New International President Takes Reins of MSF 16/09/2019 Editorial team Trauma surgeon and veteran field worker, Christos Christou, has taken over the Médecins Sans Frontières (MSF) reins as International President, following his election by the organization’s International General Assembly last June. Christou, former president of the MSF Greece Board of Directors, will be faced with the leadership challenges of an organization that has grown from a grassroots volunteer movement into a sprawling multi-billion dollar operation with a presence in 74 countries worldwide. Hailing from a small town in central Greece, Christou joined MSF in 2002 working as a field doctor with migrants and refugees in Europe, followed by field stints in Zambia, and later in conflict zones including South Sudan, Iraq and Cameroon, MSF said in an announcement of the leadership change. New MSF International President Christos Christou on a 2013 field operation. Photo: Isabel Corthier/MSF Christou replaces the Canadian physician Joanne Liu, who served as international president for six years, an unprecedented two terms of three years each. The period has been marked by a non-stop series of humanitarian and health challenges that ranged from old and new conflicts in Afghanistan, Syria, Iraq and Yemen to a unprecedented wave of refugees and migrants fleeing Africa, the Middle East and Central America; and two Ebola outbreaks, including the one still ongoing in the Democratic Republic of Congo. “As our President, Joanne made sure the reality of people caught in crises was brought directly to the attention of the authorities and public around the world,” said Christopher Lockyear, Secretary General of MSF International, in the MSF statement. “Joanne worked relentlessly through the West Africa Ebola outbreaks of 2014-2016, and the [US] bombing of our trauma centre in Kunduz, Afghanistan in 2015…Joanne was also particularly vocal on the brutality of inhumane migration policies that MSF teams witness around the world, from Mexico, to Libya and Europe.” In a recent interview, Liu said that the DRC Ebola crisis was a kind of milestone in the history of relief work. As the DRC national government asserted its control over both strategy and operational Ebola response, MSF and other humanitarian groups were compelled to recognize that they were not in the drivers seat, or in the words of Liu “…at the end of the day we are a guest wherever we are.” However, that should be seen as a positive trend, she told the New Humanitarian. It signals a shift away from a “neocolonialist” mindset where health and relief workers came to the rescue of powerless countries. “MSF is most of the time a great responder, a fairly good doer, a very bad partner,” Liu said, in the interview. “We deeply need to improve. Our survival and our success in the next decade is [going to be dependent on] how meaningfully we partner with local agencies or local [health ministries].” Joanne Liu examines a baby in an MSF feeding centre in Nigeria in 2017. Photo: Malik Samuel/MSF The outgoing president also acknowledged the huge internal management challenges of the present-day MSF, which treats some 11 million people a year and wields a budget of $US 1.6 billion. The decentralized structure of the organization, employing 68,000 people at field level, as well as in 48 offices and five operational centres, has created huge internal strains and new leadership challenges, Liu admitted. “At times, the Game of Thrones seems to be a baby playground compared to what MSF can be,” she quipped. Kenya Rolls Out Landmark Malaria Vaccine Pilot 13/09/2019 Editorial team Kenya initiated a national pilot of the world’s first malaria vaccine today, joining Ghana and Malawi to introduce the landmark vaccine as a tool against a disease that remains a leading killer of children under the age of 5 years, particularly in Sub-Saharan Africa. The vaccine, known as RTS,S, will be rolled out nationally in phases to children from 6 months of age in eight counties across the country, beginning in Homa Bay, in western Kenya, said a WHO press release. It is the first vaccine with the potential to significantly reduce malaria infection in children, including life-threatening severe malaria, which claims the life of one child every two minutes. Malaria vaccine launched in Kenya. Photo: WHO Africa Region “Africa has witnessed a recent surge in the number of malaria cases and deaths. This threatens the gains in the fight against malaria made in the past two decades,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, speaking at the Kenya launch event. “The ongoing pilots will provide the key information and data to inform a WHO policy on the broader use of the vaccine in sub-Saharan Africa. If introduced widely, the vaccine has the potential to save tens of thousands of lives.” WHO said that the aim is to vaccinate about 120,000 children per year in Kenya. The WHO-coordinated pilot is a collaboration with the ministries of health in Ghana, Kenya and Malawi, as well as international and local NGOs. PATH and GSK, the vaccine developer and manufacturer, are donating up to 10 million vaccine doses for the pilot. Financing for the pilot programme has been mobilized through a collaboration between Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and UNITAID. WHO said that the vaccine has a proven track record from Phase 3 clinical trials, which were conducted between 2009 and 2014 through a network of African research sites, including three sites in Kenya (Kombewa, Siaya and Kilifi) and enrolling more than 4,000 Kenyan children. Children receiving four doses of RTS,S experienced significant reductions in malaria and malaria-related complications in comparison to those who did not receive RTS,S. Health benefits of the vaccine were added to those already seen through the use of insecticide-treated bed nets; prompt diagnosis; and effective antimalarial treatment. The vaccine, where available, will be given in four doses: three doses between 6 months and 9 months of age, and the fourth dose at 24 months (age 2). After thirty years under development, WHO said that the vaccine is soon to be added to the core package of WHO-recommended measures for malaria prevention. Other key measures include use of insecticide-treated bed nets, indoor spraying with insecticides and access to malaria testing and treatment. Kenya is one of three countries selected from among 10 African country applicants for the RTS,S pilot. Key criteria for selection included well-functioning malaria and immunization programmes and areas with moderate to high malaria transmission. For more about the initiative, see the WHO Press release Image Credits: WHO Africa Region. World Leaders Tackle Vaccine Hesitancy At Global Summit 12/09/2019 Grace Ren At a first-ever Global Vaccination Summit, health leaders worldwide ramped up efforts to tackle “vaccine hesitancy”, which has prompted the recent resurgence of vaccine-preventable diseases such as measles. “After many years of progress, we are at a critical turning point. Measles is resurging, and 1 in 10 children continues to miss out on essential childhood vaccines. We can and must get back on track,” said Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, speaking Thursday at the meeting in Brussels, co-hosted by WHO and the European Commission. While vaccine hesitancy isn’t the only cause of gaps in vaccination coverage, it has visibly contributed to the global increase in measles, with cases rising by 30% between 2016-2017. Over the past three years, seven countries around their world, including four in the European Region, lost their status as measles-free countries, largely driven by gaps in coverage exacerbated by a spread of vaccine misinformation. A girl receives a measles vaccine in Paraguay. Photo: PAHO Countries including Albania, Czechia, Greece and the UK, which had previously eliminated the disease, lost that status. And the United States, where vaccine resistance has become a major public health debate, is in danger of losing its measles-free status due to an outbreak that occurred earlier this year. Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – was cited by WHO as one of the top 10 threats to global health in 2019. Tackling Vaccine Misinformation Vaccine hesitancy is driven by complacency, lack of convenience and confidence in vaccines, according to a WHO report. The spread of vaccine misinformation has greatly contributed to decreasing public confidence in the safety and efficacy of vaccines. Some 48% of the EU public believes that vaccines can often produce serious side effects; 38% believe that they cause the disease that they are intended to protect against; and almost a third are convinced that vaccines actually weaken the immune system, according to a Eurobarometer poll. “Misinformation about vaccines is as contagious and dangerous as the diseases it helps to spread,” noted Dr. Tedros in a statement, also referring to the role social media has played in spreading vaccine misinformation. Recent moves by Facebook and Pinterest to redirect “vaccines” searches to the US Centers for Disease Control and WHO vaccine sites have been applauded by the global health community as combating the propaganda of anti-vaccine groups, often known as “anti-vaxxers”. Rising numbers of measles cases in the United States. Photo: CDC However, people who choose not to vaccinate based on false information should not be attacked, speakers at the Summit underlined. Better education and engagement of health professionals in communicating with patients, particularly parents, about their concerns is key to improving acceptance of vaccination. “People who believe vaccine misinformation are not bad people… let’s not demonise them and build a wall, but rather extend a hand and build the bridges,” said Ethan Lindenberger, a formerly unvaccinated teen who has become a vaccine advocate, in a special address to Summit delegates. Trust in Vaccination Tied to Trust in Healthcare Vaccine resistance is not only a high-income country phenomenon, speakers at the Summit also underlined. People in developing nations also share concerns about vaccination, and community mistrust in health systems contributes to vaccine hesitancy around the world. Vaccine hesitancy may also be driven by an overall lack of access to essential health services. Members of under-served communities may become suspicious when a vaccine initiative is introduced, perceiving it as something imposed by outsiders with an agenda. Language around the introduction of new vaccines, must be thus be carefully designed in order to gain the trust of communities, particularly in places with historically low access to healthcare. Introducing new vaccines as “experimental” for example, has at times generated pushback from under-served communities who don’t wish to be “guinea pigs” for the rest of the world, noted Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies. Other participants noted that the response to the outbreak of Ebola in the Democratic Republic of Congo had suffered, particularly at the outset, as a result of the failure to gain community trust in the vaccine being used, despite its strong record of efficacy. Vaccine Costs and Logistics Remain Barriers in Developing Countries Along with combatting vaccine misperceptions, more effort still must be invested in overall support for the introduction and scale-up of vaccines in developing countries. “It is inexcusable that in a world as developed as ours, there are still children dying of diseases that should have been eradicated long ago. Worse, we have the solution in our hands but it is not being put to full use,” said European Commission President Jean-Claude Juncker, in a statement. Global vaccination coverage rose impressively in earlier decades before plateauing over the last few years at about 86% of newborns and infants under the age of 12 months. According to Gavi, The Vaccine Alliance, over 20 million children remain unvaccinated every year because of barriers to access. Costs of vaccines remain another key barrier, said Jakaya Mrisho Kikwete, the ambassador to Gavi and former president of Tanzania. He called on the international community to continue supporting governments in lower income countries, which cannot afford expensive vaccines on their own. Gavi, a public-private partnership that helps low and lower-middle income countries introduce new vaccines, recently launched its third replenishment campaign, asking donors for US$7.4 billion to help finance a bold effort to vaccinate 300 million more people by 2025. Problems in “reaching the last mile” – or reaching the most remote communities – have also plagued vaccine delivery systems. Over half of the 20 million unvaccinated children in the world live in crisis or humanitarian settings where health services delivery systems are weak or have failed. And for the hardest to reach places, vaccination cannot just be the only health service delivered to these populations, notes the CEO of RA International, Soraya Narfeldt. It must be integrated into a comprehensive package of health interventions – so that people regain confidence in health systems. Ultimately, she notes, “that trust comes from access to health services, caring health workers, and a health system that meets the needs of the people” regardless of the health intervention. On that note, the Summit concluded with a call to integrate vaccination delivery more fully into the platform for Universal Health Coverage (UHC) platform, due to be the focus of a UN High-Level Meeting on 23 September, in less than two weeks time. Image Credits: Pan American Health Organization (PAHO), CDC. AI & Healthcare Conference Considers Access, Equity & Gender 11/09/2019 Elaine Ruth Fletcher Digital health holds the potential to transform health systems so that they become more proactive and responsive to patients, advocates said at Wednesday’s launch of a two-day international conference that brought together members of the global healthcare and artificial intelligence (AI) communities in Switzerland’s pharmaceutical industry hub, Basel. But using AI doesn’t inherently empower women or other vulnerable groups, some speakers and participants also pointed out. Policies have to be shaped to ensure that such technologies advance equity and access to health care. The two-day Intelligent Health 2019 conference, organized by Novartis Foundation, brings together experts from some 67 countries, as well as representatives of the World Health Organisation, and other international agencies, along with tech giants such as Google and Microsoft. “Digital tech can transform our health and care systems from being reactive to becoming proactive and even predictive. That’s the challenge the Novartis Foundation is now fully focused on,” said Dr. Ann Aerts, Head of the Novartis Foundation, speaking about the conference aims in a blog. “Some of the biggest medical and health problems in the world today can be solved by harnessing the power of AI, big data and digital solutions. We have the potential to unite multi disciplinary groups ….from governments, corporates, healthcare providers and global clinician communities to radically transform the quality of lives globally” said Sarah Porter, CEO & Founder of Inspired Minds, a conference co-organizer. However, like all innovations and technologies, AI is neutral, and humans have to ensure that it is used for everyone’s benefit, others emphasized. “In order for AI tools to actually impact health outcomes positively, the algorithms need to be diverse and inclusive,” Stephanie Kukku, of UCL Hospital, London, was quoted as saying in a presentation. Using AI doesn’t necessarily lead to the empowerment of patients, one participant pointed out in a tweet: “We need to acknowledge the real barriers patients are facing to accessing quality care.” Image Credits: A Health Blog. WHO: One Suicide Death Every 40 Seconds; Pesticide Control Can Reduce Rates 11/09/2019 Elaine Ruth Fletcher Reducing pesticide self-poisonings is one of the most effective ways to reduce suicide deaths –the second leading cause of death among young people aged 15-29 years, after road injury, according to a new WHO report. Release of the WHO report, Preventing suicide, a resource for pesticide registrars and regulators, coincided with World Suicide Prevention Day on Tuesday. Photo: WHO The report reflects the growing body of evidence that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates. In Sri Lanka, a series of bans led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013. Globally, there is one suicide death every 40 seconds. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries have the highest rate, at 11.5 per 100 000, according to a WHO press release. Globally, there are an estimated 10.5 deaths by suicide per 100 000 people a year. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal. Image Credits: WHO. Health Equity Stagnant Or Declining Across Europe, New WHO Report Finds 11/09/2019 Grace Ren Health equity in Europe has stagnated over the past decade, and in some case there are indications of a decline, a first-ever WHO report finds. However, advancing Universal Health Coverage (UHC) along with more inclusive policies for social welfare protection and political participation could put things back on track again. A family prepares coffee following a power outage in FYR Macedonia. Living conditions are associated with health inequities. Photo: Tomislav Georgiev / World Bank The Health Equity Status Report (HESR) report cites “financial hardship” as a major driver of health inequity in the WHO European Region, and pointing to “the critical importance of providing universal access to affordable health services.” Released less than two weeks ahead of the planned UN High-Level Meeting on UHC, 23 September), the report places renewed focus on the third stated objective: of the planned UHC declaration – ensuring that “the cost of using services does not put people at risk of financial harm.” The wide-ranging study of 53 countries in WHO’s European Region, analyzed data on life expectancy, infant mortality and other health indicators, in relation to socio-economic factors such as education, gender and income. It found wide variations in equity indicators within and between European countries. For instance, while average infant mortality has decreased across Europe, the infant mortality rate in Azerbaijan (47.8 deaths per 1000 live births) is 25 times higher than the rate in Finland (1.9 deaths per 1000 live births). Differences in life-expectancy and overall health based on gender, levels of education and income were also identified. The report also highlights inequities that are faced by so-called “new disadvantaged groups” such as adolescents who drop out of school early and people with chronic illnesses. The retreat by many countries from public housing and social welfare programmes has impacted negatively on key equity indicators, the report notes. For example, 53% of countries in the Region reduced their spending on subsidies for housing and community assistance programs in the past 15 years, despite that among the health equity factors assessed, one-third are driven by poor living conditions. In order to improve equity trends, the report recommends that countries enact health-promoting policies in 5 thematic areas: Variations in life expectancy in Europe. Credit: WHO, European Regional Office Invest in quality and affordable housing and safe neighborhoods; Reducing out-of-pocket (OOP) health payments; Reduce unemployment and implement job-promoting labour market policies (LMPs); Equalize opportunities in education across the life course – including investing in adult education; Strengthen social and political representation among marginalized groups. “The Health Equity Status Report provides governments with the data and tools they need to tackle health inequities and produce visible results in a relatively short period of time, even within the lifetime of a national government of 4 years,” says Dr Zsuzsanna Jakab, regional director for WHO Europe, in a press release. In a Lancet op-ed, HESR Initiative advisor, Dr Johanna Hanefeld, of the London School of Hygiene and Tropical Medicine, said that governments must, however, focus on deeper and more systemic changes as well. These include, altering “the governance structures of policy processes to ensure the communities affected… have a meaningful voice that influences outcomes in these processes.” Image Credits: Tomislav Georgiev / World Bank. Health Care Climate Footprint Is 4.4% Of Global Emissions; Larger Than Japan Or Brazil 10/09/2019 Elaine Ruth Fletcher Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm Some 4.4% of the world’s climate emissions are from health care activities – meaning that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil. This is the key finding from a first-ever global report on climate emissions from health care, launched Tuesday by Health Care Without Harm (HCWH), an international NGO devoted to “greening” the health sector for the benefit of patients, health workers – and the environment. The report, Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action, also found that the US health care sector is by far, the largest aggregate and per capita emitter – with a whopping 27% percent of the world’s total healthcare-related emissions, or 1.2 tons of CO2 equivalent per capita (tCO2e). That is 57 times more emissions per person than India, which has the lowest per capita emissions of the 43 developed and emerging economies, where detailed data was available for the report. In absolute terms, China takes second place with 17% of emissions, and the European Union third place, with 12% of the world’s healthcare footprint. That is followed by Japan (5%), Russia (4%) and then Brazil, India, South Korea and Australia (2% each). Emissions from the rest of the world amount to no more than a quarter of the global total. The total climate footprint of the healthcare sector is estimated at 2 gigatons of CO2 equivalent emissions a year. In terms of per capita emissions, the US is followed by Australia, Canada and Switzerland; most other European Union and developed countries; followed by a range of lower middle income countries. For other lower income countries, per-capita emissions couldn’t be reliably estimated. The report’s launch comes just two weeks ahead of the planned UN Secretary General’s Climate Summit in New York City (23 September), and the study clearly takes aim at the much-discussed target for limiting global temperature rise to 1.5°C, saying that healthcare needs to do more of its share. “Hospitals and health care systems paradoxically make a major contribution to the climate crisis,” said Josh Karliner, a lead author of the report as well as HCWH’s International Director of Programs and Strategy. “Healthcare has to step up and do its part to avoid catastrophic climate change, which would be devastating to human health worldwide.” ‘Decarbonizing’ the Health Care Sector In line with that message, the also report outlines recommendations for areas where the health care sector could rapidly “decarbonize” including: Net zero emissions building design and construction; Investment in renewable energy and energy efficiency and climate-smart cooling technologies; Sustainable waste, water, and transport management; Better management of anaesthetic gases with high global warming potential; Tele-medicine and digital health technologies that reduce patient travel and related infrastructure requirements. Low-carbon procurement chains – for items ranging from pharmaceuticals to medical devices, as well as food and clothing, to improve efficiencies and reduce waste. And at the other end of the spectrum – better waste management systems. The report stresses that the health care sector remains dependent on energy supplies from national grids. “With 10% of health care facilities’ climate footprint coming from purchased energy, and with a large amount of the supply chain also consuming grid energy, decarbonization of national energy systems is essential to move health care to net zero emissions. “ However, low-carbon approaches to health care can be a win-win, fostering more equitable access to health care, and addressing health and safety risks that affect patients, health workers and the communities. For instance, some health-care facilities in low-income countries have developed their own renewable energy resources, which can provide power for health services more reliably, avoiding life-threatening interruptions in electricity supply. “In energy-poor settings, powering health care with low-carbon solutions can enhance access to care, contributing to the advancement of universal health care for the poor and most vulnerable,” the report concludes. The Climate Footprint of Different Health Care Activities The study took a “cradle to grave” approach to the assessment, estimating emissions associated with everything from the procurement of chemicals and pharmaceuticals as well as rubber, cotton and plastic healthcare products to building design and energy management, transport, and waste. Key findings were: More than one-half of the health sector’s footprint is due to generation and distribution of electricity or gas, heating/cooling, and related operational activities (53%). Manufacturing and agricultural inputs (including food supplies and materials such as cotton for bandages), are the third (13%) and fourth (11%) largest source of emissions. Transport represents about 7% of health sector emissions, while pharmaceutical products represent about 5%, followed by waste treatment (3%). Along with other chemicals, anaesthetic gases, including nitrous oxide and the fluorinated gases sevoflurane, isoflurane, and desflurane, are an unexplored source of health-care emissions, the report notes. Their Global Warming Potentials range between 130 kgCO2e/kg (sevoflurane) and 2540 kgCO2e/kg (desflurane), the report notes. At present, the majority of these gases enter the atmosphere. The report is built upon earlier studies of health sector emissions at national level; a 2017 study by HCWH and the World Bank, which provided a rough estimate of 5% of global emissions due to health care activities in 2011; and a 2018 study of Organisation for Economic Cooperation and Development (OECD) countries, plus India and China. That study estimated that health care activities in the 36 countries sampled was responsible for 1.6 GtCO2e emissions or 4.4% of the total emissions from these nations in 2014. However, this report claims to establish the first detailed estimate – going further in terms of the number of countries covered, as well as estimates of emissions from various activities. It also draws from the global World Input-Output Database (WIOD) database, to come up with initial estimates for emissions for low- and lower-middle income countries where data remains scarce. The report also breaks down global emissions according to the framework established by the Greenhouse Gas Protocol, the world’s most widely used greenhouse gas accounting standard. It thus aligns the emissions analysis of health care activities with the Protocol’s generic categories: Scope 1 (direct emissions from health care facilities), Scope 2 (indirect emissions from purchased energy), and Scope 3 (all indirect emissions, not included in scope 2, that occur in the value chain, including both upstream and downstream emissions). Health Care Climate Challenge “Health care must respond to the growing climate emergency not only by treating those made ill, injured, or dying from the climate crisis, but also by practicing primary prevention and radically reducing its own emissions,” said Karliner, of the report’s aim. As part of that response, Health Care Without Harm has launched a Health Care Climate Challenge which some 200 institutions, representing the interests of over 18,000 health facilities in 31 countries, have joined. Collectively, they have made commitments to reduce their carbon emissions by more than 34.2 million metric tons of CO2e. To date, Karliner says, the network has collectively reduced over 6.8 million metric tons of CO2e. The corresponding energy efficiency upgrades and renewable energy generation improvements have saved the partner institutions over US$394 million. “The good news is that there are hospitals and health systems all around the world leading by example and implementing climate-smart health care strategies.” Image Credits: Health Care Without Harm, Health Care Without Harm. Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Kenya Rolls Out Landmark Malaria Vaccine Pilot 13/09/2019 Editorial team Kenya initiated a national pilot of the world’s first malaria vaccine today, joining Ghana and Malawi to introduce the landmark vaccine as a tool against a disease that remains a leading killer of children under the age of 5 years, particularly in Sub-Saharan Africa. The vaccine, known as RTS,S, will be rolled out nationally in phases to children from 6 months of age in eight counties across the country, beginning in Homa Bay, in western Kenya, said a WHO press release. It is the first vaccine with the potential to significantly reduce malaria infection in children, including life-threatening severe malaria, which claims the life of one child every two minutes. Malaria vaccine launched in Kenya. Photo: WHO Africa Region “Africa has witnessed a recent surge in the number of malaria cases and deaths. This threatens the gains in the fight against malaria made in the past two decades,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, speaking at the Kenya launch event. “The ongoing pilots will provide the key information and data to inform a WHO policy on the broader use of the vaccine in sub-Saharan Africa. If introduced widely, the vaccine has the potential to save tens of thousands of lives.” WHO said that the aim is to vaccinate about 120,000 children per year in Kenya. The WHO-coordinated pilot is a collaboration with the ministries of health in Ghana, Kenya and Malawi, as well as international and local NGOs. PATH and GSK, the vaccine developer and manufacturer, are donating up to 10 million vaccine doses for the pilot. Financing for the pilot programme has been mobilized through a collaboration between Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and UNITAID. WHO said that the vaccine has a proven track record from Phase 3 clinical trials, which were conducted between 2009 and 2014 through a network of African research sites, including three sites in Kenya (Kombewa, Siaya and Kilifi) and enrolling more than 4,000 Kenyan children. Children receiving four doses of RTS,S experienced significant reductions in malaria and malaria-related complications in comparison to those who did not receive RTS,S. Health benefits of the vaccine were added to those already seen through the use of insecticide-treated bed nets; prompt diagnosis; and effective antimalarial treatment. The vaccine, where available, will be given in four doses: three doses between 6 months and 9 months of age, and the fourth dose at 24 months (age 2). After thirty years under development, WHO said that the vaccine is soon to be added to the core package of WHO-recommended measures for malaria prevention. Other key measures include use of insecticide-treated bed nets, indoor spraying with insecticides and access to malaria testing and treatment. Kenya is one of three countries selected from among 10 African country applicants for the RTS,S pilot. Key criteria for selection included well-functioning malaria and immunization programmes and areas with moderate to high malaria transmission. For more about the initiative, see the WHO Press release Image Credits: WHO Africa Region. World Leaders Tackle Vaccine Hesitancy At Global Summit 12/09/2019 Grace Ren At a first-ever Global Vaccination Summit, health leaders worldwide ramped up efforts to tackle “vaccine hesitancy”, which has prompted the recent resurgence of vaccine-preventable diseases such as measles. “After many years of progress, we are at a critical turning point. Measles is resurging, and 1 in 10 children continues to miss out on essential childhood vaccines. We can and must get back on track,” said Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, speaking Thursday at the meeting in Brussels, co-hosted by WHO and the European Commission. While vaccine hesitancy isn’t the only cause of gaps in vaccination coverage, it has visibly contributed to the global increase in measles, with cases rising by 30% between 2016-2017. Over the past three years, seven countries around their world, including four in the European Region, lost their status as measles-free countries, largely driven by gaps in coverage exacerbated by a spread of vaccine misinformation. A girl receives a measles vaccine in Paraguay. Photo: PAHO Countries including Albania, Czechia, Greece and the UK, which had previously eliminated the disease, lost that status. And the United States, where vaccine resistance has become a major public health debate, is in danger of losing its measles-free status due to an outbreak that occurred earlier this year. Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – was cited by WHO as one of the top 10 threats to global health in 2019. Tackling Vaccine Misinformation Vaccine hesitancy is driven by complacency, lack of convenience and confidence in vaccines, according to a WHO report. The spread of vaccine misinformation has greatly contributed to decreasing public confidence in the safety and efficacy of vaccines. Some 48% of the EU public believes that vaccines can often produce serious side effects; 38% believe that they cause the disease that they are intended to protect against; and almost a third are convinced that vaccines actually weaken the immune system, according to a Eurobarometer poll. “Misinformation about vaccines is as contagious and dangerous as the diseases it helps to spread,” noted Dr. Tedros in a statement, also referring to the role social media has played in spreading vaccine misinformation. Recent moves by Facebook and Pinterest to redirect “vaccines” searches to the US Centers for Disease Control and WHO vaccine sites have been applauded by the global health community as combating the propaganda of anti-vaccine groups, often known as “anti-vaxxers”. Rising numbers of measles cases in the United States. Photo: CDC However, people who choose not to vaccinate based on false information should not be attacked, speakers at the Summit underlined. Better education and engagement of health professionals in communicating with patients, particularly parents, about their concerns is key to improving acceptance of vaccination. “People who believe vaccine misinformation are not bad people… let’s not demonise them and build a wall, but rather extend a hand and build the bridges,” said Ethan Lindenberger, a formerly unvaccinated teen who has become a vaccine advocate, in a special address to Summit delegates. Trust in Vaccination Tied to Trust in Healthcare Vaccine resistance is not only a high-income country phenomenon, speakers at the Summit also underlined. People in developing nations also share concerns about vaccination, and community mistrust in health systems contributes to vaccine hesitancy around the world. Vaccine hesitancy may also be driven by an overall lack of access to essential health services. Members of under-served communities may become suspicious when a vaccine initiative is introduced, perceiving it as something imposed by outsiders with an agenda. Language around the introduction of new vaccines, must be thus be carefully designed in order to gain the trust of communities, particularly in places with historically low access to healthcare. Introducing new vaccines as “experimental” for example, has at times generated pushback from under-served communities who don’t wish to be “guinea pigs” for the rest of the world, noted Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies. Other participants noted that the response to the outbreak of Ebola in the Democratic Republic of Congo had suffered, particularly at the outset, as a result of the failure to gain community trust in the vaccine being used, despite its strong record of efficacy. Vaccine Costs and Logistics Remain Barriers in Developing Countries Along with combatting vaccine misperceptions, more effort still must be invested in overall support for the introduction and scale-up of vaccines in developing countries. “It is inexcusable that in a world as developed as ours, there are still children dying of diseases that should have been eradicated long ago. Worse, we have the solution in our hands but it is not being put to full use,” said European Commission President Jean-Claude Juncker, in a statement. Global vaccination coverage rose impressively in earlier decades before plateauing over the last few years at about 86% of newborns and infants under the age of 12 months. According to Gavi, The Vaccine Alliance, over 20 million children remain unvaccinated every year because of barriers to access. Costs of vaccines remain another key barrier, said Jakaya Mrisho Kikwete, the ambassador to Gavi and former president of Tanzania. He called on the international community to continue supporting governments in lower income countries, which cannot afford expensive vaccines on their own. Gavi, a public-private partnership that helps low and lower-middle income countries introduce new vaccines, recently launched its third replenishment campaign, asking donors for US$7.4 billion to help finance a bold effort to vaccinate 300 million more people by 2025. Problems in “reaching the last mile” – or reaching the most remote communities – have also plagued vaccine delivery systems. Over half of the 20 million unvaccinated children in the world live in crisis or humanitarian settings where health services delivery systems are weak or have failed. And for the hardest to reach places, vaccination cannot just be the only health service delivered to these populations, notes the CEO of RA International, Soraya Narfeldt. It must be integrated into a comprehensive package of health interventions – so that people regain confidence in health systems. Ultimately, she notes, “that trust comes from access to health services, caring health workers, and a health system that meets the needs of the people” regardless of the health intervention. On that note, the Summit concluded with a call to integrate vaccination delivery more fully into the platform for Universal Health Coverage (UHC) platform, due to be the focus of a UN High-Level Meeting on 23 September, in less than two weeks time. Image Credits: Pan American Health Organization (PAHO), CDC. AI & Healthcare Conference Considers Access, Equity & Gender 11/09/2019 Elaine Ruth Fletcher Digital health holds the potential to transform health systems so that they become more proactive and responsive to patients, advocates said at Wednesday’s launch of a two-day international conference that brought together members of the global healthcare and artificial intelligence (AI) communities in Switzerland’s pharmaceutical industry hub, Basel. But using AI doesn’t inherently empower women or other vulnerable groups, some speakers and participants also pointed out. Policies have to be shaped to ensure that such technologies advance equity and access to health care. The two-day Intelligent Health 2019 conference, organized by Novartis Foundation, brings together experts from some 67 countries, as well as representatives of the World Health Organisation, and other international agencies, along with tech giants such as Google and Microsoft. “Digital tech can transform our health and care systems from being reactive to becoming proactive and even predictive. That’s the challenge the Novartis Foundation is now fully focused on,” said Dr. Ann Aerts, Head of the Novartis Foundation, speaking about the conference aims in a blog. “Some of the biggest medical and health problems in the world today can be solved by harnessing the power of AI, big data and digital solutions. We have the potential to unite multi disciplinary groups ….from governments, corporates, healthcare providers and global clinician communities to radically transform the quality of lives globally” said Sarah Porter, CEO & Founder of Inspired Minds, a conference co-organizer. However, like all innovations and technologies, AI is neutral, and humans have to ensure that it is used for everyone’s benefit, others emphasized. “In order for AI tools to actually impact health outcomes positively, the algorithms need to be diverse and inclusive,” Stephanie Kukku, of UCL Hospital, London, was quoted as saying in a presentation. Using AI doesn’t necessarily lead to the empowerment of patients, one participant pointed out in a tweet: “We need to acknowledge the real barriers patients are facing to accessing quality care.” Image Credits: A Health Blog. WHO: One Suicide Death Every 40 Seconds; Pesticide Control Can Reduce Rates 11/09/2019 Elaine Ruth Fletcher Reducing pesticide self-poisonings is one of the most effective ways to reduce suicide deaths –the second leading cause of death among young people aged 15-29 years, after road injury, according to a new WHO report. Release of the WHO report, Preventing suicide, a resource for pesticide registrars and regulators, coincided with World Suicide Prevention Day on Tuesday. Photo: WHO The report reflects the growing body of evidence that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates. In Sri Lanka, a series of bans led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013. Globally, there is one suicide death every 40 seconds. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries have the highest rate, at 11.5 per 100 000, according to a WHO press release. Globally, there are an estimated 10.5 deaths by suicide per 100 000 people a year. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal. Image Credits: WHO. Health Equity Stagnant Or Declining Across Europe, New WHO Report Finds 11/09/2019 Grace Ren Health equity in Europe has stagnated over the past decade, and in some case there are indications of a decline, a first-ever WHO report finds. However, advancing Universal Health Coverage (UHC) along with more inclusive policies for social welfare protection and political participation could put things back on track again. A family prepares coffee following a power outage in FYR Macedonia. Living conditions are associated with health inequities. Photo: Tomislav Georgiev / World Bank The Health Equity Status Report (HESR) report cites “financial hardship” as a major driver of health inequity in the WHO European Region, and pointing to “the critical importance of providing universal access to affordable health services.” Released less than two weeks ahead of the planned UN High-Level Meeting on UHC, 23 September), the report places renewed focus on the third stated objective: of the planned UHC declaration – ensuring that “the cost of using services does not put people at risk of financial harm.” The wide-ranging study of 53 countries in WHO’s European Region, analyzed data on life expectancy, infant mortality and other health indicators, in relation to socio-economic factors such as education, gender and income. It found wide variations in equity indicators within and between European countries. For instance, while average infant mortality has decreased across Europe, the infant mortality rate in Azerbaijan (47.8 deaths per 1000 live births) is 25 times higher than the rate in Finland (1.9 deaths per 1000 live births). Differences in life-expectancy and overall health based on gender, levels of education and income were also identified. The report also highlights inequities that are faced by so-called “new disadvantaged groups” such as adolescents who drop out of school early and people with chronic illnesses. The retreat by many countries from public housing and social welfare programmes has impacted negatively on key equity indicators, the report notes. For example, 53% of countries in the Region reduced their spending on subsidies for housing and community assistance programs in the past 15 years, despite that among the health equity factors assessed, one-third are driven by poor living conditions. In order to improve equity trends, the report recommends that countries enact health-promoting policies in 5 thematic areas: Variations in life expectancy in Europe. Credit: WHO, European Regional Office Invest in quality and affordable housing and safe neighborhoods; Reducing out-of-pocket (OOP) health payments; Reduce unemployment and implement job-promoting labour market policies (LMPs); Equalize opportunities in education across the life course – including investing in adult education; Strengthen social and political representation among marginalized groups. “The Health Equity Status Report provides governments with the data and tools they need to tackle health inequities and produce visible results in a relatively short period of time, even within the lifetime of a national government of 4 years,” says Dr Zsuzsanna Jakab, regional director for WHO Europe, in a press release. In a Lancet op-ed, HESR Initiative advisor, Dr Johanna Hanefeld, of the London School of Hygiene and Tropical Medicine, said that governments must, however, focus on deeper and more systemic changes as well. These include, altering “the governance structures of policy processes to ensure the communities affected… have a meaningful voice that influences outcomes in these processes.” Image Credits: Tomislav Georgiev / World Bank. Health Care Climate Footprint Is 4.4% Of Global Emissions; Larger Than Japan Or Brazil 10/09/2019 Elaine Ruth Fletcher Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm Some 4.4% of the world’s climate emissions are from health care activities – meaning that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil. This is the key finding from a first-ever global report on climate emissions from health care, launched Tuesday by Health Care Without Harm (HCWH), an international NGO devoted to “greening” the health sector for the benefit of patients, health workers – and the environment. The report, Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action, also found that the US health care sector is by far, the largest aggregate and per capita emitter – with a whopping 27% percent of the world’s total healthcare-related emissions, or 1.2 tons of CO2 equivalent per capita (tCO2e). That is 57 times more emissions per person than India, which has the lowest per capita emissions of the 43 developed and emerging economies, where detailed data was available for the report. In absolute terms, China takes second place with 17% of emissions, and the European Union third place, with 12% of the world’s healthcare footprint. That is followed by Japan (5%), Russia (4%) and then Brazil, India, South Korea and Australia (2% each). Emissions from the rest of the world amount to no more than a quarter of the global total. The total climate footprint of the healthcare sector is estimated at 2 gigatons of CO2 equivalent emissions a year. In terms of per capita emissions, the US is followed by Australia, Canada and Switzerland; most other European Union and developed countries; followed by a range of lower middle income countries. For other lower income countries, per-capita emissions couldn’t be reliably estimated. The report’s launch comes just two weeks ahead of the planned UN Secretary General’s Climate Summit in New York City (23 September), and the study clearly takes aim at the much-discussed target for limiting global temperature rise to 1.5°C, saying that healthcare needs to do more of its share. “Hospitals and health care systems paradoxically make a major contribution to the climate crisis,” said Josh Karliner, a lead author of the report as well as HCWH’s International Director of Programs and Strategy. “Healthcare has to step up and do its part to avoid catastrophic climate change, which would be devastating to human health worldwide.” ‘Decarbonizing’ the Health Care Sector In line with that message, the also report outlines recommendations for areas where the health care sector could rapidly “decarbonize” including: Net zero emissions building design and construction; Investment in renewable energy and energy efficiency and climate-smart cooling technologies; Sustainable waste, water, and transport management; Better management of anaesthetic gases with high global warming potential; Tele-medicine and digital health technologies that reduce patient travel and related infrastructure requirements. Low-carbon procurement chains – for items ranging from pharmaceuticals to medical devices, as well as food and clothing, to improve efficiencies and reduce waste. And at the other end of the spectrum – better waste management systems. The report stresses that the health care sector remains dependent on energy supplies from national grids. “With 10% of health care facilities’ climate footprint coming from purchased energy, and with a large amount of the supply chain also consuming grid energy, decarbonization of national energy systems is essential to move health care to net zero emissions. “ However, low-carbon approaches to health care can be a win-win, fostering more equitable access to health care, and addressing health and safety risks that affect patients, health workers and the communities. For instance, some health-care facilities in low-income countries have developed their own renewable energy resources, which can provide power for health services more reliably, avoiding life-threatening interruptions in electricity supply. “In energy-poor settings, powering health care with low-carbon solutions can enhance access to care, contributing to the advancement of universal health care for the poor and most vulnerable,” the report concludes. The Climate Footprint of Different Health Care Activities The study took a “cradle to grave” approach to the assessment, estimating emissions associated with everything from the procurement of chemicals and pharmaceuticals as well as rubber, cotton and plastic healthcare products to building design and energy management, transport, and waste. Key findings were: More than one-half of the health sector’s footprint is due to generation and distribution of electricity or gas, heating/cooling, and related operational activities (53%). Manufacturing and agricultural inputs (including food supplies and materials such as cotton for bandages), are the third (13%) and fourth (11%) largest source of emissions. Transport represents about 7% of health sector emissions, while pharmaceutical products represent about 5%, followed by waste treatment (3%). Along with other chemicals, anaesthetic gases, including nitrous oxide and the fluorinated gases sevoflurane, isoflurane, and desflurane, are an unexplored source of health-care emissions, the report notes. Their Global Warming Potentials range between 130 kgCO2e/kg (sevoflurane) and 2540 kgCO2e/kg (desflurane), the report notes. At present, the majority of these gases enter the atmosphere. The report is built upon earlier studies of health sector emissions at national level; a 2017 study by HCWH and the World Bank, which provided a rough estimate of 5% of global emissions due to health care activities in 2011; and a 2018 study of Organisation for Economic Cooperation and Development (OECD) countries, plus India and China. That study estimated that health care activities in the 36 countries sampled was responsible for 1.6 GtCO2e emissions or 4.4% of the total emissions from these nations in 2014. However, this report claims to establish the first detailed estimate – going further in terms of the number of countries covered, as well as estimates of emissions from various activities. It also draws from the global World Input-Output Database (WIOD) database, to come up with initial estimates for emissions for low- and lower-middle income countries where data remains scarce. The report also breaks down global emissions according to the framework established by the Greenhouse Gas Protocol, the world’s most widely used greenhouse gas accounting standard. It thus aligns the emissions analysis of health care activities with the Protocol’s generic categories: Scope 1 (direct emissions from health care facilities), Scope 2 (indirect emissions from purchased energy), and Scope 3 (all indirect emissions, not included in scope 2, that occur in the value chain, including both upstream and downstream emissions). Health Care Climate Challenge “Health care must respond to the growing climate emergency not only by treating those made ill, injured, or dying from the climate crisis, but also by practicing primary prevention and radically reducing its own emissions,” said Karliner, of the report’s aim. As part of that response, Health Care Without Harm has launched a Health Care Climate Challenge which some 200 institutions, representing the interests of over 18,000 health facilities in 31 countries, have joined. Collectively, they have made commitments to reduce their carbon emissions by more than 34.2 million metric tons of CO2e. To date, Karliner says, the network has collectively reduced over 6.8 million metric tons of CO2e. The corresponding energy efficiency upgrades and renewable energy generation improvements have saved the partner institutions over US$394 million. “The good news is that there are hospitals and health systems all around the world leading by example and implementing climate-smart health care strategies.” Image Credits: Health Care Without Harm, Health Care Without Harm. Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
World Leaders Tackle Vaccine Hesitancy At Global Summit 12/09/2019 Grace Ren At a first-ever Global Vaccination Summit, health leaders worldwide ramped up efforts to tackle “vaccine hesitancy”, which has prompted the recent resurgence of vaccine-preventable diseases such as measles. “After many years of progress, we are at a critical turning point. Measles is resurging, and 1 in 10 children continues to miss out on essential childhood vaccines. We can and must get back on track,” said Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, speaking Thursday at the meeting in Brussels, co-hosted by WHO and the European Commission. While vaccine hesitancy isn’t the only cause of gaps in vaccination coverage, it has visibly contributed to the global increase in measles, with cases rising by 30% between 2016-2017. Over the past three years, seven countries around their world, including four in the European Region, lost their status as measles-free countries, largely driven by gaps in coverage exacerbated by a spread of vaccine misinformation. A girl receives a measles vaccine in Paraguay. Photo: PAHO Countries including Albania, Czechia, Greece and the UK, which had previously eliminated the disease, lost that status. And the United States, where vaccine resistance has become a major public health debate, is in danger of losing its measles-free status due to an outbreak that occurred earlier this year. Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – was cited by WHO as one of the top 10 threats to global health in 2019. Tackling Vaccine Misinformation Vaccine hesitancy is driven by complacency, lack of convenience and confidence in vaccines, according to a WHO report. The spread of vaccine misinformation has greatly contributed to decreasing public confidence in the safety and efficacy of vaccines. Some 48% of the EU public believes that vaccines can often produce serious side effects; 38% believe that they cause the disease that they are intended to protect against; and almost a third are convinced that vaccines actually weaken the immune system, according to a Eurobarometer poll. “Misinformation about vaccines is as contagious and dangerous as the diseases it helps to spread,” noted Dr. Tedros in a statement, also referring to the role social media has played in spreading vaccine misinformation. Recent moves by Facebook and Pinterest to redirect “vaccines” searches to the US Centers for Disease Control and WHO vaccine sites have been applauded by the global health community as combating the propaganda of anti-vaccine groups, often known as “anti-vaxxers”. Rising numbers of measles cases in the United States. Photo: CDC However, people who choose not to vaccinate based on false information should not be attacked, speakers at the Summit underlined. Better education and engagement of health professionals in communicating with patients, particularly parents, about their concerns is key to improving acceptance of vaccination. “People who believe vaccine misinformation are not bad people… let’s not demonise them and build a wall, but rather extend a hand and build the bridges,” said Ethan Lindenberger, a formerly unvaccinated teen who has become a vaccine advocate, in a special address to Summit delegates. Trust in Vaccination Tied to Trust in Healthcare Vaccine resistance is not only a high-income country phenomenon, speakers at the Summit also underlined. People in developing nations also share concerns about vaccination, and community mistrust in health systems contributes to vaccine hesitancy around the world. Vaccine hesitancy may also be driven by an overall lack of access to essential health services. Members of under-served communities may become suspicious when a vaccine initiative is introduced, perceiving it as something imposed by outsiders with an agenda. Language around the introduction of new vaccines, must be thus be carefully designed in order to gain the trust of communities, particularly in places with historically low access to healthcare. Introducing new vaccines as “experimental” for example, has at times generated pushback from under-served communities who don’t wish to be “guinea pigs” for the rest of the world, noted Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies. Other participants noted that the response to the outbreak of Ebola in the Democratic Republic of Congo had suffered, particularly at the outset, as a result of the failure to gain community trust in the vaccine being used, despite its strong record of efficacy. Vaccine Costs and Logistics Remain Barriers in Developing Countries Along with combatting vaccine misperceptions, more effort still must be invested in overall support for the introduction and scale-up of vaccines in developing countries. “It is inexcusable that in a world as developed as ours, there are still children dying of diseases that should have been eradicated long ago. Worse, we have the solution in our hands but it is not being put to full use,” said European Commission President Jean-Claude Juncker, in a statement. Global vaccination coverage rose impressively in earlier decades before plateauing over the last few years at about 86% of newborns and infants under the age of 12 months. According to Gavi, The Vaccine Alliance, over 20 million children remain unvaccinated every year because of barriers to access. Costs of vaccines remain another key barrier, said Jakaya Mrisho Kikwete, the ambassador to Gavi and former president of Tanzania. He called on the international community to continue supporting governments in lower income countries, which cannot afford expensive vaccines on their own. Gavi, a public-private partnership that helps low and lower-middle income countries introduce new vaccines, recently launched its third replenishment campaign, asking donors for US$7.4 billion to help finance a bold effort to vaccinate 300 million more people by 2025. Problems in “reaching the last mile” – or reaching the most remote communities – have also plagued vaccine delivery systems. Over half of the 20 million unvaccinated children in the world live in crisis or humanitarian settings where health services delivery systems are weak or have failed. And for the hardest to reach places, vaccination cannot just be the only health service delivered to these populations, notes the CEO of RA International, Soraya Narfeldt. It must be integrated into a comprehensive package of health interventions – so that people regain confidence in health systems. Ultimately, she notes, “that trust comes from access to health services, caring health workers, and a health system that meets the needs of the people” regardless of the health intervention. On that note, the Summit concluded with a call to integrate vaccination delivery more fully into the platform for Universal Health Coverage (UHC) platform, due to be the focus of a UN High-Level Meeting on 23 September, in less than two weeks time. Image Credits: Pan American Health Organization (PAHO), CDC. AI & Healthcare Conference Considers Access, Equity & Gender 11/09/2019 Elaine Ruth Fletcher Digital health holds the potential to transform health systems so that they become more proactive and responsive to patients, advocates said at Wednesday’s launch of a two-day international conference that brought together members of the global healthcare and artificial intelligence (AI) communities in Switzerland’s pharmaceutical industry hub, Basel. But using AI doesn’t inherently empower women or other vulnerable groups, some speakers and participants also pointed out. Policies have to be shaped to ensure that such technologies advance equity and access to health care. The two-day Intelligent Health 2019 conference, organized by Novartis Foundation, brings together experts from some 67 countries, as well as representatives of the World Health Organisation, and other international agencies, along with tech giants such as Google and Microsoft. “Digital tech can transform our health and care systems from being reactive to becoming proactive and even predictive. That’s the challenge the Novartis Foundation is now fully focused on,” said Dr. Ann Aerts, Head of the Novartis Foundation, speaking about the conference aims in a blog. “Some of the biggest medical and health problems in the world today can be solved by harnessing the power of AI, big data and digital solutions. We have the potential to unite multi disciplinary groups ….from governments, corporates, healthcare providers and global clinician communities to radically transform the quality of lives globally” said Sarah Porter, CEO & Founder of Inspired Minds, a conference co-organizer. However, like all innovations and technologies, AI is neutral, and humans have to ensure that it is used for everyone’s benefit, others emphasized. “In order for AI tools to actually impact health outcomes positively, the algorithms need to be diverse and inclusive,” Stephanie Kukku, of UCL Hospital, London, was quoted as saying in a presentation. Using AI doesn’t necessarily lead to the empowerment of patients, one participant pointed out in a tweet: “We need to acknowledge the real barriers patients are facing to accessing quality care.” Image Credits: A Health Blog. WHO: One Suicide Death Every 40 Seconds; Pesticide Control Can Reduce Rates 11/09/2019 Elaine Ruth Fletcher Reducing pesticide self-poisonings is one of the most effective ways to reduce suicide deaths –the second leading cause of death among young people aged 15-29 years, after road injury, according to a new WHO report. Release of the WHO report, Preventing suicide, a resource for pesticide registrars and regulators, coincided with World Suicide Prevention Day on Tuesday. Photo: WHO The report reflects the growing body of evidence that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates. In Sri Lanka, a series of bans led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013. Globally, there is one suicide death every 40 seconds. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries have the highest rate, at 11.5 per 100 000, according to a WHO press release. Globally, there are an estimated 10.5 deaths by suicide per 100 000 people a year. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal. Image Credits: WHO. Health Equity Stagnant Or Declining Across Europe, New WHO Report Finds 11/09/2019 Grace Ren Health equity in Europe has stagnated over the past decade, and in some case there are indications of a decline, a first-ever WHO report finds. However, advancing Universal Health Coverage (UHC) along with more inclusive policies for social welfare protection and political participation could put things back on track again. A family prepares coffee following a power outage in FYR Macedonia. Living conditions are associated with health inequities. Photo: Tomislav Georgiev / World Bank The Health Equity Status Report (HESR) report cites “financial hardship” as a major driver of health inequity in the WHO European Region, and pointing to “the critical importance of providing universal access to affordable health services.” Released less than two weeks ahead of the planned UN High-Level Meeting on UHC, 23 September), the report places renewed focus on the third stated objective: of the planned UHC declaration – ensuring that “the cost of using services does not put people at risk of financial harm.” The wide-ranging study of 53 countries in WHO’s European Region, analyzed data on life expectancy, infant mortality and other health indicators, in relation to socio-economic factors such as education, gender and income. It found wide variations in equity indicators within and between European countries. For instance, while average infant mortality has decreased across Europe, the infant mortality rate in Azerbaijan (47.8 deaths per 1000 live births) is 25 times higher than the rate in Finland (1.9 deaths per 1000 live births). Differences in life-expectancy and overall health based on gender, levels of education and income were also identified. The report also highlights inequities that are faced by so-called “new disadvantaged groups” such as adolescents who drop out of school early and people with chronic illnesses. The retreat by many countries from public housing and social welfare programmes has impacted negatively on key equity indicators, the report notes. For example, 53% of countries in the Region reduced their spending on subsidies for housing and community assistance programs in the past 15 years, despite that among the health equity factors assessed, one-third are driven by poor living conditions. In order to improve equity trends, the report recommends that countries enact health-promoting policies in 5 thematic areas: Variations in life expectancy in Europe. Credit: WHO, European Regional Office Invest in quality and affordable housing and safe neighborhoods; Reducing out-of-pocket (OOP) health payments; Reduce unemployment and implement job-promoting labour market policies (LMPs); Equalize opportunities in education across the life course – including investing in adult education; Strengthen social and political representation among marginalized groups. “The Health Equity Status Report provides governments with the data and tools they need to tackle health inequities and produce visible results in a relatively short period of time, even within the lifetime of a national government of 4 years,” says Dr Zsuzsanna Jakab, regional director for WHO Europe, in a press release. In a Lancet op-ed, HESR Initiative advisor, Dr Johanna Hanefeld, of the London School of Hygiene and Tropical Medicine, said that governments must, however, focus on deeper and more systemic changes as well. These include, altering “the governance structures of policy processes to ensure the communities affected… have a meaningful voice that influences outcomes in these processes.” Image Credits: Tomislav Georgiev / World Bank. Health Care Climate Footprint Is 4.4% Of Global Emissions; Larger Than Japan Or Brazil 10/09/2019 Elaine Ruth Fletcher Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm Some 4.4% of the world’s climate emissions are from health care activities – meaning that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil. This is the key finding from a first-ever global report on climate emissions from health care, launched Tuesday by Health Care Without Harm (HCWH), an international NGO devoted to “greening” the health sector for the benefit of patients, health workers – and the environment. The report, Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action, also found that the US health care sector is by far, the largest aggregate and per capita emitter – with a whopping 27% percent of the world’s total healthcare-related emissions, or 1.2 tons of CO2 equivalent per capita (tCO2e). That is 57 times more emissions per person than India, which has the lowest per capita emissions of the 43 developed and emerging economies, where detailed data was available for the report. In absolute terms, China takes second place with 17% of emissions, and the European Union third place, with 12% of the world’s healthcare footprint. That is followed by Japan (5%), Russia (4%) and then Brazil, India, South Korea and Australia (2% each). Emissions from the rest of the world amount to no more than a quarter of the global total. The total climate footprint of the healthcare sector is estimated at 2 gigatons of CO2 equivalent emissions a year. In terms of per capita emissions, the US is followed by Australia, Canada and Switzerland; most other European Union and developed countries; followed by a range of lower middle income countries. For other lower income countries, per-capita emissions couldn’t be reliably estimated. The report’s launch comes just two weeks ahead of the planned UN Secretary General’s Climate Summit in New York City (23 September), and the study clearly takes aim at the much-discussed target for limiting global temperature rise to 1.5°C, saying that healthcare needs to do more of its share. “Hospitals and health care systems paradoxically make a major contribution to the climate crisis,” said Josh Karliner, a lead author of the report as well as HCWH’s International Director of Programs and Strategy. “Healthcare has to step up and do its part to avoid catastrophic climate change, which would be devastating to human health worldwide.” ‘Decarbonizing’ the Health Care Sector In line with that message, the also report outlines recommendations for areas where the health care sector could rapidly “decarbonize” including: Net zero emissions building design and construction; Investment in renewable energy and energy efficiency and climate-smart cooling technologies; Sustainable waste, water, and transport management; Better management of anaesthetic gases with high global warming potential; Tele-medicine and digital health technologies that reduce patient travel and related infrastructure requirements. Low-carbon procurement chains – for items ranging from pharmaceuticals to medical devices, as well as food and clothing, to improve efficiencies and reduce waste. And at the other end of the spectrum – better waste management systems. The report stresses that the health care sector remains dependent on energy supplies from national grids. “With 10% of health care facilities’ climate footprint coming from purchased energy, and with a large amount of the supply chain also consuming grid energy, decarbonization of national energy systems is essential to move health care to net zero emissions. “ However, low-carbon approaches to health care can be a win-win, fostering more equitable access to health care, and addressing health and safety risks that affect patients, health workers and the communities. For instance, some health-care facilities in low-income countries have developed their own renewable energy resources, which can provide power for health services more reliably, avoiding life-threatening interruptions in electricity supply. “In energy-poor settings, powering health care with low-carbon solutions can enhance access to care, contributing to the advancement of universal health care for the poor and most vulnerable,” the report concludes. The Climate Footprint of Different Health Care Activities The study took a “cradle to grave” approach to the assessment, estimating emissions associated with everything from the procurement of chemicals and pharmaceuticals as well as rubber, cotton and plastic healthcare products to building design and energy management, transport, and waste. Key findings were: More than one-half of the health sector’s footprint is due to generation and distribution of electricity or gas, heating/cooling, and related operational activities (53%). Manufacturing and agricultural inputs (including food supplies and materials such as cotton for bandages), are the third (13%) and fourth (11%) largest source of emissions. Transport represents about 7% of health sector emissions, while pharmaceutical products represent about 5%, followed by waste treatment (3%). Along with other chemicals, anaesthetic gases, including nitrous oxide and the fluorinated gases sevoflurane, isoflurane, and desflurane, are an unexplored source of health-care emissions, the report notes. Their Global Warming Potentials range between 130 kgCO2e/kg (sevoflurane) and 2540 kgCO2e/kg (desflurane), the report notes. At present, the majority of these gases enter the atmosphere. The report is built upon earlier studies of health sector emissions at national level; a 2017 study by HCWH and the World Bank, which provided a rough estimate of 5% of global emissions due to health care activities in 2011; and a 2018 study of Organisation for Economic Cooperation and Development (OECD) countries, plus India and China. That study estimated that health care activities in the 36 countries sampled was responsible for 1.6 GtCO2e emissions or 4.4% of the total emissions from these nations in 2014. However, this report claims to establish the first detailed estimate – going further in terms of the number of countries covered, as well as estimates of emissions from various activities. It also draws from the global World Input-Output Database (WIOD) database, to come up with initial estimates for emissions for low- and lower-middle income countries where data remains scarce. The report also breaks down global emissions according to the framework established by the Greenhouse Gas Protocol, the world’s most widely used greenhouse gas accounting standard. It thus aligns the emissions analysis of health care activities with the Protocol’s generic categories: Scope 1 (direct emissions from health care facilities), Scope 2 (indirect emissions from purchased energy), and Scope 3 (all indirect emissions, not included in scope 2, that occur in the value chain, including both upstream and downstream emissions). Health Care Climate Challenge “Health care must respond to the growing climate emergency not only by treating those made ill, injured, or dying from the climate crisis, but also by practicing primary prevention and radically reducing its own emissions,” said Karliner, of the report’s aim. As part of that response, Health Care Without Harm has launched a Health Care Climate Challenge which some 200 institutions, representing the interests of over 18,000 health facilities in 31 countries, have joined. Collectively, they have made commitments to reduce their carbon emissions by more than 34.2 million metric tons of CO2e. To date, Karliner says, the network has collectively reduced over 6.8 million metric tons of CO2e. The corresponding energy efficiency upgrades and renewable energy generation improvements have saved the partner institutions over US$394 million. “The good news is that there are hospitals and health systems all around the world leading by example and implementing climate-smart health care strategies.” Image Credits: Health Care Without Harm, Health Care Without Harm. Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
AI & Healthcare Conference Considers Access, Equity & Gender 11/09/2019 Elaine Ruth Fletcher Digital health holds the potential to transform health systems so that they become more proactive and responsive to patients, advocates said at Wednesday’s launch of a two-day international conference that brought together members of the global healthcare and artificial intelligence (AI) communities in Switzerland’s pharmaceutical industry hub, Basel. But using AI doesn’t inherently empower women or other vulnerable groups, some speakers and participants also pointed out. Policies have to be shaped to ensure that such technologies advance equity and access to health care. The two-day Intelligent Health 2019 conference, organized by Novartis Foundation, brings together experts from some 67 countries, as well as representatives of the World Health Organisation, and other international agencies, along with tech giants such as Google and Microsoft. “Digital tech can transform our health and care systems from being reactive to becoming proactive and even predictive. That’s the challenge the Novartis Foundation is now fully focused on,” said Dr. Ann Aerts, Head of the Novartis Foundation, speaking about the conference aims in a blog. “Some of the biggest medical and health problems in the world today can be solved by harnessing the power of AI, big data and digital solutions. We have the potential to unite multi disciplinary groups ….from governments, corporates, healthcare providers and global clinician communities to radically transform the quality of lives globally” said Sarah Porter, CEO & Founder of Inspired Minds, a conference co-organizer. However, like all innovations and technologies, AI is neutral, and humans have to ensure that it is used for everyone’s benefit, others emphasized. “In order for AI tools to actually impact health outcomes positively, the algorithms need to be diverse and inclusive,” Stephanie Kukku, of UCL Hospital, London, was quoted as saying in a presentation. Using AI doesn’t necessarily lead to the empowerment of patients, one participant pointed out in a tweet: “We need to acknowledge the real barriers patients are facing to accessing quality care.” Image Credits: A Health Blog. WHO: One Suicide Death Every 40 Seconds; Pesticide Control Can Reduce Rates 11/09/2019 Elaine Ruth Fletcher Reducing pesticide self-poisonings is one of the most effective ways to reduce suicide deaths –the second leading cause of death among young people aged 15-29 years, after road injury, according to a new WHO report. Release of the WHO report, Preventing suicide, a resource for pesticide registrars and regulators, coincided with World Suicide Prevention Day on Tuesday. Photo: WHO The report reflects the growing body of evidence that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates. In Sri Lanka, a series of bans led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013. Globally, there is one suicide death every 40 seconds. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries have the highest rate, at 11.5 per 100 000, according to a WHO press release. Globally, there are an estimated 10.5 deaths by suicide per 100 000 people a year. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal. Image Credits: WHO. Health Equity Stagnant Or Declining Across Europe, New WHO Report Finds 11/09/2019 Grace Ren Health equity in Europe has stagnated over the past decade, and in some case there are indications of a decline, a first-ever WHO report finds. However, advancing Universal Health Coverage (UHC) along with more inclusive policies for social welfare protection and political participation could put things back on track again. A family prepares coffee following a power outage in FYR Macedonia. Living conditions are associated with health inequities. Photo: Tomislav Georgiev / World Bank The Health Equity Status Report (HESR) report cites “financial hardship” as a major driver of health inequity in the WHO European Region, and pointing to “the critical importance of providing universal access to affordable health services.” Released less than two weeks ahead of the planned UN High-Level Meeting on UHC, 23 September), the report places renewed focus on the third stated objective: of the planned UHC declaration – ensuring that “the cost of using services does not put people at risk of financial harm.” The wide-ranging study of 53 countries in WHO’s European Region, analyzed data on life expectancy, infant mortality and other health indicators, in relation to socio-economic factors such as education, gender and income. It found wide variations in equity indicators within and between European countries. For instance, while average infant mortality has decreased across Europe, the infant mortality rate in Azerbaijan (47.8 deaths per 1000 live births) is 25 times higher than the rate in Finland (1.9 deaths per 1000 live births). Differences in life-expectancy and overall health based on gender, levels of education and income were also identified. The report also highlights inequities that are faced by so-called “new disadvantaged groups” such as adolescents who drop out of school early and people with chronic illnesses. The retreat by many countries from public housing and social welfare programmes has impacted negatively on key equity indicators, the report notes. For example, 53% of countries in the Region reduced their spending on subsidies for housing and community assistance programs in the past 15 years, despite that among the health equity factors assessed, one-third are driven by poor living conditions. In order to improve equity trends, the report recommends that countries enact health-promoting policies in 5 thematic areas: Variations in life expectancy in Europe. Credit: WHO, European Regional Office Invest in quality and affordable housing and safe neighborhoods; Reducing out-of-pocket (OOP) health payments; Reduce unemployment and implement job-promoting labour market policies (LMPs); Equalize opportunities in education across the life course – including investing in adult education; Strengthen social and political representation among marginalized groups. “The Health Equity Status Report provides governments with the data and tools they need to tackle health inequities and produce visible results in a relatively short period of time, even within the lifetime of a national government of 4 years,” says Dr Zsuzsanna Jakab, regional director for WHO Europe, in a press release. In a Lancet op-ed, HESR Initiative advisor, Dr Johanna Hanefeld, of the London School of Hygiene and Tropical Medicine, said that governments must, however, focus on deeper and more systemic changes as well. These include, altering “the governance structures of policy processes to ensure the communities affected… have a meaningful voice that influences outcomes in these processes.” Image Credits: Tomislav Georgiev / World Bank. Health Care Climate Footprint Is 4.4% Of Global Emissions; Larger Than Japan Or Brazil 10/09/2019 Elaine Ruth Fletcher Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm Some 4.4% of the world’s climate emissions are from health care activities – meaning that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil. This is the key finding from a first-ever global report on climate emissions from health care, launched Tuesday by Health Care Without Harm (HCWH), an international NGO devoted to “greening” the health sector for the benefit of patients, health workers – and the environment. The report, Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action, also found that the US health care sector is by far, the largest aggregate and per capita emitter – with a whopping 27% percent of the world’s total healthcare-related emissions, or 1.2 tons of CO2 equivalent per capita (tCO2e). That is 57 times more emissions per person than India, which has the lowest per capita emissions of the 43 developed and emerging economies, where detailed data was available for the report. In absolute terms, China takes second place with 17% of emissions, and the European Union third place, with 12% of the world’s healthcare footprint. That is followed by Japan (5%), Russia (4%) and then Brazil, India, South Korea and Australia (2% each). Emissions from the rest of the world amount to no more than a quarter of the global total. The total climate footprint of the healthcare sector is estimated at 2 gigatons of CO2 equivalent emissions a year. In terms of per capita emissions, the US is followed by Australia, Canada and Switzerland; most other European Union and developed countries; followed by a range of lower middle income countries. For other lower income countries, per-capita emissions couldn’t be reliably estimated. The report’s launch comes just two weeks ahead of the planned UN Secretary General’s Climate Summit in New York City (23 September), and the study clearly takes aim at the much-discussed target for limiting global temperature rise to 1.5°C, saying that healthcare needs to do more of its share. “Hospitals and health care systems paradoxically make a major contribution to the climate crisis,” said Josh Karliner, a lead author of the report as well as HCWH’s International Director of Programs and Strategy. “Healthcare has to step up and do its part to avoid catastrophic climate change, which would be devastating to human health worldwide.” ‘Decarbonizing’ the Health Care Sector In line with that message, the also report outlines recommendations for areas where the health care sector could rapidly “decarbonize” including: Net zero emissions building design and construction; Investment in renewable energy and energy efficiency and climate-smart cooling technologies; Sustainable waste, water, and transport management; Better management of anaesthetic gases with high global warming potential; Tele-medicine and digital health technologies that reduce patient travel and related infrastructure requirements. Low-carbon procurement chains – for items ranging from pharmaceuticals to medical devices, as well as food and clothing, to improve efficiencies and reduce waste. And at the other end of the spectrum – better waste management systems. The report stresses that the health care sector remains dependent on energy supplies from national grids. “With 10% of health care facilities’ climate footprint coming from purchased energy, and with a large amount of the supply chain also consuming grid energy, decarbonization of national energy systems is essential to move health care to net zero emissions. “ However, low-carbon approaches to health care can be a win-win, fostering more equitable access to health care, and addressing health and safety risks that affect patients, health workers and the communities. For instance, some health-care facilities in low-income countries have developed their own renewable energy resources, which can provide power for health services more reliably, avoiding life-threatening interruptions in electricity supply. “In energy-poor settings, powering health care with low-carbon solutions can enhance access to care, contributing to the advancement of universal health care for the poor and most vulnerable,” the report concludes. The Climate Footprint of Different Health Care Activities The study took a “cradle to grave” approach to the assessment, estimating emissions associated with everything from the procurement of chemicals and pharmaceuticals as well as rubber, cotton and plastic healthcare products to building design and energy management, transport, and waste. Key findings were: More than one-half of the health sector’s footprint is due to generation and distribution of electricity or gas, heating/cooling, and related operational activities (53%). Manufacturing and agricultural inputs (including food supplies and materials such as cotton for bandages), are the third (13%) and fourth (11%) largest source of emissions. Transport represents about 7% of health sector emissions, while pharmaceutical products represent about 5%, followed by waste treatment (3%). Along with other chemicals, anaesthetic gases, including nitrous oxide and the fluorinated gases sevoflurane, isoflurane, and desflurane, are an unexplored source of health-care emissions, the report notes. Their Global Warming Potentials range between 130 kgCO2e/kg (sevoflurane) and 2540 kgCO2e/kg (desflurane), the report notes. At present, the majority of these gases enter the atmosphere. The report is built upon earlier studies of health sector emissions at national level; a 2017 study by HCWH and the World Bank, which provided a rough estimate of 5% of global emissions due to health care activities in 2011; and a 2018 study of Organisation for Economic Cooperation and Development (OECD) countries, plus India and China. That study estimated that health care activities in the 36 countries sampled was responsible for 1.6 GtCO2e emissions or 4.4% of the total emissions from these nations in 2014. However, this report claims to establish the first detailed estimate – going further in terms of the number of countries covered, as well as estimates of emissions from various activities. It also draws from the global World Input-Output Database (WIOD) database, to come up with initial estimates for emissions for low- and lower-middle income countries where data remains scarce. The report also breaks down global emissions according to the framework established by the Greenhouse Gas Protocol, the world’s most widely used greenhouse gas accounting standard. It thus aligns the emissions analysis of health care activities with the Protocol’s generic categories: Scope 1 (direct emissions from health care facilities), Scope 2 (indirect emissions from purchased energy), and Scope 3 (all indirect emissions, not included in scope 2, that occur in the value chain, including both upstream and downstream emissions). Health Care Climate Challenge “Health care must respond to the growing climate emergency not only by treating those made ill, injured, or dying from the climate crisis, but also by practicing primary prevention and radically reducing its own emissions,” said Karliner, of the report’s aim. As part of that response, Health Care Without Harm has launched a Health Care Climate Challenge which some 200 institutions, representing the interests of over 18,000 health facilities in 31 countries, have joined. Collectively, they have made commitments to reduce their carbon emissions by more than 34.2 million metric tons of CO2e. To date, Karliner says, the network has collectively reduced over 6.8 million metric tons of CO2e. The corresponding energy efficiency upgrades and renewable energy generation improvements have saved the partner institutions over US$394 million. “The good news is that there are hospitals and health systems all around the world leading by example and implementing climate-smart health care strategies.” Image Credits: Health Care Without Harm, Health Care Without Harm. Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO: One Suicide Death Every 40 Seconds; Pesticide Control Can Reduce Rates 11/09/2019 Elaine Ruth Fletcher Reducing pesticide self-poisonings is one of the most effective ways to reduce suicide deaths –the second leading cause of death among young people aged 15-29 years, after road injury, according to a new WHO report. Release of the WHO report, Preventing suicide, a resource for pesticide registrars and regulators, coincided with World Suicide Prevention Day on Tuesday. Photo: WHO The report reflects the growing body of evidence that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates. In Sri Lanka, a series of bans led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013. Globally, there is one suicide death every 40 seconds. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries have the highest rate, at 11.5 per 100 000, according to a WHO press release. Globally, there are an estimated 10.5 deaths by suicide per 100 000 people a year. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal. Image Credits: WHO. Health Equity Stagnant Or Declining Across Europe, New WHO Report Finds 11/09/2019 Grace Ren Health equity in Europe has stagnated over the past decade, and in some case there are indications of a decline, a first-ever WHO report finds. However, advancing Universal Health Coverage (UHC) along with more inclusive policies for social welfare protection and political participation could put things back on track again. A family prepares coffee following a power outage in FYR Macedonia. Living conditions are associated with health inequities. Photo: Tomislav Georgiev / World Bank The Health Equity Status Report (HESR) report cites “financial hardship” as a major driver of health inequity in the WHO European Region, and pointing to “the critical importance of providing universal access to affordable health services.” Released less than two weeks ahead of the planned UN High-Level Meeting on UHC, 23 September), the report places renewed focus on the third stated objective: of the planned UHC declaration – ensuring that “the cost of using services does not put people at risk of financial harm.” The wide-ranging study of 53 countries in WHO’s European Region, analyzed data on life expectancy, infant mortality and other health indicators, in relation to socio-economic factors such as education, gender and income. It found wide variations in equity indicators within and between European countries. For instance, while average infant mortality has decreased across Europe, the infant mortality rate in Azerbaijan (47.8 deaths per 1000 live births) is 25 times higher than the rate in Finland (1.9 deaths per 1000 live births). Differences in life-expectancy and overall health based on gender, levels of education and income were also identified. The report also highlights inequities that are faced by so-called “new disadvantaged groups” such as adolescents who drop out of school early and people with chronic illnesses. The retreat by many countries from public housing and social welfare programmes has impacted negatively on key equity indicators, the report notes. For example, 53% of countries in the Region reduced their spending on subsidies for housing and community assistance programs in the past 15 years, despite that among the health equity factors assessed, one-third are driven by poor living conditions. In order to improve equity trends, the report recommends that countries enact health-promoting policies in 5 thematic areas: Variations in life expectancy in Europe. Credit: WHO, European Regional Office Invest in quality and affordable housing and safe neighborhoods; Reducing out-of-pocket (OOP) health payments; Reduce unemployment and implement job-promoting labour market policies (LMPs); Equalize opportunities in education across the life course – including investing in adult education; Strengthen social and political representation among marginalized groups. “The Health Equity Status Report provides governments with the data and tools they need to tackle health inequities and produce visible results in a relatively short period of time, even within the lifetime of a national government of 4 years,” says Dr Zsuzsanna Jakab, regional director for WHO Europe, in a press release. In a Lancet op-ed, HESR Initiative advisor, Dr Johanna Hanefeld, of the London School of Hygiene and Tropical Medicine, said that governments must, however, focus on deeper and more systemic changes as well. These include, altering “the governance structures of policy processes to ensure the communities affected… have a meaningful voice that influences outcomes in these processes.” Image Credits: Tomislav Georgiev / World Bank. Health Care Climate Footprint Is 4.4% Of Global Emissions; Larger Than Japan Or Brazil 10/09/2019 Elaine Ruth Fletcher Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm Some 4.4% of the world’s climate emissions are from health care activities – meaning that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil. This is the key finding from a first-ever global report on climate emissions from health care, launched Tuesday by Health Care Without Harm (HCWH), an international NGO devoted to “greening” the health sector for the benefit of patients, health workers – and the environment. The report, Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action, also found that the US health care sector is by far, the largest aggregate and per capita emitter – with a whopping 27% percent of the world’s total healthcare-related emissions, or 1.2 tons of CO2 equivalent per capita (tCO2e). That is 57 times more emissions per person than India, which has the lowest per capita emissions of the 43 developed and emerging economies, where detailed data was available for the report. In absolute terms, China takes second place with 17% of emissions, and the European Union third place, with 12% of the world’s healthcare footprint. That is followed by Japan (5%), Russia (4%) and then Brazil, India, South Korea and Australia (2% each). Emissions from the rest of the world amount to no more than a quarter of the global total. The total climate footprint of the healthcare sector is estimated at 2 gigatons of CO2 equivalent emissions a year. In terms of per capita emissions, the US is followed by Australia, Canada and Switzerland; most other European Union and developed countries; followed by a range of lower middle income countries. For other lower income countries, per-capita emissions couldn’t be reliably estimated. The report’s launch comes just two weeks ahead of the planned UN Secretary General’s Climate Summit in New York City (23 September), and the study clearly takes aim at the much-discussed target for limiting global temperature rise to 1.5°C, saying that healthcare needs to do more of its share. “Hospitals and health care systems paradoxically make a major contribution to the climate crisis,” said Josh Karliner, a lead author of the report as well as HCWH’s International Director of Programs and Strategy. “Healthcare has to step up and do its part to avoid catastrophic climate change, which would be devastating to human health worldwide.” ‘Decarbonizing’ the Health Care Sector In line with that message, the also report outlines recommendations for areas where the health care sector could rapidly “decarbonize” including: Net zero emissions building design and construction; Investment in renewable energy and energy efficiency and climate-smart cooling technologies; Sustainable waste, water, and transport management; Better management of anaesthetic gases with high global warming potential; Tele-medicine and digital health technologies that reduce patient travel and related infrastructure requirements. Low-carbon procurement chains – for items ranging from pharmaceuticals to medical devices, as well as food and clothing, to improve efficiencies and reduce waste. And at the other end of the spectrum – better waste management systems. The report stresses that the health care sector remains dependent on energy supplies from national grids. “With 10% of health care facilities’ climate footprint coming from purchased energy, and with a large amount of the supply chain also consuming grid energy, decarbonization of national energy systems is essential to move health care to net zero emissions. “ However, low-carbon approaches to health care can be a win-win, fostering more equitable access to health care, and addressing health and safety risks that affect patients, health workers and the communities. For instance, some health-care facilities in low-income countries have developed their own renewable energy resources, which can provide power for health services more reliably, avoiding life-threatening interruptions in electricity supply. “In energy-poor settings, powering health care with low-carbon solutions can enhance access to care, contributing to the advancement of universal health care for the poor and most vulnerable,” the report concludes. The Climate Footprint of Different Health Care Activities The study took a “cradle to grave” approach to the assessment, estimating emissions associated with everything from the procurement of chemicals and pharmaceuticals as well as rubber, cotton and plastic healthcare products to building design and energy management, transport, and waste. Key findings were: More than one-half of the health sector’s footprint is due to generation and distribution of electricity or gas, heating/cooling, and related operational activities (53%). Manufacturing and agricultural inputs (including food supplies and materials such as cotton for bandages), are the third (13%) and fourth (11%) largest source of emissions. Transport represents about 7% of health sector emissions, while pharmaceutical products represent about 5%, followed by waste treatment (3%). Along with other chemicals, anaesthetic gases, including nitrous oxide and the fluorinated gases sevoflurane, isoflurane, and desflurane, are an unexplored source of health-care emissions, the report notes. Their Global Warming Potentials range between 130 kgCO2e/kg (sevoflurane) and 2540 kgCO2e/kg (desflurane), the report notes. At present, the majority of these gases enter the atmosphere. The report is built upon earlier studies of health sector emissions at national level; a 2017 study by HCWH and the World Bank, which provided a rough estimate of 5% of global emissions due to health care activities in 2011; and a 2018 study of Organisation for Economic Cooperation and Development (OECD) countries, plus India and China. That study estimated that health care activities in the 36 countries sampled was responsible for 1.6 GtCO2e emissions or 4.4% of the total emissions from these nations in 2014. However, this report claims to establish the first detailed estimate – going further in terms of the number of countries covered, as well as estimates of emissions from various activities. It also draws from the global World Input-Output Database (WIOD) database, to come up with initial estimates for emissions for low- and lower-middle income countries where data remains scarce. The report also breaks down global emissions according to the framework established by the Greenhouse Gas Protocol, the world’s most widely used greenhouse gas accounting standard. It thus aligns the emissions analysis of health care activities with the Protocol’s generic categories: Scope 1 (direct emissions from health care facilities), Scope 2 (indirect emissions from purchased energy), and Scope 3 (all indirect emissions, not included in scope 2, that occur in the value chain, including both upstream and downstream emissions). Health Care Climate Challenge “Health care must respond to the growing climate emergency not only by treating those made ill, injured, or dying from the climate crisis, but also by practicing primary prevention and radically reducing its own emissions,” said Karliner, of the report’s aim. As part of that response, Health Care Without Harm has launched a Health Care Climate Challenge which some 200 institutions, representing the interests of over 18,000 health facilities in 31 countries, have joined. Collectively, they have made commitments to reduce their carbon emissions by more than 34.2 million metric tons of CO2e. To date, Karliner says, the network has collectively reduced over 6.8 million metric tons of CO2e. The corresponding energy efficiency upgrades and renewable energy generation improvements have saved the partner institutions over US$394 million. “The good news is that there are hospitals and health systems all around the world leading by example and implementing climate-smart health care strategies.” Image Credits: Health Care Without Harm, Health Care Without Harm. Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Health Equity Stagnant Or Declining Across Europe, New WHO Report Finds 11/09/2019 Grace Ren Health equity in Europe has stagnated over the past decade, and in some case there are indications of a decline, a first-ever WHO report finds. However, advancing Universal Health Coverage (UHC) along with more inclusive policies for social welfare protection and political participation could put things back on track again. A family prepares coffee following a power outage in FYR Macedonia. Living conditions are associated with health inequities. Photo: Tomislav Georgiev / World Bank The Health Equity Status Report (HESR) report cites “financial hardship” as a major driver of health inequity in the WHO European Region, and pointing to “the critical importance of providing universal access to affordable health services.” Released less than two weeks ahead of the planned UN High-Level Meeting on UHC, 23 September), the report places renewed focus on the third stated objective: of the planned UHC declaration – ensuring that “the cost of using services does not put people at risk of financial harm.” The wide-ranging study of 53 countries in WHO’s European Region, analyzed data on life expectancy, infant mortality and other health indicators, in relation to socio-economic factors such as education, gender and income. It found wide variations in equity indicators within and between European countries. For instance, while average infant mortality has decreased across Europe, the infant mortality rate in Azerbaijan (47.8 deaths per 1000 live births) is 25 times higher than the rate in Finland (1.9 deaths per 1000 live births). Differences in life-expectancy and overall health based on gender, levels of education and income were also identified. The report also highlights inequities that are faced by so-called “new disadvantaged groups” such as adolescents who drop out of school early and people with chronic illnesses. The retreat by many countries from public housing and social welfare programmes has impacted negatively on key equity indicators, the report notes. For example, 53% of countries in the Region reduced their spending on subsidies for housing and community assistance programs in the past 15 years, despite that among the health equity factors assessed, one-third are driven by poor living conditions. In order to improve equity trends, the report recommends that countries enact health-promoting policies in 5 thematic areas: Variations in life expectancy in Europe. Credit: WHO, European Regional Office Invest in quality and affordable housing and safe neighborhoods; Reducing out-of-pocket (OOP) health payments; Reduce unemployment and implement job-promoting labour market policies (LMPs); Equalize opportunities in education across the life course – including investing in adult education; Strengthen social and political representation among marginalized groups. “The Health Equity Status Report provides governments with the data and tools they need to tackle health inequities and produce visible results in a relatively short period of time, even within the lifetime of a national government of 4 years,” says Dr Zsuzsanna Jakab, regional director for WHO Europe, in a press release. In a Lancet op-ed, HESR Initiative advisor, Dr Johanna Hanefeld, of the London School of Hygiene and Tropical Medicine, said that governments must, however, focus on deeper and more systemic changes as well. These include, altering “the governance structures of policy processes to ensure the communities affected… have a meaningful voice that influences outcomes in these processes.” Image Credits: Tomislav Georgiev / World Bank. Health Care Climate Footprint Is 4.4% Of Global Emissions; Larger Than Japan Or Brazil 10/09/2019 Elaine Ruth Fletcher Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm Some 4.4% of the world’s climate emissions are from health care activities – meaning that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil. This is the key finding from a first-ever global report on climate emissions from health care, launched Tuesday by Health Care Without Harm (HCWH), an international NGO devoted to “greening” the health sector for the benefit of patients, health workers – and the environment. The report, Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action, also found that the US health care sector is by far, the largest aggregate and per capita emitter – with a whopping 27% percent of the world’s total healthcare-related emissions, or 1.2 tons of CO2 equivalent per capita (tCO2e). That is 57 times more emissions per person than India, which has the lowest per capita emissions of the 43 developed and emerging economies, where detailed data was available for the report. In absolute terms, China takes second place with 17% of emissions, and the European Union third place, with 12% of the world’s healthcare footprint. That is followed by Japan (5%), Russia (4%) and then Brazil, India, South Korea and Australia (2% each). Emissions from the rest of the world amount to no more than a quarter of the global total. The total climate footprint of the healthcare sector is estimated at 2 gigatons of CO2 equivalent emissions a year. In terms of per capita emissions, the US is followed by Australia, Canada and Switzerland; most other European Union and developed countries; followed by a range of lower middle income countries. For other lower income countries, per-capita emissions couldn’t be reliably estimated. The report’s launch comes just two weeks ahead of the planned UN Secretary General’s Climate Summit in New York City (23 September), and the study clearly takes aim at the much-discussed target for limiting global temperature rise to 1.5°C, saying that healthcare needs to do more of its share. “Hospitals and health care systems paradoxically make a major contribution to the climate crisis,” said Josh Karliner, a lead author of the report as well as HCWH’s International Director of Programs and Strategy. “Healthcare has to step up and do its part to avoid catastrophic climate change, which would be devastating to human health worldwide.” ‘Decarbonizing’ the Health Care Sector In line with that message, the also report outlines recommendations for areas where the health care sector could rapidly “decarbonize” including: Net zero emissions building design and construction; Investment in renewable energy and energy efficiency and climate-smart cooling technologies; Sustainable waste, water, and transport management; Better management of anaesthetic gases with high global warming potential; Tele-medicine and digital health technologies that reduce patient travel and related infrastructure requirements. Low-carbon procurement chains – for items ranging from pharmaceuticals to medical devices, as well as food and clothing, to improve efficiencies and reduce waste. And at the other end of the spectrum – better waste management systems. The report stresses that the health care sector remains dependent on energy supplies from national grids. “With 10% of health care facilities’ climate footprint coming from purchased energy, and with a large amount of the supply chain also consuming grid energy, decarbonization of national energy systems is essential to move health care to net zero emissions. “ However, low-carbon approaches to health care can be a win-win, fostering more equitable access to health care, and addressing health and safety risks that affect patients, health workers and the communities. For instance, some health-care facilities in low-income countries have developed their own renewable energy resources, which can provide power for health services more reliably, avoiding life-threatening interruptions in electricity supply. “In energy-poor settings, powering health care with low-carbon solutions can enhance access to care, contributing to the advancement of universal health care for the poor and most vulnerable,” the report concludes. The Climate Footprint of Different Health Care Activities The study took a “cradle to grave” approach to the assessment, estimating emissions associated with everything from the procurement of chemicals and pharmaceuticals as well as rubber, cotton and plastic healthcare products to building design and energy management, transport, and waste. Key findings were: More than one-half of the health sector’s footprint is due to generation and distribution of electricity or gas, heating/cooling, and related operational activities (53%). Manufacturing and agricultural inputs (including food supplies and materials such as cotton for bandages), are the third (13%) and fourth (11%) largest source of emissions. Transport represents about 7% of health sector emissions, while pharmaceutical products represent about 5%, followed by waste treatment (3%). Along with other chemicals, anaesthetic gases, including nitrous oxide and the fluorinated gases sevoflurane, isoflurane, and desflurane, are an unexplored source of health-care emissions, the report notes. Their Global Warming Potentials range between 130 kgCO2e/kg (sevoflurane) and 2540 kgCO2e/kg (desflurane), the report notes. At present, the majority of these gases enter the atmosphere. The report is built upon earlier studies of health sector emissions at national level; a 2017 study by HCWH and the World Bank, which provided a rough estimate of 5% of global emissions due to health care activities in 2011; and a 2018 study of Organisation for Economic Cooperation and Development (OECD) countries, plus India and China. That study estimated that health care activities in the 36 countries sampled was responsible for 1.6 GtCO2e emissions or 4.4% of the total emissions from these nations in 2014. However, this report claims to establish the first detailed estimate – going further in terms of the number of countries covered, as well as estimates of emissions from various activities. It also draws from the global World Input-Output Database (WIOD) database, to come up with initial estimates for emissions for low- and lower-middle income countries where data remains scarce. The report also breaks down global emissions according to the framework established by the Greenhouse Gas Protocol, the world’s most widely used greenhouse gas accounting standard. It thus aligns the emissions analysis of health care activities with the Protocol’s generic categories: Scope 1 (direct emissions from health care facilities), Scope 2 (indirect emissions from purchased energy), and Scope 3 (all indirect emissions, not included in scope 2, that occur in the value chain, including both upstream and downstream emissions). Health Care Climate Challenge “Health care must respond to the growing climate emergency not only by treating those made ill, injured, or dying from the climate crisis, but also by practicing primary prevention and radically reducing its own emissions,” said Karliner, of the report’s aim. As part of that response, Health Care Without Harm has launched a Health Care Climate Challenge which some 200 institutions, representing the interests of over 18,000 health facilities in 31 countries, have joined. Collectively, they have made commitments to reduce their carbon emissions by more than 34.2 million metric tons of CO2e. To date, Karliner says, the network has collectively reduced over 6.8 million metric tons of CO2e. The corresponding energy efficiency upgrades and renewable energy generation improvements have saved the partner institutions over US$394 million. “The good news is that there are hospitals and health systems all around the world leading by example and implementing climate-smart health care strategies.” Image Credits: Health Care Without Harm, Health Care Without Harm. Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Health Care Climate Footprint Is 4.4% Of Global Emissions; Larger Than Japan Or Brazil 10/09/2019 Elaine Ruth Fletcher Solar panels supply energy for hot water at Bertha Gxowa Hospital in Johannesburg. Photo: Health Care Without Harm Some 4.4% of the world’s climate emissions are from health care activities – meaning that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil. This is the key finding from a first-ever global report on climate emissions from health care, launched Tuesday by Health Care Without Harm (HCWH), an international NGO devoted to “greening” the health sector for the benefit of patients, health workers – and the environment. The report, Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action, also found that the US health care sector is by far, the largest aggregate and per capita emitter – with a whopping 27% percent of the world’s total healthcare-related emissions, or 1.2 tons of CO2 equivalent per capita (tCO2e). That is 57 times more emissions per person than India, which has the lowest per capita emissions of the 43 developed and emerging economies, where detailed data was available for the report. In absolute terms, China takes second place with 17% of emissions, and the European Union third place, with 12% of the world’s healthcare footprint. That is followed by Japan (5%), Russia (4%) and then Brazil, India, South Korea and Australia (2% each). Emissions from the rest of the world amount to no more than a quarter of the global total. The total climate footprint of the healthcare sector is estimated at 2 gigatons of CO2 equivalent emissions a year. In terms of per capita emissions, the US is followed by Australia, Canada and Switzerland; most other European Union and developed countries; followed by a range of lower middle income countries. For other lower income countries, per-capita emissions couldn’t be reliably estimated. The report’s launch comes just two weeks ahead of the planned UN Secretary General’s Climate Summit in New York City (23 September), and the study clearly takes aim at the much-discussed target for limiting global temperature rise to 1.5°C, saying that healthcare needs to do more of its share. “Hospitals and health care systems paradoxically make a major contribution to the climate crisis,” said Josh Karliner, a lead author of the report as well as HCWH’s International Director of Programs and Strategy. “Healthcare has to step up and do its part to avoid catastrophic climate change, which would be devastating to human health worldwide.” ‘Decarbonizing’ the Health Care Sector In line with that message, the also report outlines recommendations for areas where the health care sector could rapidly “decarbonize” including: Net zero emissions building design and construction; Investment in renewable energy and energy efficiency and climate-smart cooling technologies; Sustainable waste, water, and transport management; Better management of anaesthetic gases with high global warming potential; Tele-medicine and digital health technologies that reduce patient travel and related infrastructure requirements. Low-carbon procurement chains – for items ranging from pharmaceuticals to medical devices, as well as food and clothing, to improve efficiencies and reduce waste. And at the other end of the spectrum – better waste management systems. The report stresses that the health care sector remains dependent on energy supplies from national grids. “With 10% of health care facilities’ climate footprint coming from purchased energy, and with a large amount of the supply chain also consuming grid energy, decarbonization of national energy systems is essential to move health care to net zero emissions. “ However, low-carbon approaches to health care can be a win-win, fostering more equitable access to health care, and addressing health and safety risks that affect patients, health workers and the communities. For instance, some health-care facilities in low-income countries have developed their own renewable energy resources, which can provide power for health services more reliably, avoiding life-threatening interruptions in electricity supply. “In energy-poor settings, powering health care with low-carbon solutions can enhance access to care, contributing to the advancement of universal health care for the poor and most vulnerable,” the report concludes. The Climate Footprint of Different Health Care Activities The study took a “cradle to grave” approach to the assessment, estimating emissions associated with everything from the procurement of chemicals and pharmaceuticals as well as rubber, cotton and plastic healthcare products to building design and energy management, transport, and waste. Key findings were: More than one-half of the health sector’s footprint is due to generation and distribution of electricity or gas, heating/cooling, and related operational activities (53%). Manufacturing and agricultural inputs (including food supplies and materials such as cotton for bandages), are the third (13%) and fourth (11%) largest source of emissions. Transport represents about 7% of health sector emissions, while pharmaceutical products represent about 5%, followed by waste treatment (3%). Along with other chemicals, anaesthetic gases, including nitrous oxide and the fluorinated gases sevoflurane, isoflurane, and desflurane, are an unexplored source of health-care emissions, the report notes. Their Global Warming Potentials range between 130 kgCO2e/kg (sevoflurane) and 2540 kgCO2e/kg (desflurane), the report notes. At present, the majority of these gases enter the atmosphere. The report is built upon earlier studies of health sector emissions at national level; a 2017 study by HCWH and the World Bank, which provided a rough estimate of 5% of global emissions due to health care activities in 2011; and a 2018 study of Organisation for Economic Cooperation and Development (OECD) countries, plus India and China. That study estimated that health care activities in the 36 countries sampled was responsible for 1.6 GtCO2e emissions or 4.4% of the total emissions from these nations in 2014. However, this report claims to establish the first detailed estimate – going further in terms of the number of countries covered, as well as estimates of emissions from various activities. It also draws from the global World Input-Output Database (WIOD) database, to come up with initial estimates for emissions for low- and lower-middle income countries where data remains scarce. The report also breaks down global emissions according to the framework established by the Greenhouse Gas Protocol, the world’s most widely used greenhouse gas accounting standard. It thus aligns the emissions analysis of health care activities with the Protocol’s generic categories: Scope 1 (direct emissions from health care facilities), Scope 2 (indirect emissions from purchased energy), and Scope 3 (all indirect emissions, not included in scope 2, that occur in the value chain, including both upstream and downstream emissions). Health Care Climate Challenge “Health care must respond to the growing climate emergency not only by treating those made ill, injured, or dying from the climate crisis, but also by practicing primary prevention and radically reducing its own emissions,” said Karliner, of the report’s aim. As part of that response, Health Care Without Harm has launched a Health Care Climate Challenge which some 200 institutions, representing the interests of over 18,000 health facilities in 31 countries, have joined. Collectively, they have made commitments to reduce their carbon emissions by more than 34.2 million metric tons of CO2e. To date, Karliner says, the network has collectively reduced over 6.8 million metric tons of CO2e. The corresponding energy efficiency upgrades and renewable energy generation improvements have saved the partner institutions over US$394 million. “The good news is that there are hospitals and health systems all around the world leading by example and implementing climate-smart health care strategies.” Image Credits: Health Care Without Harm, Health Care Without Harm. Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Malaria Eradication Feasible by 2050, Says New Lancet Report 09/09/2019 Grace Ren A new Lancet Commission report calls for health policy leaders to agree upon an ambitious global plan to eradicate of malaria by 2050 – contrasting with a World Health Organization report released in August that concluded it was too early to set a target date for eradication. The report Malaria eradication within a generation: ambitious, achievable, and necessary sets out a detailed roadmap for achieving eradication in the next three decades. Authored by a group of 41 leading malariologists, economists, health policy experts, and biomedical scientists, the report concludes that eradication is possible with the right tools, political commitments – and another $2 billion annually in funding. “For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, co-chair of The Lancet Commission on Malaria Eradication and director of the Global Health Group at the University of California, San Francisco (UCSF). However, in an op-ed that appeared alongside the Commission’s massive report, WHO’s Director General, Dr Tedros Adhanom Gheyebresus, cautioned that malaria could “not be eradicated within this timeframe” with the currently available tools and strategies. A young girl reading under a malaria bednet. Photo: UNDP WHO & Lancet Commission Differ on Feasibility of Eradication by 2050 In August, WHO’s Strategic Advisory Group on Malaria Eradication (SAGEme) issued a much more sobering assessment of trends. The WHO experts cautioned that the world was not even “on track to meet global targets for 2020.” And progress made in reducing malaria cases and malaria deaths has stagnated in recent years, with no change in malaria incidence or case-fatality since 2015. SAGEme concluded that under even with the most optimistic scenarios, in 2050 there would still be 11 million malaria cases annually in malaria’s epicenter, Africa. The WHO report also comes against the history of a failed 14-year global WHO campaign to eradicate malaria in the 1950’s, which observers say has made the agency reluctant to set such an ambitious goal again, unless it is really attainable. “A malaria-free world, which has been WHO’s vision since at least 1955, remains the ultimate goal of the global health community,” Dr. Pedro Alonso, director of WHO’s Global Malaria Programme told Health Policy Watch. “We have a global strategy, endorsed by the World Health Assembly in 2015, that gets the world 90% of the way to eradication.” “No one yet knows what it will take to get the final 10% of malaria, or when we will be able to finish the job, but we know what needs to be done today,” Alonso said. But to make the “ultimate push” for eradication, he underlined that the world first needs to get “back on track” to meet the 2020 global goals for malaria. Countries need to embrace Universal Health Coverage, “to deliver malaria interventions to everyone who needs them,” he added. And new R&D tools as well as more resources for health systems will also be critical. “The global malaria community has clearly united around the vision of a world free of malaria and now we need to move forward to make it happen,” he concluded at the close of the Geneva Forum. Meanwhile, David Reddy, Chief Executive Officer of the Geneva-based Medicines for Malaria Venture (MMV), applauded the focus that the recent reports by WHO as well as the Lancet Commission report had brought to the malaria issue – which could also help reinvigorate global commitments. “With more than 400,000 people dying each year from this preventable and curable disease, these analyses will help to refocus and strengthen our efforts toward eradication,” said Reddy. “It is appropriate that these two comprehensive analyses support the view that malaria eradication is achievable and identify concrete measures to regain momentum toward a malaria-free world.” He added that MMV was supporting research to develop tools that will support “the ultimate eradication of malaria” while also expanding its focus on access and product management to address key unmet needs, noting that “unless the important new tools we have co-developed can be readily available wherever and whenever they are needed, we will have fallen short on fulfilling the promise of our mission”. Malaria Incidence per 1000 population. Same Data, Two Conclusions While malaria elimination refers to the interruption of transmission in a particular country or region, eradication typically means that there is complete interruption of malaria transmission globally, with zero cases across the globe. Both the WHO SAGEme and Lancet Commission looked at the same social, environmental, and economic trends to assess the feasibility of malaria eradication, but came to different conclusions. While committed to the idea of malaria eradication since 1948, WHO has been cautious about setting a target date. WHO claims that “optimal tools” have not yet been developed and the current burden of malaria cases is still too high to target eradication. Successes in smallpox and polio eradication hinged on the low number of annual cases, and the availability of highly efficacious vaccines, points out a WHO Q&A. Dr. Tedros, in his Op-Ed arguing that the “imperfect application of imperfect tools” has reduced the malaria burden, but has not been enough to push forward to malaria eradication. As a result, the WHO SAGEme report concludes that setting a target with too many uncertainties “may actually be counterproductive.” It urges a more cautious approach that will assess the progress against malaria in five-year intervals, until a “tipping point” is reached where a time-limited malaria eradication campaign is fully feasible. On the other hand, the Lancet Commission argues that the target date should be set for 2050, believing that the goal is “a bold but attainable, and necessary one.” While acknowledging that there are outstanding challenges to malaria eradication, the Commission’s report also is more optimistic about the R&D pipeline, calling it “robust” and noting that new tools are expected to be rolled out in the next decade. Additionally, the report points to a ripe political climate for setting a target for eradication, noting many high-burden countries have increased malaria financing in the past decade. Finally, the Commission’s report notes that in the absence of full-fledged of eradication, massive efforts would in fact be needed to sustain malaria elimination. For instance, malaria has already been eliminated in a number of countries, such as the United States. However, states must continue surveillance and control efforts to prevent malaria from being imported from other endemic countries. Currently, global WHO targets sidestep the issue of eradication, and encourage regions to target malaria elimination “where it is feasible to do so,” meaning in countries with low burden of malaria. Eradication: Ambitious but Possible The Lancet Commission report, launched at a WHO-hosted Geneva Forum on Rising to the Challenge of Malaria Eradication this week, sounds a much bolder note, claiming that global eradication is possible by 2050 – providing there was sufficient political and research community leadership, finance, and country commitment. The Commission also underlines that it is critical now to accelerate efforts for malaria eradication, to end “the never-ending struggle” against increasing drug and insecticide resistance, which could even lead to malaria resurgence, associated with more human, social and economic costs. While malaria eradication by 2050 is feasible, this hinges on aggressive action in three major areas, described by the Commission as: Strengthening existing malaria control programs by improving management and use of available tools; Stimulating the research and development pipeline for new malaria medicines, vaccines, and mosquito control tools; Mobilizing new financing from malaria-endemic countries and donors. Human trials for the first malaria vaccine are underway in Malawi, and studies are being conducted to evaluate mass drug administration (MDA) as a new strategy for malaria elimination. While noting the impressive scale-up in malaria funding over the previous two decades, the Commission calls for funders to mobilize an additional USD$2 billion annually in order to reach eradication, calling for domestic governments to take on 75% of the additional costs. Currently, global expenditure for malaria stands at about USD$4.3 billion annually. The benefits, the Commission argues, outweigh the costs of investing in malaria eradication. Reducing the malaria burden by 90% by 2030 in the highest burden countries alone is estimated to yield over USD$280 billion in economic gains. Once malaria is eradicated, it will no longer cripple economies, allow resources to be diverted to other health priorities, and contribute to individuals’ improved quality of life. More precise WHO estimates of the economic benefits of malaria control will also be published as part of a SAGEme report later this year. History of Malaria Eradication Efforts Extend Back to 1950s The WHO launched the first Global Malaria Eradication Programme (GMEP) in 1955. The first GMEP made huge strides against malaria, contributing successful elimination in the United States and some South American countries. The first GMEP also excluded Africa, the continent with the highest malaria burden in the world. After a 14-year battle, experts at the WHO agreed to post-pone the target date for malaria eradication until “conditions were more favorable.” High-level commitment for malaria control decreased following the announcement. However, increased resistance to DDT, the primary insecticide used for malaria control, led to resurgence of malaria in many countries that relaxed control efforts in the 1980’s. In 2000, global momentum for malaria control increased again. Since then, malaria transmission has been interrupted in a number of countries. However, over 400,000 people still die from malaria annually. In high-burden countries such as Ethiopia, malaria remains a leading cause of maternal mortality and death in young children. Malaria is a biologically feasible target for eradication because humans are largely the only mammalian host. Image Credits: UNDP, The Lancet . WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO To Revisit Guidelines On Ebola Survivors’ Care; Study Finds 5-fold Higher Mortality 06/09/2019 Grace Ren New data revealing that survivors of Guinea’s 2013-16 Ebola outbreak were five times more likely to die within the first year after recovery, as compared to the general population, suggests a need to revisit WHO guidance on Ebola survivors’ monitoring and care, a top WHO official said on Friday. The findings were part of a study published in Lancet Infectious Diseases earlier this week. The WHO-led study also found that people hospitalized with the Ebola virus for a longer period had higher overall mortality rates than those with shorter stays. Beyond a year, however, the study of some 1130 survivors found that mortality rates of survivors and the general population evened out. The study also pointed to kidney failure as the most common cause of death. The findings have many implications for monitoring and treating survivors of the current outbreak in the Democratic Republic of the Congo, said Professor Judith Glynn, a senior author of the study from the London School of Hygiene & Tropical Medicine. Ebola survivor dons protective gear to meet and support a patient currently undergoing treatment. “Our results could help to guide current and future survivors’ programmes and the prioritisation of funds in resource-constrained settings. For example, those hospitalised with Ebola for longer may be at greater risk, and could be specifically targeted,” Glynn said in a statement. “As the evidence increases on Ebola survivors it might be good to revisit the Ebola CRF,” tweeted Sylvie Briand, director of epidemic and pandemic diseases at WHO, referring to the protocols that guide monitoring, care and treatment. Currently, interim WHO guidelines on caring for Ebola survivors do not call out kidney failure as a high risk. While a range of chronic symptoms have been previously reported in Ebola survivors, this was the first study to systematically track and document mortality rates among Ebola patients after they successfully underwent treatment and were discharged. The study followed up on survivors in Guinea, the first country hit by the 2013-2016 West African Ebola outbreak, for a year and nine months after they were discharged from treatment centers. In the first year (2015), some 55 people died, five times more than the 11 people who might have been expected to die based on mortality rates in the general population. But in the subsequent nine months of 2016, when the study continued, mortality did not differ between Ebola survivors and others. Because few detailed medical records exist, researchers relied on interviews with family members as the main source of information. Based on reported symptoms, kidney failure was the suspected cause of death in 37 out of 55 cases. Researchers stressed that the lack of documentation available to rule out other causes was a limiting factor in their findings. “The research suggests that we need to continue supporting those recovering from Ebola and provide health care to them long after they have recovered from Ebola virus disease,” Josie Golding a senior officer at Wellcome Trust told Health Policy Watch. “And I think that we need to consider other variables that can impact patients recovering from Ebola. As observed in DRC, people affected by Ebola are often stigmatised. We must better understand how this can impact on the health of those survivors in terms of access to healthcare.” Finally, Golding said, researchers need to explore the long-term impacts of vaccination and treatments that have been become available since the Guinea outbreak. “We need to understand how long people are protected from Ebola, or what the impact vaccination can have in pregnant women.” Notably Guinea’s Ebola victims did not receive the new WHO-prequalified Ebola treatments that are now being used in the DRC. Infections Now Top 3000 Since August 2018 As of 4 September another milestone in the DRC epidemic had been passed as WHO reported 3054 Ebola cases (2945 confirmed and 109 probable) since the outbreak began in August 2018, with 2052 deaths and 914 survivors, for a survival rate of about 30%. In the latest report posted by WHO Friday evening, 57 new cases had been reported over the past week, slightly less than the average of 77 new cases in the weeks of August. However, while transmission in hotspots such as the Beni Health Zone in the province of North Kivu show signs of easing, “new hotspots are emerging elsewhere,” warned the WHO report. The epicenter of the outbreak has extended across the provinces of North Kivu and Ituri. The areas stretch along DRC’s long and porous border with the neighboring countries of Rwanda, Uganda, Burundi and South Sudan, which have been on high alert for the past few months, with several cases of transmission spilling over into neighboring Uganda. Funding Shortfalls, Insecurity Continue to Plague Response Funding shortages continue to plague the response. WHO has asked for an infusion of US$287 million to fund the core public health response to the epidemic between July and December 2019, but so far only about 45 million of those funds have been received and pledges will only fund response until the end of September, said WHO, which has appealed to donors to urgently provide more support. On Thursday, USAID pledged some US$21 million more to the Ebola effort, bringing the total USAID funding for the DRC outbreak to US$158 million. In a visit earlier this week to DRC, UN Secretary General Antonio Guterres also appealed to donors to follow through on their commitments urgently; “Ebola cannot wait, if the response is interrupted by one week, we might lose the battle,” he said in an interview broadcast over Twitter. Guterres also said that more needed to be done to contain the violence that has plagued disease control efforts, due to the activities of armed militias operating in the areas of North Kivu, one of the epicenters of the epidemic. “Combating Ebola requires freedom of movement, access, security,” the UN leader also observed, during a visit to an Ebola Treatment Center in Mangina, a rural municipality in Beni territory, North-Kivu province, where the first cases of Ebola was been detected over a year ago. He said that increase cooperation between UN peacekeepers and DRC armed forces was necessary to overcome threats of “terrorist acts”. But efforts should also be intensified to demobilize local armed groups and reintegrate them into the civilian population. Elaine Ruth Fletcher contributed reporting to this story. Image Credits: UNMEER/Martine Perret 2015. Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Facebook Moves To Squash Vaccine Misinformation; WHO Website Now A Top Pick 05/09/2019 Elaine Ruth Fletcher Facebook has begun rolling out a new algorithm that directs users searching for vaccine information to the United States Centers for Disease Control (CDC) website, in the case of US-based searches, and for users elsewhere, the World Health Organization website, as a top search pick. The move was welcomed by WHO, officials at CDC, and other health experts as an important step in combating a wave of misinformation about immunization from vaccine opponents, so-called “anti-vaxxers,” that has swept over social media. The media fog, has in turn, been blamed for alarming parents, and contributing to the recent upsurge in measles cases in the US as well as vaccine resistance elsewhere. “We welcome Facebook’s efforts to mitigate the spread of misinformation about vaccines and connect people to sources of accurate information … social media response is an important dimension of our broader efforts to build trust and confidence in immunisation,” Dr Heidi Larson, who runs the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, told The Guardian, which had reported in February on the fact that Facebook users were being steered through popularity algorithms to anti-vaccine sites. Facebook announced the new policy yesterday in a company newsroom post that said, “We are working to tackle vaccine misinformation on Facebook.” The company said it would “reduce rankings” for groups and pages that spread misinformation, and it would explore ways to promote sites that “provide people more accurate information from expert organizations about vaccines at the top of results for related searches.” WHO Director General Dr. Tedros Adhanom Ghebreyesus, said in a statement: “The World Health Organization and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccuracies. Facebook will direct millions of its users to WHO’s accurate and reliable vaccine information in several languages, to ensure that vital health messages reach people who need them most.” “Vaccine misinformation is a major threat to global health that could reverse decades of progress made in tackling preventable diseases”, the statement added, noting that many “debilitating and deadly” diseases such as diphtheria, hepatitis, polio and measles can be effectively prevented through vaccination. Some users were quick to note the challenges inherent in the Facebook move, including for WHO, which needs to ensure that users around the world can easily get to the relevant content on the vaccine issue in different languages. “Facebook is doing the right thing and the ball is now in the court of @WHO headquarters,” tweeted one commentator complaining, “The WHO page that @Facebook redirects to is only in English and has a readability of grade 4. Has the text been pretested with vaccine-hesitant parents?” This reporter, signing onto Facebook from Europe Thursday evening, and searching under the word “vaccine”, got to the detailed US CDC vaccine information site as a first pick and as a second pick, to the general WHO Facebook page, promoting a Walk the Talk-Health For All walk/run event planned in New York City later this month ahead of the upcoming United Nations General Assembly. A reporter testing the new Facebook algorithm from New York City also landed on the general WHO facebook page when searching for “vaccines.” A WHO spokeswoman said she had no further details about the nature of the WHO arrangement with Facebook or how it had been reached. However, the Facebook action followed moves earlier this year by YouTube to reduce the frequency with which users would click into anti-vaccine propaganda, as well as an announcement last week by the social media platform Pinterest that it would curb misinformation on its website. A WHO statement last week lauded “Pinterest’s leadership in protecting public health” and called upon other social media platforms to follow its example. Search results for “vaccines” on Facebook. Posts navigation Older postsNewer posts