Madrid, Spain – Countries lack capacity and even more important, the money, to incorporate health factors into their climate action strategies – even though increased disease and deaths are one of the most immediate outcomes of climate change.

This is the key finding of a first-ever report by the World Health Organization that looks at how national health systems are responding to climate-related health threats that are affecting countries more frequently and with greater intensity, including food-borne and water-borne as well as vector-borne infectious diseases, as well as heat stress and extreme weather events.

Female solar engineers in India bring solar power to communities. Clean energy generates a double benefit for climate and health in terms of less air pollution.

The report, The WHO Health and Climate Change Survey Report – Tracking Global Progress – surveyed 101 countries, from high- to low-income economies across all regions of the world.

The findings show that while nearly half of the countries surveyed had developed a national health and climate change strategy or plan, less than one-fifth reported a high level of plan implementation, and fewer than 10% of countries said that they had resources to fully implement their plans.

“Countries are exposed to climate risks, they are vulnerable to health impacts and they are not receiving the support they need in order to protect people’s health,” said WHO’s Diarmid Campbell-Lendrum, speaking at a press conference here on Tuesday, the second day of the UN Climate Conference in Madrid (COP25).

In addition to the direct impacts of climate change, Campbell-Lendrum noted that some 7 million people annually die from air pollution every year, “roughly the whole population of Madrid” and those deaths are “very closely linked to the climate crisis, as about two-thirds of the outdoor air pollution we experience is from  fossil fuel combustion.”

WHO has estimated that cutting carbon emissions to meet the climate goals of the 2015 Paris Climate Agreement could save about a million lives a year worldwide by 2050 through reductions in air pollution alone. And the economic benefits of the health gains would be more than twice that of the costs of carbon reductions, he said.

“Climate change is not only racking up a bill for future generations to pay, it’s a price that people are paying for now with their health,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, in a press release on the new report. “It is a moral imperative that countries have the resources they need to act against climate change and safeguard health now and in the future.”

Among the countries that did conduct a climate and health assessment, the most common climate-sensitive health risks were identified by countries as heat stress, injury or death from extreme weather events, as well as food-, water- and vector-borne diseases (such as cholera, dengue or malaria). However, about 60% of countries responding reported that their assessment findings have had little or no influence on the allocation of human and financial resources needed to protect health from climate change.

Biggest Barrier is Finance

The biggest barrier, the survey found, was that countries have difficulties in accessing international climate finance for health-related climate plans and projects. Over 75% of the national health systems that responded to the survey, reported that they lacked information on climate finance opportunities.  Over 60% said that health actors were disconnected from climate finance processes, and over 50% said that health systems lacked capacity to even prepare proposals.

In terms of preventing future climate change, the report also notes that few countries have been able to take advantage of the synergies that exist between reducing carbon emission and reducing environmental contamination that harms health, particularly air pollution.

Fewer than 25% of countries surveyed reporting having clear collaborations between health sectors and other key sectors driving climate change, such as transport, power generation and domestic heat and power production.

Potential Health Gains of Climate Mitigation Rarely Counted 

Potential health gains that would result from cutting carbon emissions are rarely reflected in national climate commitments, with only one-fifth of Nationally Determined Commitments (NDCs) mentioning health in the context of emissions reductions and 1 in 10 NDCs specifically mentioning expected health gains.

The so-called “Nationally Determined Commitments,” the voluntary targets to which countries commit, are in fact the backbone of the 2015 Paris Climate Agreement that aims to keep climate change below 2°C and 1.5°C, if at all possible.

While two-thirds of countries’ NDCs mention health in general terms, and the health sector is among the five sectors most often described as vulnerable to climate change, when it comes to concrete action, health is just not factored into the equation, the WHO report concludes.

“For the Paris Agreement to be effective to protect people’s health, all levels of government need to prioritize building health system resilience to climate change, and a growing number of national governments are clearly headed in that direction,” said Maria Neira, WHO’s Director of the Department of Environment, Climate Change and Health, in the press release.

“By systematically including health in Nationally Determined Contributions – as well as National Adaptation Plans, climate finance pledges, and other National Communications to the UNFCCC [United Nations Framework Convention on Climate Change] — the Paris Agreement could become the strongest international health agreement of the century.”

Speaking at the press conference, Neira said that countries need to ensure that the health sector is included in climate change processes and that health ministries have the capacity and support to access the finance they need.

“The fact that the health impact is already felt by the countries but the finance is not reaching them,” said Neira, speaking at the press conference.

She added that the health sector was also calling on governments ” to be much more ambitious on tackling the causes of climate change because our health is at risk and our health is paying the price of not taking action on climate.”

From left-right, Jessica Beagley (Lancet Commission Countdown); Diarmid Campbell-Lendrum & Maria Neira (WHO).

Health Sector Involvement in Climate Response   

Collaboration on health and climate policy was greatest between the health sector and the water, sanitation and wastewater sector (45 out of 101 respondents), followed by agriculture (31 out of 101 respondents) and social services (26 out of 101 respondents). A quarter or less of countries reported having an agreement in place between the health sector and the transportation, electricity generation or household energy sectors.

While only 8 our of 45 countries reported a high level of implementation of national health and climate change strategies or plans, countries were being more proactive on certain issues. Some 61% of countries were implementing stronger systems of early warning and response to cope with flooding, 43% for heatwaves and 32% for air quality.

Although 48% of countries have assessed their public health risk to climate change 60% report that these findings have had little to no influence on the allocation of human and financial resources to meet their adaptation priorities for protecting health.

Half of the countries surveyed have developed a national health and climate change strategy or plan.  But less than 20% of countries reporting a high level of implementation.  Along with financing, other common barriers included: human resource constraints and lack of capacity, lack of prioritization; lack of multisectoral collaboration and a lack of tools, information systems and evidence for decision-making.

Only about 38% have national finances in place to even partially implement their national strategy of plan, and fewer than 10% have resources to implement it completely.

In terms of accessing international climate finance,  over 75% (35 of 46 respondents) reported a lack of information on opportunities, over 60% a lack of connection of health actors to the climate finance processes, and over 50% a lack of capacity to prepare proposals, the report found.

Campbell-Lendrum noted that the efforts need to be made by both the climate and health sectors to close the gap.  “The Green Climate Fund has identified health and well being as a focal area, they just haven’t funded any projects in that area yet.  So we need to work from both sides to make sure that the countries have the technical back- up to prepare their plans and then we have to be met from the other side.”

According to the UN Environment-hosted Climate and Clean Air Coalition, some countries have begun reporting on reductions of black carbon emissions – which are among the most health-harmful air pollutants – as part of their Nationally Determined Contributions (NDCs) to reducing climate change.

Unlike carbon dioxide, which persists in the atmosphere for hundreds of ;years, black carbon particles that are heavily emitted by diesel generators and vehicles as well as by primitive wood and biomass stoves, only remain airborne for a few days or weeks, and therefore reducing emissions can lead to rapid reductions in concentrations in the atmosphere.  Black carbon also comprises a significant portion of small particles, or PM2.5,  regarded as one of the most health-harmful air pollutants.

A 2018 report by the Intergovernmental Panel on Climate Change (IPCC), underlined that reducing emissions of black carbon and other so-called short-lived climate pollutants, such as ozone and methane, could help slow down the pace of climate change, buying the world critical time to shift to cleaner energy technologies.  However, many countries still lack the tools and awareness to clearly and quantitatively link their carbon reductions with reductions of black carbon and other air pollutants.

Conversely, the so-called health co-benefits that may be derived from climate action are not typically factored into climate assessments and financing processes, which right now focus on quantifying carbon emission cuts, as such, without regard for savings in lives or related health costs.

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This article was published as part of Covering Climate Now, a global journalistic collaboration to strengthen coverage of the climate story.

Image Credits: DFID, WHO, E. Fletcher .

For the second year running, some 37 organizations have launched a week-long mini campaign to raise awareness and promote action against falsified and substandard medicines.  This year’s annual Fight the Fakes week aims to mobilize the public and international global health community to speak up more assertively about the growing threat of fake or substandard medicines under the theme “Be Aware, Speak Up, Fight the Fakes.”

“Poor-quality care is now as big a barrier to reducing mortality than insufficient access to healthcare. This is why ensuring high-quality medicines reach patients should be a key component of Universal Health Coverage initiatives,” said Grey Perry, assistant director-general of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), a founding member of the campaign.

Drugs that deliberately misrepresent their identity and medicines that do not meet regulatory or quality specifications are particularly prevalent in low- and middle-income countries, where an estimated 1 in 10 medical products is falsified or substandard, according to a 2017 report by the World Health Organization.

But the problem can affect higher income regions too. A medical product alert issued earlier this year by the WHO found that a falsified version of the leukemia medication ICLUSIG containing none of the active cancer-fighting agent Ponatinib hydrochloride had been circulating in the WHO Region of the Americas as well as in WHO’s European Region.

There is also evidence that take and substandard products can fuel illicit trade, as well as organized crime, which has broader social and economic implications, according to a report released by the UN Office on Drugs and Crime in June. The report estimates that consumers in Southeast Asia alone spend between US$20 million and US$2.6 billion a year on falsified medicines.

Legitimate pharmaceutical producers in countries such as China and India often outsource parts of their drug production process to manufacturers in countries with weaker regulatory requirements, and that can lead to substandard medications, says the UN Office on Drugs and Crime report. The rapid proliferation of online pharmacies has also facilitated the trade of substandard and falsified medications, the report finds.

The Fight the Fakes campaign has received support from industry, product development partnerships, and civil society actors alike, who say that addressing the issue of falsified and substandard drugs is paramount to ensuring that patients have access to safe and quality essential medicines.

“The risk [of falsified and substandard medicines] concerns everyone in every corner of the world,” said the World Heart Federation’s Director of Partnerships and Programmes, Andrea Vassalotti.

Individual and Societal Risks of Substandard and Falsified Pharmaceutical Products

Antibiotics and antimalarials are among the most frequently reported falsified medical products – accounting for almost 65% of all products reported to WHO.

This also contributes to the growing resistance of many bacteria and parasites to commonly used drugs – known as antimicrobial resistance. Many falsified or substandard antibiotics or antimalarials do not contain the proper dose of the active ingredient. When ingested by patients, exposure to lower doses of the active ingredient allows pathogens to develop resistance to the drug. Although the extent of the effect is unclear, WHO has listed drug resistance driven by subpar medications as a global concern in its 2017 review, A study on the public health and socioeconomic impact of substandard and falsified medical products.

While antibiotics and antimalarials represent the lion’s share of reported falsified and substandard medical products, fake and substandard medicines for other life-threatening illnesses such as rabies, diabetes, cancer, cardiovascular disease, and HIV are also present on the market. This year so far WHO issued 11 alerts for falsified medical products that have been circulating in certain countries and globally.

Confirmed falsified hydrochlorothiazide 50mg

These medications at best fail to have any impact on the disease they purport to treat, and at worst contain other compounds that can have devastating consequences on individuals’ health.

In March, a falsified medication claiming to contain hydrochlorothiazide, a medicine used to control hypertension, caused blood sugar levels to crash in a number of patients who were prescribed the medication in Cameroon. According to the WHO alert on the product, the medication instead contained glibenclamide, an antidiabetic medication, and was the cause of the hypoglycaemia experienced by patients.

“Currently, cases come to light when high numbers of people are affected by very severe or unusual suspected side effects,” said Oksana Pyzik, senior teaching fellow at the University College London and founder of UCL’s Fight the Fakes chapter.

The combined effects of exposure to substandard and falsified medicines can also erode public trust in health authorities and health systems, mistrust that is already fueled by a growing anti-vaccination movement, said Pyzik.

“We have entered an interesting time in history where trust of science, fact and authority has never been so fragile, fleeting and called into question… As such leading health authorities cannot afford any further dents in credibility that damage trust in health systems,” she added.

“Awareness of the issue remains low amongst health care professionals (HCPs) and the general public globally. Education and training of HCPs, alongside wider campaign efforts such as Fight the Fakes, are of paramount importance to improve reporting rates of substandard and falsified medical products by pharmacists and patients,” said Pyzik.

As part of this year’s Fight the Fakes campaign, partners of the movement have organized events around the world, including a series of events at UCL, a photo competition hosted by the International Pharmaceutical Students Federation, and a panel that will be co-hosted by IFPMA and the Graduate Institute in Geneva on Friday.

Image Credits: WHO, WHO, Sanofi.

[Drugs for Neglected Diseases Initiative]

Geneva, Switzerland (29 November 2019) – The Indian pharmaceutical company Cipla has announced their commitment to price the ground-breaking new product Quadrimune, a “4‑in‑1” treatment for young children with HIV, at below a dollar a day. Quadrimune is currently under review by the US Food and Drug Administration (FDA) for use in children between 3 and 25 kg bodyweight.

This pleasant tasting, heat-stable fixed-dose combination of four antiretrovirals (ARVs) for infants and young children with HIV was developed in partnership by Cipla and the not-for-profit Drugs for Neglected Diseases initiative (DNDi) with financial support from Unitaid and other donors. If it receives FDA tentative approval in 2020, the 4-in-1 will represent a major improvement in the treatment of HIV in very young children and will replace older, bitter-tasting medicines, medicines requiring refrigeration, or regimens that are no longer recommended by the World Health Organization (WHO).

Demonstration of how to administer Quadrimune, a “4-in-1” treatment for young children with HIV

‘Cipla is happy that over the past 20 years it has contributed to making adult antiretroviral drugs available at affordable prices for patients throughout the developing world, in particular Africa, and has pioneered the development of paediatric fixed-dose combinations of ARVs for children,’ said Dr Yusuf K Hamied, Chairman of Cipla. ‘Over the years, the treatment of children with HIV has been neglected. In order to ensure faster access, particularly in sub-Saharan Africa, our product Quadrimune, once approved, will be offered for less than one dollar a day for children.’

‘Children living with HIV have been neglected for too long, with the recommended treatment for years consisting of a bitter-tasting syrup with 40% alcohol content,’ said Dr Bernard Pécoul, Executive Director of DNDi. ‘Mothers were often forced to bury the syrup in the sand to keep it cool, because it required refrigeration. The new Quadrimune is pleasant-tasting, heat-stable, and easy-to-use. We will finally have a treatment designed specifically for infants and young children, who are at the highest risk of dying if they do not receive treatment.’

It is estimated that 1.8 million children are living with HIV, almost 90% of whom live in sub-Saharan Africa. Only an estimated 54% of these children have access to HIV treatment and over 300 children still die from the disease every day. Inappropriate, suboptimal treatment options have contributed to low treatment coverage.

Cipla will provide Quadrimune at an ex-factory price of US$ 15 per pack of 120 capsules, giving a price of $1 per day ($360 per year) for children in the medium weight bracket of 10 to 13.9 kg, with prices lower, at 50 US cents per day, for younger children and infants. Quadrimune contains the WHO-recommended ARVs abacavir, lamivudine, lopinavir, and ritonavir in the form of granule-filled capsules. If approved, parents and caretakers will be able to administer the drugs to children by sprinkling the granules on soft food, water, or milk. The 4-in-1 does not require refrigeration and is easy to administer to infants and children of different weights and ages.

‘This optimal child-adapted all-in-one ARV regimen, that meets WHO recommendations, will be a game-changer for millions of infants and young children,’ Unitaid Executive Director Lelio Marmora said. ‘Unitaid is proud to have supported from day one the development of this new 4-in-1 treatment that is safe and effective, adapted and palatable, easy-to-use and with no requirement for refrigeration. Once adopted, this innovative formulation will enable great advances in the treatment of the youngest kids.’

Since 2013, WHO has recommended regimens that include a class of ARVs called protease inhibitors, which includes lopinavir/ritonavir (LPV/r), for infants and young children. Cipla and DNDi worked closely to develop Quadrimune, testing over 30 formulations of abacavir, lamivudine, and LPV/r, ensuring good taste-masking, and selecting one which met the standards required to enable regulatory submission.

The 4-in-1 could be the first of several new treatment options now on the horizon for young children with HIV.

 

Image Credits: Emmanuel Museruka/DNDi.

Madrid – UN Secretary General António Guterres said he is more hopeful about obtaining commitments on climate action from the world’s largest carbon emitters, following the European Commission’s announcement of plans for a European “green pact” – committing Europe to dramatic reductions in its carbon emissions by 2030 and carbon neutrality by 2050.

Guterres spoke here at a press conference on Monday, the opening day of the 25th UN Climate Conference (COP25), in a joint appearance with the President of Spain, Pedro Sánchez.

“We see already the very strong determination from many governments, but also from many actors in the business community, in the financial community, civil society, in cities and regions. We see a lot of commitment. The problem is that the most important emitters, the countries that have the largest emissions of greenhouse gases are lagging behind,” Guterres said.

UN Secretary General António Guterres (right) with Spanish President Pedro Sánchez.

“However, something very important has happened today, where the president of the European Commission has announced that the Commission will present a green pact, and that Europe will be determined to create the conditions for carbon neutrality in 2050, and for dramatic reductions in emissions from 2020 and 2030 – the conditions that are needed to reach 1.5 °C degrees at the end of the century,” Guterres said.

European Commission President-elect Ursula von der Leyen has said that she wants to lead the way for a “green new deal” in Europe, and last week the European Parliament gave her resounding support, declaring a climate emergency. The Parliament called for a 55% reduction in European carbon emissions by 2030 and carbon neutrality by 2050.

“I believe with Europe in this position, there is potential for successful negotiation with other key actors, be it the United States, China, India and Japan, and we need that negotiation…in 2020 in order to make sure that we are able to effectively defeat climate change,” Guterres said.

He added that the struggle will not, however, only be waged among governments.  “This is also an issue for public opinion, youth, the business community, civil society, cities and regions. We see everywhere a new dynamism a new determination that makes me be hopeful. I am hopeful but not yet entirely sure because there is still a long way to go and we are still running behind climate change,” he added.

Guterres praised Spain for the “exemplary” job in organizing the conference in “record time” after the original host, Chile, announced in late October that it couldn’t hold the event in Santiago due to prolonged civil unrest that has wracked the country.  Guterres added that the Spanish offer to host the conference on behalf of Chile was an “impeccable demonstration of the multilateralism” needed for a positive outcome on the climate agenda as well.

Spain has also been a leader in action on climate and social welfare agenda, Guterres noted, adding that the welfare benefits of climate action in terms of both jobs creation and social equity needs more emphasis in the climate debate.

‘”Better to subsidize families in need rather than subsidize fossil fuels,” Guterres said, noting that new taxes on carbon could help “support a just transition” to a green economy.

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This article was published as part of Covering Climate Now, a global journalistic collaboration to strengthen coverage of the climate story.

Image Credits: E. Fletcher .

African leaders, scientists, and activists are mobilizing to address the scientific, political, and social challenges inherent to ending the HIV epidemic. That was the key message as the 20th International Conference on AIDS and STIs in Africa (ICASA) kicked off on Monday in Kigali, Rwanda under the theme, “AIDS-free Africa: Innovation, Community and Political Leadership.”

“HIV, Hepatitis B and syphilis are all endemic in Africa. All three can be maternally transmitted; are devastating; take a heavy toll on health systems, with catastrophic expenditures for families leading to poverty in our communities. And all three can be prevented,” said World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus at the conference opening ceremony.

(back row, left-right) Rwandan President Paul Kagame, Rwandan First Lady Jeannette Kagame WHO Director General Dr Tedros, and UNAIDS Executive Director Winnie Byanyima along with other First Ladies of African States (first row) at the ICASA 2019 Opening Ceremony.

Rwandan President Paul Kagame added that AIDS is an “epidemic without borders.” In a brief opening statement, the president of the host country highlighted a number of key challenges that the HIV/AIDS response faces – themes around which the conference has organized.

When it comes to sexually-transmitted infections, Kagame said, stigma and silence “are the real killers, just as much as the underlying virus.”  Stigma discourages people with STIs, including people with HIV, from seeking life-saving care, he explained.

On the care provision side, sustained investment in strengthening health systems is needed to “win the fight” against HIV/AIDS, and “build the resilience required to handle other challenges down the line,” he said.

He stressed the importance of “good politics and good governance,” highlighting that governments in Africa must prioritize domestic financing for healthcare, investing in infrastructure, technology, and a highly-skilled medical and administrative workforce. Additionally, investment in community health workers can help build trust in the health system so that citizens will to “act on health guidelines from public institutions and change their behavior accordingly.”

The conference is organized along three thematic tracks that address the major opportunity areas for improving HIV/AIDS response. A scientific track features sessions that focus on tools for HIV prevention and treatments regimens, including topics such as “operationalizing the implementation of innovative biomedical prevention such as PrEP, microbicides, and long-acting antiretrovirals.”

A second track focuses on leadership and issues around the political mobilization required in the fight against HIV/AIDs, including sessions such as “Stronger positioning of women leadership in Africa in the HIV response.” A third stream focuses on community-based work in the HIV response, with sessions such as “accessing services for people living with disabilities.”

The six-day conference is co-sponsored by the Society for AIDS in Africa (SAA) and the Government of Rwanda, and runs from December 2-7. Co-organized by WHO, UNAIDS, and the UN Population Fund (UNFPA), as well as the pharmaceutical companies Gilead and Mylan, it brings together thousands of delegates to share lessons learned and chart the way forward for reaching the 90-90-90 UNAIDS targets for HIV/AIDS and sexually transmitted infections (STIs) on the African continent. Those targets aim to ensure that by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will be have the virus supressed.

 

Image Credits: Twitter: @DrTedros.

WHO and its partners have evacuated Ebola response workers in the Biakato Mines Area of the Democratic Republic of Congo following two deadly attacks on Wednesday night that left 4 Congolese staff dead, and 6 staff wounded – including a WHO staff member. The scale back of the Ebola response raises the possibility of a resurgence of the Ebola virus just as the outbreak that has been raging for over a year appeared to be nearly vanquished.

“We are heartbroken that people have died in the line of duty as they worked to save others,” said World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus in a press release as well as videotaped remarks. “Ebola was retreating. These attacks will give it force again, and more people will die as a consequence.”

Only seven confirmed cases were reported between 18 to 24 November, down dramatically from a peak of 120 cases per week in April and a second peak of 85 cases per week in July.

Peacekeepers from the UN Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) on patrol in DRC’s IIturi Province to deter activities by militias that have targeted Ebola response teams. (Photo: MONUSCO)

But with the attacks on health workers in the Biakato Mines area, the latest event in a rash of violence in eastern DRC, critical outbreak response activities have been suspended in many areas where the threat of the virus still lingers.

“It will be a tragedy to see more unnecessary suffering in the communities that have already been through so much. Without responders, the virus spreads through the community undetected and uninterrupted,” Mike Ryan, WHO’s Emergency Ebola Coordinator told a Geneva press conference.

The interruption of the outbreak response has led to an over 50% decrease in alerts of suspected cases, a collapse in vaccination efforts, and a decrease in contact-tracing, said Ryan. These, he added, were “all of the key indicators that point towards ending the outbreak.” Case-management of Ebola patients, safe and dignified burials, and a very limited alert system continue in the Biakato Mines area.

He emphasized that this has been the deadliest attack of the Ebola outbreak so far, with the violence claiming the lives of one health worker responsible for immunizations  and two drivers in Biakato, as well as one policeman in nearby Mangina who was involved in security the Ebola response teams. In total, the WHO has recorded over 386 attacks against Ebola responders during this outbreak alone, resulting in 77 injuries, and 7 deaths.

“My heart goes out to the family and friends of the first responders killed in these attacks,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “We are doing everything possible to bring the injured and front-line workers in the impacted areas to safety. These constant attacks must stop. We will continue to work with the DRC Government, partners and [UN peacekeeping troops] MONUSCO to ensure the security of our staff and other health workers.”

Tragedy On The Brink Of Ending The Outbreak

Surges of violence and unrest have been a frequent feature of this latest Ebola outbreak in Ituri and North Kivu provinces, which began in August of 2018. The latest attack comes just days after WHO was forced to evacuate 49 of its 120 staffers in Beni, following civil unrest there that led to angry attacks on the MONUSCO base, which in response to an attack by the rebel Allied Democratic Forced (ADF) on civilians that left at least 19 dead and many more displaced.  Protesters in Beni said that they were frustrated that MONUSCO had failed to protect them from rebel militias.

Ebola case map as of Nov 14, 2019. The epicenter in Mandima Health District has been the Biakato Mines area, the source of about half of recently reported cases. (Map by: EU Humanitarian Aid – @eu_echo)

As for the attack on Biakato Mines, Ryan noted that it was “unmistakably directed at the [Ebola] response.” He said it was unclear exactly who perpetrated the attack, although local officials told TRT World that Mai-Mai fighters had attacked the camp.

With the rash of violence, Ryan told reporters that WHO had lost access to “key communities” not only in Biakato Mines, but also in nearby Oicha, Lwemba and Beni where some of the last known Ebola chains of transmission had persisted.

Until very recently, some 98% of the known Ebola cases had been traced back to two chains of transmission involving those areas, but the suspension of activities due to the recent attacks could result in “losing some of those gains,” Ryan said. “The last stronghold of the virus was in these very areas, and now because of violence, because of insecurity, we’ve lost access to these communities.”

While no cases have been reported from the Biakato Mines area itself in almost two weeks, the risk of resurgence there and in the surrounding area remains high, says Ryan, noting that cases in Beni and Oicha had been previously traced back to Biakato Mines.

The Biakato Mines health centre also serves the Lwemba health area, he noted, and the Lwemba area has been one of the “most complex and difficult contexts, both in terms of disease transmission and community acceptance.” Without teams on the ground, Lwemba has become even more inaccessible, says Ryan.

Throughout the response, community acceptance and community engagement have been major challenges. But recently, more and more people suspected of having Ebola had been actively seeking treatment at Ebola Treatment Units.

“Just yesterday, a pastor and his family from Lwemba presented themselves for care at an Ebola Treatment Unit,” said Ryan. “The real tragedy is also losing access to those communities, just at the moment where their views and attitudes were turning,.”

Insecurity and Violence Hindering the Outbreak Response

The insecurity has been attributed to the multitude of armed groups in eastern DRC – estimated at around 100.  WHO has long warned that the militias’ presence has significantly complicated the work of Ebola responders who have to be deeply embedded in the community to trace and vaccinate individuals who have come into contact with infected individuals.

To date, 2,199 people have died from the current Ebola outbreak, among 3303 probable and confirmed cases, according to DRC officials.  Ebola is endemic to the region, and this represents the 10th outbreak, but also the most deadly, since the disease was identified in the 1970s.

See Video of Dr. Tedros’ remarks below:

 

Image Credits: @eu_echo, Monusco .

The European Parliament on Thursday declared a “climate and environmental emergency” in Europe and globally – calling on EU Member States to meet a target of a 55% reduction in greenhouse gas emissions by 2030, as well as phasing out fossil fuel subsidies in 2020.

The Parliament called on new European Commission President Ursula von der Leyen to include the 55% GHG reduction target into a planned series of measures for a “European Green Deal.” A formal EU strategy to reach climate neutrality as soon as possible, and by 2050 at the latest, should be submitted to the UN Framework Convention on Climate Change (UNFCCC), the Parliament said. The Parliament also asked the European Commission to ensure that all legislative and budgetary proposals fully align with the objective of limiting global warming to under 1.5 °C.

Photo credit: ©123RF/EU–EP

The Parliamentary moves come just ahead of the UNFCCC Climate Conference that begins Monday in Madrid, and just on the heels of the latest UN Emissions Gap Report, which projects that even if all of the current commitments made under the 2015 Paris Climate Agreement are met, global temperatures will rise by 3.2°C by the end of the century, bringing even wider-ranging and more destructive climate impacts.

The report Tuesday by the UN Environment Programme (UNEP) report warns that unless global greenhouse gas emissions fall by 7.6 per cent each year between 2020 and 2030, the world will fail to meet the Paris Agreement target to keep warming to 1.5°C.

“For ten years, the Emissions Gap Report has been sounding the alarm – and for ten years, the world has only increased its emissions,” said UN Secretary-General António Guterres, in a press release. “There has never been a more important time to listen to the science. Failure to heed these warnings and take drastic action to reverse emissions means we will continue to witness deadly and catastrophic heatwaves, storms and pollution.”

Reduce Emissions From Aviation and Shipping – Increase Financial Support 

In Thursday’s European Parliament decision, members of parliament also said that EU countries should more than double their contributions to the international Green Climate Fund, to fully comply with international commitments to finance the fund, which supports climate mitigation in low income countries. EU member states are already the largest providers of public climate finance however pledges by developed countries have so far fallen short of the global goal of US$100 billion per year by 2020.

“The European Parliament has just adopted an ambitious position in view of the upcoming COP 25 in Madrid. Given the climate and environmental emergency, it is essential to reduce our greenhouse gas emissions by 55% in 2030. It also sends a clear and timely message to the Commission a few weeks before the publication of the Communication on the Green Deal” Pascal Canfin, French chair of the Committee on the Environment, Public Health and Food Safety, was quoted as saying on the EU Parliamentary website.

Members noted that aviation and international shipping sectors, in particular, need to make further reductions and that all EU countries should include emissions targets for both in their nationally determined  contributions (NDCs), the voluntary commitments system created by the 2015 Paris Climate Agreement.

UN Environment Emissions Gap Report 2019 

As for the latest UN Emissions Gap Report, it concludes that based on present trends, national commitments to emissions reductions must increase at least fivefold to keep temperatures below 1.5°C goal and threefold to meet the goal of an average 2°C rise in temperatures.

The report assesses the gap between current emissions levels, national commitments for emissions reductions by 2030, and what would actually be needed to meet the 1.5°C and 2°C targets of the Paris Agreement. This year’s report found that emissions in 2018, including from land-use changes such as deforestation, hit a new high of 55.3 gigatonnes of CO2 equivalent. Over the past decade, greenhouse gas emissions have risen 1.5 per cent annually.

To limit temperatures to the 2°C goal, annual emissions in 2030 would need to reduce climate emissions by 15 gigatonnes of CO2 equivalent below that of existing national commitments (NDCs) by UN member states. Annual emissions by 2030 would need to be 32 gigatonnes lower in order to meet the 1.5°C goal. On an annual basis, this means cuts in emissions of 7.6 per cent per year from 2020 to 2030 to meet the 1.5°C goal and 2.7 per cent per year for the 2°C goal.

The Intergovernmental Panel on Climate Change (IPCC) has warned that temperature rise beyond 1.5°C will increase the frequency and intensity of climate impacts, in unforeseen ways.

“Our collective failure to act early and hard on climate change means we now must deliver deep cuts to emissions – over 7 per cent each year, if we break it down evenly over the next decade,” said Inger Andersen, UNEP’s Executive Director, in the UNEP press release. “This shows that countries simply cannot wait until the end of 2020, when new climate commitments are due, to step up action. They – and every city, region, business and individual – need to act now.”

“We need quick wins to reduce emissions as much as possible in 2020, then stronger Nationally Determined Contributions to kick-start the major transformations of economies and societies. We need to catch up on the years in which we procrastinated,” she added. “If we don’t do this, the 1.5°C goal will be out of reach before 2030.”

The world’s largest economies – G20 nations – collectively account for 78 per cent of all emissions, but only five G20 members have committed to a long-term zero emissions target, UNEP says.

In the short-term, developed countries will have to reduce their emissions quicker than developing countries, UN leaders have stressed. However, as emissions from China as well as other emerging economies rise sharply, the new message has been that countries at all economic levels need to pull together, and developing countries can even leapfrog over polluting technologies and adopt cleaner technologies at a faster rate.

The report also focuses on the potential of selected sectors to deliver emissions cuts. This year’s report looks in depth at the potential of energy efficiencies in the use of materials for buildings, construction and industry, which make significant contributions to closing the emissions gap.

 

 

Image Credits: ©123RF/EU–EP, UN Environment Programme .

The World Health Organization has issued new HIV testing recommendations to help countries expand treatment coverage and reach the estimated 8.1 million people living with HIV who have not yet been diagnosed. The WHO guidelines were released on Wednesday ahead of World AIDS Day on December 1 and the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA2019), which will take place in Kigali, Rwanda on December 2-7.

“The face of the HIV epidemic has changed dramatically over the past decade,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release. “More people are receiving treatment than ever before, but too many are still not getting the help they need because they have not been diagnosed.”

A woman prepares for an HIV test in Uganda.

The launch of the WHO guidelines comes right on the heels of a UNAIDS report published Wednesday that highlighted mixed success in tackling the HIV/AIDS epidemic. Access to HIV treatment has expanded and new HIV infections have declined by 28% from 2010 to 2018 in eastern and southern Africa, the region most affected by HIV, but women and girls are still disproportionately affected. Four out of five new HIV infections among adolescents in the Sub-Saharan Africa region occur in girls. Additionally, new HIV infections are increasing in eastern Europe, central Asia, northern Africa, and parts of Latin America.

WHO estimates that at the end of 2018, there were 36.7 million people with HIV worldwide. Of these, 21% have not yet been diagnosed. Expanding testing for HIV helps ensure that people are diagnosed early and can start treatment. Testing also helps identify people who are HIV-negative but may be at high risk for contracting the infection and link them to appropriate and effect prevention services.

Both publications highlight that key populations such as injecting drug users, sex workers, transgender people and prison populations are at higher risk of testing positive for HIV, but may be less engaged in HIV decision-making and have less access to healthcare services. Additionally, in countries where high proportions of people have already been tested and treated, it can be difficult to reach the remaining proportion of people living with HIV who have not yet been tested, according to WHO.

The new “WHO consolidated guidelines on HIV testing services” recommends strategies for expanding a package of HIV-related services to those hardest to reach including:

  • Adoption of a standard HIV testing strategy which uses three consecutive reactive tests to provide an HIV positive diagnosis. Previously, most high burden countries were using two consecutive tests. The new approach can help countries achieve maximum accuracy, particularly in high-prevalence settings.
  • Use of HIV self-testing as a gateway to diagnosis based on new evidence that finds people who are at higher HIV risk and not tested in clinical settings are more likely to be tested if they can access HIV self-tests.
  • Implement social network-based HIV testing to reach key populations who are at high risk but have less access to services, and use peer-led, innovative digital communications such as short messages and videos to build demand and increase uptake of HIV testing.
  • Focus on community-based delivery of rapid testing through lay providers for relevant countries in the European, South-East Asian, Western Pacific and Eastern Mediterranean regions. Rapid testing methods cost less and can provide results up to 2-3 weeks earlier than traditional laboratory-based diagnostic tests.
  • Use HIV/syphilis dual rapid tests in antenatal care as the first HIV test to help eliminate mother-to-child transmission of both infections.
Power to Choose, Power to Know, Power to Thrive, Power to Demand

The UNAIDS report, Power to the People, found that significant progress has been made in expanding access to treatment, with an estimated 24.5 million people with HIV accessing anti-retroviral drugs and other therapies. However, progress to slow HIV transmission has stalled, and an estimated 1.7 million people were newly infected with the virus in 2018.

In Eastern and Southern Africa, the hot spots of the global HIV/AIDS epidemic, new infections declined by 28% between 2010 and 2018. However, outside of eastern and southern Africa, new HIV infections have declined by only 4% since 2010. Of concern is the rise of new HIV infections in certain regions. The annual number of new HIV infections rose by 29% in eastern Europe and central Asia, by 10% in the Middle East and North Africa and by 7% in Latin America. the report notes.

“In many parts of the world, significant progress has been made in reducing new HIV infections, reducing AIDS-related deaths and reducing discrimination, especially in eastern and southern Africa, but gender inequality and denial of human rights are leaving many people behind,” said Winnie Byanyima, executive director of UNAIDS in a press release.

The report aims to highlight the importance of including people and communities affected by HIV in HIV service delivery and policy-making. Specifically, stigma and discrimination can still prevent people from seeking knowledge on how to prevent HIV transmission, or accessing diagnosis and treatment.  But when people living with HIV are empowered, these barriers are more frequently overcome. Specifically, the report notes four areas of empowerment for programmes to target:

  • Power to Choose – The report finds almost 40% of adult women and 60% of adolescent girls (aged 15–19 years) in sub-Saharan Africa have unmet needs for modern contraception. Family planning services are closely tied to HIV treatment and prevention services. In sub-Saharan Africa, young women’s uptake of medicine to prevent HIV—pre-exposure prophylaxis (PrEP)—is high in projects that integrate PrEP into youth-friendly health services and family planning clinics and when provision of PrEP is separated from treatment services.
  • Power to Know – Knowledge of HIV among young people is alarmingly low in many regions. In countries with recently available survey data, just 23% of young women (aged 15–24 years) and 29% of young men (aged 15–24 years) have comprehensive and correct knowledge of HIV. This can lead to people finding out their HIV status too late, sometimes years after they became infected, facilitating transmission and leading to a delay in starting treatment.
  • Power to Thrive – Certain populations are being left behind. In 2018, 160 000 children (aged 0–14 years) became newly infected with HIV, and 100 000 children died from an AIDS-related illness. In Eswatini, a recent study showed that adolescent girls and young women who experienced gender-based violence were 1.6 times more likely to acquire HIV than those who did not. The same study also showed that economic empowerment of girls and women helped reduce new HIV infections among women by more than 25% and increased the probability of young women and girls going back to school and finishing their education.
  • Power to Demand – There have been reports of crackdowns, restrictions and even attacks on groups and campaigns supporting key populations most affected by HIV. Some governments refuse to recognize, support or engage community organizations in their national responses to HIV and are subsequently missing out on their enormous potential to reach the people most affected by HIV.

Image Credits: 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI).

The lower house of the French parliament has approved a milestone requirement that pharmaceutical companies must disclose the amount of public funding that was used in the research and development of new medicines entering the national market, as well as allowing those contributions to be factored into negotiations over final drug pricing.

After being initially rejected by the government, the new provision was adopted as an amendment to the French Social Security Budget Bill for 2020 in a nearly unanimous vote by the National Assembly, with 40 Members of Parliament voting in favor and only one opposed. The bill must still pass the French Senate in order to become law, but observers said the upper house was unlikely to drop the amendment after being approved in the National Assembly.

“Of course the adopted amendment is not perfect, but it’s still a historical first step toward the implementation of transparency at the French Parliament, and another proof that mobilization works,” said Pauline Londiex, co-founder of  l’Observatoire Transparence Médicaments (OTM), a French civil society watchdog that had lobbied heavily to see the provision passed by parliament.

The new requirement, enshrined in amendments n°474, n°505 and n°520 of the budget bill, stipulates that pharma companies must disclose the amount of public funding that was received for R&D of a new drug when applying for approval to market the product in France. Moreover, the government body in charge of negotiating drug prices, CEPS, will be able to take into account such public investments when negotiating the final drug price to be paid.

A series of other proposed requirements to disclosing the manufacturing costs of drugs, including costs of active ingredients, as well as profits such as the margins of intermediaries, were dropped from the final approved version of the amendment. A last minute sub-amendment was added to National Assembly approved-bill to further clarify that CEPS’ consideration of public R&D funding in drug price negotiations was optional.

Véran presenting the transparency amendment at the National Assembly on November 25.

Still, the parliamentary move is an important win for civil society groups advocating greater price transparency for health products after months of mobilization, following the approval in May of a landmark World Health Assembly (WHA) resolution on transparency in medicines markets.

The French National Assembly amendments appear to take the WHA resolution a step further – unlike the watered down WHA-approved language to only recommend voluntary disclosure by industry of public contributions to R&D costs, the National Assembly amendments appear to require companies report public funding.

The parliamentary proposal to require disclosure of public funds used for R&D costs had initially been shot down by French Minister of Health Agnéz Buzyn and the general rapporteur Olivier Véran at the first reading of the Social Security Budget Bill on October 24.

A month of political tensions followed, including the French Senate’s rejection of the original budget bill on November 14 in the wake of Prime Minister Emmanuel Macron’s announcement of an Emergency Funding Plan for Hospitals. Civil society groups continued to pressure the government to adopt the transparency amendment, publishing an open letter signed by over 80 notable French personalities that urged the government to support the amendment.

In a turn-around show of support, Véran presented the R&D cost amendment alongside presentations by La France Insoumise, and MP Caroline Janvier at a second meeting of the National Assembly on Monday where it was finally approved.

The final Social Security Budget Bill for 2020 must still be sent to the Senate for a first reading of the bill on Saturday, where the transparency amendment could then still be dropped  – or further expanded. But observers predict that the amendment may remain unchanged due to the wide consensus reached by the National Assembly, although there might be more attempts to weaken rather than strengthen the amendments in the Senate.

Image Credits: http://www.assemblee-nationale.fr.

Global greenhouse gas (GHG) concentrations have reached record-breaking levels again this year, according to the latest annual report on GHG trends by the World Meteorological Organization (WMO).  Publication of the new data in the WMO’s annual Greenhouse Gas Bulletin, comes just a week ahead of the start of the 25th UNFCCC Climate Conference in Madrid, where nations will huddle once more to try to break the stalemate over action on soaring emissions.

The WMO Secretary General Petteri Taalas warned at a press conference Monday at Geneva’s UN Headquarters that trends are putting humanity’s “future welfare” at risk.

WMO Secretary General Petteri Taalas presents the latest Greenhouse Gas Bulletin in a Geneva press conference.

According to the WMO Bulletin globally averaged concentrations of carbon dioxide (CO2) reached 407.8 parts per million in 2018, up from 405.5 parts per million (ppm) in 2017. Levels of two other key greenhouse gases, methane and nitrous oxide, also are at record highs.

“We have again broken records in carbon dioxide concentrations and we have already exceeded 400 ppm level which was regarded as a critical level,” said Taalas, at the press conference. “This carbon dioxide concentration continues and continues, and last year’s increase was about the same as we have been observing in the past 10 years, as an average.”

“There is no sign of a slowdown, let alone a decline, in greenhouse gases concentration in the atmosphere despite all the commitments under the Paris Agreement on Climate Change,»  said Taalas in a press release. “We need to translate the commitments into action and increase the level of ambition for the sake of the future welfare of the mankind,” he said.

“It is worth recalling that the last time the Earth experienced a comparable concentration of CO2 was 3-5 million years ago. Back then, the temperature was 2-3°C warmer, sea level was 10-20 meters higher than now,” said Taalas.

Together, the three greenhouse gases, methane, nitrous oxide and CO2, have caused a 43% increase in total radiative forcing since 1990 – which is the scientific measure for climate’s warming effects.

But of the three gases, CO2  is particularly dangerous because it can remain in the atmosphere for hundreds of years.  In comparison, nitrous oxides persists for about a century and methane for about a decade – although per unit of emissions, methane and nitrous oxide have a far more powerful impact on warming.

Methane & Nitrous Oxide Also Break Records 

Concentrations of atmospheric methane (CH4) , responsible for 17 per cent of warming effects, have also been “breaking records”, and 2018 levels reached a new high of 1,869 parts per billion (ppb) in 2018, more than two and a half times the pre-industrial level, Taalas said.

Approximately 40 per cent of methane comes from natural sources, such as wetlands and termites, but 60 per cent comes from human activities, including cattle breeding, rice paddies, mines, landfills and biomass burning. The increase in atmospheric methane between 2017-2018 was also greater than the year before (2016-2017) as well as the average over the last decade, the WMO report notes.

For nitrous oxide (N2O), concentrations in 2018 were estimated at 331.1 ppb, or 123 per cent above pre-industrial levels.

“Nitrous oxide has contributed about 6% of the warming so far”, said Taalas at the press conference. “Again there we have been breaking records, the steady growth of N2O concentration still continues.”  Major sources of nitrous oxide emissions are nitrogen-based agricultural fertilizers, livestock manure, biomass and fossil fuels combustion,  according to the pan-European research consortium ICOS (integrated carbon observation system). And nitrous oxide levels are now higher than at any time in the past 800,000 years.

Based on current trends, global emissions will not even peak by 2030, unless there is a radical turn around in national climate policies among countries worldwide, says WMO.

Can Madrid Conference Break Impasse?

Countries meeting at Madrid will be re-evaluating their Nationally Determined Contributions (NDCs) to reduce emissions, as well as finance to support lower-income countries to shift to low-carbon technologies. But under the provisions of the 2015 Paris Climate agreement, NDC commitments are purely voluntary, and have so far fallen way short of the commitments needed to halt the rise in atmospheric GHG concentrations, says WMO.

The WMO findings reinforce a slew of recent warnings by the Intergovernmental Panel on Climate Change, other leading scientific bodies, health professionals, and top UN officials, including UN Secretary General António Guterres at September’s UN Climate Summit, that the humanity is on a collision course with nature.

Key to reversing trends with be a more massive shift to renewable energy sources, Taalas emphasized, saying that the world still uses fossil fuels for 85% of its global energy needs, as compared to 15% reliance on nuclear, hydro and renewables.

And while the biggest polluters used to be Europe and North America, China has now become the world’s number one greenhouse gas emitter – along with “fairly strong growth in the emissions of non-OECD countries” too, Taalas added.

This means that both developed and developing economies need to find a common strategy on an issue that was once perceived as the responsibility of rich countries alone.  Said Taalas, “you have to have all of the countries involved.”

Watch the press conference on UN TV

 

This story was published as part of Covering Climate Now, a global collaboration of more than 250 news outlets to strengthen coverage of the climate story, co-founded by The Nation and Columbia Journalism Review.

 

Image Credits: WMO, UN News , WMO .