INB co-chairs Anne-Claire Amprou and Precious Matsoso, alongside WHO Director-General Dr Tedros Adhanom Ghebreyusus.

The pandemic agreement talks resumed on Monday for two weeks, but parties only have a week to decide whether they have sufficient common ground to call a special World Health Assembly (WHA) in December to adopt the document.

Procedurally, 12 November is the last day by which a December WHA can be called. Negotiators will “stocktake” progress on Friday and decide by next Monday whether to call a December WHA or wait until next year’s regular assembly in May.

Several countries are pushing for a December agreement amid growing geopolitical uncertainties including the imminent US election, and outbreaks of mpox, H5N1 and Marburg.

A Donald Trump victory could mean the US withdrawal from the negotiations and withholding their dues from the World Health Organization (WHO), which Trump did during the COVID-19 pandemic.

US and African negotiators pushed for the December WHA during the opening of the 12th meeting of the intergovernmental negotiating body (INB), while others including stakeholders, cautioned against sacrificing content for speed.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus warned negotiators not to make “the perfect the enemy of the good”, stressing that no party will get all their demands.

“With the proposals on the table, I believe you have the ingredients in place to meet your objective,” Tedros told the INB, which has been negotiating for almost three years.

He also said that reaching agreement would provide hope that, “despite political and ideological differences between countries, we can still come together to find common solutions to common problems”.

Africa, US push for December adoption

Tanzania, speaking for the Africa Group, wants the agreement adopted in December.

“The Africa group is resolute in its ambition to finalise the agreement process by December 2024. This timeline is not arbitrary, but a moral imperative,”  said Tanzania, speaking on behalf of the Africa Group of 48 countries.

For Ethiopia’s Ambassador Tsegab Kebebew Daka, “the outstanding issues are not that many, but are those that require political decisions to ensure whether the language in the current text addresses the shared threat of the next pandemic and the challenges that our countries are facing on the ground”.

US Ambassador Pamela Hamamoto told the INB: “There’s no question that this pandemic agreement will have real-world consequences. The recent declaration of mpox as a public health emergency of international concern (PHEIC) demonstrates just how relevant our work remains. 

“Concluding these negotiations is a priority for the United States, and we seek to facilitate an effective agreement by year-end, if at all possible.”

Hamamoto said that the Friday stock-take was crucial to “carefully assess progress made and accurately identify areas of convergence, as well as issues that will require further discussion before consensus can be reached”. To assist, she appealed to the INB bureau to develop a framework of clear  criteria for member states to consider to make the December call.

US Amabassador Pamela Hamamoto.

At a stakeholder briefing last week, the INB Bureau stressed that they are aiming for a document that can grow in the future – in other words, what commentators have described as a pandemic agreement “lite” that can provide the framework for more detailed plans about contentious issues such as the proposed pathogen access and benefit-sharing (PABS) system.

‘Consensus is the silver bullet’

But many countries advocated caution, including the European Union (EU). EU Ambassador Lotte Knudsen called for “pragmatic solutions that work for all of us” given that “a number of key issues are still outstanding”

“To proceed with calling a special session, we all need to be fully convinced that the agreement will be ready for adoption. This is too important an objective to make any leap of faith that is not properly grounded in tangible progress in the negotiations,” Lotte stressed.

The agreement’s test is whether it will make a substantial difference to improving prevention, preparedness and response on the ground, she added.

“The content will be far more important than the timing of its adoption. Consequently, our top priority remains to achieve a meaningful and impactful agreement that can command large, ideally universal, participation.”

Comparing the agreement to food, Germany’s Bjorn Kummel stressed that negotiators had to ensure that the “dish needs to be tasteful to all of us” for it to be adopted by all 194 member states.

“Consensus is the magic bullet here,” Kummel stressed.

Germany’s Bjorn Kummel.

Equity challenges

Malaysia, on behalf of the 35 countries making up the Equity Group, spelt out the mountain that still needs to be climbed to change the status quo in favour of low and middle-income countries.

The Equity Group’s key concern is how the proposed PABS system ensures that countries sharing information about pathogens with pandemic potential can benefit from vaccines, therapeutics and diagnostics (VTDs) developed as a result.

“We cannot leave all the critical details for the PABS system for the future,” Malaysia noted.

Malaysia, speaking for the Equity Group, outlined some of the shortcomings of the current draft.

The Equity Group’s demands to ensure fair and equitable benefit sharing include a clear link between access and benefit sharing, making 20% of real-time production of VTDs available to LMICs during a pandemic and annual payments for access to PABS by entities that may profit, such as pharmaceutical companies.

Appeal from the coalface

Meanwhile, Rwanda’s Minister of State for Health Dr Yvan Butera said that his country’s outbreak of the deadly Marburg virus shows that the world is “prone to shocks at any time and anywhere”.

When asked by Health Policy Watch whether he had a message for INB negotiators, Butera said “being able to work together collaboratively to handle these situations efficiently” is essential.

“The capacity to be able to prevent, rapidly detect, respond, and deploy innovative tools in terms of prevention, therapeutics and  diagnostics, is extremely important,” said Butera.

“And then sharing the knowledge so that it can shape better policies or better tools to contain and control future diseases that have potential to become outbreaks, epidemics or pandemics.”

Meanwhile, Africa CDC’s lead on mpox, Dr Ngashi Ngongo, stressed that “benefit-sharing really resonates”.

“If you have used the viruses and pathogens from an African country to develop vaccines, it is really common sense that, in the distribution of the medical countermeasures, those that also contributed with the pathogens also get a share,” said Ngongo.

“Perhaps the lines were a bit hard at the first time, but we are hoping, with everything that has gone behind the scenes, that both sides will be able to come to to a compromise.”

WHO EURO Region Committee leadership
WHO European Region leaders and member states met to discuss policies and priorities for the coming years, including a focus on health security and health systems strengthening.

WHO Member States gathered in Doha, Washington, D.C, Copenhagen, Manila, and Brazzaville for their respective World Health Organization (WHO) Regional Committee sessions in the past months to set policies, strategies, and frameworks for the coming years. 

The WHO Regional Committees – the WHO’s governing bodies in each of six regions – meet yearly to formulate regional policies, supervise WHO activities, comment on the regional components of WHO’s budget, and every five years, nominate a regional director. 

On Wednesday, in the final edition of the regional series, the WHO European Regional Committee nominated Dr Hans Henri Kluge as WHO Regional Director for Europe for a second 5-year term, which will begin in February 2025 after his formal re-election by the WHO Executive Board at their January 2025 meeting. 

That followed the nomination of a new Regional Director for WHO’s African Region in late August, where Dr Faustine Engelbert Ndugulile of Tanzania was nominated to take over the helm from Matshidiso Moeti, Africa’s first female RD, who served ten years in the position. The AFRO Regional Committee featured WHO director general Dr Tedros Adhanom Ghebreyesus pledging support for Africa CDC and the African Medicines Agency, in an attempt to sooth purpoted tensions between the two agencies.

The Pan American Health Organization Directing Council, which met in early October, unveiled a roadmap for a new strategic plan, after member states adopted policies ranging from health system strengthening to climate and health adaptation and mitigation.

Kluge’s tenure began at the beginning of the COVID-19 pandemic, and along with the pandemic response, he has made a name for himself leading the Region through a broad range of other health emergencies. Those range from extreme weather events, to Europe’s mpox outbreak, the war in Ukraine and the Region’s response to crises in Africa and the Eastern Mediterranean regions. 

“By identifying and acting on priorities of importance to the almost one billion people across Europe and Central Asia, our Member States display welcome solidarity and multilateralism at a time of deepening distrust and division,” said Dr Kluge at the close of the Regional Committee session, where he was nominated for a second term. “Health can and does bring countries and communities together. We at WHO/Europe are grateful for the opportunity to work with our Member States and partners to help shape the future of health for the benefit of all.”

At the European Regional meeting, member states also discussed plans and strategies for: healthcare system resiliency and primary healthcare investment, health emergency preparedness – known as “Preparedness 2.0”, emergency medical teams capacity, and health innovations and emerging technologies. Member states also discussed five year plans and strategies around national health security, mental health, the climate crisis, and gender-based violence. 

Western Pacific focuses on improving health financing, digital health

The Western Pacific Region (WPRO) member states, home to more than 1.9 billion people across 37 countries and areas, including the Philippines, Malaysia, Australia, Korea, China, and Japan, met 21 to 25 October, adopting strategies that aim to increase national public health funding, and implement digital health solutions. 

Despite recent reforms in health financing, public health spending in the Western Pacific Region remains “inadequate” to meet growing needs, the WRPO said in a press release. The lack of healthcare service access and the financial burden of care costs presents a growing burden in the Region, where in 2019 more than 300 million people faced “catastrophic” health costs. 

To curb costs, the Regional Committee endorsed a regional action framework for health financing. The Framework aims to improve health financing through five action domains: 1) greater reliance on public funding for health; 2) more equitable and efficient health spending; 3) financing primary health care (PHC) now and into the future; 4) strengthening governance for health financing; and 5) promoting health for all in economic and social policy, according to a statement. 

The Committee also endorsed measures to accelerate digital healthcare technologies, which calls on countries to prioritize “governance, socio-technical infrastructure, financing and economics, digital health solutions, and data in strengthening health systems in the era of digital transformation.” 

Regional conflicts take center stage at Eastern Mediterranean regional committee

Dr Hanan Balkhy, EMRO director, at the Regional Committee meeting in Doha.

On 14 October, meanwhile, Eastern Mediterranean Region member states met in Doha, Qatar, for its 71st regional committee. The conflicts in Gaza, Sudan, Yemen, and Lebanon occupied much of the discussion. The devastation of health infrastructure and the outbreaks of vaccine-preventable diseases – “an unprecedented series of emergencies” – were the backdrop to the Committee’s “Health Beyond Borders” theme. 

“In several countries in the Eastern Mediterranean Region, conflicts, epidemics and political unrest have weakened health services, requiring responsibility, solidarity and equity to improve the lives of all people. We have learned from pandemics and epidemics the importance of solidarity, and that protecting health requires global efforts that transcend national borders,” observed Dr Hanan Al-Kuwari, Qatar Minister of Health in her opening remarks. 

WHO director general Dr Tedros Adhanom Ghebreyesus echoed the intensity of threats facing the region in his opening address, noting : “The eruption of conflict in Lebanon has put the health of millions more people at risk. The number of internally displaced people is growing rapidly, and so is the threat of disease outbreaks, compounded by overcrowding in shelters and the closure of hospitals.”

The Director General urged EMRO Member States to engage in Pandemic Agreement negotiations, “and if possible, to complete it by the end of this year” as well as to participate in the ‘WHO Investment Round’ that aims to raise some $7 billion in supplementary funds to fill a gaping hole in WHO’s $11 billion budget for the next four years. 

The EMRO four-year strategic plan focuses on three flagship initiatives: expanding equitable access to essential medicines, vaccines and medical products, investing in a more resilient health workforce and scaling up public health action on substance abuse. Member states formally adopted the plan at the end of the four day conference; approved a strategic frameworks for implementation of Immunization Agenda 2030, strengthening health laboratory services in the Region 2024–2029. The Committee also endorsed a new regional strategy to strengthen local vaccine production.

South Asia regional meeting under cloud of Regional Director’s controversy

Saima Wazed (in black), along with her mother Bangladesh Prime Minister Sheikh Hasina, during an official visit to the United States to meet US President Joe Biden and First Lady Jill Biden in 2023. A few months later, Wazed’s nomination as the next SEARO Regional Director was confirmed by the WHO Executive Board.

In New Delhi, meanwhile, South-East Asian (SEARO) Member States converged  in the first week of October to adopt resolutions on adolescent health and set measles and rubella elimination targets.  The meeting took place despite late summer unrest in neighbouring Bangladesh that saw Prime Minister Sheikh Hasina resign and flee the country. That followed the controversial election in February 2024 of Sheikh Hasina’s daughter, Dr Saima Wazed, as the new SEARO regional director – in a vote that critics said was laced with politics.

There were fears that the subsequent resignation of Sheikh Hasina could further complicate Wazed’s job as the new SEARO RD.  However, despite the political upheaval, the Regional Committee session took place on schedule.

The SEARO event also featured a number of regional health achievements by member states. Those included six countries’ attainment of SDG targets for reducing  under five mortality and still  birth rates; India’s elimination of trachoma; Timor-Leste’s elimination of lymphatic filariasis; Bhutan’s achievement of interim WHO targets for cervical cancer elimination; and Maldives and Sri Lanka’s progress on Hepatitis B control in children.

“The progress being made is the Region is heartening. I congratulate countries for their achievements which demonstrates their commitment to health and wellbeing of people. I look forward to together building on this momentum to further accelerate efforts for equitable access to health services for all in our Region in the coming years,” said Dr Wazed in a press release at the close of the meeting.

WHO ‘investment rounds’ now a feature of Regional Committee meetings

In a new twist on the decades’ old formula, WHO has also now been making use of the Regional Committee events to stage awareness-raising events about the agency’s new ‘Investment Round’ strategy – which aims to streamline and amplify member states’ voluntary contributions so as to raise roughly $7.4 million more to fund WHO’s 2025-28 budget of $11.1 billion.

In the case of the African, WPRO and SEARO regions, fund raising events even took place directly at the regional meetings. In the first-ever SEARO WHO Investment Round,countries pledged some $345 million, beyond their assessed annual contributions. That followed pledges from the African region for $45 million at their annual meeting in August. At the Western Pacific Regional meeting, in late October, meanwhile, countries pledged a total of $20 million.

As for other (richer) regions, such as the European Region, the Americas and the Eastern Mediterranean, those all-important pledges are being recruited and announced separately.  A gala European Region event was featured at the mid-October World Health Summit in Berlin, which garnered nearly a$1 billion for the organization – although major donors such as France, Spain and the United Kingdom did not announce commitments there.  As for the conflict-wracked EMRO region, which also includes wealthy Gulf countries, and the Americas, where a US election win by former President Donald Trump could lead to another US disengagement from WHO, as per the moves made during his last term, the Regional Committee meetings were used for briefings and awareness-raising. But it remains to be seen when and how concrete pledges will actually be finalized and announced.

WHO Secures $1 Billion at First European Investment Round

See the following links for Health Policy Watch coverage of outcomes from two other WHO regional committees – the Pan American Health Organization (PAHO) and the African Region (AFRO).

Image Credits: WHO/EURO, WHO/EMRO, X.

First stage of the polio vaccine campaign gets underway in northern Gaza on 10 September: WHO has doubts whether the second dose will reach as many children.

WHO Director General Dr Tedros Adhanom Ghebreyesus appealed to Israel to reverse this week’s decision by the country’s Knesset, or parliament, to close the Jerusalem-based operations of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), saying that “there is simply no other alternative to UNRWA.” 

Tedros also said that the third phase of a polio booster campaign in northern Gaza would get underway Tuesday, after Israel had agreed to a ‘humanitarian’ pause in the Gaza City metropolitan area.  But he also expressed fears that the significantly smaller in which health workers would be allowed to move about freely without fear of attack could mean that the campaign would not hit its target of 90% of children, under the age of 10 living in the northern region of the 365 square meter enclave. 

“The final phase of the campaign had aimed to reach an estimated 119,000 children under 10 years old,” Tedros said. “But achieving that target is now unlikely as conditions in northern Gaza get worse every day in the past two weeks.”

The WHO Director General was speaking at a WHO press conference in Geneva on Friday. 

‘Communications directly with Israel to reconsider’

WHO Director General Dr Tedros Adhanom Ghebreyesus appeals directly to Israel to reverse the decision to close UNRWA’s Jerusalem headquarters.

Asked if he had tried to speak directly with Prime Minister Benjamin Netanyahu about the UNRWA closure, scheduled in 90 days time, Tedros sidestepped the question, saying: 

“There are communications directly to Israel to reconsider; and not implement the decision by the Knessset. And I hope that will be the case…we encourage Israel actually to reconsider.” 

Israel’s decision stems from allegations that UNRWA  employees participated in the bloody 7 October 2023 assault on Israeli communities along the border with Gaza, while it’s schools and health facilities have provided a base for Hamas weapons stores and operations.  Testimony by several former Israeli hostages in Gaza described their captors as being affiliated with UNRWA. But there also has been a longstanding Israeli grudge regarding UNRWA,  a sprawling institution with schools, clinics and welfare activities serving 6 million Palestinians in the Occupied West Bank and Gaza, as well as Jordan, Lebanon and Syria, and institutionally separate from the mandate of the UN High Commissioner for Refugees (UNHCR), which serves the rest of the world’s 32 million UN-registered refugees.

Tedros acknowledged that nine employees are being investigated for operating on behalf of Hamas, including during the 7 October 2023 rampage in Israeli communities and a music festival near the Gaza border. 

“But even if we said these people have relationships with Hamas, they cannot represent the whole of UNRWA,” he asserted.  “This ban will not make Israel safer. It will only deepen the suffering of the people of Gaza, and increase the risk of outbreaks.” 

“They (UNRWA) are the engine block of humanitarian support, education, (water and sanitation) WASH, shelter, logistical support,” added Dr Rick Peeperkorn, WHO’s representative to the Occupied Palestinian Territories, speaking from Gaza. “The UN will not replace UNRWA.”

Mass dislocation and siege in north limits effectiveness of second polio campaign phase

Dr Rik Peeperkorn, WHO Representive to the Occupied Palestinian Territories

In terms of the polio campaign, where a second dose is set to be delivered in northern Gaza on Tuesday, vaccine workers won’t be able to reach the enclave’s northernmost areas, including Jabalia refugee camp, Beit Lahia and Beit Hanoun, WHO warned.

While mass Israeli evacuation orders have sent tens of thousands of Palestinians streaming south, and into safer areas close to Gaza City, tens of thousands of people still remain in those areas, where fierce fighting has been underway for weeks. 

“We currently have a humanitarian pause, necessary to conduct a campaign,” said Peeperkorn. “However, the area which this pause is covering has substantially been reduced compared to the first round of vaccination [in September]. 

“It’s mainly limited to the broader Gaza area, and while unfortunately, 100,000 people have been forced to evacuate from the northern Gaza, fleeing North Gaza to Gaza City, we still estimate…that approximately 15,000 children under 10 years in the towns of north Gaza, Jabalia, Beit Lahia and Beit Hanoun, still remain inaccessible and will be missed during the campaign. 

“So this is not an ideal campaign,” Peeperkorn said. “I want to stress that it’s a compromise campaign. And to interrupt poliovirus transmission, you want to get at least 90% of the children in every community, which will be challenging.”

Dysfunctional hospitals 

WHO teams arrive at Kamal Adwan hospital in embattled Beit Lahia, Gaza, on 28 October to evacuate critically ill patients and bring fresh medical supplies.

Along with the limitations of the polio campaign, WHO has been barred by Israel from operating  numerous relief and supply missions to northern Gaza’s hospitals, and particularly Kamal Adwan hospital, in Beit Lahia, which has been at the epicenter of fierce fighting over the past week. 

In the ensuing battles, the hospital’s pharmacy and an oxygen center were both destroyed, while two children in the intensive care unit died, according to Palestinian sources. Some 44 hospital staff were also detained in a two-day siege by Israel, which said it was trying to root out a Hamas command center on the hospital grounds.

The net result, however, is that the three main hospitals in northern Gaza, Kamal Adwan, Al Awda and the Indonesian hospital are barely functioning now, WHO officials said. 

On the brighter side, Shifa Hospital in Gaza City, which had been the site of a major Israeli siege and gun battles in mid-November, and again in the spring, has however, resumed partial operations, performing about ten surgeries a day, along with the reopening of its intensive care and dialysis services, as well as emergency trauma case, Peeperkorn said.

Over the past few weeks, WHO managed to operate six missions to the besieged hospitals of northern Gaza in October, including the evacuation of 60 critically ill patients from Kamal Adwan to other hospitals further south, added Peeperkorn. 

“But I want to stress that many of the missions in October were denied, delayed or, indeed on one of the missions, we were not allowed to bring in a fuel supply,” he added. Many of the WHO supplies that had been brought to Kamal Adwan also were destroyed or damaged during the destruction of the pharmacy. 

“Just to summarize, there were three partly functional hospitals in north Gaza: Kamal Adwan, Al Awda and the Indonesian Hospital.  The Indonesian is currently not functional anymore. It’s damaged. Kamal Adwan and Al Awda are minimally functional. WHO plans another support mission to Al Awda and to Kamal Adwan, this coming Sunday, bringing supplies and also, probably again, transferring critical patients to Shifa. I want to stress again, it is critically important that these hospitals remain functional.”

MPOX – new mechanism began allocating almost 900,000 vaccines this week

Vaccines as part of a multi-pronged strategy. Here, the International Organization for Migration conducts mpox screenings along the DRC-Uganda border.

In other news, Tedros said that a new mpox Access and Allocation Mechanism (AAM) this week began allocating almost 900,000 doses of donated mpox vaccines to nine African countries, based on their public health need – “and especially those with significant transmission of Clade 1B virus.

“Countries are being informed of allocations today, and WHO and our partners will announce the details soon. This is the first allocation of almost 6 million vaccine doses that we expect to be available by the end of 2024,” he declared. 

The AAM mechanism was created by WHO last month, together with Africa CDC, the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) Gavi, the Vaccine Alliance, and UNICEF, with donations secured so far from the European Union, Canada, the United States and others.

More than 50,000 people in the Democratic Republic of Congo (DRC) and Rwanda had now been vaccinated against the mpox virus – since a campaign in those countries began in earnest at the beginning of October, he added.

While vaccination is an important step towards bringing the mpox outbreak under control, he stressed that, “it’s important to underscore that vaccination is only one part of that plan, alongside case finding, contact tracing, infection prevention and control, clinical care, risk communication and testing.

“Although testing rates have risen significantly this year, only 40 to 50% of suspected cases were tested in DRC in the two past weeks.”

Image Credits: WHO, @WHOoPt, @daniels_ugochi.

Abandoned cars and campers debris litter the entrance to theNova Music Festival in Israel, following the surprise attack by Hamas on festival goers in the early morning hours of 7 October 2023.

Israeli researchers were surprised to find that alcohol use, as compared to psychedelics, contributed more significantly to psychological challenges amongst survivors of the October 7, 2023, Nova music festival attack, following a study, conducted by researchers from Sheba Medical Centre and Ben-Gurion University of the Negev. The study was published in October in World Psychiatry.

On October 7, about 4,000 people were attending the Nova music festival in southern Israel when Hamas militants entered early in the morning and began attacking their encampment. The massacre claimed the lives of nearly 400 people at the festival, as well as another 800 people living in surrounding rural communities and military outposts. Some 250 people, including about 40 festival goers, were also abducted by Hamas and taken to Gaza.

Many attendees had consumed various recreational drugs and alcohol, including LSD, MDMA, MMC, cannabis, and combinations of these. They had to react quickly, fleeing and hiding to save their lives.

The research team wanted to examine how the use of these drugs and alcohol impacted the way attendees responded to the attack, explained Prof Mark Weiser, chairperson of the Division of Psychiatry at Sheba and a professor at Tel Aviv University. The team hypothesised that survivors who were on drugs at the time would have been more hyper-aware of the event and their surroundings, thereby experiencing more post/trauma from the attack overall. However, they were wrong.

‘It was the alcohol’

“It was the alcohol,” he told Health Policy Watch. “These people were the ones who had more severe post-traumatic symptoms.”

After the attack, a total of 232 people sought treatment at Sheba Medical Center, located near Tel Aviv, which was treating post-trauma victims. Of these, 123 survivors qualified for the study, after excluding those with severe physical injuries or histories of mental disorders, including prior PTSD, as well as two participants who had used hallucinogenic mushrooms and ketamine before the event. The latter two were excluded due to the small sample size for these substances.

The average age of participants was 28. Most (61%) were male, 69% were single, and 68% had at least a high school diploma or equivalent. Amongst participants, 71 reported using psychoactive drugs, 12 only alcohol, nine only LSD, seven only MDMA, six only cannabis, three only MMC, 15 a combination including alcohol, and 19 a combination excluding alcohol.

The researchers administered a series of questionnaires to assess how these substances impacted participants’ cognitive and stress responses during the attack. They found that all participants experienced high levels of anxiety and hyperarousal-related symptoms, regardless of drug use. Amongst those who had taken drugs, such responses were significantly elevated during the crisis, which lasted for hours.

Alcohol consumption and brain function

A installation in Tel Aviv’s Hostage Square to the victims of the Nova Music Festival attack; some 400 people died and 40 were taken hostage by Hamas on 7 October 2023.

Even so, those who consumed alcohol—either alone or with drugs—had a much greater likelihood of experiencing post-traumatic symptoms such as depression, anxiety, arousal and hyperactivity, as well as emotional numbness.

“Alcohol consumption exerts various effects on brain function and behaviour, ranging from anxiolytic and mild disinhibitory effects to sedation, motor incoordination, altered memory, and emotional processing,” the researchers wrote. “Therefore, pre-trauma alcohol consumption may have interfered with the cognitive, emotional, and psychological processes necessary to cope with the traumatic event.”

They researchers did not differentiate between the different types of drugs used as there was not a large enough sample size.

Weiser noted that this study only looked at participants up to two months after the event. To determine any potential long-term effects, or whether drugs and alcohol might impact cognitive responses differently over time, further research would be needed. Weiser said he hoped that he and his research team might follow up with these 123 participants to assess their status over a year after the attack.

He also emphasised the small sample size, which primarily includes “people who were treatment seekers,” meaning those who recognised their need for help.

“There were a lot of people at Nova who were frightened, saw horrible things, but they went home, and life went on,” Weiser said. “It is important to realise we are talking about treatment seekers and not a random sampling from the party.”

Weiser added that, statistically, 15% to 20% of people who experience trauma will develop longer-term post traumatic stress disorder (PTSD). He noted that PTSD has a very broad diagnostic range, including those who have recurring bad dreams or troubling memories as well as those whose trauma disrupts their daily lives and ability to function.

Suicide after trauma

Beyond this study, however, a comprehensive tracking of the health and mental health outcomes of the festival goers, has not been undertaken.

Just last week, one Nova festival survivor, 22-year-old Shirel Golan, took her own life after a year-long struggle with PTSD, according to her parents. Her death has sparked concerns about whether the country is providing enough support for survivors of the October 7 events.

Hundreds of survivors continue to face serious mental health challenges, including PTSD, survivor’s guilt, depression, and anxiety.

In April, festival survivor Guy Ben Shimon told a State Audit Commission that “there have been almost 50 suicides amongst the Nova survivors.” However, the Health Ministry quickly countered, stating it has no data confirming this claim, and Weiser agrees.

In response to October 7, the Israeli government established a public mental health support program offering free therapy. Survivors with PTSD qualify for up to 36 sessions, while others can receive up to 12. As of July, nearly 1,900 survivors had been referred for treatment. The government has committed about $5 million to this and related programs.

“Every suicide is a tragedy, but it is very premature and inappropriate to say [Golan] suicided because of her experience at Nova,” Weiser said.

“This does not mean it is not true, but suicide is a multifactorial event, and we don’t fully understand why one person may end their life while another does not.”

Both in Israel and the United States, studies have shown elevated suicide rates amongst those with PTSD, and especially those who served in the military.

As of 2021, 30,177 US active-duty soldiers and veterans who had served in Afghanistan, Iraq and other conflict zones over the past two decades, had died by suicide, as compared to 7,057 combat-related deaths over the same period, according to the United Service Organisations. In Israel, suicide also was the leading cause of death amongst soldiers in 2021, two years before the Gaza war broke out, with 11 soldiers taking their lives that year.

Image Credits: Kobi Gideon / GPO/Wikipedia, Chuttersnap/ Unsplash, Wikimedia.

Dr Yvan Butera, Minister of State in Rwanda’s health ministry, is vaccinated with Sabin’s experimental vaccine.

The spread of mpox in Uganda is “of great concern”, with some 830 recorded cases in 19 states, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Uganda’s first recorded case was in Nakasongola Prison in Central Uganda, but new cases have been reported close to the border with the Democratic Republic of Congo (DRC) while “new clusters” in fishing communities are a cause for concern, Dr Ngashi Ngongo, Africa CDC’s mpox lead, told a media briefing on Thursday.

In the past week, 61 new cases were confirmed and one death, he added.

Unlike the DRC where children make up half the mpox cases, only 12,5% of Uganda’s mpox cases are children. The majority, 63%, are adult men and clade 1b, which can be sexually transmitted, is the dominant strain. 

Meanwhile, Mauritius has recorded its first mpox case – and the UK recorded its first case of Clade 1b case in someone who recently travelled to a country with mpox, said Ngongo.

The continent’s weekly case tally increased by 2,766 cases – a similar increase to previous weeks. The vast majority of cases are in the DRC and Burundi.

Almost 900,000 mpox vaccines have been distributed to nine countries, with vaccination campaigns going well in the DRC and Rwanda. However, Nigeria postponed its planned vaccination campaign this week.

Four more Marburg cases

Meanwhile, Rwanda recorded four new Marburg cases in the past two weeks – a health worker (reported on last week) and three contacts of other cases, according to Dr Yvan Butera, Minister of State in the health ministry. Two people have also died in the past week.

Rwanda has confirmed 66 Marburg cases and 15 deaths reported, a case-fatality rate of around 23%. Close to 6,000 people have now been tested while close to 1,600 frontline workers have been vaccinated, said Butera.

The source of the outbreak has been traced to fruit bats in a mine near Kigali, which infected the index case who had visited the mine.

The Sabine Vaccine Institute has sent a further 1,000 of its investigational vaccines to Rwanda, the company reported on Thursday. These will be used for a randomized clinical trial arm within the ongoing open-label study.

Previously, Rwanda had rejected the World Health Organization (WHO) protocol, which would have involved a control group that got vaccinated three weeks after the trial group, according to the journal, Science.

Instead, Rwanda opted to vaccinate all trial participants  “as part of a Phase 2 rapid response open-label trial, sponsored by the Rwanda Biomedical Centre”, according to Sabin. 

“Under the updated protocol, sponsored by the Rwanda Biomedical Center, approximately 1,000 at-risk individuals, including mine workers, will receive Sabin’s single-dose investigational vaccine in a one-to-one randomization. Half will receive the vaccine immediately, and the other half 21 days later to align with the end of the disease incubation period,” according to Sabin.

Designed to prevent illness before exposure to the virus, Sabin’s Marburg vaccine has not yet been proven to have clinical benefit for recipients of the vaccine.

Image Credits: Sabin Vaccine Institute.

Cholera oral vaccine Sudan
A Sudanese child gets an oral cholera vaccine.

While the global stockpile of oral cholera vaccines (OCV) has been empty since mid-October, vaccine doses are being produced each week and shipped directly to countries in need, according to the World Health Organization (WHO).

“As soon as adequate quantities are produced, they are shipped to countries in need. This is why the stockpile can remain at zero for long periods. It does not mean that there is no production,” a WHO spokesperson clarified to Health Policy Watch after reporting on 18 October that the stockpile was empty.

This year, 30 countries have reported cholera outbreaks involving over 430,000 people which is driving demand for the vaccines.

Pharmaceutical company EuBiologics in the Republic of Korea is the only company currently producing cholera vaccines under the brand name, Euvichol.

However, the WHO prequalified a simplified oral cholera vaccine in April, which will “nearly double the available doses from around 45 million this year to about 90 million by 2026”, according to the spokesperson.

“But the current increase will not fully address the existing vaccine gap. The demand remains exceptionally high and is still growing, despite the increase in production.”

Huge demand

The global stockpile of the oral cholera vaccine was established in 2013 with two million doses. By 2023, this had expanded to 36 million doses. 

The stockpile is overseen by the International Coordinating Group on Vaccine Provision (ICG) consisting of the International Federation of the Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF, and WHO. 

Gavi, the Vaccine Alliance pays for the vaccine and its distribution to all eligible countries.

“The ICG has approved 14 million cholera doses for outbreak response over the last two months, a volume that represents twice the size of the current stockpile,” according to a Gavi spokesperson.

“However, while there may be short periods where all available doses are allocated to specific country requests, the stockpile is continually replenished on a rolling basis by the manufacturer.”

Investments made by Gavi and its partners to increase the volume and speed of supply have halved the timeline needed for replenishing the global vaccine stockpile this year. 

Gavi expects close to three million new doses to be made available this week, seven million in November, and six million in December, “all ready to be shipped to countries that may request them for ongoing outbreaks”.

 “In April we welcomed the arrival of a new OCV, Euvichol-S which enabled EuBiologics, its manufacturer, to produce more volumes of vaccine, faster, and at a lower cost – a key step to expanding supply amidst the ongoing acute global upsurge of cholera outbreaks,” said the Gavi spokesperson.

“The global availability of OCV has once again shown an annual increase from 38 million doses in 2023 to approximately 50 million in 2024, and is further expected to increase again in 2025, to 70 million doses,” said Gavi.

However, creating both sustainable and predictable demand for OCV, and supporting efforts towards long-term control by launching preventive programmes in endemic countries, is vital for controlling the disease, Gavi notes.

Image Credits: WHO.

A woman displays maize ears from her drought stricken garden in Mauritania. Across Africa, more and more people are at risk of food insecurity, exacerbated by climate change.

The 9th Lancet Countdown report on health and climate change shows that deaths from extreme heat, hunger, and disease, all are rising because of climate change. Authors call out governments and companies that continue “fuelling the fire” with continued investment in fossil fuels and subsidies, leading to all-time high energy-related greenhouse gas emissions, which are reducing the prospects for the survival of billions.  

People worldwide are facing a series of unprecedented threats to their wellbeing, health, and survival from the rapidly changing climate. Of the 15 indicators of  climate change-related health hazards, exposures, and impacts monitored by the Lancet Countdown on Health and Climate Change, 10 reached new records of risk, in this year’s report, released on Wednesday.  

The 50-page report is the product of contributions of 172 researchers from 57 leading research organizations and United Nations (UN) agencies worldwide, working in close collaboration with the World Health Organization (WHO). 

Years of delayed climate action are “reducing the chances of mankind’s long-term survival,” declared Green Climate Fund Director Dr Oyun Sanjaasuren, speaking at an expert panel launching the report.

“Financial resources to support the transition to cleaner, green energy but these are “unfortunately being allocated to activities that perpetuate the fossil fuel-based economy.” 

Green Climate Fund Director Dr Oyun Sanjaasuren.

More deaths

Globally heat-related deaths amongst those aged over 65 increased last year by a record-breaking 167% higher than deaths in the 1990s – substantially above the 65% increase that would have been expected had temperatures not changed (accounting only for changing demographics). 

Heat stress even from light exercise

Last year also saw an all-time high exposure of over 1,500 hours of high temperatures. This means that even light outdoor exercise such as walking or cycling posed a moderate risk of heat stress to billions worldwide, for almost 28% more hours than in the 1990s.

Because of climate change, people faced a record-high average of 50 more days of temperatures that could threaten human health.

More disease

Lead author, Marina Romanello, describes trends in extreme precipitation and drought at the launch of the Lancet Countdown report.

Another all-time high was recorded with over five million dengue cases in over 80 countries, thanks to more extreme rain as well as heatwaves, enhancing the climatic suitability for the spread of deadly mosquito-borne infectious diseases. 

Billions in economic losses

Global potential income losses are equivalent to $835 billion because of increasing temperatures leading to over 500 billion potential hours of labour lost in 2023.

More drought

There was extreme drought on almost half the landmass. Forty-eight per cent of the global land area was affected by at least one month of extreme drought, the second-highest level since at least 1951.

Heat-triggered food insecurity affected the highest number of people ever. The increase in drought and heatwave events since 1981–2010 was associated with 151 million more people experiencing moderate or severe food insecurity across 124 countries. 

“It’s the most concerning report that we found in our eight years of monitoring,” lead author Marina Romanello said at the launch. 

“Out of 15 indicators, 10 have reached record highs, new levels of threats. This means that our health is increasingly at risk, and in the heat maps where we’ve represented their values, from blue being safer conditions for health, to red, the worst conditions, you can see that very clear trend towards redder, worsening conditions across every indicator.”

Rising heat a driving factor of disease, disasters and deaths

Days ot health threatening temperature in 2019-23

Last year, 2023, was the hottest on record. 

Cross-cutting many of the health effects is the rising levels of extreme heat – with heat-related illness in multiple dimensions from more cardiovascular disease, to more work-related heat stress, and even more sleepless nights – not to mention the knock-on effects of heat-related drought on food production and hunger.

“One of the key impacts of climate change obviously comes from extreme heat and from heat exposure,” said Romanello.  

“As the temperatures rise, we see that the threats to our health associated with high temperatures is also growing, and this is particularly so for vulnerable groups like very young children, people with underlying health conditions like heart disease, lung disease, and other elderly people over 65 years of age. 

“And what we’re monitoring here is heat-related deaths of people over 65 years of age, and we see that it is more than twice the level of expected mortality if temperatures hadn’t changed. 

“So we know that it’s climate change that is driving this rapid growth in heat related mortality to record high levels this year. But obviously mortality is just the tip of what we know is a very big iceberg of health impacts of climate change that is associated with disease associated with heat stress and health conditions that are worsened by rising temperatures.” 

Fossil fuels’ share in global energy mix increased for first time in a decade 

Despite all of the warning signs, levels of energy-related carbon dioxide emissions also reached an all-time high in 2022 of 37.2 gigatons. In 2021, the share of fossil fuels in the global energy system also increased for the first time in a decade, reaching 80.3%. 

“Extraordinary rainfall hit South Asia after a summer with temperatures regularly above 40°C through the night. Look at the devastating flooding now in the Valencia area of Spain. Think of the wildfires that have torn through southern Europe, the long list of tragedies around the world goes on,” declared Helen Clark, former New Zealand Prime Minister at the report’s launch event.

“We are in a very grave situation. Climate change threats are rising as emissions continue to grow, and it often seems that the many alarms which are being raised by scientists around the world are just being ignored. Yet we cannot afford to continue down this ridiculous path, this irresponsible path where every moment of delay is being paid for in people’s lives.”

Former New Zealand Prime Minister Helen Clark.

Oil and gas production to exceed 1.5° target by 60% in 2030 – and 149% by 2040 

Despite all of the talk and promises of a “green energy” transition, governments allocated a record-breaking $1.4 trillion to net fossil fuel subsidies, dwarfing any financial commitments in support of climate action made at COP28, the report also notes. 

The world’s 114 largest oil and gas companies, covering 80% of all exploitation, have also increased their projections for levels of fossil fuel production by 2040. 

This would lead to greenhouse gas (GHG) emissions exceeding levels compatible with 1.5°C of warming by as much as 59% in 2030, and a staggering 189% in 2040. Worse still, 33 of these companies are expected to continue exceeding their 1.5°C-compatible GHG emissions by over 300% in 2040. 

Oil and gas companies higher production targets would put the planet well beyond 1.5C

Beyond 1.5° global warming above pre-industrial times, scientists have warned of increasing intensity of heatwaves, extreme rainfall, stronger storms, water scarcity, diminishing agriculture, and extinction of many species in some of the more dangerous fallouts. 

“Cure the sickness of climate inaction”

The Lancet Countdown,  established the same year that the Paris Climate Agreement came into force, aims to monitor the health impacts and opportunities of the world’s response to this landmark commitment to keep global warming below 1.5°C. 

Responding to the report, António Guterres, UN Secretary-General, said: “Record-high emissions are posing record-breaking threats to our health. We must cure the sickness of climate inaction – by slashing emissions, protecting people from climate extremes, and ending our fossil fuel addiction – to create a fairer, safer, and healthier future for all.” 

Some silver linings

There is some reason for “cautious optimism” the report points out, despite the record-breaking health harms it flags. 

The share of renewable energy reached 10.5% in 2021, almost double that of 2016. Global investment in clean energy grew 10% in 2023 to US$1.9 trillion, exceeding fossil fuel investment by 73%. Jobs in renewables also reached a record-high with almost 14 million employees in 2022, up by over a third since 2016. 

Deaths from fossil fuel-associated air pollution fell from 2.25 million in 2016 to 2.09 million in 2021, mostly due to reduced pollution from coal burning, demonstrating the life-saving potential of coal phase-out. 

However, household use of biomass as a primary cooking fuel, caused 1.24 million deaths in 2021, an increase of 135,000 from 2016.

Contrasting conclusions about fossil fuels’ contribution to air pollution

Mortality attributable to PM2·5, produced by fossil fuels and other sources, in relation to human development index (HDI) country level.

Notably, however, the Countdown’s assessment of premature deaths attributable to fossil-fuel related air pollution overall is less than half the 5.13 million estimate published by The BMJ, in late 2023. 

The assumptions and models underlying the contrasting conclusions are still being debated amongst the scientists. But according to both Lancet lead author Romanello and The BMJ lead author Jos Lelieveld, the key differences revolve around the fact that The BMJ article estimated lives that could be saved if fossil fuel emissions were eliminated, whereas the Lancet Countdown estimated deaths attributable to fossil fuels in today’s current mix of pollution sources. 

As compared to the BMJ, The Lancet Countdown also uses a different model to estimate the relative proportion of fossil fuel emissions in the total air pollution mix – leading to a different estimate of health effects.  

And finally, in the BMJ “fossil fuels elimination” scenario, there would be knock-on benefits in other sectors, particularly agriculture – which produces significant ammonia that interacts with fossil fuel-produced sulphur oxides (SOx) and oxides of nitrogen (NOx) to form significant amounts of secondary PM2.5. 

Either way, Romanello,  who along with being lead author is the Executive Director of the Lancet Countdown project at University College London, explained why public investment is vital to tackle the twin dangers of energy poverty and toxic air. 

“Globally, 4 million people and 30% of vulnerable households around the world are still using biomass, a very unreliable, very dirty source (of fuel.) 

“These are the poorest and most vulnerable in countries in the world. So this is a system of energy poverty. The direct health impact of that, beyond the health harms of energy poverty, is that people are also being exposed to toxic air inside their homes because of the persistent use of solid fuel.”

Taking it down to the country level 

In countries of South East Asia the toll of air pollution is particularly high, while fossil fuel subsidies are also at record levels. 

India saw 1.6 million deaths in 2021 due to PM 2.5, the report says. This is estimated to be equivalent to a loss of $320 billion. Over a third of these deaths were due to fossil fuels, even according to the Countdown’s more ‘conservative’ estimate of fossil fuel’s role. 

In 2022, India also allocated a record net total of nearly $58 billion in subsidies to the fossil fuel sector. Heat exposure has increased over the past few decades and this the report estimates cost the economy $141 billion in potential income loss from labour capacity reduction due to heat in 2023. The agricultural sector was the most affected, with more than $71.9 billion in potential losses. 

In the United States, historically the largest greenhouse gas emitter, there were approximately 125,800 deaths attributable to human sources of air pollution (PM 2.5) in 2021. Fossil fuels contributed to 39% of the mortality. The monetised value of premature mortality due to anthropogenic air pollution was $669 billion, whereas the fossil fuel sector received $9 bn in subsidies in 2022. Heat cost the economy a potential income loss of $103 billion last year.

The Lancet Countdown has been published days ahead of the start of COP29, the UN’s annual, mega climate conference of all governments and several institutions, agencies and civil society. 

For decades, UN Climate Change has pushed for climate action. The hottest year on record and increasing GHG emissions is a reality check on exactly what three decades of climate talks have achieved. Now, COP29 is being held in Baku, the capital of a fossil fuel-rich nation Azerbaijan, which is expanding its gas industry. 

Image Credits: Pablo Tosco/Oxfam, Lancet Countdown on Health and Climate Change 2024, Lancet Countdown on Health and Climate, 2024, Lancet Countdown on Health and Climate, 2024, Lancet Countdown, 2024, Lancet Countdown, 2024 , Lancet Countdown on Health and Climate .

Institute of Women’s Health’s Anita Mpambara Cox, former Trump officials Alma Golden and Valerie Huber and Burundi’s First Lady, Angeline Ndayishimiye, meet in Washington, DC.

Post 2020, ex-Trump officials have worked through NGOs to undermine abortion and LGBTQ rights in Africa, preparing the ground for his re-election

Despite Donald Trump’s electoral defeat as US president in 2020, his ex-officials and allies have never stopped campaigning for African countries to prevent abortion and LGBTQ rights  – in league with some of the most right-wing countries on the planet, including Russia and Hungary.

If Trump is re-elected on 5 November, he is likely to entrench opposition to abortion as a key pillar of US foreign aid. Project 2025, the controversial conservative blueprint for a Trump victory written primarily by his former officials, proposes that all US aid including humanitarian assistance, is conditional on the rejection of abortion.

“Proposed measures for USAID [US Agency for International Development] include a significant restructuring, and reduction of budget, the removal of diversity, equity, and inclusion programs, and dismantling of the apparatus that supports gender equality and LGBTQ+ rights,” notes researcher Malayah Harper in an analysis of Project 2025.

‘Sending people to their deaths’

“The return of Trump, at a time when nationalist African presidents are also prosecuting women and queer people, means sending these groups to their death,” observes Saoyo Tabitha Griffith, a Kenyan high court lawyer and women’s rights activist.

“This is not alarmist. It is purely informed by the observation of past patterns,” she tells Health Policy Watch.

One of Trump’s first presidential actions in 2017 was to prohibit foreign NGOs from receiving US government funding for health if they “provided, promoted, or discussed” abortion – known as the Expanded Global Gag Rule (GGR). 

Many family planning organisations lost their funding and women lost access to contraception in some of the continent’s poorest countries such as Madagascar and Ethiopia – ironically contributing to more unplanned pregnancies.

Banning abortion has never stopped it

But abortion bans have never stopped women and girls from trying to end unwanted pregnancies. It has simply driven them to unsafe providers whose methods often maim and even kill them.

Approximately 6.2 million women and girls had abortions in Sub-Saharan Africa in 2019, and the region has the highest rate of unplanned pregnancies and abortion-related deaths in the world – 185 maternal deaths per 100,000 abortions, according to  Guttmacher.

While the percentage of women in Sub-Saharan seeking abortions has remained constant, the number of abortions has surged with population growth.

When Trump was elected, Griffith was deputy head of the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) which works on HIV and women’s issues.

“After the Expanded Gag Rule, we saw the deaths of sex workers. We saw the deaths of women who needed safe abortions. People died because service delivery programmes shut down,” she said.

Trump’s administration also cut funding to the United Nations Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. This affected the provision of maternal and reproductive health services throughout the world – particularly in humanitarian settings.

Trump also froze the US contributions to the World Health Organization (WHO) in the middle of the COVID-19 pandemic.

In 2023, Republican congressional lobbying even put the brakes on the US President’s Emergency Plan for AIDS Relief (PEPFAR), claiming – incorrectly – that some grant recipients were promoting abortion. As a result of the right-wing lobby, PEPFAR projects now receive yearly budgets instead of five-year funding.

Ex-Trump officials prepare ground for his re-election

While legal abortion is out of the reach of most African women and girls, 19 African countries have eased access since 1994 – mostly in an attempt to reduce the maternal deaths caused by unsafe abortions.

Infographic: Abortion in Africa: 28 Years of Progress | Statista

But US groups have stoked opposition to easing abortion access in Africa, led most recently by Valerie Huber, the Trump-era Special Representative for Global Women’s Health, and Alma Golden, ex-Assistant Administrator for Global Health at USAID.

Huber was the architect of an anti-abortion pact, the Geneva Consensus Declaration (GCD), adopted in the dying weeks of Trump’s rule in October 2020 with the support of an array of global human-rights polecats such as Iraq, Uganda, Belarus and Sudan.

The GCD also promotes “the natural family” – primarly aimed at removing any recognition of the existence of  LGBTQ people.

When Biden withdrew the US from the GCD in 2020, Hungary took over the secretariat. However, Trump has confirmed that the US will rejoin the pact if he is elected “to reject the globalist claim of an international right to abortion”.

After Trump’s defeat, Huber and Golden launched an NGO called the Institute for Women’s Health (IWH) in 2021, to seek support for the GCD. The IWH is on Project 2025’s advisory board. Its Africa coordinator is Phillip Sayuni, a Ugandan anti-gay pastor, while its international programmes director, Anita Mpambara Cox, is a Ugandan American who sought election as a  Republican Senator in 2022.

Valerie Huber addressing the fourth anniversary of the anti-abortion pact, the Geneva Consensus Declaration, in Washington DC, in September in front of the flags of signatories, including Iraq, Belarus, Benin and Hungary.

In the past year, the IWH has persuaded Burundi and Chad, countries with poor human rights records, to sign the GCD. Burundi only allow abortion to save the life of a pregnant woman, not even allowing it in cases of rape and incest. Women who have abortions face prison sentences. The military dictatorship in Chad allows abortions to save a woman’s life and in cases of rape and incest.

Since forming IWH, Huber has courted several right wing African governments, including Sudan, South Sudan, Mali, Burkino Faso and Tanzania, but her closest links are with the Ugandan government.

Support from US conservative Christian groups

Supporting Huber’s anti-abortion, anti-LGBTQ crusade is a phalanx of conservative US NGOs active in Africa, particularly Family Watch International (FWI), headed by conservative Mormon Sharon Slater. FWI has been pushing the same agenda in Africa for over 20 years, and Slater and Huber both work closely with Ugandan First Lady Janet Museveni.

Several of these US groups also oppose contraception and sex education for school children known as “comprehensive sexuality education”.

The African spending of 17 conservative US Christian organisations known for opposing sexual and reproductive rights, including FWI, almost doubled after Trump’s 2020 defeat. FWI’s spending increased by 495%, albeit off a low base.

The 17 groups spent about $16.5 million in Africa between 2019 and 2022, with almost a third ($5.2 million) in 2022, the year after Biden took office, according to the Institute for Journalism and Social Change (IJSC). 

Institute for Journalism and Social Change (IJSC)

Importing US anti-LGBTQ laws

A group of US anti-rights groups have worked with conservative African politicians for decades to encourage laws that crack down on the very existence of LGBTQ people across the continent. 

In the past year, Uganda and Ghana have passed draconian anti-LGBTQ laws with the encouragement of these US groups, particularly FWI.

US conservative Christian group Family Watch International leader Sharon Slater (centre, black dress) meets Uganda’s first lady, Janet Museveni (centre, white skirt) in April 2023 to encourage the passage of the  country’s Anti-Homosexuality Bill.

FWI was one of the driving forces behind the recent Inter-Parliamentary Conference on Family Values and Sovereignty, which also received a $300,000 boost from the Russian government, according to a recent Wall Street Journal exposé. 

The conference also featured speakers who attacked routine vaccination campaigns and the World Health Organization (WHO), as previously exposed by Health Policy Watch.

However, its main agenda was to galvanise support from politicians across Africa for anti-LGBTQ, anti-abortion legislation.

The government of Kenyan President William Ruto, the country’s first evangelical leader, is considering “family values” laws to crack down on LGBTQ people and even make divorce more difficult. 

Copycat laws from US

Kenyan LGBTQ activist Āryā Jeipea Karijo says that parts of her country’s anti-LGBTQ Bill are “a direct copy” of US anti-transgender bills. 

Two concerns in the Bill – transgender people’s access to bathrooms and minors transitioning – “are not contextual to Kenya’s state of access to water as well as to meeting healthcare needs of transgender people”, Karijo says.

Kenya is struggling to provide adequate toilets in many schools and there is very little opportunity for adults to transition, let alone minors, she explains to Health Policy Watch.

“A side-by-side reading of US anti-transgender legislation and sections of the anti-LGBTQ laws that have been passed in Ghana, Uganda, and are proposed for Kenya, show that the authors are the same, and they are definitely not from the continent,” adds Karijo.

Meanwhile, Namibian LGBTQ activist Omar van Reenen notes that “anti-rights groups in the US share resources, strategies and rhetoric internationally”.

“The transnational exchange of anti-rights ideologies imported from American evangelical groups and NGOs like Family Watch International are alive and well,” said Van Reenen in a recent interview with the journal, Transcript.

Griffith sounds a grim warning if Trump wins the US election: “African women and LGBTQ people must anticipate that Trump’s return will re-ignite an ideological war with real and physical consequences on their bodies.

“Issues such as contraceptives, surrogacy, single parenting, safe abortion, HPV vaccines and sexual orientation are all going to be contested, not through science and data but by conspiracies and misinformation.”

Image Credits: IJSC.

An government health worker explaining the adult BCG vaccination to protect against TB to a beneficiary in the Indian state of Goa

In 2021, I lost a close friend to tuberculosis (TB), the world’s most lethal infection. But I cannot say anything else about this friend, where I met him or when we became close. 

The stigma surrounding tuberculosis is too impenetrable and, unfortunately, it would not be fair to my friend’s family. Still, for me, his recent death highlights the threat this disease poses, not only to the millions of people living with TB, but to their friends and family members globally.

Growing up in Pantnagar, a university town in North India, we were familiar with TB and other diseases including cholera, dengue, malaria, and typhoid fever. All of them were unfortunate. But it is only TB that we shy away from talking about, even when someone we know contracts the disease. We keep pretending that it doesn’t exist – despite all evidence to the contrary.

Updated TB numbers show progress is needed

According to the World Health Organization’s latest report, TB kills more than one million people annually, more than any other infectious disease. Every year, an estimated 10.8 million people contract the disease, but in 2023 only 8.2 million people were diagnosed, according to the World Health Organization’s 2024 TB report, released Tuesday.

Millions of people are sick but either cannot or will not seek medical help. Stigma is likely one of the reasons why; too many times, it gets in the way of preventing and treating TB. This stigma has nothing to do with whether people are underprivileged or poor or are well off and live in good places. TB is simply considered something that shouldn’t be discussed.

The WHO report shows that we have not seen significant improvements in how many people contracted the disease in 2023, how many people died from the disease, where the hardest-hit locations can be found. 

Stigma is an issue globally, in too many settings – from Nepal to South Africa, and most everywhere else. Up to 75% or more of TB patients experience stigma, with impacts ranging from delays in seeking out a diagnosis and treatment to patients ignoring preventive measures like masks that can help curb the spread of the disease.

On a personal level, TB is a health and financial crisis

Compounding matters, the economic damage caused by TB magnifies the harms of TB stigma. WHO has estimated that half of TB patients and their families experience a catastrophic impact on their household income, along with the declining health of a family member, for at least half a year. In this context, the stigma hits very hard: family budgets shrink as expenses increase, while everyone copes with a health crisis that no one can discuss.

India’s plan is to eliminate TB by 2025 and the global plan is to eliminate it by 2030. To reach these goals, we need to be bold in conversations. It’s not just about finding a cure, we must work on social stigmas. India, for example, is a very populous country. To achieve its goals, the government maintains an online data center that tracks TB statistics, but stigma persists. The trains are crowded, the cities are congested, it only takes one person to ignore their symptoms and spread the disease.

Outreach and patient empowerment can shrink stigma 

To address the stigma and enable conversations, we need stronger patient education and support initiatives so that those who have TB can be empowered as they navigate a life-threatening illness. 

Examples of this programming include the “TB clubs” in Ethiopia and Nicaragua where small groups of patients meet regularly and help each other get through the six-month treatment process. These groups reduce the social isolation that patients so often experience, which then helps alleviate the disease stigma. Patients have also asked for community engagement that provides safe spaces for people affected by TB to share their experiences and advocate for changing the social norms that reinforce stigma.

Outreach efforts that focus on TB healthcare workers are also important, as how they talk about the disease with patients and families can help alleviate some of the stigma that they experience—and TB healthcare workers also face TB stigma from those whose practices do not include TB. Helping to ease this stigma aids their patients as well.

These initiatives to reduce stigma stand out because too few have been put into practice. But as long as a strong social stigma remains attached to TB, it will be difficult to gain traction against this disease. Scientific breakthroughs in prevention and treatment will have limited value if people will not go near them.

The WHO’s plan to end TB by 2030 includes improving diagnosis and treatment services and taking advantage of current technologies, especially those that can help curb the spread of drug-resistant strains of TB, but we also need to start having the difficult discussions to address stigma.

We can develop new ways to prevent and treat the disease, but unless we include programming that encourages openness, we are only fighting half the battle.

Neelima Sharma, PhD, is a Senior Toxicologist at the Bill & Melinda Gates Medical Research Institute

Image Credits: UNDP.

In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis.

Shaka Brown was diagnosed with tuberculosis (TB) in November 2023.

“I was dropped off at the emergency room in Miami, Florida,” he recalled. “In September, I thought I’d caught the flu, but after weeks of night sweats, fainting spells, and losing my hearing in my left ear—and over 50 pounds—I knew something was wrong.”

Brown underwent ultrasounds, X-rays, and a battery of tests within hours of arriving. Then, the doctors delivered the news: he had TB.

“I told them no one gets TB,” he said. But Brown was quickly moved to a negative-pressure isolation room. “It turned out they were right. I had TB everywhere.”

Shaka Brown
Shaka Brown

The bacteria had spread from Brown’s lungs to nearly every organ in his body, including his bladder, brain, and spine. The infection had compromised his lower spine, causing sharp pain down his leg.

“The hospital had a molecular diagnostic machine, which helped them quickly figure out that I needed a specialised drug regimen. The standard treatment wouldn’t work for me,” he said.

“I started life-saving antibiotics the next day—over 15 pills every day. The TB growth was halted within a week. I remember slowly opening my eyes, surrounded by doctors who told me I was going to make it. It was only then I realised how close I’d come to not making it.”

Despite daily pills, four months later, Brown was back in the hospital, this time with seizures and unable to speak.

“The TB in my brain wasn’t going away as quickly as they hoped,” Brown said.

A week later, he underwent brain surgery to remove the infection. His doctors added anti-seizure medication to his TB regimen.

“They told me they’d stick with me every step of the way,” he added.

However, as Brown highlighted Tuesday during a presentation of new TB data by the World Health Organization (WHO), not everyone shares his good fortune.

“Twenty percent of people who get TB are never diagnosed and, therefore, never treated,” he said. “If we could just identify and treat those individuals, we could save lives. Every person we miss gives the bacteria a chance to evolve, weakening the effectiveness of current treatments. Yet, funding for research to develop effective drugs is decreasing.”

TB is top infectious disease killer in 2023

World Health Organization's 2024 Global Tuberculosis Report.
World Health Organization’s 2024 Global Tuberculosis Report.

Brown’s message was underscored by the WHO’s release of its 2024 Global Tuberculosis Report. The 68-page report offers comprehensive data on TB trends and the global response, covering 215 countries and regions, including all 193 WHO member states. It provides the latest insights into the TB epidemic, tracking global, regional, and national progress, along with the impact of key factors driving the disease.

In 2023, TB reclaimed its position as the world’s leading infectious disease killer, following three years when COVID-19 took the lead. It caused almost twice as many deaths as HIV/AIDS. Specifically, there were an estimated 1.25 million deaths in 2023, including 161,000 amongst people with HIV.

“The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “WHO urges all countries to make good on the concrete commitments they have made to expand the use of those tools, and to end TB.”

Globally, the number of deaths caused by TB fell in 2023, reinforcing the decline seen in 2022 after increases during the worst years of the COVID-19 pandemic. However, the number of people contracting TB rose slightly to approximately 8.2 million, the highest number recorded since WHO began global TB monitoring in 1995. This represents a notable increase from the 7.5 million reported in 2022.

Of those who developed TB, 55% were men, 33% were women, and 12% were children and young adolescents.

While TB occurs worldwide, 87% of cases in 2023 came from 30 high-burden countries. The majority of new TB cases were in Southeast Asia (45%) and Africa (24%), with smaller percentages in the Western Pacific (17%), Eastern Mediterranean (8.6%), the Americas (3.2%), and Europe (2.1%).

Eight countries accounted for two-thirds of the total: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of Congo.

Several major risk factors drive a significant portion of TB cases, including undernutrition, HIV infection, alcohol use disorders, smoking (especially amongst men), and diabetes.

Since 2000, TB prevention and treatment efforts have saved 79 million lives. The global gap between estimated TB cases (incidents) and reported new diagnoses (notifications) narrowed to about 2.7 million in 2023, down from around 4 million in 2020 and 2021 and below the pre-pandemic level of 3.2 million in 2019.

Drug-resistant TB remains a serious public health threat, said Dr. Tereza Kasaeva, WHO’s Global TB Program director. Presenting the data to health officials and the press on Tuesday alongside Brown, she noted that in 2023, 175,923 people were diagnosed and treated for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB)—just 44% of the estimated 400,000 cases worldwide.

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Kasaeva said progress toward global TB milestones and targets is lagging, including those set for 2027. Global funding for TB prevention and care dropped in 2023. Of the $22 billion target, only $5.7 billion was received—just 26% of the goal, with low- and middle-income countries bearing 98% of the TB burden.

“With only 26% funding, it’s impossible to provide 100% access for everyone in need,” Kasaeva said.

Domestic sources provided 80% of TB funding, while international funding for low- and middle-income countries has held steady at around $1.2 billion per year. Funding for TB research also remains critically low at around $1 billion per year—just a fifth of what’s needed.

“This is absolutely insufficient,” Kasaeva said.

“We are confronted with a multitude of formidable challenges: funding shortfalls and catastrophic financial burden on those affected, climate change, conflict, migration and displacement, pandemics, and drug-resistant tuberculosis, a significant driver of antimicrobial resistance,” Kasaeva added. “It is imperative that we unite across all sectors and stakeholders, to confront these pressing issues and ramp up our efforts.”

‘We can end TB’

Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID)

The United States is the largest bilateral donor to global TB efforts, thanks to bipartisan support from Congress, explained Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID), who also spoke on Monday.

Since 2000, USAID has invested $4.7 billion in the fight against TB.

“We have a global TB strategy for 2023 to 2030 that focusses on our 24 priority countries,” Vincent said.

The strategy aims to ensure that 90% of people with TB, including drug-resistant TB, are diagnosed and treated. It also seeks to provide preventive treatment for 30 million people eligible for it.

“While it’s heartening to see some positive trends in our battle against TB, we must confront a harsh reality: despite our efforts, we are merely treading water, failing to make significant strides toward our goal of ending TB,” said Dr Cassandra Kelly-Cirino, executive director of the International Union Against Tuberculosis and Lung Disease, in response to the report.

“To create a world free from TB, we must urgently address the areas where we continue to fall short.”

She added, “We’re diagnosing only 48% of the individuals needed to meet the 90% target. This is unacceptable. We must ramp up testing, ensure timely diagnosis, and support effective treatment to turn these numbers around and accelerate the reduction in the global TB incidence rate.”

Similarly, Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, stated, “The big message from this year’s World TB Report is that if we act decisively, we can end TB.”

“We have momentum, tools, and leadership, but we need more funding—and we also need to dismantle human rights and gender-related barriers that prevent people from accessing the services they need,” he continued. “Winning will take political will and sustained commitment. In a world facing increasing challenges from conflict and climate change, we cannot hesitate.”

Image Credits: Stop TB Partnership, Shaka Brown's official website, World Health Organization.