enforcement mechanisms, and improve access to justice and support for survivors,” said Jean Paul Murunga, a human rights lawyer and the report’s lead author. The report looked at rape laws and their enforcement in 47 African countries with an in-depth analysis of nine of these: Cameroon, Democratic Republic of Congo, Madagascar, Rwanda, Senegal, Sierra Leone, South Africa, South Sudan, and Zambia. Equality Now Africa Director Faiza Jama Mohamed says that the report identifies “key gaps in rape law that result in routine denial of justice to survivors of sexual violence”. “The gaps include laws allowing the perpetrator to walk free on reaching some form of ‘settlement’, including marrying the victim; laws framed in terms of morality rather than bodily integrity, thereby perpetuating a cycle of violence and discrimination; laws that explicitly permit rape in marriage, even of children,” notes Mohamed, writing in the foreword of the report. Narrow definition of rape Approximately 33% of women in Africa have experienced intimate partner violence or sexual violence in their lifetime, while in West, East, Central, and Southern Africa, the rate 44%, according to UN Women. The African Development Bank’s Gender Data Index 2019 reported that intimate partner sexual or physical violence ranges from 10% to 40% across the continen “It is critical for its definitions in the various jurisdictions within Africa, both in the context of conflict and peace, to be clear and based on human rights standards,” adds the report. Rape is when a person has not given voluntary, genuine, and willing consent for sexual interaction – and that this consent can be withdrawn anytime during the interaction. “True consent is impossible in situations of dependency or extreme vulnerability, for example, in educational settings, correctional facilities, or when a victim is incapacitated, such as being intoxicated or infirm,” according to the report. Several countries’ definitions of rape or legal frameworks fail to recognise all forms of unwanted sexual penetration (anal, oral, or vaginal by use of any body part or object) as rape . Some 25 African countries have penal codes that are “incomplete or ambiguous and do not meet international standards” by, for example, confining the definition to acts of violence and failing to recognise rape involving intimidation, coercion, fraud, and unequal power dynamics. Marital rape not recognised Justice for rape survivors Cote D’Ivoire, Gambia, Seychelles, Equatorial Guinea, Ethiopia and South Sudan do not criminalise marital rape. South Sudan explicitly notes that non-consensual sexual intercourse within marriage does not constitute rape. The Penal Code of Côte d’Ivoire provides for the presumption of married couples’ consent to the sexual act unless proven otherwise. Eritrea only criminalize marital rape when spouses are not living together, while Tanzania criminalizes it if the couple is not living together. Lesotho recognises marital rape under certain conditions. In Gabon, where child marriage is legal, if an abductor has married an abducted minor, he can only be prosecuted after the marriage is annulled. “International human rights standards require states to criminalise all forms of rape, irrespective of the relationship between the perpetrator and their victim,” says Murunga. “Failing to specifically criminalise marital rape ignores how consent must be ongoing and freely given, regardless of marital status. Legal recognition provides clarity to law enforcement, prosecutors, and judges that marital rape must be treated as a serious crime and prosecuted accordingly.” Harmful traditional beliefs Although 20 African countries have consent-based definitions of rape, rapists are often shielded by traditional beliefs and societal attitudes towards sex. “Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation,” according to the report. In Equatorial Guinea, for example, out-of-court settlements are legally permitted when a rape victim explicitly or tacitly forgives the perpetrator. This often results in rape survivors being pressurised to agree to this route. In several countries, officials opt not to investigate, prosecute, or convict rape cases unless there is physical evidence, especially which indicates a victim fought back. “Many jurisdictions emphasize force, morality, or circumstances and apply gender-discriminatory concepts such as ‘honour’ and ‘modesty’. This prejudices judgments over victims’ behavior and “chastity” and whether they are perceived as deserving justice for having been raped,” the report notes. Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation. Inadequate punishment Sudanese women wait for treatment at Fashir Reproductive health centre. Many women are pregnant as a result of being raped during the conflict. The African Commission on Human and People’s Rights recommends 16 years imprisonment for rape, but many countries have thresholds well below this. In Equatorial Guinea, Article 429 of the Criminal Code states that “rape of a woman shall be punished with minor confinement. Guinea Bissau includes an exemption where ‘the behavior of the victim has considerably contributed” to the rape. Even where not elaborated in the law, settlements with respect to rape are reportedly common in Benin, Cameroon, Chad, Côte d’Ivoire, The Gambia, Ghana, Guinea, Liberia, Nigeria and South Sudan. In South Africa, there is a serious backlog of rape cases and insufficient funding for the justice delivery system. In May 2022, the Minister of Justice announced that only 19% of reported cases were going through the courts. With the breakdown of the rule of law and security in conflicts, women and girls are rmore vulerable. In addition, rape is still being used as “a weapon of war to denigrate, disempower, demoralize and destroy communities”, the report notes. During conflict, reporting cases, collecting evidence and prosecution are often huge challenges. Providing justice to survivors of sexual violence and ensuring perpetrators do not enjoy impunity is critical in preventing and addressing rape With so many legal, procedural, and societal obstacles to addressing rape, very few cases make it to court, and even fewer result in conviction. Urgent reform Urgent reform is needed to ensure legal definitions of rape encompass all acts of non-consensual sexual penetration, with no exceptions for marital rape, according to the report. It also calls for adequate training of government officials to ensure laws are implemented and other measures including a register of sex offenders. “Effective legal implementation is equally crucial, requiring robust mechanisms to enforce justice and hold perpetrators accountable. Transparency and accountability are essential to building trust and ensuring fairness in how cases are handled,” the report notes. It advocates for supportive systems for rape survivors that” facilitate healing and enable them to pursue justice if they choose” Rwanda is highlighted as a positive example for promoting a “victim-centered approach to investigating and prosecuting sexual violence cases” that includes .gender-based violence recovery centers in numerous districts, providing survivors with witness protection, medical and psychosocial support, and legal aid. Image Credits: CC, Mohamed Zakaria/ UNICEF. Amid Global HIV Funding Challenges, PEPFAR Head Will Resign Before Trump Takes Office 03/12/2024 Kerry Cullinan Ambassador John Nkengasong, head of PEPFAR. As a political appointee, Ambassador John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January. “The rules that govern a transition are that all the political appointees have to resign on the 20th and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday. However, he stressed that PEPFAR has been a bipartisan programme since its inception in 2003 when it was launched by Republican President George W Bush. “It has since enjoyed the support of all administrations,” said Nkengasong, the US Global AIDS Coordinator in the Bureau of Health Security and Diplomacy. Nkengasong was appointed by President Joe Biden, confirmed by the US Senate in May 2022, and he started work the following month. PEPFAR’s achievements by 2024. Nkengasong is a Cameronian-born US citizen, who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the COVID-19 pandemic. Prior to that, he had worked for the US Centers for Disease Control and Prevention, as well as at the World Health Organization. “We should always think about PEPFAR, not the individual – 26 million lives saved over the last 21 years,” Nkengasong stressed at the briefing, although his re-appointment prospects are regarded as slim. “PEPFAR was reauthorised [by the US Congress] for one year last year. That reauthorisation expires in March, and we are hoping that we’ll get a clean five-year reauthorisation going forward,” he added. But this may not be plain sailing. PEPFAR has come under attack from US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion. This is why the programme only received a one-year extension rather than the usual five years. Trump has made cutting government spending and opposing abortion cornerstones of his election campaign, which does not augur well for the campaign to end AIDS by 2030. HIV money is drying up HIV is incurable but thanks to antiretroviral (ARV) drugs, it has become a controllable chronic disease and if people living with the virus have an undetectable viral load, they don’t transmit HIV. As many as 25 million people depend on PEPFAR and the Global Fund to subsidise their ARVs, which they need to take for life. Yet money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023. Meanwhile, donor resources for HIV dropped by 5%, UNAIDS Deputy Director Christine Stegling told the briefing. UNAIDS deputy director Christine Stegling. Global Fund executive director Peter Sands said that global overseas development assistance is under pressure, and health has lost its “prime spot” to both climate change and conflict. “There is a particular issue with funding for HIV/ AIDS, which is that we run the risk of being a victim of our own success. Because the number of people dying has dropped so much, and because HIV/ AIDS is no longer seen as that much of a threat in donor nations themselves, it’s dropped off the radar screen and seems like an old problem; one that’s largely won or gone away,” said Sands. “But HIV is a formidable adversary. We are nowhere near getting a vaccine, and we don’t have a cure for it yet.” But the single-minded focus on eliminating HIV has made “extraordinary progress”, Sands added. “AIDS-related deaths have come down by 51% since 2010 and more than three-quarters of people living with HIV are on treatment, but we still have another nine million people not on treatment and we still have 1.3 million new infections each year,” according to Stegling. Shift to domestic financing Economist Professor Dean Jamison, co-chair of the Lancet Commission on investing in health, says it is unlikely that for a better response to funding HIV globally. “So that does put greater emphasis on a transition to domestic finance where the reliance has been substantially on donors. It’s not to say that the external finance is likely to go away and then there won’t be important additions to that. I would be looking to parts of Asia for external finance, but on the domestic side, what are the range of options?” asked Jamison, who is an emeritus professor of Global Health Financing at UCSF, UCLA and the University of Washington. Poor countries would prioritise HIV spending, likely focusing on preventive interventions and treatment. Drawing on private resources, perhaps through payroll taxes, may also be a solution. Professor Dean Jamison Stegling singled out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing for HIV. “Last year in GDP term, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted. Meanwhile, sub-Saharan Africa loses about $80 billion in uncollected tax revenue. Debt relief, future financing at affordable rates and better tax revenue collection are the solutions UNAIDS is focusing on. “These are the issues of the future that we need to look into if we’re talking about self reliance, more resilient systems for health that are financed by countries, by every country themselves,” Stegling noted. With South Africa being the chair of the G20 next year, she sees “an amazing opportunity” for African leadership debt restructuring and different financing mechanisms. What lies ahead? Stegling says donors are likely to move into “gaps”, such as human rights protections for particular marginalized groups that might not immediately find support from their governments. Meanwhile, Nkengasong stressed that progress should not be confused with success. “The progress that we have made is very fragile,” Nkengasong stressed. PEPFAR did an analysis of 10 to 12 high-burden countries that it supports and found that, to maintain their programmes if PEPFAR was unable to fund them would result in debt risk increasing by 400 percentage point,. “Are we ready to live with this? We pride ourselves with the success we’ve made over the last 25 years or so against HIV. But the response to HIV is extremely fragile. It’s extremely fragile because it requires that the millions of people that are receiving treatment receive that treatment every day. “We cannot afford to leave them behind. If we do that, the billions that we’ve put into the fight against HIV AIDS will be completely wasted.” Image Credits: US State Department. UN Plastic Pollution Treaty Derailed as Fossil Fuel Nations Block Production Limits 03/12/2024 Stefan Anderson Global plastic production is set to triple by 2050, even as only 9% of plastic waste has ever been recycled. Negotiations to produce a legally binding treaty to curb the global explosion of plastic pollution fell short on Sunday as efforts to limit the production of fossil fuel-based plastics supported by over 100 countries, including the European Union, met fierce opposition from oil-producing nations. A coalition of oil and gas producers led by Saudi Arabia that included Iran, Russia, and other Gulf states under the Arab group, opposed capping plastic production, insisting the treaty should focus solely on plastics waste management. Negotiations this week in Busan, South Korea (known as INC-5), were meant to be the final round of a two-year process to create what the UN Environment Agency and environmental groups called “the most important multilateral treaty” since the 2015 Paris climate agreement. Instead, the Busan summit became the third major failure of multilateral environmental negotiations in as many weeks, following disappointing outcomes at COP29 in Baku and a total collapse of talks over new funding and enforcement mechanisms at the UN Convention on Biological Diversity’s COP16 in Cali, Colombia, which aimed to protect nature and wildlife. “A few critical issues still prevent us from reaching a comprehensive agreement,” said the chair of the negotiations, Luis Vayas Valdivieso, Sunday evening, in delivering the message there would be no final outcome at this round. Nearly 200 nations participated in the negotiations. The next round of plastics negotiations has not been scheduled or assigned a location. “Our mandate has always been ambitious. But ambition takes time to land,” Valdivieso said. “We have many of the elements that we need, and Busan has put us firmly on a pathway to success … to reverse and remedy the severe effects of plastic pollution on ecosystems and human health.” Deep fault lines unresolved Microplastics were detected in human blood for the first time this year, heightening research efforts to understand their effects on our health. Deep fault lines have persisted since talks began in Paris in March 2022. Nations remain divided over plastic production limits, bans on harmful chemicals in plastics, recycling’s role in solving the crisis, and funding for developing nations to implement the treaty’s goals. The scale of disagreement was laid bare in the previous negotiating round in Ottawa in April, which produced a near-illegible draft with 3,400 disputed sections. The final text published by the chair has whittled these down to 340 contested items, but the core disputes that have defined debates since the start remain unsolved. “It is clear there is persisting divergence in critical areas,” UNEP executive director Inger Andersen said in a statement, adding that talks had “moved us closer” to a legally binding treaty to protect “our future from the onslaught of plastic pollution.” While the failure to reach an agreement after 18 months marks a significant setback, other major UN environmental processes have faced far longer paths. It took three decades for climate negotiations to formally acknowledge fossil fuels’ role in global warming, while UN biodiversity talks reached their first binding treaty in 2022, thirty years after the 1992 Rio Earth Summit. “The world’s commitment to ending plastic pollution is clear and undeniable,” Andersen said. “More time is needed.” Ambition up Plastic waste is contaminating land, water and even food resources, with unknown health harms, experts have warned. More than 100 countries, including the EU and the United Kingdom, backed a Panama-led draft text in Busan calling for reducing plastic production to “sustainable levels”. The proposal would require nations to report their plastic production, import and export data to monitor global progress on curbing new plastics. The level of support mirrors broader backing for tough measures on plastics. WWF tallies from the third round of negotiations in Nairobi in late 2023 showed over 100 countries favouring bans or phase-outs of the most harmful plastics, with 140 pushing for a legally binding treaty. These nations argue plastic production is the root of the crisis. In the thousand days since nations first agreed to establish a binding treaty on plastic pollution, manufacturers have produced more than 800 million tonnes of new plastic, over 30 million tonnes have leaked into oceans, while millions more have been incinerated or sent to landfills. “Postponing negotiations does not postpone the crisis,” Panama’s lead negotiator, Juan Carlos Monterrey Gomez, told the closing plenary on Sunday. “When we reconvene, the stakes will be higher. This is not a drill, this is a fight for survival. We did not accept a weak treaty here, and we never will.” But the bloc known as the “like-minded” group of petrochemical producers, led by Saudi Arabia and including Russia, Iran, and other Arab states, oppose Panama’s proposal to limit production. These nations argue that including production limits oversteps the treaty’s mandate, which they say should focus solely on plastic pollution and waste. Their plan to maintain plastic production growth threatens to derail global climate goals. Scientists estimate that a 75% reduction in plastic production is needed by 2040 to keep global warming to 1.5 degrees Celsius. Without such cuts, plastic production alone could consume up to 31% of the world’s remaining carbon budget to stay within that critical temperature threshold. Health risks mount as treaty’s approach remains undecided Beyond the climate impacts, plastics pose escalating health risks through contamination of air, water, soil, and through those channels, terrestrial food chains and ocean life – all pathways for contaminants to penetrate people’s bodies. Scientists have detected plastic particles in human blood, lungs, breast milk, and unborn children. Research shows that people unknowingly consume about five grams of microplastics weekly through eating, drinking and breathing, while over 3,200 chemicals in plastics have known toxic effects and another 5,000 remain inadequately studied. Researchers have even discovered “plasticosis,” a new condition where microplastics alter cell behaviour in human and animal organs. Despite this growing evidence base, the treaty’s approach to health remains undecided. The final text presents two options: a standalone health article championed by Brazil, or strengthened health references throughout the document. With negotiations in Busan conducted behind closed doors, countries’ positions on this choice remain unclear. “Our babies are entering this world with their brains and bodies already contaminated with plastics, exposing them to toxic chemicals that can affect their ability to learn and increase their risk of endocrine disorders, reproductive harm, and cancers,” Aileen Lucero from the International Pollutants Elimination Network (IPEN) told delegates at the closing session. The financial toll on health is mounting. The Endocrine Society found just four families of plastic chemicals cause over $400 billion in annual health costs in the United States alone. Globally, the UN Environment Programme warns that inaction on chemical and plastic pollution could cost up to 10% of global GDP. “The science is clear: A treaty that protects human health and the environment needs to address the issues of plastic production and chemicals,” said Bethanie Carney Almroth, Professor at the University of Gothenburg, speaking for the Scientists’ Coalition for an Effective Plastics Treaty, a network of over 400 independent experts. Paradox for the healthcare industry There is also a paradox, however, for healthcare professionals. The healthcare industry relies heavily on plastics like PVC in essential medical equipment from IV tubing to protective gloves and masks. The COVID-19 pandemic only deepened this dependence as single-use protective gloves and masks became even more widely used by the general public, as well as health care practitioners, for infection prevention. But at the same time that a growing chorus of voices in the health sector also are calling attention to the health impacts of plastics in medical devices. Groups like Health Care Without Harm have worked to reduce use, and improve management, of plastics in health care facilities, and particularly of PVC, whose production requires large inputs of highly toxic mercury, asbestos or PFAS [per- and polyfluoroalkyl. One PVC’s main building blocks, vinyl chloride, is a potent carcinogen. They also have called out the impacts of health sector medical waste incineration – which in low- and middle-income countries may be in primitive stoves or open pit fires. This further generates community exposures to dangerous particulate pollution as well as longer-lived Persistent Organic Pollutants (POPS), such as dioxins and furans. At the same time, improving health sector management of plastics used, and eventually transition to new types of single-use materials that are both safe and environmentally friendly is not an easy process – a widely acknowledged fact of life. “There are specific considerations for the health industry due to the stringent regulatory rules that are applied to ensure that materials meet rigorous quality, safety, and efficacy standards to protect patient health. Changes require time and resources, from industry and from national regulatory agencies, to be implemented. Testing and validation of innovative packaging material can take up to 5-10 years to complete,” said the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a joint statment with the Global Self Care Federation and the International Generic and Biosimilar Medicines Association, at the start of the Busan meeting. “We believe it is possible to achieve a treaty that protects both the environment and human health, through harmonized, targeted extended compliance periods; in line with regulatory standards and timelines; and through limited exemptions where no feasible and safe alternatives exist at sufficient quality and scale,” the statement continued. “It will be critical to include such provisions in both the instrument and the annexes, as required. This will provide the approach needed to transition while new or alternative materials, processes, and formulations are established in collaboration with regulatory authorities.” Fossil fuels crash the party, again Unrecycled plastics have knock-on effects on the environment, emissions, biodiversity, and human health. Regardless of whether the concerns related to health, environment or climate, oil-producing nations maintained the treaty’s focus should be on the waste, and not the product itself. “The objective of this treaty is to end plastic pollution, not plastic itself,” Kuwait stated for the “like-minded group” of fossil fuel producers on the final day. “Attempting to phase out plastic rather than addressing the issue of plastic production risks undermining global progress and exacerbating economic inequality.” With negotiations largely behind closed doors, observer access was limited. Yet reports emerged of Saudi Arabia’s blocking tactics – from demanding unanimity on every decision to raising repeated procedural objections. The Saudi delegation even disputed a Brazilian working group leader’s authority to schedule a lunch meeting to recover lost time, the New York Times reported. The Global Partnership for Plastics Circularity, an industry group established specifically to influence the treaty talks and representing fossil fuel giants like Saudi Aramco, Chevron, Shell, and ExxonMobil, emphasised “addressing mismanaged waste” through improved recycling and waste collection systems. These arguments mirror tactics the petrochemical industry has employed since the 1960s. But decades of evidence tell a different story. Of the 8.3 billion tons of plastic ever produced, only 9% has been recycled, while 79% has ended up in landfills or the environment. The 2023 Plastics Overshoot report found that 43% of plastic produced globally is mismanaged and will likely contaminate air, water, or soil. The 2023 Plastic Waste Makers Index, meanwhile, called recycling “at most, a marginal activity” – and with increasingly complex chemical compositions in plastics, the problem is only getting worse. Industry’s strategic pivot Top 20 global producers of single-use plastics for the year 2021. The list remains effectively unchanged since 2019. The fierce resistance to production limits stems from oil-producing nations’ strategic pivot toward plastics as traditional markets decline. For the fossil fuel industry and its partners, plastics offer a horizon for continued expansion even as power grids and vehicles shift to renewable energy. Petrochemicals and plastics are projected to become oil’s primary demand driver – accounting for half of consumption by 2050, according to IEA forecasts, with plastic production set to represent 20% of oil and gas output. While Saudi Arabia led the fight against production caps in Busan, it’s part of a broader trend. Despite global pledges on climate and plastic pollution, major petrochemical investments continue across the Middle East, China, and the US, University of Lund research shows. For oil and gas producers, plastics offer a profitable sanctuary as clean energy expands. Petrochemicals yield higher margins than transport fuels – crucial as energy-sector fossil fuel demand wanes. Lost in the battles in Busan were the positions of the world’s two largest plastic producers. Both China and the United States were notably absent when treaty advocates made their case for production limits on Sunday. Though the US backed production cuts earlier this year, observers suggest this position is likely to shift following Donald Trump’s recent victory and pledges to continue expanding record levels of oil production. Beijing has put forth proposals to limit the use of harmful chemicals in plastics, but shown little interest in capping production. Plastics lobbyists swarm talks Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia. Plastic-producing nations were supported by an unprecedented industry presence at the UN talks. Fossil fuel and chemical industry lobbyists formed the largest single delegation, with 220 representatives. This group outnumbered both the European Union’s combined delegation and the host country South Korea’s representatives, according to analysis by the Center for International Environmental Law. The industry’s efforts to shape the treaty have been extensive. Over 93% of statements opposing an ambitious treaty came from chemical and petrochemical sectors, with companies like ExxonMobil, Dow Inc, BASF, and SABIC leading efforts to weaken the agreement, according to a report released during the talks by InfluenceMap. “Their strategy — lifted straight from the climate negotiations playbook — is designed to preserve the financial interests of countries and companies who are putting their fossil-fueled profits above human health, human rights, and the future of the planet,” said Delphine Levi Alvares, Global Petrochemical Campaign Manager at CIEL. The industry’s aggressive presence at the talks reflects what’s at stake. Petrochemical companies increasingly see plastics as a safe haven from carbon regulations as demand for fossil fuels declines in other sectors. This pivot to plastics production helps offset falling fuel demand, but threatens to dramatically increase plastic waste globally, research shows. “There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives (GAIA), representing local communities affected by plastic pollution, said in a statement. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.” Updated 3 December with added content on health sector plastics use. Image Credits: Photo by Hermes Rivera on Unsplash, University of Oregon, UNEP, QPhia. Pandemic Agreement: ‘Get it done’ 02/12/2024 Kerry Cullinan Dame Barbara Stocking urged negotiators to reach agreement. At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations. “The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors. “It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.” Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”. “As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros. “I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week. Handful of outstanding issues Yuan Qiong Hu of Medecins sans Frontieres (MSF) Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement. Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D. The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials. “Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. “You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked. “On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. “Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.” IFPMA’s Grega Kumer The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. “The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer. “To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting, regulatory challenges, limited absorption capacity and export restrictions,” he added. “The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added. Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring. Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday. Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. 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Pakistan’s ‘Super Seeders’ Show Promise in Curbing Stubble Burning, But Uptake is Slow 04/12/2024 Rahul Basharat Rajput Three-wheelers and motorcyclists trapped in smog in Lahore, Pakistan in late November, 2024 LAHORE, Pakistan – Capital of the agriculturally rich Punjab Province, Lahore, has been engulfed in intense smoke for nearly a month. The government closed schools in Lahore and parts of the province on 7 November but even though they reopened a few weeks later, air pollution has remained at record, hazardous levels throughout the region. Air Quality Index scores were 218-425 in the first few days of December. Scores of 150 and above are considered a “red alert” while 300 or higher ranks as emergency conditions in the Index, which rank ozone, PM2.5 and other pollution levels in a scoring system modelled on the US Environmental Protection Agency. Along with mandatory mask-wearing for students and the public and banning outside sports and activities, the government ordered offices to reduce staffing by 50%, thus reducing workers’ exposures. Lahore was ranked fifth most polluted city in the world in 2023, with the top four slots going to Indian cities, according to IQAir. In what has become almost an annual ritual, Senior Minister Punjab Marriyum Aurangzeb, in a press conference, blamed neighboring India for the high air pollution in Lahore. Blame game or shared airshed? Air pollution levels in Pakistan’s Punjab Province, India’s Punjab State and across the Indo-Gangetic plain as far as Dhaka, Bangladesh on 3 December 2024. Aurangzeb said that as winds blow from east to west, smoke from seasonal crop stubble fires in India, where farmers burn their fields to sow winter wheat, drift into the skies of Pakistan. However, international experts point out that when winds blow the other way, around 30% of India’s pollution in Punjab may be coming from Pakistani Punjab across the border. And roughly one-third of the air pollution in Bangladesh, is blown in from India, around this time of year. The two rival countries, as well as Nepal and Bangladesh, all share an important airshed along the Himalayan foothills and Indo-Gangetic Plain and the pollution of each nation affects the others. In the late autumn and early winter, crop stubble burning plays a significant role in air pollution on both sides of the India-Pakistan frontier, according to a 2023 UN report on Sustainable Management of Crop Residues in Bangladesh, India, Nepal, and Pakistan: Challenges and Solutions. Punjab environmental officers put out fires set by Pakistani farmers in Province – an annual ritual on both sides of the border that leaves the entire Indo-Gangetic Plain shrouded in smoke. The problems typically begin in late October when farmers, in a hurry to prepare their land for winter wheat sowing, burn the rice stalks that remain in their fields. Thousands of fires visible across the region from satellite images. Experts have long said that a shift to more modern crop residue technologies is critical to reducing the harmful effects of stubble burning in both India and Pakistan, which are the world’s largest, and fourth largest, rice exporters respectively. Although across the Indo-Gangetic plains region, a wide variety of other pollution sources also play a role, from inefficient traditional brick kilns, to smoky household wood and coal fires, as well as polluting factories and diesel vehicles. Punjab Province launches ambitious smog control programme Punjab Chief Minister Maryam Nawwaz launches super seeder programme for farmers In April 2024, Punjab’s new Chief Minister, Maryam Nawaz set out to change that. She launched an ambitious new Smog Control Program, aimed at a range of far-reaching measures intended to better control the region’s heavy air pollution from a variety of sources. These included shifting brick kilns to more modern technologies, along with other industrial pollution sources, encouraging a transition to electric vehicles (EV’s) and a shift away from burning crop residue. Observers say that the transition to cleaner brick kiln technology shows signs of progress, while the introduction of EVs will take much more time. The crop residue programme, meanwhile, included a stick and a carrot. The stick was a ban on stubble burning, punishable by fines of $170 for offenders. The carrot was the offer of new generation “Super Seeder” machines subsidised by 65%. Despite the smoggy skies over Lahore, Health Policy Watch conversations with Punjab farmers and experts suggest that the new “Super Seeder” technology shows some promise, although its benefits won’t be reaped this season. Happy Seeders didn’t work well Hamza Cheema sits atop his conventional tractor – which he uses to clear rice stubble. He’s waiting to see how the Super Seeder performs. The SuperSeeders represent an upgrade from first-generation “Happy Seeders” – which were introduced in Pakistan a decade ago, but never really took off. Speaking with Health Policy Watch, Hamza Cheema, a farmer from Wazirabad District, around 150 kilometres north of Lahore, explained why. “I tried the Happy Seeder once as well, but the [wheat] seeds often remain on the surface rather than going deep into the wet soil. That yields a poor wheat crop,” he explained. The Super Seeder’s new features address this by plunging the seed deep in the earth. But even with the generous subsidies offered on new machines, they remain a hefty purchase and farmers like Cheema are still waiting to see how they perform over time. “It softens the soil, making it easier to plant seeds deep into the ground and removes the rice straw residue, but I have not used it because it costs around $5000 USD (PKR 1. 5 million) to purchase,” he said. While many of his neighbors still prefer to pay the fines for crop-burning, imposed by government regulators, Cheema’s farm of about 100 acres lies adjacent to a forest, which he doesn’t own but still cherishes, and he fears that smoke would harm the tree cover. “So I continue to level the rice stalks on my land by plowing them under with a tractor,” said Cheema. Even though that process, followed by seeding, is time-consuming. Super Seeders: cost remains a barrier Super Seeders – upgraded machine yielding better results. About 200 kilometres south-west of Lahore, farmer, Dilawar Khan Rath was an early adopter of the new Super Seeder, and he’s happy with the results despite the investment it required. Rath, who farms about 125 acres, purchased his machine in 2023. He believes that the investment will pay off in the long-term, in terms of field operations. The machine mixes the stubble into the soil, which helps increase the fertility of the land- as compared to crop-burning, which depletes soil fertility. “It also saves time, as a single pass is required for land preparation, fertiliser placement, and seed sowing,” Rath explained. The machine’s expense makes it feasible largely for larger landholders. As the owner of 125 acres of fertile land, he falls into that category but could just about afford the investment. Maintenance costs are high because trained technicians are not widely available and fuel consumption is also significant. However, if the government reduced the interest rates on purchase loans and launching a leasing programme through local farm councils, the machines would catch on much more widely, he asserts. “The Punjab government is providing Super Seeders on subsidy, which is a good initiative, but their numbers are limited,” Rath said. Meanwhile, Rath is also conscious of the health and environmental benefits of using Super Seeders. Smog remains a serious problem in his district . Super Seeders: not the only solution Vaqar Zakriya Indeed, the Punjab government intends to launch a leasing programme for the new machines, according to the office of Punjab’s Chief Minister. “There are 300 Super Seeders in the whole of Punjab, and the government is adding 1,000 more, with a total of 5,000 to be added over the next five years,” said a statement by Chief Minister Nawaz. The price of purchasing a machine outright will be set at $1,800 – with the remaining $2,800 covered by the government. “Public cooperation is essential to eliminate smog,” she added. While pollution from burning crop residue is indeed an issue, it should also not be seen as the primary cause of environmental pollution, Vaqar Zakaria, an environmental activist, told Health Policy Watch. He said that there remains a lack of data, overall, on the contribution of crop-burning to Punjab’s overall pollution load. “This technology has helped address the issue of residue burning for farmers, but that the current focus should be on increasing its availability to reach more farmers,” Pakistan’s former Federal Minister for Climate Change, Malik Amin Aslam, told Health Policy Watch in an interview. He noted that the Super Seeder technology was in fact first introduced three years ago by the previous government – and since then it has gained significant popularity among farmers, resulting in a notable reduction in residue burning in Punjab. But regional dialogue and data exchange is also essential to tackle smog effectively – as East Asian countries did successfully, he stressed. “Only through data sharing and regional cooperation, can this issue be managed, adding that he believes India might be willing to participate in such efforts.” Image Credits: Punjab Enviornment Department, IQ Air , YouTube/Business Recorder , Rahul Basharat, Engro Energy. Inadequate Laws Allow Rapists to Avoid Punishment in Many African Countries 04/12/2024 Kerry Cullinan Sudanese women, many of whom became leaders of the 2019 revolution, are being targeted by soldiers using rape as a weapon of war. Rape is common across Africa yet inadequate laws, weak implementation and cultural barriers mean that many perpetrators go unpunished, according to new research by Equality Now. “After examining rape laws across Africa, it is clear that to end impunity for perpetrators, governments urgently need to carry out comprehensive legal reform of rape laws, strengthen enforcement mechanisms, and improve access to justice and support for survivors,” said Jean Paul Murunga, a human rights lawyer and the report’s lead author. The report looked at rape laws and their enforcement in 47 African countries with an in-depth analysis of nine of these: Cameroon, Democratic Republic of Congo, Madagascar, Rwanda, Senegal, Sierra Leone, South Africa, South Sudan, and Zambia. Equality Now Africa Director Faiza Jama Mohamed says that the report identifies “key gaps in rape law that result in routine denial of justice to survivors of sexual violence”. “The gaps include laws allowing the perpetrator to walk free on reaching some form of ‘settlement’, including marrying the victim; laws framed in terms of morality rather than bodily integrity, thereby perpetuating a cycle of violence and discrimination; laws that explicitly permit rape in marriage, even of children,” notes Mohamed, writing in the foreword of the report. Narrow definition of rape Approximately 33% of women in Africa have experienced intimate partner violence or sexual violence in their lifetime, while in West, East, Central, and Southern Africa, the rate 44%, according to UN Women. The African Development Bank’s Gender Data Index 2019 reported that intimate partner sexual or physical violence ranges from 10% to 40% across the continen “It is critical for its definitions in the various jurisdictions within Africa, both in the context of conflict and peace, to be clear and based on human rights standards,” adds the report. Rape is when a person has not given voluntary, genuine, and willing consent for sexual interaction – and that this consent can be withdrawn anytime during the interaction. “True consent is impossible in situations of dependency or extreme vulnerability, for example, in educational settings, correctional facilities, or when a victim is incapacitated, such as being intoxicated or infirm,” according to the report. Several countries’ definitions of rape or legal frameworks fail to recognise all forms of unwanted sexual penetration (anal, oral, or vaginal by use of any body part or object) as rape . Some 25 African countries have penal codes that are “incomplete or ambiguous and do not meet international standards” by, for example, confining the definition to acts of violence and failing to recognise rape involving intimidation, coercion, fraud, and unequal power dynamics. Marital rape not recognised Justice for rape survivors Cote D’Ivoire, Gambia, Seychelles, Equatorial Guinea, Ethiopia and South Sudan do not criminalise marital rape. South Sudan explicitly notes that non-consensual sexual intercourse within marriage does not constitute rape. The Penal Code of Côte d’Ivoire provides for the presumption of married couples’ consent to the sexual act unless proven otherwise. Eritrea only criminalize marital rape when spouses are not living together, while Tanzania criminalizes it if the couple is not living together. Lesotho recognises marital rape under certain conditions. In Gabon, where child marriage is legal, if an abductor has married an abducted minor, he can only be prosecuted after the marriage is annulled. “International human rights standards require states to criminalise all forms of rape, irrespective of the relationship between the perpetrator and their victim,” says Murunga. “Failing to specifically criminalise marital rape ignores how consent must be ongoing and freely given, regardless of marital status. Legal recognition provides clarity to law enforcement, prosecutors, and judges that marital rape must be treated as a serious crime and prosecuted accordingly.” Harmful traditional beliefs Although 20 African countries have consent-based definitions of rape, rapists are often shielded by traditional beliefs and societal attitudes towards sex. “Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation,” according to the report. In Equatorial Guinea, for example, out-of-court settlements are legally permitted when a rape victim explicitly or tacitly forgives the perpetrator. This often results in rape survivors being pressurised to agree to this route. In several countries, officials opt not to investigate, prosecute, or convict rape cases unless there is physical evidence, especially which indicates a victim fought back. “Many jurisdictions emphasize force, morality, or circumstances and apply gender-discriminatory concepts such as ‘honour’ and ‘modesty’. This prejudices judgments over victims’ behavior and “chastity” and whether they are perceived as deserving justice for having been raped,” the report notes. Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation. Inadequate punishment Sudanese women wait for treatment at Fashir Reproductive health centre. Many women are pregnant as a result of being raped during the conflict. The African Commission on Human and People’s Rights recommends 16 years imprisonment for rape, but many countries have thresholds well below this. In Equatorial Guinea, Article 429 of the Criminal Code states that “rape of a woman shall be punished with minor confinement. Guinea Bissau includes an exemption where ‘the behavior of the victim has considerably contributed” to the rape. Even where not elaborated in the law, settlements with respect to rape are reportedly common in Benin, Cameroon, Chad, Côte d’Ivoire, The Gambia, Ghana, Guinea, Liberia, Nigeria and South Sudan. In South Africa, there is a serious backlog of rape cases and insufficient funding for the justice delivery system. In May 2022, the Minister of Justice announced that only 19% of reported cases were going through the courts. With the breakdown of the rule of law and security in conflicts, women and girls are rmore vulerable. In addition, rape is still being used as “a weapon of war to denigrate, disempower, demoralize and destroy communities”, the report notes. During conflict, reporting cases, collecting evidence and prosecution are often huge challenges. Providing justice to survivors of sexual violence and ensuring perpetrators do not enjoy impunity is critical in preventing and addressing rape With so many legal, procedural, and societal obstacles to addressing rape, very few cases make it to court, and even fewer result in conviction. Urgent reform Urgent reform is needed to ensure legal definitions of rape encompass all acts of non-consensual sexual penetration, with no exceptions for marital rape, according to the report. It also calls for adequate training of government officials to ensure laws are implemented and other measures including a register of sex offenders. “Effective legal implementation is equally crucial, requiring robust mechanisms to enforce justice and hold perpetrators accountable. Transparency and accountability are essential to building trust and ensuring fairness in how cases are handled,” the report notes. It advocates for supportive systems for rape survivors that” facilitate healing and enable them to pursue justice if they choose” Rwanda is highlighted as a positive example for promoting a “victim-centered approach to investigating and prosecuting sexual violence cases” that includes .gender-based violence recovery centers in numerous districts, providing survivors with witness protection, medical and psychosocial support, and legal aid. Image Credits: CC, Mohamed Zakaria/ UNICEF. Amid Global HIV Funding Challenges, PEPFAR Head Will Resign Before Trump Takes Office 03/12/2024 Kerry Cullinan Ambassador John Nkengasong, head of PEPFAR. As a political appointee, Ambassador John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January. “The rules that govern a transition are that all the political appointees have to resign on the 20th and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday. However, he stressed that PEPFAR has been a bipartisan programme since its inception in 2003 when it was launched by Republican President George W Bush. “It has since enjoyed the support of all administrations,” said Nkengasong, the US Global AIDS Coordinator in the Bureau of Health Security and Diplomacy. Nkengasong was appointed by President Joe Biden, confirmed by the US Senate in May 2022, and he started work the following month. PEPFAR’s achievements by 2024. Nkengasong is a Cameronian-born US citizen, who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the COVID-19 pandemic. Prior to that, he had worked for the US Centers for Disease Control and Prevention, as well as at the World Health Organization. “We should always think about PEPFAR, not the individual – 26 million lives saved over the last 21 years,” Nkengasong stressed at the briefing, although his re-appointment prospects are regarded as slim. “PEPFAR was reauthorised [by the US Congress] for one year last year. That reauthorisation expires in March, and we are hoping that we’ll get a clean five-year reauthorisation going forward,” he added. But this may not be plain sailing. PEPFAR has come under attack from US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion. This is why the programme only received a one-year extension rather than the usual five years. Trump has made cutting government spending and opposing abortion cornerstones of his election campaign, which does not augur well for the campaign to end AIDS by 2030. HIV money is drying up HIV is incurable but thanks to antiretroviral (ARV) drugs, it has become a controllable chronic disease and if people living with the virus have an undetectable viral load, they don’t transmit HIV. As many as 25 million people depend on PEPFAR and the Global Fund to subsidise their ARVs, which they need to take for life. Yet money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023. Meanwhile, donor resources for HIV dropped by 5%, UNAIDS Deputy Director Christine Stegling told the briefing. UNAIDS deputy director Christine Stegling. Global Fund executive director Peter Sands said that global overseas development assistance is under pressure, and health has lost its “prime spot” to both climate change and conflict. “There is a particular issue with funding for HIV/ AIDS, which is that we run the risk of being a victim of our own success. Because the number of people dying has dropped so much, and because HIV/ AIDS is no longer seen as that much of a threat in donor nations themselves, it’s dropped off the radar screen and seems like an old problem; one that’s largely won or gone away,” said Sands. “But HIV is a formidable adversary. We are nowhere near getting a vaccine, and we don’t have a cure for it yet.” But the single-minded focus on eliminating HIV has made “extraordinary progress”, Sands added. “AIDS-related deaths have come down by 51% since 2010 and more than three-quarters of people living with HIV are on treatment, but we still have another nine million people not on treatment and we still have 1.3 million new infections each year,” according to Stegling. Shift to domestic financing Economist Professor Dean Jamison, co-chair of the Lancet Commission on investing in health, says it is unlikely that for a better response to funding HIV globally. “So that does put greater emphasis on a transition to domestic finance where the reliance has been substantially on donors. It’s not to say that the external finance is likely to go away and then there won’t be important additions to that. I would be looking to parts of Asia for external finance, but on the domestic side, what are the range of options?” asked Jamison, who is an emeritus professor of Global Health Financing at UCSF, UCLA and the University of Washington. Poor countries would prioritise HIV spending, likely focusing on preventive interventions and treatment. Drawing on private resources, perhaps through payroll taxes, may also be a solution. Professor Dean Jamison Stegling singled out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing for HIV. “Last year in GDP term, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted. Meanwhile, sub-Saharan Africa loses about $80 billion in uncollected tax revenue. Debt relief, future financing at affordable rates and better tax revenue collection are the solutions UNAIDS is focusing on. “These are the issues of the future that we need to look into if we’re talking about self reliance, more resilient systems for health that are financed by countries, by every country themselves,” Stegling noted. With South Africa being the chair of the G20 next year, she sees “an amazing opportunity” for African leadership debt restructuring and different financing mechanisms. What lies ahead? Stegling says donors are likely to move into “gaps”, such as human rights protections for particular marginalized groups that might not immediately find support from their governments. Meanwhile, Nkengasong stressed that progress should not be confused with success. “The progress that we have made is very fragile,” Nkengasong stressed. PEPFAR did an analysis of 10 to 12 high-burden countries that it supports and found that, to maintain their programmes if PEPFAR was unable to fund them would result in debt risk increasing by 400 percentage point,. “Are we ready to live with this? We pride ourselves with the success we’ve made over the last 25 years or so against HIV. But the response to HIV is extremely fragile. It’s extremely fragile because it requires that the millions of people that are receiving treatment receive that treatment every day. “We cannot afford to leave them behind. If we do that, the billions that we’ve put into the fight against HIV AIDS will be completely wasted.” Image Credits: US State Department. UN Plastic Pollution Treaty Derailed as Fossil Fuel Nations Block Production Limits 03/12/2024 Stefan Anderson Global plastic production is set to triple by 2050, even as only 9% of plastic waste has ever been recycled. Negotiations to produce a legally binding treaty to curb the global explosion of plastic pollution fell short on Sunday as efforts to limit the production of fossil fuel-based plastics supported by over 100 countries, including the European Union, met fierce opposition from oil-producing nations. A coalition of oil and gas producers led by Saudi Arabia that included Iran, Russia, and other Gulf states under the Arab group, opposed capping plastic production, insisting the treaty should focus solely on plastics waste management. Negotiations this week in Busan, South Korea (known as INC-5), were meant to be the final round of a two-year process to create what the UN Environment Agency and environmental groups called “the most important multilateral treaty” since the 2015 Paris climate agreement. Instead, the Busan summit became the third major failure of multilateral environmental negotiations in as many weeks, following disappointing outcomes at COP29 in Baku and a total collapse of talks over new funding and enforcement mechanisms at the UN Convention on Biological Diversity’s COP16 in Cali, Colombia, which aimed to protect nature and wildlife. “A few critical issues still prevent us from reaching a comprehensive agreement,” said the chair of the negotiations, Luis Vayas Valdivieso, Sunday evening, in delivering the message there would be no final outcome at this round. Nearly 200 nations participated in the negotiations. The next round of plastics negotiations has not been scheduled or assigned a location. “Our mandate has always been ambitious. But ambition takes time to land,” Valdivieso said. “We have many of the elements that we need, and Busan has put us firmly on a pathway to success … to reverse and remedy the severe effects of plastic pollution on ecosystems and human health.” Deep fault lines unresolved Microplastics were detected in human blood for the first time this year, heightening research efforts to understand their effects on our health. Deep fault lines have persisted since talks began in Paris in March 2022. Nations remain divided over plastic production limits, bans on harmful chemicals in plastics, recycling’s role in solving the crisis, and funding for developing nations to implement the treaty’s goals. The scale of disagreement was laid bare in the previous negotiating round in Ottawa in April, which produced a near-illegible draft with 3,400 disputed sections. The final text published by the chair has whittled these down to 340 contested items, but the core disputes that have defined debates since the start remain unsolved. “It is clear there is persisting divergence in critical areas,” UNEP executive director Inger Andersen said in a statement, adding that talks had “moved us closer” to a legally binding treaty to protect “our future from the onslaught of plastic pollution.” While the failure to reach an agreement after 18 months marks a significant setback, other major UN environmental processes have faced far longer paths. It took three decades for climate negotiations to formally acknowledge fossil fuels’ role in global warming, while UN biodiversity talks reached their first binding treaty in 2022, thirty years after the 1992 Rio Earth Summit. “The world’s commitment to ending plastic pollution is clear and undeniable,” Andersen said. “More time is needed.” Ambition up Plastic waste is contaminating land, water and even food resources, with unknown health harms, experts have warned. More than 100 countries, including the EU and the United Kingdom, backed a Panama-led draft text in Busan calling for reducing plastic production to “sustainable levels”. The proposal would require nations to report their plastic production, import and export data to monitor global progress on curbing new plastics. The level of support mirrors broader backing for tough measures on plastics. WWF tallies from the third round of negotiations in Nairobi in late 2023 showed over 100 countries favouring bans or phase-outs of the most harmful plastics, with 140 pushing for a legally binding treaty. These nations argue plastic production is the root of the crisis. In the thousand days since nations first agreed to establish a binding treaty on plastic pollution, manufacturers have produced more than 800 million tonnes of new plastic, over 30 million tonnes have leaked into oceans, while millions more have been incinerated or sent to landfills. “Postponing negotiations does not postpone the crisis,” Panama’s lead negotiator, Juan Carlos Monterrey Gomez, told the closing plenary on Sunday. “When we reconvene, the stakes will be higher. This is not a drill, this is a fight for survival. We did not accept a weak treaty here, and we never will.” But the bloc known as the “like-minded” group of petrochemical producers, led by Saudi Arabia and including Russia, Iran, and other Arab states, oppose Panama’s proposal to limit production. These nations argue that including production limits oversteps the treaty’s mandate, which they say should focus solely on plastic pollution and waste. Their plan to maintain plastic production growth threatens to derail global climate goals. Scientists estimate that a 75% reduction in plastic production is needed by 2040 to keep global warming to 1.5 degrees Celsius. Without such cuts, plastic production alone could consume up to 31% of the world’s remaining carbon budget to stay within that critical temperature threshold. Health risks mount as treaty’s approach remains undecided Beyond the climate impacts, plastics pose escalating health risks through contamination of air, water, soil, and through those channels, terrestrial food chains and ocean life – all pathways for contaminants to penetrate people’s bodies. Scientists have detected plastic particles in human blood, lungs, breast milk, and unborn children. Research shows that people unknowingly consume about five grams of microplastics weekly through eating, drinking and breathing, while over 3,200 chemicals in plastics have known toxic effects and another 5,000 remain inadequately studied. Researchers have even discovered “plasticosis,” a new condition where microplastics alter cell behaviour in human and animal organs. Despite this growing evidence base, the treaty’s approach to health remains undecided. The final text presents two options: a standalone health article championed by Brazil, or strengthened health references throughout the document. With negotiations in Busan conducted behind closed doors, countries’ positions on this choice remain unclear. “Our babies are entering this world with their brains and bodies already contaminated with plastics, exposing them to toxic chemicals that can affect their ability to learn and increase their risk of endocrine disorders, reproductive harm, and cancers,” Aileen Lucero from the International Pollutants Elimination Network (IPEN) told delegates at the closing session. The financial toll on health is mounting. The Endocrine Society found just four families of plastic chemicals cause over $400 billion in annual health costs in the United States alone. Globally, the UN Environment Programme warns that inaction on chemical and plastic pollution could cost up to 10% of global GDP. “The science is clear: A treaty that protects human health and the environment needs to address the issues of plastic production and chemicals,” said Bethanie Carney Almroth, Professor at the University of Gothenburg, speaking for the Scientists’ Coalition for an Effective Plastics Treaty, a network of over 400 independent experts. Paradox for the healthcare industry There is also a paradox, however, for healthcare professionals. The healthcare industry relies heavily on plastics like PVC in essential medical equipment from IV tubing to protective gloves and masks. The COVID-19 pandemic only deepened this dependence as single-use protective gloves and masks became even more widely used by the general public, as well as health care practitioners, for infection prevention. But at the same time that a growing chorus of voices in the health sector also are calling attention to the health impacts of plastics in medical devices. Groups like Health Care Without Harm have worked to reduce use, and improve management, of plastics in health care facilities, and particularly of PVC, whose production requires large inputs of highly toxic mercury, asbestos or PFAS [per- and polyfluoroalkyl. One PVC’s main building blocks, vinyl chloride, is a potent carcinogen. They also have called out the impacts of health sector medical waste incineration – which in low- and middle-income countries may be in primitive stoves or open pit fires. This further generates community exposures to dangerous particulate pollution as well as longer-lived Persistent Organic Pollutants (POPS), such as dioxins and furans. At the same time, improving health sector management of plastics used, and eventually transition to new types of single-use materials that are both safe and environmentally friendly is not an easy process – a widely acknowledged fact of life. “There are specific considerations for the health industry due to the stringent regulatory rules that are applied to ensure that materials meet rigorous quality, safety, and efficacy standards to protect patient health. Changes require time and resources, from industry and from national regulatory agencies, to be implemented. Testing and validation of innovative packaging material can take up to 5-10 years to complete,” said the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a joint statment with the Global Self Care Federation and the International Generic and Biosimilar Medicines Association, at the start of the Busan meeting. “We believe it is possible to achieve a treaty that protects both the environment and human health, through harmonized, targeted extended compliance periods; in line with regulatory standards and timelines; and through limited exemptions where no feasible and safe alternatives exist at sufficient quality and scale,” the statement continued. “It will be critical to include such provisions in both the instrument and the annexes, as required. This will provide the approach needed to transition while new or alternative materials, processes, and formulations are established in collaboration with regulatory authorities.” Fossil fuels crash the party, again Unrecycled plastics have knock-on effects on the environment, emissions, biodiversity, and human health. Regardless of whether the concerns related to health, environment or climate, oil-producing nations maintained the treaty’s focus should be on the waste, and not the product itself. “The objective of this treaty is to end plastic pollution, not plastic itself,” Kuwait stated for the “like-minded group” of fossil fuel producers on the final day. “Attempting to phase out plastic rather than addressing the issue of plastic production risks undermining global progress and exacerbating economic inequality.” With negotiations largely behind closed doors, observer access was limited. Yet reports emerged of Saudi Arabia’s blocking tactics – from demanding unanimity on every decision to raising repeated procedural objections. The Saudi delegation even disputed a Brazilian working group leader’s authority to schedule a lunch meeting to recover lost time, the New York Times reported. The Global Partnership for Plastics Circularity, an industry group established specifically to influence the treaty talks and representing fossil fuel giants like Saudi Aramco, Chevron, Shell, and ExxonMobil, emphasised “addressing mismanaged waste” through improved recycling and waste collection systems. These arguments mirror tactics the petrochemical industry has employed since the 1960s. But decades of evidence tell a different story. Of the 8.3 billion tons of plastic ever produced, only 9% has been recycled, while 79% has ended up in landfills or the environment. The 2023 Plastics Overshoot report found that 43% of plastic produced globally is mismanaged and will likely contaminate air, water, or soil. The 2023 Plastic Waste Makers Index, meanwhile, called recycling “at most, a marginal activity” – and with increasingly complex chemical compositions in plastics, the problem is only getting worse. Industry’s strategic pivot Top 20 global producers of single-use plastics for the year 2021. The list remains effectively unchanged since 2019. The fierce resistance to production limits stems from oil-producing nations’ strategic pivot toward plastics as traditional markets decline. For the fossil fuel industry and its partners, plastics offer a horizon for continued expansion even as power grids and vehicles shift to renewable energy. Petrochemicals and plastics are projected to become oil’s primary demand driver – accounting for half of consumption by 2050, according to IEA forecasts, with plastic production set to represent 20% of oil and gas output. While Saudi Arabia led the fight against production caps in Busan, it’s part of a broader trend. Despite global pledges on climate and plastic pollution, major petrochemical investments continue across the Middle East, China, and the US, University of Lund research shows. For oil and gas producers, plastics offer a profitable sanctuary as clean energy expands. Petrochemicals yield higher margins than transport fuels – crucial as energy-sector fossil fuel demand wanes. Lost in the battles in Busan were the positions of the world’s two largest plastic producers. Both China and the United States were notably absent when treaty advocates made their case for production limits on Sunday. Though the US backed production cuts earlier this year, observers suggest this position is likely to shift following Donald Trump’s recent victory and pledges to continue expanding record levels of oil production. Beijing has put forth proposals to limit the use of harmful chemicals in plastics, but shown little interest in capping production. Plastics lobbyists swarm talks Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia. Plastic-producing nations were supported by an unprecedented industry presence at the UN talks. Fossil fuel and chemical industry lobbyists formed the largest single delegation, with 220 representatives. This group outnumbered both the European Union’s combined delegation and the host country South Korea’s representatives, according to analysis by the Center for International Environmental Law. The industry’s efforts to shape the treaty have been extensive. Over 93% of statements opposing an ambitious treaty came from chemical and petrochemical sectors, with companies like ExxonMobil, Dow Inc, BASF, and SABIC leading efforts to weaken the agreement, according to a report released during the talks by InfluenceMap. “Their strategy — lifted straight from the climate negotiations playbook — is designed to preserve the financial interests of countries and companies who are putting their fossil-fueled profits above human health, human rights, and the future of the planet,” said Delphine Levi Alvares, Global Petrochemical Campaign Manager at CIEL. The industry’s aggressive presence at the talks reflects what’s at stake. Petrochemical companies increasingly see plastics as a safe haven from carbon regulations as demand for fossil fuels declines in other sectors. This pivot to plastics production helps offset falling fuel demand, but threatens to dramatically increase plastic waste globally, research shows. “There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives (GAIA), representing local communities affected by plastic pollution, said in a statement. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.” Updated 3 December with added content on health sector plastics use. Image Credits: Photo by Hermes Rivera on Unsplash, University of Oregon, UNEP, QPhia. Pandemic Agreement: ‘Get it done’ 02/12/2024 Kerry Cullinan Dame Barbara Stocking urged negotiators to reach agreement. At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations. “The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors. “It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.” Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”. “As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros. “I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week. Handful of outstanding issues Yuan Qiong Hu of Medecins sans Frontieres (MSF) Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement. Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D. The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials. “Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. “You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked. “On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. “Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.” IFPMA’s Grega Kumer The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. “The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer. “To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting, regulatory challenges, limited absorption capacity and export restrictions,” he added. “The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added. Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring. Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday. Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. 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Inadequate Laws Allow Rapists to Avoid Punishment in Many African Countries 04/12/2024 Kerry Cullinan Sudanese women, many of whom became leaders of the 2019 revolution, are being targeted by soldiers using rape as a weapon of war. Rape is common across Africa yet inadequate laws, weak implementation and cultural barriers mean that many perpetrators go unpunished, according to new research by Equality Now. “After examining rape laws across Africa, it is clear that to end impunity for perpetrators, governments urgently need to carry out comprehensive legal reform of rape laws, strengthen enforcement mechanisms, and improve access to justice and support for survivors,” said Jean Paul Murunga, a human rights lawyer and the report’s lead author. The report looked at rape laws and their enforcement in 47 African countries with an in-depth analysis of nine of these: Cameroon, Democratic Republic of Congo, Madagascar, Rwanda, Senegal, Sierra Leone, South Africa, South Sudan, and Zambia. Equality Now Africa Director Faiza Jama Mohamed says that the report identifies “key gaps in rape law that result in routine denial of justice to survivors of sexual violence”. “The gaps include laws allowing the perpetrator to walk free on reaching some form of ‘settlement’, including marrying the victim; laws framed in terms of morality rather than bodily integrity, thereby perpetuating a cycle of violence and discrimination; laws that explicitly permit rape in marriage, even of children,” notes Mohamed, writing in the foreword of the report. Narrow definition of rape Approximately 33% of women in Africa have experienced intimate partner violence or sexual violence in their lifetime, while in West, East, Central, and Southern Africa, the rate 44%, according to UN Women. The African Development Bank’s Gender Data Index 2019 reported that intimate partner sexual or physical violence ranges from 10% to 40% across the continen “It is critical for its definitions in the various jurisdictions within Africa, both in the context of conflict and peace, to be clear and based on human rights standards,” adds the report. Rape is when a person has not given voluntary, genuine, and willing consent for sexual interaction – and that this consent can be withdrawn anytime during the interaction. “True consent is impossible in situations of dependency or extreme vulnerability, for example, in educational settings, correctional facilities, or when a victim is incapacitated, such as being intoxicated or infirm,” according to the report. Several countries’ definitions of rape or legal frameworks fail to recognise all forms of unwanted sexual penetration (anal, oral, or vaginal by use of any body part or object) as rape . Some 25 African countries have penal codes that are “incomplete or ambiguous and do not meet international standards” by, for example, confining the definition to acts of violence and failing to recognise rape involving intimidation, coercion, fraud, and unequal power dynamics. Marital rape not recognised Justice for rape survivors Cote D’Ivoire, Gambia, Seychelles, Equatorial Guinea, Ethiopia and South Sudan do not criminalise marital rape. South Sudan explicitly notes that non-consensual sexual intercourse within marriage does not constitute rape. The Penal Code of Côte d’Ivoire provides for the presumption of married couples’ consent to the sexual act unless proven otherwise. Eritrea only criminalize marital rape when spouses are not living together, while Tanzania criminalizes it if the couple is not living together. Lesotho recognises marital rape under certain conditions. In Gabon, where child marriage is legal, if an abductor has married an abducted minor, he can only be prosecuted after the marriage is annulled. “International human rights standards require states to criminalise all forms of rape, irrespective of the relationship between the perpetrator and their victim,” says Murunga. “Failing to specifically criminalise marital rape ignores how consent must be ongoing and freely given, regardless of marital status. Legal recognition provides clarity to law enforcement, prosecutors, and judges that marital rape must be treated as a serious crime and prosecuted accordingly.” Harmful traditional beliefs Although 20 African countries have consent-based definitions of rape, rapists are often shielded by traditional beliefs and societal attitudes towards sex. “Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation,” according to the report. In Equatorial Guinea, for example, out-of-court settlements are legally permitted when a rape victim explicitly or tacitly forgives the perpetrator. This often results in rape survivors being pressurised to agree to this route. In several countries, officials opt not to investigate, prosecute, or convict rape cases unless there is physical evidence, especially which indicates a victim fought back. “Many jurisdictions emphasize force, morality, or circumstances and apply gender-discriminatory concepts such as ‘honour’ and ‘modesty’. This prejudices judgments over victims’ behavior and “chastity” and whether they are perceived as deserving justice for having been raped,” the report notes. Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation. Inadequate punishment Sudanese women wait for treatment at Fashir Reproductive health centre. Many women are pregnant as a result of being raped during the conflict. The African Commission on Human and People’s Rights recommends 16 years imprisonment for rape, but many countries have thresholds well below this. In Equatorial Guinea, Article 429 of the Criminal Code states that “rape of a woman shall be punished with minor confinement. Guinea Bissau includes an exemption where ‘the behavior of the victim has considerably contributed” to the rape. Even where not elaborated in the law, settlements with respect to rape are reportedly common in Benin, Cameroon, Chad, Côte d’Ivoire, The Gambia, Ghana, Guinea, Liberia, Nigeria and South Sudan. In South Africa, there is a serious backlog of rape cases and insufficient funding for the justice delivery system. In May 2022, the Minister of Justice announced that only 19% of reported cases were going through the courts. With the breakdown of the rule of law and security in conflicts, women and girls are rmore vulerable. In addition, rape is still being used as “a weapon of war to denigrate, disempower, demoralize and destroy communities”, the report notes. During conflict, reporting cases, collecting evidence and prosecution are often huge challenges. Providing justice to survivors of sexual violence and ensuring perpetrators do not enjoy impunity is critical in preventing and addressing rape With so many legal, procedural, and societal obstacles to addressing rape, very few cases make it to court, and even fewer result in conviction. Urgent reform Urgent reform is needed to ensure legal definitions of rape encompass all acts of non-consensual sexual penetration, with no exceptions for marital rape, according to the report. It also calls for adequate training of government officials to ensure laws are implemented and other measures including a register of sex offenders. “Effective legal implementation is equally crucial, requiring robust mechanisms to enforce justice and hold perpetrators accountable. Transparency and accountability are essential to building trust and ensuring fairness in how cases are handled,” the report notes. It advocates for supportive systems for rape survivors that” facilitate healing and enable them to pursue justice if they choose” Rwanda is highlighted as a positive example for promoting a “victim-centered approach to investigating and prosecuting sexual violence cases” that includes .gender-based violence recovery centers in numerous districts, providing survivors with witness protection, medical and psychosocial support, and legal aid. Image Credits: CC, Mohamed Zakaria/ UNICEF. Amid Global HIV Funding Challenges, PEPFAR Head Will Resign Before Trump Takes Office 03/12/2024 Kerry Cullinan Ambassador John Nkengasong, head of PEPFAR. As a political appointee, Ambassador John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January. “The rules that govern a transition are that all the political appointees have to resign on the 20th and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday. However, he stressed that PEPFAR has been a bipartisan programme since its inception in 2003 when it was launched by Republican President George W Bush. “It has since enjoyed the support of all administrations,” said Nkengasong, the US Global AIDS Coordinator in the Bureau of Health Security and Diplomacy. Nkengasong was appointed by President Joe Biden, confirmed by the US Senate in May 2022, and he started work the following month. PEPFAR’s achievements by 2024. Nkengasong is a Cameronian-born US citizen, who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the COVID-19 pandemic. Prior to that, he had worked for the US Centers for Disease Control and Prevention, as well as at the World Health Organization. “We should always think about PEPFAR, not the individual – 26 million lives saved over the last 21 years,” Nkengasong stressed at the briefing, although his re-appointment prospects are regarded as slim. “PEPFAR was reauthorised [by the US Congress] for one year last year. That reauthorisation expires in March, and we are hoping that we’ll get a clean five-year reauthorisation going forward,” he added. But this may not be plain sailing. PEPFAR has come under attack from US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion. This is why the programme only received a one-year extension rather than the usual five years. Trump has made cutting government spending and opposing abortion cornerstones of his election campaign, which does not augur well for the campaign to end AIDS by 2030. HIV money is drying up HIV is incurable but thanks to antiretroviral (ARV) drugs, it has become a controllable chronic disease and if people living with the virus have an undetectable viral load, they don’t transmit HIV. As many as 25 million people depend on PEPFAR and the Global Fund to subsidise their ARVs, which they need to take for life. Yet money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023. Meanwhile, donor resources for HIV dropped by 5%, UNAIDS Deputy Director Christine Stegling told the briefing. UNAIDS deputy director Christine Stegling. Global Fund executive director Peter Sands said that global overseas development assistance is under pressure, and health has lost its “prime spot” to both climate change and conflict. “There is a particular issue with funding for HIV/ AIDS, which is that we run the risk of being a victim of our own success. Because the number of people dying has dropped so much, and because HIV/ AIDS is no longer seen as that much of a threat in donor nations themselves, it’s dropped off the radar screen and seems like an old problem; one that’s largely won or gone away,” said Sands. “But HIV is a formidable adversary. We are nowhere near getting a vaccine, and we don’t have a cure for it yet.” But the single-minded focus on eliminating HIV has made “extraordinary progress”, Sands added. “AIDS-related deaths have come down by 51% since 2010 and more than three-quarters of people living with HIV are on treatment, but we still have another nine million people not on treatment and we still have 1.3 million new infections each year,” according to Stegling. Shift to domestic financing Economist Professor Dean Jamison, co-chair of the Lancet Commission on investing in health, says it is unlikely that for a better response to funding HIV globally. “So that does put greater emphasis on a transition to domestic finance where the reliance has been substantially on donors. It’s not to say that the external finance is likely to go away and then there won’t be important additions to that. I would be looking to parts of Asia for external finance, but on the domestic side, what are the range of options?” asked Jamison, who is an emeritus professor of Global Health Financing at UCSF, UCLA and the University of Washington. Poor countries would prioritise HIV spending, likely focusing on preventive interventions and treatment. Drawing on private resources, perhaps through payroll taxes, may also be a solution. Professor Dean Jamison Stegling singled out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing for HIV. “Last year in GDP term, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted. Meanwhile, sub-Saharan Africa loses about $80 billion in uncollected tax revenue. Debt relief, future financing at affordable rates and better tax revenue collection are the solutions UNAIDS is focusing on. “These are the issues of the future that we need to look into if we’re talking about self reliance, more resilient systems for health that are financed by countries, by every country themselves,” Stegling noted. With South Africa being the chair of the G20 next year, she sees “an amazing opportunity” for African leadership debt restructuring and different financing mechanisms. What lies ahead? Stegling says donors are likely to move into “gaps”, such as human rights protections for particular marginalized groups that might not immediately find support from their governments. Meanwhile, Nkengasong stressed that progress should not be confused with success. “The progress that we have made is very fragile,” Nkengasong stressed. PEPFAR did an analysis of 10 to 12 high-burden countries that it supports and found that, to maintain their programmes if PEPFAR was unable to fund them would result in debt risk increasing by 400 percentage point,. “Are we ready to live with this? We pride ourselves with the success we’ve made over the last 25 years or so against HIV. But the response to HIV is extremely fragile. It’s extremely fragile because it requires that the millions of people that are receiving treatment receive that treatment every day. “We cannot afford to leave them behind. If we do that, the billions that we’ve put into the fight against HIV AIDS will be completely wasted.” Image Credits: US State Department. UN Plastic Pollution Treaty Derailed as Fossil Fuel Nations Block Production Limits 03/12/2024 Stefan Anderson Global plastic production is set to triple by 2050, even as only 9% of plastic waste has ever been recycled. Negotiations to produce a legally binding treaty to curb the global explosion of plastic pollution fell short on Sunday as efforts to limit the production of fossil fuel-based plastics supported by over 100 countries, including the European Union, met fierce opposition from oil-producing nations. A coalition of oil and gas producers led by Saudi Arabia that included Iran, Russia, and other Gulf states under the Arab group, opposed capping plastic production, insisting the treaty should focus solely on plastics waste management. Negotiations this week in Busan, South Korea (known as INC-5), were meant to be the final round of a two-year process to create what the UN Environment Agency and environmental groups called “the most important multilateral treaty” since the 2015 Paris climate agreement. Instead, the Busan summit became the third major failure of multilateral environmental negotiations in as many weeks, following disappointing outcomes at COP29 in Baku and a total collapse of talks over new funding and enforcement mechanisms at the UN Convention on Biological Diversity’s COP16 in Cali, Colombia, which aimed to protect nature and wildlife. “A few critical issues still prevent us from reaching a comprehensive agreement,” said the chair of the negotiations, Luis Vayas Valdivieso, Sunday evening, in delivering the message there would be no final outcome at this round. Nearly 200 nations participated in the negotiations. The next round of plastics negotiations has not been scheduled or assigned a location. “Our mandate has always been ambitious. But ambition takes time to land,” Valdivieso said. “We have many of the elements that we need, and Busan has put us firmly on a pathway to success … to reverse and remedy the severe effects of plastic pollution on ecosystems and human health.” Deep fault lines unresolved Microplastics were detected in human blood for the first time this year, heightening research efforts to understand their effects on our health. Deep fault lines have persisted since talks began in Paris in March 2022. Nations remain divided over plastic production limits, bans on harmful chemicals in plastics, recycling’s role in solving the crisis, and funding for developing nations to implement the treaty’s goals. The scale of disagreement was laid bare in the previous negotiating round in Ottawa in April, which produced a near-illegible draft with 3,400 disputed sections. The final text published by the chair has whittled these down to 340 contested items, but the core disputes that have defined debates since the start remain unsolved. “It is clear there is persisting divergence in critical areas,” UNEP executive director Inger Andersen said in a statement, adding that talks had “moved us closer” to a legally binding treaty to protect “our future from the onslaught of plastic pollution.” While the failure to reach an agreement after 18 months marks a significant setback, other major UN environmental processes have faced far longer paths. It took three decades for climate negotiations to formally acknowledge fossil fuels’ role in global warming, while UN biodiversity talks reached their first binding treaty in 2022, thirty years after the 1992 Rio Earth Summit. “The world’s commitment to ending plastic pollution is clear and undeniable,” Andersen said. “More time is needed.” Ambition up Plastic waste is contaminating land, water and even food resources, with unknown health harms, experts have warned. More than 100 countries, including the EU and the United Kingdom, backed a Panama-led draft text in Busan calling for reducing plastic production to “sustainable levels”. The proposal would require nations to report their plastic production, import and export data to monitor global progress on curbing new plastics. The level of support mirrors broader backing for tough measures on plastics. WWF tallies from the third round of negotiations in Nairobi in late 2023 showed over 100 countries favouring bans or phase-outs of the most harmful plastics, with 140 pushing for a legally binding treaty. These nations argue plastic production is the root of the crisis. In the thousand days since nations first agreed to establish a binding treaty on plastic pollution, manufacturers have produced more than 800 million tonnes of new plastic, over 30 million tonnes have leaked into oceans, while millions more have been incinerated or sent to landfills. “Postponing negotiations does not postpone the crisis,” Panama’s lead negotiator, Juan Carlos Monterrey Gomez, told the closing plenary on Sunday. “When we reconvene, the stakes will be higher. This is not a drill, this is a fight for survival. We did not accept a weak treaty here, and we never will.” But the bloc known as the “like-minded” group of petrochemical producers, led by Saudi Arabia and including Russia, Iran, and other Arab states, oppose Panama’s proposal to limit production. These nations argue that including production limits oversteps the treaty’s mandate, which they say should focus solely on plastic pollution and waste. Their plan to maintain plastic production growth threatens to derail global climate goals. Scientists estimate that a 75% reduction in plastic production is needed by 2040 to keep global warming to 1.5 degrees Celsius. Without such cuts, plastic production alone could consume up to 31% of the world’s remaining carbon budget to stay within that critical temperature threshold. Health risks mount as treaty’s approach remains undecided Beyond the climate impacts, plastics pose escalating health risks through contamination of air, water, soil, and through those channels, terrestrial food chains and ocean life – all pathways for contaminants to penetrate people’s bodies. Scientists have detected plastic particles in human blood, lungs, breast milk, and unborn children. Research shows that people unknowingly consume about five grams of microplastics weekly through eating, drinking and breathing, while over 3,200 chemicals in plastics have known toxic effects and another 5,000 remain inadequately studied. Researchers have even discovered “plasticosis,” a new condition where microplastics alter cell behaviour in human and animal organs. Despite this growing evidence base, the treaty’s approach to health remains undecided. The final text presents two options: a standalone health article championed by Brazil, or strengthened health references throughout the document. With negotiations in Busan conducted behind closed doors, countries’ positions on this choice remain unclear. “Our babies are entering this world with their brains and bodies already contaminated with plastics, exposing them to toxic chemicals that can affect their ability to learn and increase their risk of endocrine disorders, reproductive harm, and cancers,” Aileen Lucero from the International Pollutants Elimination Network (IPEN) told delegates at the closing session. The financial toll on health is mounting. The Endocrine Society found just four families of plastic chemicals cause over $400 billion in annual health costs in the United States alone. Globally, the UN Environment Programme warns that inaction on chemical and plastic pollution could cost up to 10% of global GDP. “The science is clear: A treaty that protects human health and the environment needs to address the issues of plastic production and chemicals,” said Bethanie Carney Almroth, Professor at the University of Gothenburg, speaking for the Scientists’ Coalition for an Effective Plastics Treaty, a network of over 400 independent experts. Paradox for the healthcare industry There is also a paradox, however, for healthcare professionals. The healthcare industry relies heavily on plastics like PVC in essential medical equipment from IV tubing to protective gloves and masks. The COVID-19 pandemic only deepened this dependence as single-use protective gloves and masks became even more widely used by the general public, as well as health care practitioners, for infection prevention. But at the same time that a growing chorus of voices in the health sector also are calling attention to the health impacts of plastics in medical devices. Groups like Health Care Without Harm have worked to reduce use, and improve management, of plastics in health care facilities, and particularly of PVC, whose production requires large inputs of highly toxic mercury, asbestos or PFAS [per- and polyfluoroalkyl. One PVC’s main building blocks, vinyl chloride, is a potent carcinogen. They also have called out the impacts of health sector medical waste incineration – which in low- and middle-income countries may be in primitive stoves or open pit fires. This further generates community exposures to dangerous particulate pollution as well as longer-lived Persistent Organic Pollutants (POPS), such as dioxins and furans. At the same time, improving health sector management of plastics used, and eventually transition to new types of single-use materials that are both safe and environmentally friendly is not an easy process – a widely acknowledged fact of life. “There are specific considerations for the health industry due to the stringent regulatory rules that are applied to ensure that materials meet rigorous quality, safety, and efficacy standards to protect patient health. Changes require time and resources, from industry and from national regulatory agencies, to be implemented. Testing and validation of innovative packaging material can take up to 5-10 years to complete,” said the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a joint statment with the Global Self Care Federation and the International Generic and Biosimilar Medicines Association, at the start of the Busan meeting. “We believe it is possible to achieve a treaty that protects both the environment and human health, through harmonized, targeted extended compliance periods; in line with regulatory standards and timelines; and through limited exemptions where no feasible and safe alternatives exist at sufficient quality and scale,” the statement continued. “It will be critical to include such provisions in both the instrument and the annexes, as required. This will provide the approach needed to transition while new or alternative materials, processes, and formulations are established in collaboration with regulatory authorities.” Fossil fuels crash the party, again Unrecycled plastics have knock-on effects on the environment, emissions, biodiversity, and human health. Regardless of whether the concerns related to health, environment or climate, oil-producing nations maintained the treaty’s focus should be on the waste, and not the product itself. “The objective of this treaty is to end plastic pollution, not plastic itself,” Kuwait stated for the “like-minded group” of fossil fuel producers on the final day. “Attempting to phase out plastic rather than addressing the issue of plastic production risks undermining global progress and exacerbating economic inequality.” With negotiations largely behind closed doors, observer access was limited. Yet reports emerged of Saudi Arabia’s blocking tactics – from demanding unanimity on every decision to raising repeated procedural objections. The Saudi delegation even disputed a Brazilian working group leader’s authority to schedule a lunch meeting to recover lost time, the New York Times reported. The Global Partnership for Plastics Circularity, an industry group established specifically to influence the treaty talks and representing fossil fuel giants like Saudi Aramco, Chevron, Shell, and ExxonMobil, emphasised “addressing mismanaged waste” through improved recycling and waste collection systems. These arguments mirror tactics the petrochemical industry has employed since the 1960s. But decades of evidence tell a different story. Of the 8.3 billion tons of plastic ever produced, only 9% has been recycled, while 79% has ended up in landfills or the environment. The 2023 Plastics Overshoot report found that 43% of plastic produced globally is mismanaged and will likely contaminate air, water, or soil. The 2023 Plastic Waste Makers Index, meanwhile, called recycling “at most, a marginal activity” – and with increasingly complex chemical compositions in plastics, the problem is only getting worse. Industry’s strategic pivot Top 20 global producers of single-use plastics for the year 2021. The list remains effectively unchanged since 2019. The fierce resistance to production limits stems from oil-producing nations’ strategic pivot toward plastics as traditional markets decline. For the fossil fuel industry and its partners, plastics offer a horizon for continued expansion even as power grids and vehicles shift to renewable energy. Petrochemicals and plastics are projected to become oil’s primary demand driver – accounting for half of consumption by 2050, according to IEA forecasts, with plastic production set to represent 20% of oil and gas output. While Saudi Arabia led the fight against production caps in Busan, it’s part of a broader trend. Despite global pledges on climate and plastic pollution, major petrochemical investments continue across the Middle East, China, and the US, University of Lund research shows. For oil and gas producers, plastics offer a profitable sanctuary as clean energy expands. Petrochemicals yield higher margins than transport fuels – crucial as energy-sector fossil fuel demand wanes. Lost in the battles in Busan were the positions of the world’s two largest plastic producers. Both China and the United States were notably absent when treaty advocates made their case for production limits on Sunday. Though the US backed production cuts earlier this year, observers suggest this position is likely to shift following Donald Trump’s recent victory and pledges to continue expanding record levels of oil production. Beijing has put forth proposals to limit the use of harmful chemicals in plastics, but shown little interest in capping production. Plastics lobbyists swarm talks Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia. Plastic-producing nations were supported by an unprecedented industry presence at the UN talks. Fossil fuel and chemical industry lobbyists formed the largest single delegation, with 220 representatives. This group outnumbered both the European Union’s combined delegation and the host country South Korea’s representatives, according to analysis by the Center for International Environmental Law. The industry’s efforts to shape the treaty have been extensive. Over 93% of statements opposing an ambitious treaty came from chemical and petrochemical sectors, with companies like ExxonMobil, Dow Inc, BASF, and SABIC leading efforts to weaken the agreement, according to a report released during the talks by InfluenceMap. “Their strategy — lifted straight from the climate negotiations playbook — is designed to preserve the financial interests of countries and companies who are putting their fossil-fueled profits above human health, human rights, and the future of the planet,” said Delphine Levi Alvares, Global Petrochemical Campaign Manager at CIEL. The industry’s aggressive presence at the talks reflects what’s at stake. Petrochemical companies increasingly see plastics as a safe haven from carbon regulations as demand for fossil fuels declines in other sectors. This pivot to plastics production helps offset falling fuel demand, but threatens to dramatically increase plastic waste globally, research shows. “There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives (GAIA), representing local communities affected by plastic pollution, said in a statement. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.” Updated 3 December with added content on health sector plastics use. Image Credits: Photo by Hermes Rivera on Unsplash, University of Oregon, UNEP, QPhia. Pandemic Agreement: ‘Get it done’ 02/12/2024 Kerry Cullinan Dame Barbara Stocking urged negotiators to reach agreement. At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations. “The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors. “It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.” Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”. “As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros. “I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week. Handful of outstanding issues Yuan Qiong Hu of Medecins sans Frontieres (MSF) Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement. Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D. The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials. “Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. “You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked. “On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. “Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.” IFPMA’s Grega Kumer The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. “The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer. “To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting, regulatory challenges, limited absorption capacity and export restrictions,” he added. “The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added. Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring. Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday. Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. 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Amid Global HIV Funding Challenges, PEPFAR Head Will Resign Before Trump Takes Office 03/12/2024 Kerry Cullinan Ambassador John Nkengasong, head of PEPFAR. As a political appointee, Ambassador John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January. “The rules that govern a transition are that all the political appointees have to resign on the 20th and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday. However, he stressed that PEPFAR has been a bipartisan programme since its inception in 2003 when it was launched by Republican President George W Bush. “It has since enjoyed the support of all administrations,” said Nkengasong, the US Global AIDS Coordinator in the Bureau of Health Security and Diplomacy. Nkengasong was appointed by President Joe Biden, confirmed by the US Senate in May 2022, and he started work the following month. PEPFAR’s achievements by 2024. Nkengasong is a Cameronian-born US citizen, who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the COVID-19 pandemic. Prior to that, he had worked for the US Centers for Disease Control and Prevention, as well as at the World Health Organization. “We should always think about PEPFAR, not the individual – 26 million lives saved over the last 21 years,” Nkengasong stressed at the briefing, although his re-appointment prospects are regarded as slim. “PEPFAR was reauthorised [by the US Congress] for one year last year. That reauthorisation expires in March, and we are hoping that we’ll get a clean five-year reauthorisation going forward,” he added. But this may not be plain sailing. PEPFAR has come under attack from US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion. This is why the programme only received a one-year extension rather than the usual five years. Trump has made cutting government spending and opposing abortion cornerstones of his election campaign, which does not augur well for the campaign to end AIDS by 2030. HIV money is drying up HIV is incurable but thanks to antiretroviral (ARV) drugs, it has become a controllable chronic disease and if people living with the virus have an undetectable viral load, they don’t transmit HIV. As many as 25 million people depend on PEPFAR and the Global Fund to subsidise their ARVs, which they need to take for life. Yet money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023. Meanwhile, donor resources for HIV dropped by 5%, UNAIDS Deputy Director Christine Stegling told the briefing. UNAIDS deputy director Christine Stegling. Global Fund executive director Peter Sands said that global overseas development assistance is under pressure, and health has lost its “prime spot” to both climate change and conflict. “There is a particular issue with funding for HIV/ AIDS, which is that we run the risk of being a victim of our own success. Because the number of people dying has dropped so much, and because HIV/ AIDS is no longer seen as that much of a threat in donor nations themselves, it’s dropped off the radar screen and seems like an old problem; one that’s largely won or gone away,” said Sands. “But HIV is a formidable adversary. We are nowhere near getting a vaccine, and we don’t have a cure for it yet.” But the single-minded focus on eliminating HIV has made “extraordinary progress”, Sands added. “AIDS-related deaths have come down by 51% since 2010 and more than three-quarters of people living with HIV are on treatment, but we still have another nine million people not on treatment and we still have 1.3 million new infections each year,” according to Stegling. Shift to domestic financing Economist Professor Dean Jamison, co-chair of the Lancet Commission on investing in health, says it is unlikely that for a better response to funding HIV globally. “So that does put greater emphasis on a transition to domestic finance where the reliance has been substantially on donors. It’s not to say that the external finance is likely to go away and then there won’t be important additions to that. I would be looking to parts of Asia for external finance, but on the domestic side, what are the range of options?” asked Jamison, who is an emeritus professor of Global Health Financing at UCSF, UCLA and the University of Washington. Poor countries would prioritise HIV spending, likely focusing on preventive interventions and treatment. Drawing on private resources, perhaps through payroll taxes, may also be a solution. Professor Dean Jamison Stegling singled out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing for HIV. “Last year in GDP term, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted. Meanwhile, sub-Saharan Africa loses about $80 billion in uncollected tax revenue. Debt relief, future financing at affordable rates and better tax revenue collection are the solutions UNAIDS is focusing on. “These are the issues of the future that we need to look into if we’re talking about self reliance, more resilient systems for health that are financed by countries, by every country themselves,” Stegling noted. With South Africa being the chair of the G20 next year, she sees “an amazing opportunity” for African leadership debt restructuring and different financing mechanisms. What lies ahead? Stegling says donors are likely to move into “gaps”, such as human rights protections for particular marginalized groups that might not immediately find support from their governments. Meanwhile, Nkengasong stressed that progress should not be confused with success. “The progress that we have made is very fragile,” Nkengasong stressed. PEPFAR did an analysis of 10 to 12 high-burden countries that it supports and found that, to maintain their programmes if PEPFAR was unable to fund them would result in debt risk increasing by 400 percentage point,. “Are we ready to live with this? We pride ourselves with the success we’ve made over the last 25 years or so against HIV. But the response to HIV is extremely fragile. It’s extremely fragile because it requires that the millions of people that are receiving treatment receive that treatment every day. “We cannot afford to leave them behind. If we do that, the billions that we’ve put into the fight against HIV AIDS will be completely wasted.” Image Credits: US State Department. UN Plastic Pollution Treaty Derailed as Fossil Fuel Nations Block Production Limits 03/12/2024 Stefan Anderson Global plastic production is set to triple by 2050, even as only 9% of plastic waste has ever been recycled. Negotiations to produce a legally binding treaty to curb the global explosion of plastic pollution fell short on Sunday as efforts to limit the production of fossil fuel-based plastics supported by over 100 countries, including the European Union, met fierce opposition from oil-producing nations. A coalition of oil and gas producers led by Saudi Arabia that included Iran, Russia, and other Gulf states under the Arab group, opposed capping plastic production, insisting the treaty should focus solely on plastics waste management. Negotiations this week in Busan, South Korea (known as INC-5), were meant to be the final round of a two-year process to create what the UN Environment Agency and environmental groups called “the most important multilateral treaty” since the 2015 Paris climate agreement. Instead, the Busan summit became the third major failure of multilateral environmental negotiations in as many weeks, following disappointing outcomes at COP29 in Baku and a total collapse of talks over new funding and enforcement mechanisms at the UN Convention on Biological Diversity’s COP16 in Cali, Colombia, which aimed to protect nature and wildlife. “A few critical issues still prevent us from reaching a comprehensive agreement,” said the chair of the negotiations, Luis Vayas Valdivieso, Sunday evening, in delivering the message there would be no final outcome at this round. Nearly 200 nations participated in the negotiations. The next round of plastics negotiations has not been scheduled or assigned a location. “Our mandate has always been ambitious. But ambition takes time to land,” Valdivieso said. “We have many of the elements that we need, and Busan has put us firmly on a pathway to success … to reverse and remedy the severe effects of plastic pollution on ecosystems and human health.” Deep fault lines unresolved Microplastics were detected in human blood for the first time this year, heightening research efforts to understand their effects on our health. Deep fault lines have persisted since talks began in Paris in March 2022. Nations remain divided over plastic production limits, bans on harmful chemicals in plastics, recycling’s role in solving the crisis, and funding for developing nations to implement the treaty’s goals. The scale of disagreement was laid bare in the previous negotiating round in Ottawa in April, which produced a near-illegible draft with 3,400 disputed sections. The final text published by the chair has whittled these down to 340 contested items, but the core disputes that have defined debates since the start remain unsolved. “It is clear there is persisting divergence in critical areas,” UNEP executive director Inger Andersen said in a statement, adding that talks had “moved us closer” to a legally binding treaty to protect “our future from the onslaught of plastic pollution.” While the failure to reach an agreement after 18 months marks a significant setback, other major UN environmental processes have faced far longer paths. It took three decades for climate negotiations to formally acknowledge fossil fuels’ role in global warming, while UN biodiversity talks reached their first binding treaty in 2022, thirty years after the 1992 Rio Earth Summit. “The world’s commitment to ending plastic pollution is clear and undeniable,” Andersen said. “More time is needed.” Ambition up Plastic waste is contaminating land, water and even food resources, with unknown health harms, experts have warned. More than 100 countries, including the EU and the United Kingdom, backed a Panama-led draft text in Busan calling for reducing plastic production to “sustainable levels”. The proposal would require nations to report their plastic production, import and export data to monitor global progress on curbing new plastics. The level of support mirrors broader backing for tough measures on plastics. WWF tallies from the third round of negotiations in Nairobi in late 2023 showed over 100 countries favouring bans or phase-outs of the most harmful plastics, with 140 pushing for a legally binding treaty. These nations argue plastic production is the root of the crisis. In the thousand days since nations first agreed to establish a binding treaty on plastic pollution, manufacturers have produced more than 800 million tonnes of new plastic, over 30 million tonnes have leaked into oceans, while millions more have been incinerated or sent to landfills. “Postponing negotiations does not postpone the crisis,” Panama’s lead negotiator, Juan Carlos Monterrey Gomez, told the closing plenary on Sunday. “When we reconvene, the stakes will be higher. This is not a drill, this is a fight for survival. We did not accept a weak treaty here, and we never will.” But the bloc known as the “like-minded” group of petrochemical producers, led by Saudi Arabia and including Russia, Iran, and other Arab states, oppose Panama’s proposal to limit production. These nations argue that including production limits oversteps the treaty’s mandate, which they say should focus solely on plastic pollution and waste. Their plan to maintain plastic production growth threatens to derail global climate goals. Scientists estimate that a 75% reduction in plastic production is needed by 2040 to keep global warming to 1.5 degrees Celsius. Without such cuts, plastic production alone could consume up to 31% of the world’s remaining carbon budget to stay within that critical temperature threshold. Health risks mount as treaty’s approach remains undecided Beyond the climate impacts, plastics pose escalating health risks through contamination of air, water, soil, and through those channels, terrestrial food chains and ocean life – all pathways for contaminants to penetrate people’s bodies. Scientists have detected plastic particles in human blood, lungs, breast milk, and unborn children. Research shows that people unknowingly consume about five grams of microplastics weekly through eating, drinking and breathing, while over 3,200 chemicals in plastics have known toxic effects and another 5,000 remain inadequately studied. Researchers have even discovered “plasticosis,” a new condition where microplastics alter cell behaviour in human and animal organs. Despite this growing evidence base, the treaty’s approach to health remains undecided. The final text presents two options: a standalone health article championed by Brazil, or strengthened health references throughout the document. With negotiations in Busan conducted behind closed doors, countries’ positions on this choice remain unclear. “Our babies are entering this world with their brains and bodies already contaminated with plastics, exposing them to toxic chemicals that can affect their ability to learn and increase their risk of endocrine disorders, reproductive harm, and cancers,” Aileen Lucero from the International Pollutants Elimination Network (IPEN) told delegates at the closing session. The financial toll on health is mounting. The Endocrine Society found just four families of plastic chemicals cause over $400 billion in annual health costs in the United States alone. Globally, the UN Environment Programme warns that inaction on chemical and plastic pollution could cost up to 10% of global GDP. “The science is clear: A treaty that protects human health and the environment needs to address the issues of plastic production and chemicals,” said Bethanie Carney Almroth, Professor at the University of Gothenburg, speaking for the Scientists’ Coalition for an Effective Plastics Treaty, a network of over 400 independent experts. Paradox for the healthcare industry There is also a paradox, however, for healthcare professionals. The healthcare industry relies heavily on plastics like PVC in essential medical equipment from IV tubing to protective gloves and masks. The COVID-19 pandemic only deepened this dependence as single-use protective gloves and masks became even more widely used by the general public, as well as health care practitioners, for infection prevention. But at the same time that a growing chorus of voices in the health sector also are calling attention to the health impacts of plastics in medical devices. Groups like Health Care Without Harm have worked to reduce use, and improve management, of plastics in health care facilities, and particularly of PVC, whose production requires large inputs of highly toxic mercury, asbestos or PFAS [per- and polyfluoroalkyl. One PVC’s main building blocks, vinyl chloride, is a potent carcinogen. They also have called out the impacts of health sector medical waste incineration – which in low- and middle-income countries may be in primitive stoves or open pit fires. This further generates community exposures to dangerous particulate pollution as well as longer-lived Persistent Organic Pollutants (POPS), such as dioxins and furans. At the same time, improving health sector management of plastics used, and eventually transition to new types of single-use materials that are both safe and environmentally friendly is not an easy process – a widely acknowledged fact of life. “There are specific considerations for the health industry due to the stringent regulatory rules that are applied to ensure that materials meet rigorous quality, safety, and efficacy standards to protect patient health. Changes require time and resources, from industry and from national regulatory agencies, to be implemented. Testing and validation of innovative packaging material can take up to 5-10 years to complete,” said the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a joint statment with the Global Self Care Federation and the International Generic and Biosimilar Medicines Association, at the start of the Busan meeting. “We believe it is possible to achieve a treaty that protects both the environment and human health, through harmonized, targeted extended compliance periods; in line with regulatory standards and timelines; and through limited exemptions where no feasible and safe alternatives exist at sufficient quality and scale,” the statement continued. “It will be critical to include such provisions in both the instrument and the annexes, as required. This will provide the approach needed to transition while new or alternative materials, processes, and formulations are established in collaboration with regulatory authorities.” Fossil fuels crash the party, again Unrecycled plastics have knock-on effects on the environment, emissions, biodiversity, and human health. Regardless of whether the concerns related to health, environment or climate, oil-producing nations maintained the treaty’s focus should be on the waste, and not the product itself. “The objective of this treaty is to end plastic pollution, not plastic itself,” Kuwait stated for the “like-minded group” of fossil fuel producers on the final day. “Attempting to phase out plastic rather than addressing the issue of plastic production risks undermining global progress and exacerbating economic inequality.” With negotiations largely behind closed doors, observer access was limited. Yet reports emerged of Saudi Arabia’s blocking tactics – from demanding unanimity on every decision to raising repeated procedural objections. The Saudi delegation even disputed a Brazilian working group leader’s authority to schedule a lunch meeting to recover lost time, the New York Times reported. The Global Partnership for Plastics Circularity, an industry group established specifically to influence the treaty talks and representing fossil fuel giants like Saudi Aramco, Chevron, Shell, and ExxonMobil, emphasised “addressing mismanaged waste” through improved recycling and waste collection systems. These arguments mirror tactics the petrochemical industry has employed since the 1960s. But decades of evidence tell a different story. Of the 8.3 billion tons of plastic ever produced, only 9% has been recycled, while 79% has ended up in landfills or the environment. The 2023 Plastics Overshoot report found that 43% of plastic produced globally is mismanaged and will likely contaminate air, water, or soil. The 2023 Plastic Waste Makers Index, meanwhile, called recycling “at most, a marginal activity” – and with increasingly complex chemical compositions in plastics, the problem is only getting worse. Industry’s strategic pivot Top 20 global producers of single-use plastics for the year 2021. The list remains effectively unchanged since 2019. The fierce resistance to production limits stems from oil-producing nations’ strategic pivot toward plastics as traditional markets decline. For the fossil fuel industry and its partners, plastics offer a horizon for continued expansion even as power grids and vehicles shift to renewable energy. Petrochemicals and plastics are projected to become oil’s primary demand driver – accounting for half of consumption by 2050, according to IEA forecasts, with plastic production set to represent 20% of oil and gas output. While Saudi Arabia led the fight against production caps in Busan, it’s part of a broader trend. Despite global pledges on climate and plastic pollution, major petrochemical investments continue across the Middle East, China, and the US, University of Lund research shows. For oil and gas producers, plastics offer a profitable sanctuary as clean energy expands. Petrochemicals yield higher margins than transport fuels – crucial as energy-sector fossil fuel demand wanes. Lost in the battles in Busan were the positions of the world’s two largest plastic producers. Both China and the United States were notably absent when treaty advocates made their case for production limits on Sunday. Though the US backed production cuts earlier this year, observers suggest this position is likely to shift following Donald Trump’s recent victory and pledges to continue expanding record levels of oil production. Beijing has put forth proposals to limit the use of harmful chemicals in plastics, but shown little interest in capping production. Plastics lobbyists swarm talks Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia. Plastic-producing nations were supported by an unprecedented industry presence at the UN talks. Fossil fuel and chemical industry lobbyists formed the largest single delegation, with 220 representatives. This group outnumbered both the European Union’s combined delegation and the host country South Korea’s representatives, according to analysis by the Center for International Environmental Law. The industry’s efforts to shape the treaty have been extensive. Over 93% of statements opposing an ambitious treaty came from chemical and petrochemical sectors, with companies like ExxonMobil, Dow Inc, BASF, and SABIC leading efforts to weaken the agreement, according to a report released during the talks by InfluenceMap. “Their strategy — lifted straight from the climate negotiations playbook — is designed to preserve the financial interests of countries and companies who are putting their fossil-fueled profits above human health, human rights, and the future of the planet,” said Delphine Levi Alvares, Global Petrochemical Campaign Manager at CIEL. The industry’s aggressive presence at the talks reflects what’s at stake. Petrochemical companies increasingly see plastics as a safe haven from carbon regulations as demand for fossil fuels declines in other sectors. This pivot to plastics production helps offset falling fuel demand, but threatens to dramatically increase plastic waste globally, research shows. “There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives (GAIA), representing local communities affected by plastic pollution, said in a statement. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.” Updated 3 December with added content on health sector plastics use. Image Credits: Photo by Hermes Rivera on Unsplash, University of Oregon, UNEP, QPhia. Pandemic Agreement: ‘Get it done’ 02/12/2024 Kerry Cullinan Dame Barbara Stocking urged negotiators to reach agreement. At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations. “The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors. “It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.” Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”. “As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros. “I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week. Handful of outstanding issues Yuan Qiong Hu of Medecins sans Frontieres (MSF) Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement. Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D. The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials. “Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. “You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked. “On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. “Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.” IFPMA’s Grega Kumer The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. “The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer. “To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting, regulatory challenges, limited absorption capacity and export restrictions,” he added. “The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added. Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring. Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday. Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. 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UN Plastic Pollution Treaty Derailed as Fossil Fuel Nations Block Production Limits 03/12/2024 Stefan Anderson Global plastic production is set to triple by 2050, even as only 9% of plastic waste has ever been recycled. Negotiations to produce a legally binding treaty to curb the global explosion of plastic pollution fell short on Sunday as efforts to limit the production of fossil fuel-based plastics supported by over 100 countries, including the European Union, met fierce opposition from oil-producing nations. A coalition of oil and gas producers led by Saudi Arabia that included Iran, Russia, and other Gulf states under the Arab group, opposed capping plastic production, insisting the treaty should focus solely on plastics waste management. Negotiations this week in Busan, South Korea (known as INC-5), were meant to be the final round of a two-year process to create what the UN Environment Agency and environmental groups called “the most important multilateral treaty” since the 2015 Paris climate agreement. Instead, the Busan summit became the third major failure of multilateral environmental negotiations in as many weeks, following disappointing outcomes at COP29 in Baku and a total collapse of talks over new funding and enforcement mechanisms at the UN Convention on Biological Diversity’s COP16 in Cali, Colombia, which aimed to protect nature and wildlife. “A few critical issues still prevent us from reaching a comprehensive agreement,” said the chair of the negotiations, Luis Vayas Valdivieso, Sunday evening, in delivering the message there would be no final outcome at this round. Nearly 200 nations participated in the negotiations. The next round of plastics negotiations has not been scheduled or assigned a location. “Our mandate has always been ambitious. But ambition takes time to land,” Valdivieso said. “We have many of the elements that we need, and Busan has put us firmly on a pathway to success … to reverse and remedy the severe effects of plastic pollution on ecosystems and human health.” Deep fault lines unresolved Microplastics were detected in human blood for the first time this year, heightening research efforts to understand their effects on our health. Deep fault lines have persisted since talks began in Paris in March 2022. Nations remain divided over plastic production limits, bans on harmful chemicals in plastics, recycling’s role in solving the crisis, and funding for developing nations to implement the treaty’s goals. The scale of disagreement was laid bare in the previous negotiating round in Ottawa in April, which produced a near-illegible draft with 3,400 disputed sections. The final text published by the chair has whittled these down to 340 contested items, but the core disputes that have defined debates since the start remain unsolved. “It is clear there is persisting divergence in critical areas,” UNEP executive director Inger Andersen said in a statement, adding that talks had “moved us closer” to a legally binding treaty to protect “our future from the onslaught of plastic pollution.” While the failure to reach an agreement after 18 months marks a significant setback, other major UN environmental processes have faced far longer paths. It took three decades for climate negotiations to formally acknowledge fossil fuels’ role in global warming, while UN biodiversity talks reached their first binding treaty in 2022, thirty years after the 1992 Rio Earth Summit. “The world’s commitment to ending plastic pollution is clear and undeniable,” Andersen said. “More time is needed.” Ambition up Plastic waste is contaminating land, water and even food resources, with unknown health harms, experts have warned. More than 100 countries, including the EU and the United Kingdom, backed a Panama-led draft text in Busan calling for reducing plastic production to “sustainable levels”. The proposal would require nations to report their plastic production, import and export data to monitor global progress on curbing new plastics. The level of support mirrors broader backing for tough measures on plastics. WWF tallies from the third round of negotiations in Nairobi in late 2023 showed over 100 countries favouring bans or phase-outs of the most harmful plastics, with 140 pushing for a legally binding treaty. These nations argue plastic production is the root of the crisis. In the thousand days since nations first agreed to establish a binding treaty on plastic pollution, manufacturers have produced more than 800 million tonnes of new plastic, over 30 million tonnes have leaked into oceans, while millions more have been incinerated or sent to landfills. “Postponing negotiations does not postpone the crisis,” Panama’s lead negotiator, Juan Carlos Monterrey Gomez, told the closing plenary on Sunday. “When we reconvene, the stakes will be higher. This is not a drill, this is a fight for survival. We did not accept a weak treaty here, and we never will.” But the bloc known as the “like-minded” group of petrochemical producers, led by Saudi Arabia and including Russia, Iran, and other Arab states, oppose Panama’s proposal to limit production. These nations argue that including production limits oversteps the treaty’s mandate, which they say should focus solely on plastic pollution and waste. Their plan to maintain plastic production growth threatens to derail global climate goals. Scientists estimate that a 75% reduction in plastic production is needed by 2040 to keep global warming to 1.5 degrees Celsius. Without such cuts, plastic production alone could consume up to 31% of the world’s remaining carbon budget to stay within that critical temperature threshold. Health risks mount as treaty’s approach remains undecided Beyond the climate impacts, plastics pose escalating health risks through contamination of air, water, soil, and through those channels, terrestrial food chains and ocean life – all pathways for contaminants to penetrate people’s bodies. Scientists have detected plastic particles in human blood, lungs, breast milk, and unborn children. Research shows that people unknowingly consume about five grams of microplastics weekly through eating, drinking and breathing, while over 3,200 chemicals in plastics have known toxic effects and another 5,000 remain inadequately studied. Researchers have even discovered “plasticosis,” a new condition where microplastics alter cell behaviour in human and animal organs. Despite this growing evidence base, the treaty’s approach to health remains undecided. The final text presents two options: a standalone health article championed by Brazil, or strengthened health references throughout the document. With negotiations in Busan conducted behind closed doors, countries’ positions on this choice remain unclear. “Our babies are entering this world with their brains and bodies already contaminated with plastics, exposing them to toxic chemicals that can affect their ability to learn and increase their risk of endocrine disorders, reproductive harm, and cancers,” Aileen Lucero from the International Pollutants Elimination Network (IPEN) told delegates at the closing session. The financial toll on health is mounting. The Endocrine Society found just four families of plastic chemicals cause over $400 billion in annual health costs in the United States alone. Globally, the UN Environment Programme warns that inaction on chemical and plastic pollution could cost up to 10% of global GDP. “The science is clear: A treaty that protects human health and the environment needs to address the issues of plastic production and chemicals,” said Bethanie Carney Almroth, Professor at the University of Gothenburg, speaking for the Scientists’ Coalition for an Effective Plastics Treaty, a network of over 400 independent experts. Paradox for the healthcare industry There is also a paradox, however, for healthcare professionals. The healthcare industry relies heavily on plastics like PVC in essential medical equipment from IV tubing to protective gloves and masks. The COVID-19 pandemic only deepened this dependence as single-use protective gloves and masks became even more widely used by the general public, as well as health care practitioners, for infection prevention. But at the same time that a growing chorus of voices in the health sector also are calling attention to the health impacts of plastics in medical devices. Groups like Health Care Without Harm have worked to reduce use, and improve management, of plastics in health care facilities, and particularly of PVC, whose production requires large inputs of highly toxic mercury, asbestos or PFAS [per- and polyfluoroalkyl. One PVC’s main building blocks, vinyl chloride, is a potent carcinogen. They also have called out the impacts of health sector medical waste incineration – which in low- and middle-income countries may be in primitive stoves or open pit fires. This further generates community exposures to dangerous particulate pollution as well as longer-lived Persistent Organic Pollutants (POPS), such as dioxins and furans. At the same time, improving health sector management of plastics used, and eventually transition to new types of single-use materials that are both safe and environmentally friendly is not an easy process – a widely acknowledged fact of life. “There are specific considerations for the health industry due to the stringent regulatory rules that are applied to ensure that materials meet rigorous quality, safety, and efficacy standards to protect patient health. Changes require time and resources, from industry and from national regulatory agencies, to be implemented. Testing and validation of innovative packaging material can take up to 5-10 years to complete,” said the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a joint statment with the Global Self Care Federation and the International Generic and Biosimilar Medicines Association, at the start of the Busan meeting. “We believe it is possible to achieve a treaty that protects both the environment and human health, through harmonized, targeted extended compliance periods; in line with regulatory standards and timelines; and through limited exemptions where no feasible and safe alternatives exist at sufficient quality and scale,” the statement continued. “It will be critical to include such provisions in both the instrument and the annexes, as required. This will provide the approach needed to transition while new or alternative materials, processes, and formulations are established in collaboration with regulatory authorities.” Fossil fuels crash the party, again Unrecycled plastics have knock-on effects on the environment, emissions, biodiversity, and human health. Regardless of whether the concerns related to health, environment or climate, oil-producing nations maintained the treaty’s focus should be on the waste, and not the product itself. “The objective of this treaty is to end plastic pollution, not plastic itself,” Kuwait stated for the “like-minded group” of fossil fuel producers on the final day. “Attempting to phase out plastic rather than addressing the issue of plastic production risks undermining global progress and exacerbating economic inequality.” With negotiations largely behind closed doors, observer access was limited. Yet reports emerged of Saudi Arabia’s blocking tactics – from demanding unanimity on every decision to raising repeated procedural objections. The Saudi delegation even disputed a Brazilian working group leader’s authority to schedule a lunch meeting to recover lost time, the New York Times reported. The Global Partnership for Plastics Circularity, an industry group established specifically to influence the treaty talks and representing fossil fuel giants like Saudi Aramco, Chevron, Shell, and ExxonMobil, emphasised “addressing mismanaged waste” through improved recycling and waste collection systems. These arguments mirror tactics the petrochemical industry has employed since the 1960s. But decades of evidence tell a different story. Of the 8.3 billion tons of plastic ever produced, only 9% has been recycled, while 79% has ended up in landfills or the environment. The 2023 Plastics Overshoot report found that 43% of plastic produced globally is mismanaged and will likely contaminate air, water, or soil. The 2023 Plastic Waste Makers Index, meanwhile, called recycling “at most, a marginal activity” – and with increasingly complex chemical compositions in plastics, the problem is only getting worse. Industry’s strategic pivot Top 20 global producers of single-use plastics for the year 2021. The list remains effectively unchanged since 2019. The fierce resistance to production limits stems from oil-producing nations’ strategic pivot toward plastics as traditional markets decline. For the fossil fuel industry and its partners, plastics offer a horizon for continued expansion even as power grids and vehicles shift to renewable energy. Petrochemicals and plastics are projected to become oil’s primary demand driver – accounting for half of consumption by 2050, according to IEA forecasts, with plastic production set to represent 20% of oil and gas output. While Saudi Arabia led the fight against production caps in Busan, it’s part of a broader trend. Despite global pledges on climate and plastic pollution, major petrochemical investments continue across the Middle East, China, and the US, University of Lund research shows. For oil and gas producers, plastics offer a profitable sanctuary as clean energy expands. Petrochemicals yield higher margins than transport fuels – crucial as energy-sector fossil fuel demand wanes. Lost in the battles in Busan were the positions of the world’s two largest plastic producers. Both China and the United States were notably absent when treaty advocates made their case for production limits on Sunday. Though the US backed production cuts earlier this year, observers suggest this position is likely to shift following Donald Trump’s recent victory and pledges to continue expanding record levels of oil production. Beijing has put forth proposals to limit the use of harmful chemicals in plastics, but shown little interest in capping production. Plastics lobbyists swarm talks Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia. Plastic-producing nations were supported by an unprecedented industry presence at the UN talks. Fossil fuel and chemical industry lobbyists formed the largest single delegation, with 220 representatives. This group outnumbered both the European Union’s combined delegation and the host country South Korea’s representatives, according to analysis by the Center for International Environmental Law. The industry’s efforts to shape the treaty have been extensive. Over 93% of statements opposing an ambitious treaty came from chemical and petrochemical sectors, with companies like ExxonMobil, Dow Inc, BASF, and SABIC leading efforts to weaken the agreement, according to a report released during the talks by InfluenceMap. “Their strategy — lifted straight from the climate negotiations playbook — is designed to preserve the financial interests of countries and companies who are putting their fossil-fueled profits above human health, human rights, and the future of the planet,” said Delphine Levi Alvares, Global Petrochemical Campaign Manager at CIEL. The industry’s aggressive presence at the talks reflects what’s at stake. Petrochemical companies increasingly see plastics as a safe haven from carbon regulations as demand for fossil fuels declines in other sectors. This pivot to plastics production helps offset falling fuel demand, but threatens to dramatically increase plastic waste globally, research shows. “There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives (GAIA), representing local communities affected by plastic pollution, said in a statement. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.” Updated 3 December with added content on health sector plastics use. Image Credits: Photo by Hermes Rivera on Unsplash, University of Oregon, UNEP, QPhia. Pandemic Agreement: ‘Get it done’ 02/12/2024 Kerry Cullinan Dame Barbara Stocking urged negotiators to reach agreement. At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations. “The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors. “It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.” Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”. “As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros. “I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week. Handful of outstanding issues Yuan Qiong Hu of Medecins sans Frontieres (MSF) Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement. Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D. The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials. “Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. “You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked. “On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. “Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.” IFPMA’s Grega Kumer The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. “The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer. “To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting, regulatory challenges, limited absorption capacity and export restrictions,” he added. “The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added. Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring. Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday. Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. 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Pandemic Agreement: ‘Get it done’ 02/12/2024 Kerry Cullinan Dame Barbara Stocking urged negotiators to reach agreement. At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations. “The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors. “It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.” Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”. “As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros. “I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week. Handful of outstanding issues Yuan Qiong Hu of Medecins sans Frontieres (MSF) Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement. Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D. The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials. “Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. “You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked. “On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. “Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.” IFPMA’s Grega Kumer The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. “The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer. “To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting, regulatory challenges, limited absorption capacity and export restrictions,” he added. “The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added. Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring. Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday. Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Health Systems Need to Use the New Tools to Address RSV, a Leading Cause of Baby Hospitalisations 02/12/2024 Susan Hepworth & Leyla Kragten-Tabatabaie A policy panel held at the World Vaccine Congress Europe. From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape. Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress. Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations. The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. “Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa. Impact on families Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner. The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families. Long-term burden of respiratory illnesses Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.” This chronic burden reinforces the necessity of early intervention. RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems. The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by ambulance. New tools to prevent RSV With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. “Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar. Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV. This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families. Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP). “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. Challenges in implementing technologies Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers. Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres. The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding. Pivotal moment The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said. Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health. This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD. Susan Hepworth is executive director of the National Coalition for Infant Health. Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
World Needs Urgent Course Correction for How We Grow Food 02/12/2024 Disha Shetty A new report cautions that land degradation, if not reversed in time, could harm generations. The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday. Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with the UN Convention to Combat Desertification (UNCCD). Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report. “We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report. There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024). Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction. Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink. Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns. “If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD. Land is under threat from human activities, climate change The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009. How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary. “The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report. Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact. Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use. In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report. What governments must do The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement. Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution. In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted. For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies. Transformative actions can halt land degradation Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then. Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues. Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed. They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy. This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis. Image Credits: Unsplash, UNCCD report. Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. 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Why are People Still Dying Needlessly of AIDS? Politics – not Science – is to Blame 29/11/2024 Hans Henri P. Kluge & Robb Butler Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada. This was the question posed to us recently by a young person from our Youth4Health network. Our answer, both simple and sad: the reasons are not medical. As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions. Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals. Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms. We need to depoliticise the HIV response At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed. Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers. In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. To end AIDS once and for all, we have to overcome stubborn hurdles and take action. First, countries have to depoliticize the HIV response. Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns. Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus. HIV-related stigma is a problem almost everywhere But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing. Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love. Second, countries and development partners need to invest in the HIV response to leverage new innovations. In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections. Reaching the ’95 goals’ Challenging AIDS stigmatization in Uzbekistan We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 95% of people living with HIV knowing their status; 95% of people with diagnosed HIV infection receiving sustained ART; and 95% of people receiving ART having viral suppression. We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve. Third, we need to reach people with information, prevention, testing. and treatment. The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions. The human right to health Consultation in Hospital in Chisinau, Moldova. In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit. In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections. We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done. But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need? In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself. Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health. Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS. Posts navigation Older postsNewer posts