Nearly 4.1 billion people, roughly half the planet’s population, experienced unusually hot temperatures between June and August, in what was Earth’s hottest season on record.

Climate change made these high temperatures three times more likely, according to the latest report by Climate Central, a US-based non-profit of scientists and science communicators that conducts research on climate change.  

The average person experienced 17 extra days of risky heat because of climate change during this period. Risky heat days are when temperatures are hotter than 90% of the temperatures recorded in a local area from 1991-2020. Heat-related health risks rise when temperatures climb above this local threshold.

The report looked at 22 regions across 218 countries and territories using the Climate Shift Index (CSI), a metric developed by Climate Central and launched in 2022, that quantifies the influence of climate change on daily temperatures.
The report is among the growing pieces of evidence on the deadly impact of heat. In July this year UN Secretary-General António Guterres called on countries to act on heat by protecting vulnerable populations and by investing in early warning systems. 

The health impacts of climate change have also been discussed at the ongoing climate week in New York as well as the United Nations General Assembly.

Hottest season on record

The effects of human-induced climate change, mainly from burning fossil fuels, were evident in all regions of the world in the form of extreme heat, climate scientists found.  

The heat was so bad that one in four people on the planet had no break from climate change-driven heat. On every day in June, July, and August, they experienced unusually warm temperatures made at least three times more likely by climate change. 

Global exposure peaked on 13 August, by which time 4.1 billion people or roughly half (50%) of all people worldwide experienced unusual heat at CSI level 3 or higher.

Over two billion people or 25% of the global population experienced 30 or more days of risky heat that were made at least three times more likely by climate change. 

This heat can worsen underlying illnesses including cardiovascular disease, diabetes, mental health, asthma, and can increase the risk of accidents and transmission of some infectious diseases, according to the World Health Organization (WHO).  
Heavy rainfall, deadly floods and storms, and raging wildfires were also exacerbated during this period. 

Global phenomenon

The areas affected by deadly heat were spread around the world. This included nearly the entire population of the Caribbean and at least three in every four people in Western Asia, Micronesia, Northern Africa, and Southern Europe. 

As many as 72 countries, home to more than 2.3 billion people, experienced their hottest June–August period since at 1970. The average person in these countries experienced a very strong influence of climate change on 34 of the 92 total days from June-August.

Around 180 cities in the Northern Hemisphere where June to August were the summer months had at least one dangerous extreme heatwave. Heatwaves were calculated as a place having at least five consecutive days with temperatures hotter than 99% of temperatures recorded in that city from 1991-2020.

Across these 180 cities, extreme heat waves of this intensity and duration are, on average, 21 times more likely today because of human-caused climate change, the report found. 

Influence of climate change 

The report did not just look at the heat extremes but also the influence of climate change.

Of the 22 regions analyzed, the highest regional average temperature anomalies were in Eastern Europe. The region experienced temperatures 1.9°C above normal, and 14 days with temperatures very strongly influenced by climate change.

Western Asia, Southern Europe, Northern Africa and Eastern Asia were other regions that saw temperatures significantly above normal for several days.

WHO and the World Meteorological Organization (WMO) are already working together to draw attention and respond to the health impacts of heat on human health. 

Guterres has reiterated the call for limiting temperature rise to 1.5°C by phasing out fossil fuels and scaling up investment in renewable energy to prevent further heat escalation. 

Image Credits: Dikaseva/ Unsplash.

Dr Ethel Maciel, Brazil, (center) talks about the interlinkages between Climate, One Health and AMR at a panel on the margins of the UN General Assembly.

NEW YORK CITY – Brazil is advancing two major health-related declarations – on climate and One Health and on local medicines production – that it hopes to have ready for the upcoming G20 Summit that it is hosting in Rio in November.

Despite political pushback, Brazil’s Deputy Minister of Health expressed hopes that the two declarations would be ready in time for the November Summit, marking the end of Brazil’s G20 Presidency. 

“I’m a believer. So I think that in the end of the June 20 presidency, we will have these two declarations in place,” said Vice Minister Dr Ethel Maciel.

She was speaking at a side event Tuesday on Pandemics, Climate and Conflict hosted by the Pandemic Action Network (PAN),  ahead of a UN High Level Meeting on Antimicrobial Resistance (AMR), scheduled for Thursday. 

The G20 Leaders’ Summit is scheduled for 18-19 November in Rio de Janeiro, and will be attended by 19 member states, plus the European Union and the African Union. 

The declaration on local production of medicines and vaccines aims to accelerate the recent drive to expand  pharma manufacturing in low- and middle-income regions that found themselves unable to secure significant supplies of critical health products during the COVID pandemic, Maciel said.

“The pandemic showed us the importance of local production in the regions, because if we cannot depend on only one or two countries for our pharmaceutical components; we need to have capacity-building in the region.”

G20 Climate and health declaration to have AMR focus

From global climate change to drug resistant microscopic bacteria – trends are deeply interlinked.

The declaration on Climate and One Health. meanwhile, will have a specific focus on AMR  – the growing trend of superbugs that do not respond to available antibiotics, antiviral or anti-parasitic medicines, she noted. 

“Health is a very important argument to climate change, because the health sector is at the frontier of climate change; we are the first sector that has the impact, that has suffered the impact of the climate change,” Maciel said.  “And we took AMR as a pathway for work on the One Health approach,” she added.  

The wide-ranging event featured over a dozen global health government and agency leaders, as well as ‘Elders’, Helen Clark, former New Zealand Prime Minister; Ellen Johnson Sirleaf, former Liberian President; and Juan Manuel Santos, Former President of Colombia.

Climate change, AMR and pandemics

A participant is prepared for a blood test as part of a clinical trial of new TB drugs that can overcome drug resistant pathogens.

Maciel and other panellists underlined how the issue of climate change, AMR trends, and pandemic risks are all deeply interlinked but not well understood. 

An estimated 1.14 million people died in 2021 from drug resistant bacterial diseases alone, while a total of 4.71 million people die from bacterial conditions that may have some association to drug resistant pathogens. And that number could double by 2050, with a total of 39 million AMR-related deaths between 2025 and 2050, according to the latest estimates, published by The Lancet, in mid-September.  

So far, most of the policy emphasis on combatting AMR has been focused on the more judicious health sector use and administration of antibiotics, antivirals and other drugs in humans – as well as research to develop new drug solutions. 

However, the even wider use of such drugs in industrial livestock and fisheries production, as well as plant agriculture, has been largely neglected by global health leaders. 

More than 73% of all antimicrobial drugs sold globally are used in animals not people – highlighting their large contribution to AMR trends – and pandemic risks.  Even so, targets for reducing animal antibiotic use were dropped at the last minute from the draft text of the UN High Level declaration on AMR, to be approved Thursday, under pressure from a coalition of meat-producing nations.  

Trends in animal antimicrobial sales also correspond with growing AMR hotspots in Asia, the Americas and parts of Europe and southern Africa, according to recent research by the Swiss-led Zurich Resistancebank.org.

Unsustainable practices in these sectors also contribute to deforestation, coastline degradation, and biodiversity loss – which in turn drive climate change.  

These, in turn, exacerbate conflicts over land and resources when communities face drought, a loss of livelihoods and displacement. 

It’s a complex web of connections that gets far too little attention, said Joanne Liu, former International President of Médecins sans Frontières and now a professor of global health at McGill University in Canada.

“Climate and conflict, that’s really, honestly, a toxic mix,” Liu said. “It’s an amplifier of existing problems.” 

Tackling AMR to address One Health and climate 

Firefighters battle blazes in Brazil’s Pantanal region, the world’s largest tropical wetland, in August 2024.

Brazil is currently at a nexus of many One Health and climate issues, which have also been highly politicized, Maciel noted.

The country is battling wildfires, many set deliberately by loggers, ranchers and others who support the policy lines of former president Jair Bolsonaro,. They aim to continue deforesting the Amazon and the Pantanal, the world’s largest tropical wetland, to expand grain, livestock and mineral production – without any regard to the climate impacts. 

The number of fires in the country have more than doubled compared to last year – darkening the skies over cities from Buenos Aires to La Paz, Bolivia. The fires are so vast – with one-half burning in pristine forests – that critical tipping points for some of the world’s most important carbon sinks may soon be breached. 

“In Brazil, we have a very polarized country as here in the US and people that follow one politician, they don’t believe in climate change,” Maciel said. “We have a lot of wildfires that people are setting by themselves. More than 50 people are under investigation by the Supreme Court for setting fires… because they don’t believe in climate change.”

Health on the pathway to COP30 in Rio

Industrial livestock production and related antibiotic use, has multiple knock-on impacts for health, AMR – and climate.

Against this background, Brazil’s push in the G20 to win approval for a declaration on One Health and Climate aims to bring this complex thicket of issues down to a more practical level, the Brazilian vice minister said. 

One Health is a ‘very abstract’,” she noted, whereas AMR is beginning to be understood as a tangible health threat. “We hope, with this declaration, that climate change and a One Health approach will be linked with AMR.” 

At the same time, the G20 resolution is not a foregone conclusion. The negotiations to arrive at a diplomatic consensus on the text have been much more difficult than expected. There will be another meeting of G20 negotiators in Rio, ahead of the Summit, to attempt to finalize a text. 

If consensus is achieved, Brazil also hopes it will build momentum toward a major emphasis on health at next year’s UN Climate Conference (COP30), which the country is hosting in Rio. 

A first-ever Climate and Health Day was convened at last year’s COP28 Conference in Dubai.  A second health day is now planned for COP29 in Baku – with the possible launch of a new Health and Environment Coalition, according to WHO. 

But health and climate advocates are looking to the Rio conference in 2025 to outshine everything else – an aspiration shared by Brazil.  

“We started in the Cop 28 with the Health Day, and now in COP 29 [Baku 2024] there will be a Health Day.  And at COP 30, we want a big Health Day in the climate change conference,” said Maciel. 

Trust in science 

Although evidence about the vast array of linkages between climate, health, and disease risks is constantly expanding, disinformation remains a huge problem in terms of getting policymakers to accept the evidence, and move on it, Maciel observed.  

Trust in science remains a key challenge, agreed John-Arne Røttingen, CEO of the UK-based Wellcome Trust, one of the world’s largest philanthropic funders of research.  

“Climate is also worsening climate sensitive infectious diseases, and people are concerned about climate,” he said.

“So how can we better really understand the already existing health impacts from climate both directly due to heat and extreme weather events. And how can we take climate action that will also deliver health benefits here and now? 

“I think people need to see a here and now benefit.

“And although this is driven by science and scientific solutions, we also need to work on the broader issue of trust in science, trust in scientific knowledge, and the solutions that can be derived from science.”

Image Credits: Staicon Life/Flickr, TB Alliance, Van Boeckel et al, ETH Zurich, Diego Baravelli/GRAB via Environmental Justice Foundation (EJF)., Commons Wikimedia.

European Health Forum underway in Bad Hofgastein, Austria.

BAD HOFGASTEIN, Austria — Declining health is driving more citizens to support far-right, populist parties and reducing overall participation in the democratic process, according to a new review of studies from a World Health Organization-backed (WHO) think tank.

The report, released Wednesday by the European Observatory on Health Systems and Policies, analyzed 97 studies at the intersection of health, democracy and populism. 

“There are two findings. One of them is that ill health reduces political participation. The other, possibly more shocking, is that ill health leads to a substantially larger likelihood that you’re going to vote for whatever your local populist radical right party is,” said Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan.

Europeans who report worse health have much lower trust in political actors and lower satisfaction with democratic and health institutions

Europe faces a perfect storm of health challenges that could shake its political foundations, the study warns. An ageing population, rising chronic illness rates, and COVID-19’s after-effects combine with looming threats from climate change, conflict-driven migration, and widening income gaps. 

These pressures have exposed weaknesses in health systems and put health at the center of the European political battleground for the foreseeable future, with over half of Europeans saying health is their top political priority, according to Comission data.

“The stakes if you’re an elected politician are really high,” Greer said. 

The report found that people in poor health are significantly less likely to vote, often by margins of 10 to 20 percentage points compared to healthier individuals. This trend has been documented across Europe, the United States, and Canada.

When those in poor health do vote, they are primarily supporting far-right populist parties. Greer pointed to the 2016 Brexit referendum as an example of how health issues can influence major political outcomes. 

“Moving from self-reported fair to poor health makes you about 16-20% more likely to vote for the populist radical right,” Greer explained. “It is mathematically possible that the number of people in the United Kingdom whose health state deteriorated as a fairly clear consequence of the Cameron government’s austerity budgets and who therefore voted for Brexit is larger than the Brexit victory margin.” 

Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan

Protecting health, rebuilding trust in democracy

“Policies that protect health and ability are not only essential to preserving the economic and social well-being of Europe – but they may also be essential to rebuilding trust in democracy and democratic institutions,” the authors state.

While the study focuses on how health influences political behaviour, experts caution that the relationship between health and politics is complex and potentially bidirectional. For instance, research has shown that political affiliations can influence health behaviors, from Trump supporters frequently rejecting COVID-19 precautions in the United States to Labour supporters in the United Kingdom more likely to smoke. 

Untangling the causal relationships between health, socioeconomic factors, and political preferences presents significant challenges. However, the authors argue that the mounting evidence is compelling enough to warrant serious attention from policymakers.

“To be clear, population health is unlikely to be the primary driver of the rise in anti-democratic politics,” the authors explain. “Even so, the connection between the two highlights an important shortcoming in the performance of democratic institutions: people in poor health have systematically low trust in their health systems and governments.” 

Mistrust in political actors and dissatisfaction with democratic and health institutions are widespread throughout Europe

The shift towards populism marks a dramatic change from historical patterns. Until recently, people in poorer health typically favored left-leaning parties that supported greater health and social protections. However, the rise of right-wing populist movements has provided a new outlet for voters frustrated with existing institutions.

“Why does becoming seriously sick seem to lead to this change in political behaviour? The answer is trust,” Greer said. “People whose health status gets worse tend to lose trust in the healthcare system, the political system, the elements of society at large, and they tend to lose a sense of agency.”

This loss of trust appears to be driving support for parties that promise to reshape what they describe as a “failing” political establishment, even when these parties often oppose public health measures.

The study cites examples such as the National Rally in France, the Alternative for Germany (AfD), and Vox in Spain as typical European populist parties that have attracted support from voters in poor health.

Historical data identified in the report suggests this is not a unique phenomenon. German communities with worsening mortality in the 1930s became more supportive of the Nazi Party, while Italian cities hit harder by the 1918 influenza pandemic showed greater support for the Fascist Party in the 1924 election.

“Governments are moving through uncharted waters, facing new crises that threaten both health and the long-standing political order,” the report states. “A better understanding of the interplay between these forces and their impact on political thought and action can help policy-makers protect not only the health of populations but also democratic institutions.” 

If we aren’t fixing health – why expect votes? 

Clemens Martin Auer, President of European Health Forum Gastein

Minutes before the new data was presented, Clemens Martin Auer, President of the European Health Forum Gastein, challenged the health policy experts in attendance: Does anyone believe our system is properly addressing the impending crises of health workforce shortages? 

No hands were raised. 

“The healthcare sector has to be clear that it contributes to populism,” Martin Auer said. “Stop just talking about problems without operationally solving them… … just wait until they throw our incompetence to solve health problems to delegitimise democratic legitimacy.” 

Martin Auer didn’t mince words at a closed-door presser earlier Wednesday either. Populism, in his view, isn’t just about finger-pointing. EU citizens keep flagging health as their top concern and demanding reform in the sector. And when they don’t see the changes they’re after? Well, their ballots are doing the talking.

“We have to act, we have to make people not vote for populists, and we have to act in these areas where people are affected by health policy measures,” Martin Auer said. “Every single person is affected by the healthcare sector. 

“If we don’t do anything, that is why people support populists.”

EU Health Commissioner controversy

Ursula von der Leyen outraged European health advocates and MEPs with her selection of Olivér Várhelyi to be the bloc’s next health commissioner. 

Meanwhile, Austrian Health Minister Johannes Rauch joined the chorus of European officials alarmed at the appointment of a far-right, EU-skeptic, Viktor Orban loyalist with no health experience to lead the bloc’s health policy for the next five years. 

“This is a very important department,” Rauch said on Wednesday, speaking at a closed-door press briefing at Gastein. “I am worried that if a representative of an EU-hostile government is appointed, this will lead to problems.” 

Olivér Várhelyi, Hungary’s nominee for EU commissioner, has faced fierce backlash from Brussels insiders since Commission Chief Ursula von der Leyen announced last week he would head Health and Animal Welfare in her next commission.

European Parliament members have ample reasons to oppose Várhelyi’s appointment as health commissioner – chief among these an incident last year when he was heard on a hot microphone calling MEPs “idiots.”

MEPs also remain furious at his unilateral declaration last year that the EU would cut off all aid to Palestinians, which he had no authority to do and was quickly overruled by Von der Leyen. His close ties to Israeli officials, including meeting with Prime Minister Benjamin Netanyahu and Defense Minister Noav Gallant after the International Criminal Court issued arrest warrants for their arrests for war crimes, have left MEPs worried he could impact EU assistance to Gazans. 

Former staff and Hungarian officials are also not fans of Várhelyi, variously describing him to Politico as “incredibly rude,” having an “appetite to humiliate,” and running his office in an environment of “emotional terror.” 

Várhelyi’s loyalty to Orban has also raised fears that, should he be appointed, no action at the EU level on abortion protections or reproductive rights will be possible during his mandate – a goal many states had hoped to advance. 

The complex European health portfolio handed to Várhelyi is set to include major files such as a complete revamp of EU pharmaceutical regulations, the European data space, and building a European Health Union, continuing efforts to combat cancer, and promoting preventive health,” von der Leyen said.

Várhelyi is also viewed in some MEP circles as being friendly to pharmaceutical interests given his three years as the leader of the EU’s intellectual property rights division from 2008 to 2011 – a potential conflict of interest given that, as Commissioner, he would oversee the reworking of pharmaceutical regulations. 

His appointed has to be agreed to by the European Parliament’s environment and health committee, and there is widespread expectation that he is unlikely to get past the MEPs represented there. 

But if he does, some solace can be found in that he is not the only Commissioner with power to influence health given the EU’s labyrinthine structure.

Health-related responsibilities will be spread across several portfolios. Commissioners from Spain and Romania will share oversight of certain health tasks, while a Belgian representative will focus on emergency preparedness and medical supplies. Meanwhile, France’s nominee to the Industrial Strategy role is set to spearhead efforts in biotechnology and pharmaceutical policy development.

Image Credits: European Commission.

Geneva Graduate Institute panellists David Evans, Erika Placella, Nathan Sussman (chair) and Alegnta Gebreyesus.

Financing for public health is dwindling in many countries, sapped by COVID-related economic difficulties, debt repayment and “poly crises” such as climate and conflict. 

“In the current economic conditions, the only way [some countries can spend more on health] when their overall government spending is going down, is to give more priority to health in government budgets,” said David Evans, visiting professor in interdisciplinary programmes at the Geneva Graduate Institute (GGI) told a recent event on health financing organised by the institute.

But, Evans warned: “Historically, when your government expenditure is falling, giving more priority to health is often very politically difficult. It doesn’t happen very often.”

“Some of you are involved in the push to have more money for pandemic preparedness and response. It’s very worthy, but if the budget is going down, where is that money going to come from?” asked Evans, who described competition between different urgent needs as a “zero-sum game”.

Development assistance for health in 2021

However, he said there was much diversity within low-income countries and middle-income countries, with some facing economic contraction or stagnation while others were progressing.

“It might be time to think about changing the criteria under which countries get development assistance.”

Evans also identified some opportunities including debt restructuring, special drawing rights at the International Monetary Fund (IMF) and the reform of international financial institutions to direct more money to countries most affected by economic crisis.

Development Assistance for Health: challenges and opportunities.

Seeking complementarity

Erika Placella, head of health at the Swiss Agency for Development and Cooperation (SDC), agreed that the “competition for replenishment” with a “proliferation of funds and the fragmentation of initiatives” was “a zero-sum game”.

“In this zero-sum game, there is a race to find the smallest comparative advantage and the sexiest narrative,” said Placella.

Every international negotiation forum and resolution calls for a dedicated fund and new global health instruments are also being introduced, she added.

“So it is a very fragmented landscape, [and] it’s very difficult to navigate it.”

SDC was pushing for “complementarity” at a global level, said Placella.

“I’m going to take off with the pandemic preparedness and response from the Swiss government. First of all, instead of supporting new ventures and new narratives and new funds, we tried to adapt the mandate of existing organizations to the current context and needs and to promote complementarity. 

“A lot of our partners already had pandemic prevention, preparedness and response (PPR) functions, but in our narrative, it was not understood as such,” she said.

Organisations such as UNAIDS, the Global Fund and FIND include PPR, she noted.

“So we are trying to leverage and to build on what partners were already contributing to in the PPR space, instead of further fragmenting the financing landscape.”

The Swiss government’s health funding uses “many instruments to support health”, including global and thematic work supported through large health organisations including the World Health Organization (WHO) as well as bilateral cooperation.

These different avenues are important to address bottlenecks, she added.

“We also take a systematic approach to avoid further fragmentation. For example with mpox, we are supporting strengthening the primary health care services to include sexual reproductive health services.”

Ethiopia’s dependence

Ethiopian health diplomat Alegnta Gebreyesus said that almost half of her country’s health expenditure depends on overseas development assistance (ODA) so the funding crunch could impact on all aspects of health.

To mitigate this, Ethiopia is discussing setting up a health fund – “a sort of basket fund” which will cover a range of key health issues, with government matching donor investment in some of these.

The fund “would cater for resilience, health system strengthening, equity and, of course, preparedness for pandemics,” she added.

But high prices for medicines, vaccines and other medical commodities can only be addressed by building “a conducive environment for sustainable local manufacturing” at country and regional level – covering research and development, supply chain and logistics, the regulatory system, technology transfer and know-how.

Joyce Ng’ang’a, senior policy advisor at WACI Health.

Kenyan Joyce Ng’ang’a, senior policy advisor at WACI Health, a Nairobi-based health advocacy organisation, said the current global health landscape is already in a poly crisis involving pandemics (COVD-19 and now mpox), food shortages and climate change. 

“We need to make health a priority. We need to make health a political agenda. I believe that there is enough money in the world to fund health and to replenish the global health institutions,” said Ng’ang’a.

“As civil societies and communities, we refuse to accept that there’s not enough money to fund systemic issues for health,” she said, calling for a health approach that started by tackling the social determinants of health.

“By the time cases are coming to the health facility or hospital, the community health system has failed because there should have been preventive and promotive care at community level.

“Most LMICs now have a deliberate strategy on community health and how health is structured, and at the basic unit is the primary level, which is a prevention and health promotion.”

The ECDC chief said the move is part of a broader strategy to increase global public health cooperation before the next pandemic.

The European Centre for Disease Prevention and Control (ECDC) will sign an official memorandum of understanding with its Japanese counterpart next month, the director of Europe’s largest public health agency announced Wednesday.

“Next month I will sign a cooperation agreement with the Japanese Center for Disease Control,” said Pamela Rendi-Wagner, who took over the agency in June.

Her remarks came at a closed-door press briefing on pandemic preparedness at the European Health Forum in Gastein, Austria. She said the deal was part of a wider European effort to expand global cooperation within and outside the EU to better prepare for future pandemics.

“Scientists [globally] need to understand each other before the crisis, not during the crisis,” Rendi-Wagner said. “We learned our lessons from the pandemic.”

The ECDC chief added that the agency has deepened its ties with many other centres for disease control globally since the COVID-19 pandemic, including a four-year partnership with Africa CDC signed in 2021 with financial support from the European Commission.

The memorandum of understanding with Japan will add the country to a list of CDCs that have signed such agreements with the European agency, including those in the United States, China, Mexico, the United Kingdom and South Korea.

ECDC collaborators without official agreements include regional CDCs in Africa, the Caribbean and Gulf states, as well as Israel, Singapore, Thailand and Australia.

In her closing remarks, the ECDC chief warned global public health authorities that the window to prepare for the next pandemic “will close” and urged immediate action.

“Only joint and cooperative preparedness will allow us to cope with pandemics in the future,” Rendi-Wagner said.

Image Credits: ECDC.

Clinician monitors telehealth platform
A clinician monitors a Pan-American Health Organization-developed telehealth platform in Trinidad and Tobago.

Investing in as little as $0.24 per patient per year in digital health interventions – telemedicine, mobile messaging, and chatbots – could significantly lower the burden of non-communicable diseases (NCDs), says a new report from the World Health Organization (WHO) and the International Telecommunication Union (UTI). These interventions could avert 2 million deaths and 7 million acute events and hospitalizations over the next decade. 

The report comes as the United Nations General Assembly meets in New York City this week. 

Non-communicable diseases cause 74% of all deaths globally and are on track to cost $30 trillion in lost productivity by 2030. 

The newly released publication highlights the promise of digital health interventions in tackling this growing crisis, especially through expanded healthcare access. Behavioral choices fuel many NCDs, says the report, and digital health could enable individuals to “take control of their own health and well-being” through personalized health content delivery.

Digital health interventions proved to be powerful tools in managing NCDs during the COVID-19 pandemic, from electronic vaccine passes to telemedicine, but the report warns that the rollout of these technologies requires widespread access, and guardrails to protect patient data. 

“The future of health is digital,” said WHO director-general Tedros Adhanom Ghebreyesus and Doreen Bogdan Martin, ITU secretary-general in a statement. “We must work together to promote universal access to these innovations and prevent them from becoming another driver of inequality. While the new technologies hold great potential, strong governance, ethics, digital skills and equity are essential to realize their potential and to avoid risks such as unethical data collection and biases encoded in artificial intelligence.”

Chat bots, telemedicine, online counseling could “close gap” of NCD care

Digital health benefits for NCDs
Th report found that up to 2 million lives could be saved in the next decade if countries invest in less than 25 cents per patient yearly.

Chronic conditions typically require long-term management, which is often unavailable at primary health care level in many low- and middle-income countries. 

So digital health solutions “can help patients to track their symptoms, manage their medications and monitor their progress over time,” the WHO report notes.

Patients, healthcare providers, and the public can use these tools for diagnosis, treatment and management and for disease prevention through diet and  lifestyle interventions. 

Digital health interventions span a host of technologies, including: online programs for patient education; mobile apps, virtual reality, and other telehealth and telemedicine technologies for rapid diagnosis and treatment; connected and wearable devices for monitoring health conditions; as well as online peer support and counseling. Meanwhile, the health sector is incorporating artificial intelligence and big data-enabled apps to diagnose, monitor, and support NCDs. 

“The digital revolution has the potential to unleash a health revolution,” said Bogdan-Martin at the report release, on the margins of the UN General Assembly’s Summit for the Future in New York City. 

Digital tools can support individuals in understanding their risk factors for NCDs, WHO said in a statement. “Four major risk factors linked to our everyday environment – tobacco use, unhealthy diet, the harmful use of alcohol and physical inactivity – drive responses in our bodies that also increase NCD risk: raised blood pressure, obesity, raised blood glucose and raised cholesterol.” 

Mental health conditions – prevention and treatment

The report warns that in addition to NCDs, mental health conditions present a looming concern – and one that is in dire need of more healthcare coverage, including through digital solutions. In 2019 alone, nearly a billion people lived with a mental disorder, of whom only a “fraction” received care. These conditions account for the largest proportion of years lived with disability, and lead to a higher risk of premature death. 

With expanded healthcare delivery options, argues the report, people with mental health conditions are more likely to seek timely care. For a person living with dementia, for example, a service like mobile messaging with a doctor provides discreet access to support. 

These measures can continue to optimize health service delivery and influence health-related behavior, especially when it comes to preventing and managing NCDs, says the report.

COVID-19 pandemic shed light on digital health potential

digital health strategies for NCDs
Digital health can help prevent non-communicable diseases through education, monitoring, and increased access to care.

With healthcare systems disrupted during the COVID-19 pandemic, many providers switched to offering digital services when possible. Health systems quickly turned to online counseling, telemedicine, and digital vaccine records to continue providing care.

“Although interest in digital health grew during and after the pandemic, few solutions have scaled successfully,”  Alexey Kulikov, deputy head of secretariat for the UN NCD Task Force, told Health Policy Watch. “A key challenge has been the use of siloed, monolithic systems that lack integration with broader digital infrastructure, making them hard to manage. The report promotes ‘smart’ investments in digital health, emphasizing a whole-of-government, collaborative approach that focuses on interoperability and cross-sector integration for long-term success.”

Now, for patients in rural or underserved areas, the benefits of digital health measures means telemedicine is here to stay to overcome the barriers to accessing health care, including geographical distance, transport and cost.  “Additionally, digital health contributes to environmental sustainability by reducing the need for travel through
telemedicine and virtual care, thereby lowering healthcare’s carbon footprint,” noted Kulikov.

While significant progress has been made in combating NCDs, the integration of digital health technologies into mainstream health systems remains a “challenge,” the WHO said in a statement. For countries still developing internet infrastructure, digital health programs must first overcome internet access issues, and begin developing digital health strategies. 

Only 60% of countries have such a strategy, and many are slow to integrate new technologies into existing health infrastructure, the WHO notes. Which is why the report highlights the urgency for country-level investments in digital infrastructure.  

“We call for greater collaboration between the health and tech sectors, including the development of strong digital public infrastructure, essential for the delivery of digital health services that can benefit people everywhere without leaving anyone behind,” said Bodgan-Martin.

Image Credits: PAHO, WHO , WHO.

Over 130 United Nations member states convened in New York City Sunday and Monday for a long-anticipated Summit of the Future  that aimed to press the “reset button” on stalled global development goals and polarized geopolitical debate.

The event, held  just ahead of the annual debate in the U.N. General Assembly, kicked off with the adoption of the “Pact for the Future,” alongside two key annexes: a “Global Digital Compact” and the “Declaration of Future Generations.”

The non-binding declarations cover the world’s most critical global issues, including: peace and security, sustainable development, climate change, digital cooperation, human rights, gender equality, and empowering youth and future generations.

The pact outlines 56 specific “actions” that member states need to take, underscoring the growing complexity of threats to global peace, highlighting the dangers of nuclear conflict, and confirming the core principles of the United Nations.

A central promise of the pact is accelerating progress on the 2030 Sustainable Development Goals (SDGs), which aspire to universal healthcare access, the eradication of extreme poverty and hunger, the promotion of gender equality, climate and environmental sustainability and the expansion of education worldwide.

“With so much dividing us and with so many wars going on, I think we can salute yesterday’s agreement and that we came together and be able to agree on ambitious targets,” said Norwegian Prime Minister Jonas Gahr Støre, speaking at Monday’s session.

“The pact for the future provides a vision for this across all the UN’s three main pillars that should be solutions… First, we have reaffirmed our commitment to international law, including human rights… Those who deliberately breach it must be held accountable.”

Address climate change and transform energy systems

“Second, we urgently need to address climate change, cut emissions, transform our energy systems and protect the environment,” he said, noting that addressing climate also requires increasing climate finance and investments and providing provide sufficient and timely debt relief to deeply indebted low- and middle-income countries.

The pact also calls for the global community to work towards an inclusive, open and secure digital future for all, he noted, pointing out that “some 2.6 billion people remain excluded from the digital world. For too many people also they lack access to electricity.”

Finally, he called for “preventive diplomacy and peace building” to be at the center of global efforts on sustainable development, including “a more transparent, inclusive and effective Security Council with great limitations to the use of veto,” as well as a greater presence of under-represented groups in global governance.

Is this pact a genuine path forward, or is it another lofty rhetoric exercise?

Despite the bright notes, many critics question the real-world impact the pact will have, in light of the world’s geopolitical polarization and stalled progress already seen on most SDGs.

“It was great to see people clapping for the new Pact, but the lagging SDGs problem is not one of planning but rather execution.  Let’s clap louder for results,” Peter Singer, a former top advisor to Director General Tedos Adhanom Ghebreyesus, told Health Policy Watch. “That means complementing SDGs with GSD (Getting Sh*t Done): better governance, scaling innovation, and translating data into delivery.”

Only 17% of the 2015 SDG targets are on track to reach the 2030 Goals, Singer pointed out in a blog published just ahead of the Summit.

“Rather than critically examine why the SDGs are off track and support countries to overcome these obstacles, the U.N. comes up with a new list of things it wants to accomplish,” Singer continued. “But if you failed to accomplish the last thing you promised and now do not critically examine the underlying reasons for that failure, why would anyone believe you could accomplish the next big thing?

“This is the same for health as it is for every SDG.  SDGs are fought and won in countries, but the UN can start by ‘cleaning its house from the inside out.’”

Guterres hails the pact as ‘step-change’

Defying the doubters, U.N. Secretary-General Antonio Guterres hailed the adoption of the Pact for the Future, at the start of the two-day summit as a “step-change towards more effective, inclusive, networked multilateralism.

“Excellencies, throughout my life, whether as an activist or at the United Nations, I have learned that people never agree on the past. To rebuild trust, we must start from the present and look toward the future,” Guterres said.

U.N. Secretary-General Antonio Guterres
U.N. Secretary-General Antonio Guterres

The pact, negotiated over the past nine months, represents the fruits of a dialogue launched in 2020 as the United Nations marked its 75th anniversary with a “global conversation” on people’s hopes and fears for the future. That dialogue set the stage for what would eventually become the Summit of the Future four years later.

Guterres had long championed the need for both the summit and the pact, emphasising that global crises have exposed the urgent necessity for U.N. reform and the transformation of international financial systems. These crises include ongoing conflicts in Russia/Ukraine, Israel/Gaza, and Sudan, insufficient progress on climate change, mounting national debt, and the unregulated rise of new technologies.

“I called for this Summit because 21st-century challenges require 21st-century solutions: frameworks that are networked and inclusive, drawing on the expertise of all humanity,” Guterres said in his opening speech on Sunday “Our world is heading off the rails, and we need tough decisions to get back on track.”

Specifically, he has called for major reforms to global institutions, including changes in the structure and rules governing the 15-member U.N. Security Council, where constant vetos by Russia, China and the United States of initiatives backed by rivals have progressively weakened the clout of the global body.  Guterres has also stressed the importance of redesigning multilateral finance and developing a system of global governance over the use of artificial intelligence.

Philemon Yang, President of the 79th U.N. General Assembly
Philemon Yang, President of the 79th U.N. General Assembly

Cameroon’s Philemon Yang, President of the 79th U.N. General Assembly, echoed these sentiments as he opened the event, saying, “We stand at a crossroads of global transformation, facing unprecedented challenges that demand urgent, collective action.” He continued, “The commitments embodied in the pact and its annexes reflect the collective will of member states. They must guide our actions to promote international peace and security, accelerate the sustainable development goals, foster just and inclusive societies, and ensure technologies serve the common good of humankind. We must move forward together in a spirit of solidarity and multilateral cooperation.”

Throughout the summit’s two days of speeches and presentations, delegates discussed the pressing need for a transformed United Nations capable of addressing today’s intertwined political, social, economic, and ecological crises. Key issues raised included failing to meet sustainable development and climate change goals, rising global military expenditures, and the need for debt relief to low-income nations that cannot afford to provide basic services.

Nearly half of the world’s population live in countries spending more on debt than health or education

“Our delivery and commitments made on sustainable development and climate change have been so much less than what was committed,” said Michael D. Higgins, President of Ireland. “The failure to achieve peace, eliminate acute global poverty, hunger or the consequences of climate change and biodiversity loss have been accompanied by a return to an arms race. Last year, global military expenditure increased by 6.8% to $2.44 billion, the highest ever recorded.”

Michael D. Higgins, President of Ireland
Michael D. Higgins, President of Ireland

Some 3.2 billion people live in nations that spend more on debt interest payments than on essential services like education and healthcare, Higgins added. Along with gaps in basic social services, the debt burden also leaves them with insufficient resources for making capital investments in the energy transition and sustainable development.

Charles Michel, President of the European Council
Charles Michel, President of the European Council

“We need to make our international financial architecture more effective and more inclusive,” agreed Charles Michel, President of the  European Council, the European Union’s governing body.

“Developing Countries need more private and public money now. We must also tackle that problem because we cannot accept that low- and middle-income countries must choose between fighting poverty and fighting climate change. They must do both, and we must support them to do both.”

Reforms in the UN Security Council

Kuwait, meanwhile, stressed the need for reforms to the U.N. Security Council, including fairer geographic distribution of Security Council membership.

Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah
Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah

“We agree with the Secretary General when he said that it is impossible to put the future for our children and grandchildren through an order or a system that was built by our forefathers without taking into account the future of young people,” said the Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah.

“We are required today to work on introducing serious and practical changes to the global economic governance system, to networks of financial security, to international tax cooperation. We must reform multilateral development banks and address the problem of sovereign debts.”

Harnessing Technology

The challenges and opportunities presented by new technologies, particularly artificial intelligence, was another topic at the center of discussion.  Member states also stressed the importance of ensuring more equitable access to digital tools essential to education, healthcare, poverty alleviation and sustainable development.

“We believe that science and technology are foundations of a sustainable environment. Therefore, we are working on the digital transformation of our economy and providing an integrated and comprehensive database to support decision-making,” said Mohammed Shia’ Al Sudani, the Prime Minister of Iraq. This requires equitable access to AI tools and the capacity to benefit from AI and other digital technologies in a “responsible and moral way” he emphasized.

Jamaica's Prime Minister, Andrew Holness
Jamaica’s Prime Minister, Andrew Holness

Jamaica’s Prime Minister, Andrew Holness, expressed similar sentiments, adding that “admittedly, new technologies, such as artificial intelligence and robotics, create new challenges to security and some livelihoods. However, they also create important opportunities, especially for young people, and hold great potential to empower generations, transform economies, and solve complex challenges. So great is the potential, in fact, that we must emphasise the importance of international cooperation to address the challenges and harness the opportunities, especially for the benefit of people in developing countries.”

War and peace: Addressing ‘double standards’

The ongoing destruction of war in regional hotspots, particularly Ukraine and Gaza served as a grim backdrop to discussions.

garbage accumulates in gaza, raising risk of polio
Garbage accumulates in Gaza, contaminating water supplies and raising the risk of polio.

Kuwait’s Al-Sabah called for ‘universal adherence’ to international law and conventions, and the elimination of double standards. He pointed to the situation in Gaza as an example of the U.N. Security Council’s failure to prevent aggression and highlighted the damaging consequences of inconsistent enforcement of international law.

He further urged the international community to prioritise reforming global governance, and to establish a more inclusive, effective, transparent, and accountable Security Council.

Qatar, a key player in the Israel-Hamas negotiations over a ceasefire in exchange for a release of Israeli hostages still held by Hamas, also referred to the Gaza conflict, stressing that development cannot be achieved without solid peace, security, and stability foundations.

“Qatar maintains its efforts in mediation to prevent and resolve conflicts in a peaceful manner,” said Prime Minister Sheikh Mohammed bin Abdulrahman Al Thani.

“We reiterate our call to reach a ceasefire agreement and to release all hostages,” Al Thani said. “We call on the international community to take a clear and decisive stance against violations of international humanitarian law and human rights law.”

Japan, meanwhile, addressed the “increasingly dire situation” around nuclear disarmament and non-proliferation, nearly 80 years after American nuclear bombing raids on the Japanese cities of Hiroshima and Nagasaki.

“No matter how difficult the path to a world without nuclear weapons may be, we cannot stop our progress,” said Japan’s Prime Minister, Fumio Kishida.

Call to action on adolescent health

Another aspect of Summit emphasis was the future of the world’s youths. And related to that, WHO issued a call on the summit margins for greater attention to the mental, sexual and reproductive health of adolescents.

“Promoting and protecting the health and rights of young people is essential to building a better future for our world,” said Tedros in one of Monday’s breakout sessions, that saw the launch of a WHO report on adolescent health.

The WHO report found that least one in seven adolescents globally now suffer from a mental disorder; close to one in 10 teenagers is obese; and sexually transmitted infections are on the rise.

“Failing to address the health threats that adolescents face – some long-standing, some emerging – will not only have serious and life-threatening consequences for young people themselves but will create spiralling economic costs,” Tedros pointed out.

He condemned efforts to restrict young people’s access to sexual and reproductive healthcare, and sex education, which he said were a result of the recent pushback against gender equality and human rights in some countries and societies.

He emphasised that policies imposing strict age limits on young people’s access to vital reproductive health services, will only boomerang, leading to more HIV/AIDS and other sexually transmitted infections, as well as other spiraling health impacts on societies.

There are around 1.3 billion adolescents globally today – more than ever before.

“Adolescents are powerful and incredibly creative forces for good when they are able to shape the agenda for their wellbeing and their future,” said Rajat Khosla, executive director of the Partnership for Maternal, Newborn and Child Health, which co-hosted the launch of the WHO report. “Leaders must listen to what young people want and ensure they are active partners and decision-makers.”

Image Credits: Screenshot, UNRWA , Reproductive Health Supplies Coalition/ Unsplash.

The chairs of the One Health congress, Marietjie Venter and Misheck Mulumba, with a representative from Singapore, which hosted the last congress.

CAPE TOWN – Drug-resistant pathogens have been found in the Kuwaiti sea, soil and rivers in South Africa, Nigerian poultry, Ugandan pigs and numerous other sites, according to scientists at the eighth global One Health congress held in Cape Town over the past four days.

This evidence was presented on the eve of Thursday’s United Nations High-Level Meeting on Antimicrobial Resistance (AMR), where global leaders are due to adopt a political declaration aimed at addressing the alarming possibility that drug resistance will render many antibiotics useless in coming years – leaving humans vulnerable to death from common germs.

Around three-quarters of antibiotics are used on animals and AMR can only be addressed if urgent changes are made to agricultural practices, particularly in low and middle-income countries (LMICs), focusing on the overuse of antibiotics, and the management of wastewater.

This underscores the importance of a One Health response, which means developing an integrated approach to human, animal and environmental health.

Sewage is a major source of AMR

Mary Chibwe reported on high levels of AMR in a South African river.

Sewage is a major source of AMR, yet farmers in many countries use untreated wastewater to irrigate their crops. This spreads pathogens to vegetables and the animals and humans that eat them.

Lack of sanitation is also driving AMR. Researcher Mary Chibwe painted an alarming picture of a South African river teeming with pathogens in the places where people lived alongside it in shacks. With no sanitation, everything ends up in the water – including human and animal faeces, used nappies, trash and unfinished medicine, said Chibwe.

“Industrial effluents are also contributing to AMR, through the discharge of heavy metals, residues and other pollutants,” she added.

Chibwe’s research found 87,5% of water samples were positive for Campylobacter, a bacteria that causes diarrhoea, in parts of the Swartkops River where there was high human activity. (The river flows near the biggest city in South Africa’s Eastern Cape province.)

Some 81% of these samples contained Campylobacter multi-drug resistant gene B, and 62,5% were resistant to tetracycline.

China’s Chendi Zhu reported an “alarming” level of AMR in E-coli samples.

China’s Chendi Zhu reported on a study in Guangxi region, home to half a million people. Samples of E-coli were collected from slaughterhouses, local markets, households, farms and hospitals.

“The overall rate of multi-drug resistance was an alarmingly high 87,3%,” he reported. “The high multi-drug resistance rate highlights the critical need for integrated surveillance and intervention strategies that encompass human, animal and environmental health.”

Other studies and posters showed antibiotic-resistant Salmonella in poultry being sold in Ghana and Nigeria, drug-resistant pathogens in pigs in Uganda, and many other alarming examples of how widespread AMR is.

Wild animals are not exempt

Even wild animals are not exempt from AMR. Ghana’s Winnifred Offih-Kyei reported on research on the carcasses of 60 wild animals at a bushmeat market in the Ashanti region. Some 522 bacteria were isolated, and there was an almost total resistance (97%) to Ampicillin, with high resistance to Cefotaxime (84.6%) and Tetracycline (78.2%).

“Wildlife are important reservoirs of AMR,” said  Offih-Kyei. “The continuous consumption of bushmeat may heighten AMR and limit the effective treatment of bacterial infections in both humans and animals.”

Around 60% of emerging infectious diseases come from animals, while three-quarters of the 30 new human pathogens detected in the last 30 years originated in animals, according to the World Health Organization (WHO).

Yewande Alimi, head of One Health and AMR at the Africa Centres for Disease Control and Prevention, told the congress that outbreaks of zoonotic diseases on the continent have jumped from 63% to about 85% in the past decade.

“We are faced with a multi-faceted crises dealing with several other health issues, economic issues, and this is why the One Health approach is important,” said Alimi.

Managing animal, human and environmental health has become more and more important. Thus in 2022, the FAO, WHO, UN Environmental Program (UNEP) and the World Organization of Animal Health (WOAH) formalised their leadership of One Health, now known as the Quadripartite.

Thanawat Tiensen, the Food and Agricultural Organization (FAO)’s Director of Animal Production and Health, speaking via a video message.

Thanawat Tiensen, the Food and Agricultural Organization (FAO)’s Director of Animal Production and Health, described AMR as “a silent pandemic with devastating effect on food production, ecosystems and economies”. 

“FAO is leading the fight against AMR with a 10-year global initiative to reduce the need for antimicrobials on farms for a sustainable agri-food system transformation,” said Tiensen.

In addition, FAO’s international AMR antimicrobial resistance monitoring system called InFARM, helps countries to collect and analyze AMR surveillance and monitoring data, primarily from livestock, fisheries and agriculture, he added.

Strengthening countries’ One Health efforts

Maria Van Kerkhove, interim Director of Epidemic and Pandemic Preparedness and Prevention.

The WHO’s Maria Van Kerkhove, interim Director of Epidemic and Pandemic Preparedness and Prevention, told the congress on Monday that the WHO has identified 18 pathogens that have the potential to cause epidemics and pandemics. These include mpox, dengue, Heniparviruses and Nipah.

The WHO is building a dashboard to map the emergence and spillover potential of these pathogens, which will eventually include diagnostic resources, available healthcare systems services and reporting capacity.

“Our aim is partly efficacy. Working with governments to say: ‘You do know the risks that are there, but how do you consider the following based on the changes that we’re seeing in terms of climate, in terms of urbanization, in terms of displaced people, so that governments can anticipate and be ready.”

WHO is building a data dashboard focusing on 18 pathogens with epidemic and pandemic potential.

There is also a global arbovirus initiative focusing on dengue, chikungunya, yellow fever and Zika and a global focus on respiratory threats, added Van Kerkhove. 

“We would like a world that is on alert. We don’t want every individual on alert. We need governments to be on alert and across different sectors, looking at different legal aspects, looking at financial aspects. So that, where we can prevent, we do and when we can’t, that we mitigate as much as we can. 

“These spillovers that we see happening, which will continue to happen, don’t amplify. And all of this is based on a foundation of science, trust, transparency and collaboration,” she concluded.

Dr Tedros Adhanom Ghebreyesus

Not enough progress was made at the 11th round of the World Health Organization (WHO) pandemic agreement negotiations, conceded Dr Tedros Adhanom Ghebreyesus, the global body’s Director-General on Friday.

“I know you have made progress, but I also know that from what you have been saying, it’s not as good as what we wanted,” Tedros told delegates at the Intergovernmental Negotiation Body (INB) at the end of the two-week-long talks.

According to the latest draft of the pandemic agreement, the most controversial part of the agreement – developing a pathogen access and benefit-sharing (PABS) system (Article 12) – will now be addressed via a separate “instrument”.

The provisions governing the PABS system – described as a “multilateral system for safe, transparent, and accountable, access and benefit sharing for pathogens with pandemic potential” – will be developed by the Conference of the Parties (COP). This COP will be set up after the World Health Assembly has adopted the pandemic agreement.

The COP has also been given responsibility for defining “pathogens with pandemic potential and PABS Materials and Sequence Information, modalities, legal nature, terms and conditions, and operational dimensions” for PABS. 

All these details will be contained in a PABS instrument – and no deadline for its finalisation has been set. The COP itself has to be set up within a year of the adoption of the pandemic agreement, so it could be years before any PABS system comes into being.

Some observers have described the current document as “pandemic agreement lite” as it defers many key decisions. Delegates appear to have accepted this deferment, as text dealing with it is “greened” in the draft agreement, indicating its acceptance.

Tedros told the INB that he believed it was still possible for the pandemic agreement to be adopted by the end of the year at a special session of the World Health Assembly (WHA) in December.

However, the next round of negotiations set for 4-15 November, will determine whether this is realistic. Procedurally, 12 November is the latest date by which a December special WHA can be called.

However, the INB Bureau will hold informal meetings with member states during the course of October to try to reach consensus on key articles.

Will Africa trade deferring PABS details for speed?

African member states are anxious for the speedy adoption of the agreement, which currently includes support for “local manufacturing” and technology transfer to help member states to prepare for, and mitigate against, another pandemic.

While the Africa Group has pushed hardest for a PABS system in which countries are rewarded for sharing pathogen information, it may be prepared to accept deferring the PABS system details in exchange for early adoption of a pandemic agreement.

The spectre of the US elections this November and the possibility of a Donald Trump victory is also causing jitters amongst some member states. Trump previously froze the US contribution to the WHO, which severely affected its operations.

On 11 September, the US Congress passed the No WHO Pandemic Preparedness Treaty Without Senate Approval Act, which was introduced by Republicans who claim that the pandemic agreement will undermine US national sovereignty. 

This is despite all iterations of the pandemic agreement affirming member states’ national sovereignty in pandemics.

At the close of the INB meeting on Friday, the representative from Argentina – which now has a far-right government – asserted that the pandemic agreement should ensure no “interference with national regulations and legislation”. 

“My country firmly believes that we need to implement an International instrument to tackle pandemics but this must be designed respecting the sovereignty of all states. Without exception, we must maintain the capacity to legislate and apply our own laws within our jurisdictions as we see fit, with regard to the health of our citizens,” said Argentina, which has resisted joining regional positions on the pandemic agreement with other Latin American countries.

Tedros has previously described the notion that the agreement threatens nations’ sovereignty as “misinformation”, but it hasn’t stopped right-wing groups and parties globally from portraying the agreement as a “globalist power-grab”.

Their campaigning is part of growing nationalist populist rhetoric against international bodies and human-rights-oriented agreements.

This has also been evident in negotiations over the UN’s Summit of the Future starting on Sunday. The UN is due to adopt a Pact for the Future, but this has been watered down by conservative countries – particularly regarding the right to health, gender equity and human rights.

Happier stakeholders

INB co-chairs Ambassador Anne-Claire Amprou and Precious Matsoso

One aspect of INB11 that is different and, by most accounts better, has been the daily consultations with officials stakeholders at the start of each day.

These stakeholders include patient advocates, the pharmaceutical industry, NGOs and academics, who have long complained at being shut out of the talks.

“We’ve seen [stakeholders] engage in the corridors, but this time, it was different, because they also participated in the meeting,” said INB co-chair Precious Matsoso.

“They were able to provide their advice as best as possible, and I must say that there’s a lot of goodwill and there’s a lot of commitment.”

Nina Jamal, Head of Pandemics at the global animal welfare organisation FOUR PAWS, thanked the INB Bureau “for transparency towards relevant stakeholders, increased openness and constructive proposals by member states, promoting successful negotiations”.

Michelle Childs, Policy Advocacy Director for the Drugs for Neglected Diseases initiative (DNDi), said that her organisation welcomed the sharing of the draft texts and daily briefings.

“These help to improve the ability of stakeholders to follow and input and counter misinformation about what is actually being discussed. We encourage further steps to enhance transparency, including making stakeholder interventions publicly available,” added Childs.

‘Messy middle’

The Pandemic Action Network said “progress efforts [were] bumping into the messy middle”, adding that while engagement with stakeholders was better, they want more transparency and access to the actual negotiations.

Matsoso said progress had been made on “research and development, regulatory systems strengthening, One Health, pandemic prevention and technology , supply chain networks and a new system for increased access to pathogens of pandemic potential and sharing of benefits, such as vaccines, diagnostics and treatments”.

“Following nearly three years of negotiations, countries are now focused on the remaining and most critical elements of the draft agreement to protect the world from future pandemics,” Ms Matsoso said.

Matsoso added that “we are going to find a solution in our life time.”

Africa CDC Director-General Dr Jean Kaseya

African heads of state from countries affected by mpox will meet virtually on Sunday to address the “worrying” increase of the virus – with 2,912 new cases and 14 deaths recorded in the past week, the Africa Centres for Disease Control and Prevention reported at a media briefing on Thursday.

“Mpox is not under control in Africa. We still have this increase of cases that is becoming worrying for all of us. In many countries, we have different clades [so] the mpox outbreak is a combination of many outbreaks in one,” Africa CDC Director-General Dr Jean Kaseya told the media briefing.

Clade 1A and Clade 1B are both circulating in Kinshasa, the capital of the Democratic Republic of Congo (DRC) which is worst affected by mpox. 

However, because the continent’s surveillance, testing and laboratory systems are not strong enough, “we cannot confirm that we don’t have this kind of joint circulation of clades” across the continent, Kaseya admitted.

Of the 29,152 suspected mpox cases identified since the beginning of the year, only 6,105 have been confirmed by laboratory testing.

In the past week, Morocco in North Africa reported its first mpox cases, which means that mpox now affects all regions of the continent, said Kaseya.

Japan donates three million vaccines

On Wednesday, the government of Japan signed an agreement with the DRC to donate three million KM Biologics’ LC16 vaccines which, unlike Bavarian Nordic’s MVA-BN vaccine, are authorised for children. Around 40% of the continent’s suspected mpox cases are in children.

However, health workers will need special training to vaccinate people with LC16, which requires a similar process to that of smallpox, said Dr Mike Ryan, the World Health Organization’s (WHO) global head of health emergencies.

“The LC 16 vaccine is not delivered by the same method as the MVA vaccine, and that does introduce complexity to the training and logistics,” Ryan confirmed at a WHO global press conference on Thursday.

“The LC16 is given the same way the previous smallpox vaccination was done, which is scraping intradermally on the skin. That’s quite a skilled technique, and that will take time, and that hasn’t been used in vaccination programs for decades now.” 

Rwanda meanwhile started its vaccination campaign earlier in the week, but it has only received 1,000 donated so far vaccines.

The DRC will start its vaccination campaign in the first week of October, while the Africa CDC expects to soon dispatch vaccines to South Africa, Uganda, Burundi “and any other country that will be in need”. 

It is also establishing an expert technical review committee to assist countries to develop “strong vaccination campaign plans”, said Kaseya.

Isolating at home or hospital?

Burundi, despite having 1,600 case, has recorded zero deaths. However, Dr Ngashi Ngongo, Africa CDC Chief of Staff, told the media briefing that all Burundi’s cases were hospitalised and in isolation.

Dr Maria Van Kerkhove, WHO’s interim director for epidemic and pandemic preparedness and prevention, stressed that it is “really important that cases do isolate, but there are options for where they can isolate”.

“If there’s an indication of clinical severity, if they have a risk of developing severe disease, it’s important that they get appropriate clinical care, so isolation in a hospital is helpful,” said Van Kerkhove.

“But we do have guidance for isolation at home. For people who are presenting mildly, and people who aren’t at risk of developing severe disease, home care is completely appropriate,” she added.

“It is really important that the scabs are covered, that we use good hand hygiene, that the close physical contact between caregivers is done appropriately so that we can prevent onward spread,” said Van Kerkhove.

“Also, it is really critical to clean bed linen and clean clothes, etcetera and that’s very difficult in many different contexts.”

Dr Maria Van Kerkhove, WHO Director for epidemic and pandemic preparedness and prevention.

WHO Director-General Dr Tedros Adhanom Ghebreyesus told the briefing that the mpox virus “is being spread primarily through close personal contact, including sex and within families, through caring for young children, breastfeeding and sharing clothing or bedding”. 

“The response to the outbreak is made more difficult by the context with insecurity in the affected areas and concurrent outbreaks of other diseases, including measles and chicken pox,” added Tedros.

In comparison to a year ago, there has been a 177% increase in cases and a 38.5% increase in deaths in Africa, and the Africa CDC has committed to developing an open-access dashboard that is regularly updated with information about the spread of the virus.

Image Credits: Africa CDC.