Africa CDC headquarters
Africa CDC headquarters, Addis Ababa, Ethiopia.

The Africa Centres for Disease Control and Prevention (Africa CDC) plans to declare mpox a public health emergency of continental concern next week, marking the first such declaration in the agency’s history. 

The decision follows a surge in mpox cases across Africa in 2024, matching 2023’s total in just six months. Since January 2022, over 38,000 cases and 1,456 deaths have been reported. This year, 10 African Union states have recorded more than 14,000 cases and 450 deaths, with 2,750 confirmed — 160% higher than the same period in 2023.

Recent outbreaks in Ivory Coast, Kenya and Uganda highlight the virus’s expanding reach. Mpox infections in Burundi, Kenya, Rwanda and Uganda are the first on record in these countries. 

A new variant of the mpox virus, known as clade 1b, is fueling the outbreak in eastern Democratic Republic of Congo (DRC) that has spread to neighboring countries. The DRC, where mpox was first detected in 1970 and remains endemic, bears the brunt of this outbreak, accounting for more than 96% of both cases and deaths. 

Jean Kaseya, director of Africa CDC, announced the impending declaration Thursday, emphasizing its significance in controlling the outbreak and mobilizing resources. The declaration is expected to boost African production of diagnostic tools and ease import restrictions on medical supplies.

“This declaration will increase coordination between Africa CDC and member states,” Kaseya said, adding it would accelerate research and development of diagnostics and vaccines.

The move coincides with the World Health Organization considering a similar global declaration. WHO Director-General Tedros Adhanom Ghebreyesus said Wednesday an emergency committee would be convened “as soon as possible” to advise on whether the outbreak represents a public health emergency of international concern.

“In light of the spread of mpox outside DRC and the potential for further international spread within and outside Africa, I have decided to convene an emergency committee under the International Health Regulations,” Tedros said at a press briefing in Geneva.

This is a developing story. 

Image Credits: Africa CDC .

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

The World Health Organization (WHO) aims to begin a major polio booster vaccination campaign in Gaza next week with the dispatch of over 1.2 million vaccines to the war-torn Palestinian enclave – against a backdrop of spiralling regional tensions.  

WHO director-general Dr Tedros Adhanom Ghebreyesus warned again on Wednesday that the presence of polio virus in wastewater is a “tell-tale” sign that polio is circulating in the war-stricken zone. Unvaccinated children under 5 years are at highest risk for contracting the highly infectious disease, the WHO chief said. 

The agency is now gearing up to vaccinate 600,000 children under 8 in two rounds, beginning Wednesday, August 17, as part of an emergency deployment it first announced on July 26.  

 “There is a high risk of spreading of the circulating vaccine-derived polio virus in Gaza, not only because of the detection but because of the very dire situation with the water sanitation,” said Ayadil Saparbekov, team lead for health emergencies at WHO in Gaza and the West Bank via video link from Jerusalem.

Gaza’s health authority has declared the territory a “polio epidemic zone,” blaming the virus’s presence on Israel’s continued military attacks and the subsequent destruction of health facilities. Israel’s military has begun vaccinating its personnel against polio. 

Only 16 of the territory’s 36 hospitals are partially functional, according to the WHO.

Conflict leaves Gazan children lacking routine immunizations

Administering oral polio vaccine – Gaza’s vaccination rates have dropped sharply.

Before the war, polio immunization rates in Gaza and the Israeli-occupied West Bank approached 99% – considered optimal by the WHO. Rates in Gaza have plummeted in the 10 months since fighting began between Gaza’s Islamic Hamas regime and Israel. 

The WHO said barriers to vaccination include “lack of security, access obstruction, constant population displacement, shortages of medical supplies, poor quality of water and weakened sanitation”. 

Saparbekov described dire sanitary conditions across the enclave, with many people living in shelters with one toilet for 600 people and little access to safe drinking water. 

The polio virus spreads through contact with sewage and feces containing traces of vaccine-derived variants of the live virus. In under-vaccinated groups, the vaccine-derived virus can cause paralysis and sometimes death. 

The fight against polio, considered a crowning achievement in global health, has seen cases plummet by over 99.9% since 1988. The outbreak in Gaza underscores the fragility of this progress.

Conflict causes polio to “thrive”

girl in gaza strip
Polio has been detected in two locations in the Gaza strip.

Tedros said the discovery of polio in Gaza’s wastewater samples amid the destruction isn’t surprising. Recent wars in Syria, Somalia and Afghanistan led to devastating polio outbreaks, paralyzing underimmunized children. Afghanistan and Pakistan, the last two countries with wild polio, continue to struggle with repeated outbreaks due to humanitarian crises. 

“We have seen polio thrive in places hit by conflict and instability,” wrote Dr Tedros in a recent article. 

“[It is] just a matter of time before it reaches the thousands of children who have been left unprotected,” the WHO chief warned.  

Gaza’s decimated health and sanitation systems have set back routine immunizations not just for polio, but also measles, hepatitis A, and meningococcal meningitis. People in the territory are also suffering from high levels of diarrheal diseases, lice, scabies, and skin diseases from the ever-worsening sanitary conditions. 

“The waste management system in Gaza has collapsed,” Philippe Lazzarini, head of the UN agency that assists Palestine, said on Twitter. “Sewage discharges on the streets while people queue for hours just to go to the toilets…make a dangerous recipe for diseases to spread.”

Lack of ceasefire threatens vaccine delivery

Delivering 1.2 million doses of polio vaccines to Gaza’s children is a “huge logistical challenge,” said WHO technical officer Andrea King. Polio vaccines require stable refrigeration – a challenge even in peacetime

The UN reports ongoing obstacles to aid delivery, including “hostilities, unexploded ordnance, damaged and impassable roads, attacks on aid convoys, a lack of public order and safety, and not enough border crossings.”

Dr Tedros emphasized the agency needs “absolute freedom of movement for health workers and medical equipment to carry out these complex operations safely and effectively” in order “to protect children in Gaza from polio.” 

“A ceasefire is essential to allow an effective response,” he said. 

Image Credits: UNRWA , Global Polio Eradication Initiative, UNRWA.

Saima Wazed, Regional Director for WHO-SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General during her swearing in ceremony in January this year.

The ouster of Bangladesh’s long-ruling Prime Minister Sheikh Hasina in a student-led revolution this week could reverberate through the World Health Organization (WHO), where her daughter holds a key regional post.

Saima Wazed, installed earlier this year as regional director for WHO’s South-East Asia (WHO-SEARO) office after a contested election, now faces increased scrutiny following her mother’s fall from power.

Wazed’s appointment was seen as driven by her mother’s political influence, according to multiple sources who spoke on the condition of anonymity. Sources in Bangladesh, speaking to Health Policy Watch, suggested Hasina had sought to secure an international position for her daughter amid growing political instability.

Wazed’s election to lead WHO’s South-East Asia office, which oversees health policies for over a billion people, raised concerns amongst health experts. Despite lacking significant global health experience or a medical degree, she was chosen over a 30-year WHO veteran from Nepal.

Sources within WHO told Health Policy Watch that her tenure has been marked by confusion and mismanagement, validating concerns raised by critics prior to her election. The sudden loss of her mother’s political power may further complicate Wazed’s position.

“I would be surprised if it’s not going to actually hamper her work,” said Mukesh Kapila, a Geneva-based physician and public health specialist. “She’ll have to work twice as hard, and there will be that much more mistrust.”

Political pressure on WHO officials from their home countries has precedent. In 2022, Bloomberg News reported on documents outlining an alleged Ethiopian government plan to discredit WHO Director-General Tedros Adhanom Ghebreyesus ahead of his re-election bid.

The reported campaign, which included accusations of corruption and sexual misconduct, coincided with escalating tensions between Ethiopia’s government and Tedros’ home region of Tigray, where he had political ties before joining WHO.

Interim government takes power

Nobel Peace Prize laureate Muhammad Yunus, supported by student protesters who led the revolution, will head the interim government as Prime Minister Sheikh Hasina’s 15-year rule ends.

The new Bangladeshi regime, potentially hostile to Hasina, could complicate Wazed’s position at WHO. The interim government is set to be led by Muhammad Yunus, who won the Nobel Peace Prize in 2006 for his microfinance work helping lift Bangladeshis out of poverty.

Hasina’s government pursued multiple criminal charges against Yunus while in power, including corruption, tax evasion and money laundering. Human rights groups described the persistent prosecution of the Nobel laureate as “emblematic of the beleaguered state of human rights in Bangladesh, where the authorities have eroded freedoms and bulldozed critics into submission.”

“I think a lot depends on what happens with the Bangladesh government, the interim government, and then whatever government follows,” said Kapila. “If there is a vindictive element in the new government…then, undoubtedly, they could make her life in WHO difficult.”

Forced to resign under army pressure, Hasina fled to India earlier this week. Her career as a scion of modern Bangladesh’s founding dynasty spanned decades from leading a popular democratic uprising against military rule in 1990 to now, in the view of her critics, destroying the democracy she fought to create.

Wazed expressed her sadness at the political turmoil in her country while reiterating her commitment to her role at the WHO.

Hasina came to power in 2008 and for the better part of the last decade has crushed dissent, jailed political opponents, and clamped down on media using extra-judicial killings and torture.

Earlier this year her government won yet another election boycotted by the opposition.

The protests that led to Hasina’s resignation began peacefully but turned violent. Human Rights Watch reported an estimated 300 deaths, thousands of injuries, and over 10,000 arrests. On 8 August, Wazed posted a comment on X about the unrest, but it was later deleted.

Comment by SEARO RD Saima Wazed posted on X, then later deleted.

WHO’s integrity in the dock

The 2023 WHO-SEARO regional director election took place between just two candidates amid reports of bullying from Hasina’s government to force countries to withdraw their candidates to limit competition. This contrasted sharply with other regions’ elections taking place around the same time: the Western Pacific had five candidates in the fray, and the Eastern Mediterranean region had six.

Media reports emerged from in and outside Bangladesh of trade deals being struck in exchange for a vote for Wazed in the election. India, now hosting Hasina in exile, reportedly supported her candidacy.

She won as expected over WHO veteran Dr Shambhu Prasad Acharya who was nominated by his home country Nepal.

Reports of widespread anger against Indian Prime Minister Narendra Modi’s government have emerged in Bangladesh, with critics accusing Modi of supporting Hasina’s rule and helping her remain in power.

To what extent this will affect Wazed’s ability to push WHO’s agenda in the region remains unclear.

Calls for electoral reform

Health experts and advocates are pushing for a change in the election of the regional directors following controversial appointments like Wazed’s.

“One proposal is to abolish the electoral process altogether in favour of the Director-General appointing regional directors,” wrote a group of health advocates, including former New Zealand Prime Minister Helen Clarke, in a correspondence to the peer-reviewed medical journal The Lancet last year.

“This change might not obviate the political nature of the appointments but would serve One WHO aspirations,” they added.

Other suggestions included revising eligibility criteria, holding town hall meetings, and increasing interactions with journalists. The authors highlighted concerns about corruption, vote trading, and campaign finance. They called for full transparency of campaign contributions and spending.

“A more difficult set of issues concerns alleged corruption and non-adherence to codes of conduct with respect to vote trading, negative campaigning, and campaign finance. Spendings and full transparency of campaign contributions is needed,” the letter said.

They also urged WHO to prohibit member states from nominating close relatives and friends and to establish a whistleblower function during elections.

Despite these recommendations, little has changed. WHO has not publicly addressed allegations of nepotism or concerns about the election’s integrity.

“It does not mean that people in Geneva in WHO aren’t embarrassed or don’t recognize what has happened, or feel bad about it,” Kapila said. “But this is one of the problems of the governance of the organization.”

Image Credits: X/Saima Wazed, WEF, @DrSaimaWazed.

mpox virus

A surge in mpox cases in the Democratic Republic of Congo (DRC) has spilled over to neighbouring countries, prompting the World Health Organization (WHO) to consider declaring a new international emergency as several nations report their first-ever cases of the virus.

WHO Director-General Dr Tedros Adhanom Ghebreyesus announced Wednesday he will convene an emergency committee “as soon as possible” to advise on whether the current mpox outbreak represents a public health emergency of international concern – the WHO’s highest level of alarm. 

“In light of the spread of mpox outside DRC and the potential for further international spread within and outside Africa, I have decided to convene an emergency committee under the International Health Regulations,” Tedros said at a press briefing in Geneva.

The potential declaration comes just over a year after WHO ended the previous global health emergency for mpox in May 2023. The earlier crisis, declared in July 2022, stemmed from a worldwide outbreak mainly affecting men who have sex with men. About 90,000 cases and 140 deaths were reported across 111 countries during that emergency.

Mpox is back

monkeypox
Mpox was first discovered in the Democratic Republic of Congo in 1970. It is endemic in the country.

A new variant of the mpox virus, known as clade 1b, is fueling the outbreak in eastern DRC that has spread to neighboring countries. Burundi, Kenya, Rwanda and Uganda, which have never reported mpox cases before, are now seeing infections.

Mpox cases in the first half of 2024 have already matched the total for all of 2023. Since the start of the year, the Africa Centers for Disease Control and Prevention reports that 10 African Union member states have recorded over 14,000 mpox cases, with more than 450 deaths. Of these, nearly 2,750 cases have been confirmed, while the rest are suspected.

The DRC, where mpox was first detected in 1970 and remains endemic, bears the brunt of this outbreak, accounting for more than 96% of both cases and deaths. The country, then known as Zaire, has been grappling with the virus for over five decades.

The virus has reached urban areas, including Goma, a city of more than 2 million people bordering Rwanda. Other outbreak hotspots, such as the mining town of Kamituga, see frequent travel to Rwanda and Burundi. Goma hosts more than 200,000 displaced people in four camps west of the city, the capital of North Kivu province.

“There is a real risk of an explosion of the disease given the huge population movements in and out of DRC,” said Albert Massing, medical coordinator for Doctors Without Borders in DRC.

Burundi, Kenya, Rwanda and Uganda reported their first-ever mpox cases amid the outbreak.

Early reports indicate clade 1b could be more lethal, with a 3% to 6% case fatality rate compared to 0.2% for clade 2, which drove the 2022-2023 global outbreak. However, health officials caution more data is needed to draw definitive conclusions.

“We don’t know if it is more severe,” said Dr Rosamund Lewis, WHO’s mpox lead. “Most of the persons affected so far have been children, who are more vulnerable, so it is still difficult to say whether this strain is less or more severe.”

The outbreak has affected diverse groups, including sex workers, students, businessmen and travelers, according to DRC health authorities. Scientists have identified mutations in clade 1b that indicate the virus now spreads exclusively from person to person, confirming sustained human-to-human transmission.

A Nature study published in June, examining 108 confirmed mpox cases near Goma, revealed unexpected trends. Unlike the 2022 global outbreak that mainly affected men who have sex with men, 51.9% of cases were female, with 29% of these being sex workers. WHO reports that while sex workers initially accounted for about a third of all cases, this proportion is declining as the virus spreads more widely in the community.

“At the moment, there is no specific information that suggests that the clade 1b is more transmissible per se,” Lewis said. She noted that the rapid spread might be due to sexual transmission rather than increased transmissibility of the virus itself.

“We know from the global outbreak that transmission through sexual networks occurs more rapidly,” she explained. “That doesn’t necessarily mean that the virus itself is more transmissible.”

Vaccines sitting in stockpiles

Bavarian Nordic is the only company in the world that manufactures mpox vaccines.

WHO is working to accelerate vaccine access in affected countries by initiating an emergency use listing for two approved mpox vaccines. This move aims to speed up procurement and distribution through partners like Gavi and UNICEF, while also facilitating national approvals by health authorities.

Tedros noted WHO is collaborating with affected governments, Africa CDC, the African Union, and other partners to surveil and stem outbreaks. The organization’s $15 million regional response plan is currently supported by just $1 million from its emergency fund. To the dismay of WHO officials, no funding has yet been made available at an international level.

“We’re having once again to dip into the contingency fund for emergencies to begin the response,” said Dr Michael Ryan, WHO’s emergency response chief. “It was frankly amazing to me that even in the large-scale mpox outbreak we had around the world, there was no funding made available at the international level. There must be a financial commitment to stop this virus.”

Mpox vaccines are available. Bavarian Nordic, the sole manufacturer of mpox vaccines, reported record financial results in 2023, with preliminary revenue of $1 billion, primarily driven by vaccine sales.

“The increased manufacturing capacity and broader customer base also mean that we will be able to respond to future surges in demand, following increased cases of mpox, or extraordinary governmental orders,” Bavarian Nordic CEO Paul Chaplin said in a February press release.

The company’s growth was propelled by public health preparedness actions, including several mpox vaccine orders from an undisclosed European country and 500,000 doses purchased by the United States for its national stockpile.

Despite these stockpiles, vaccine access remains limited in frontline regions. The DRC has approved two vaccines and received 50,000 doses donated by the United States, but these haven’t been deployed. Médecins Sans Frontières (MSF) reports a lack of available vaccines on the ground.

“We can only plead, like so many others, for the vaccines to arrive in the country as quickly as possible and in large quantities, so that we can protect communities in the areas most affected—particularly the most at-risk groups such as Congolese health workers, who are on the front line of the infection, as well as other at-risk groups such as sex workers and displaced people in camps,” said Massing, the group’s head of operations in DRC, this week.

At Wednesday’s Geneva press briefing, Tedros acknowledged Japan, the United States, the European Union and vaccine manufacturers for their efforts on “vaccine donations”. These vaccines have not yet reached the outbreak’s frontline.

“It’s a virus that can be contained, quite straightforwardly, if we do the right things,” said Ryan. “Countermeasures themselves, vaccines do nothing. Vaccination is what saves lives.”

Image Credits: National Institute of Allergy and Infectious Diseases.

Technician at work in South Africa’s mRNA vaccine hub, Afrigen.

The COVID-19 pandemic underscored the risks of over-reliance on global supply chains for essential health products. Disruptions led to severe delays and shortages of vaccines, therapeutics, and diagnostics, with low- and middle-income countries bearing the brunt.

Vaccine inequality starkly highlighted Africa’s vulnerability. Yet this crisis unveiled a unique opportunity for the continent: a chance to revolutionize its vaccine manufacturing sector, crucial for health security and economic empowerment.

Strengthening local manufacturing capabilities ensures timely, equitable access to life-saving products and lays the foundation for a healthier, more self-reliant Africa. Despite representing about 20% of the global population, Africa’s vaccine industry only meets about 0.1% of the worldwide demand.

This significant disparity not only poses a threat to public health but highlights the untapped economic potential in the continent’s vaccine manufacturing sector. The demand for vaccines in Africa is currently estimated at over US$ 1 billion per year, and it’s expected to increase significantly as the continent’s population expands, according to Gavi.

African leaders have no excuse: they must capitalize on these opportunities to advance the continent’s health security.

Opportunity meets regulatory momentum

Several recent developments offer promising opportunities to transform Africa’s vaccine manufacturing landscape.

The operationalization of the African Medicines Agency (AMA), with its Governing Board recently established, is a game-changer for Africa’s pharmaceutical landscape. AMA’s mandate to harmonize regulations, streamline processes, and bolster laboratory capacities is crucial for ensuring locally manufactured health products meet global quality standards. This regulatory support is essential for building trust and ensuring the success of local manufacturing initiatives.

Moreover, the inclusion of the African Union (AU) as a permanent member of the G20 not only demonstrates the advancements made in realizing the objectives of Agenda 2063, which seeks to position Africa as a major global player, but also empowers the African Union to wield substantial influence on matters crucial to Africa. This membership provides a unique platform for advocating and securing support for health initiatives crucial to the continent’s needs.

The AU’s Platform for Harmonized African Health Products Manufacturing (PHAHM) is another significant step forward, as it seeks to create a unified single market to foster demand certainty and promote investment in local production.

To date, 21 of Africa’s 54 countries have signed the African Medicines Agency treaty. Fifteen have ratified it.

The launch of the Africa Vaccine Manufacturing Accelerator (AVMA), meanwhile, is set to significantly accelerate the local manufacturing agenda in Africa. Through the AVMA, Gavi will make up to $1 billion available over ten years to support the sustainable growth of vaccine manufacturing on the continent.

This initiative, launched in June, aims to address the high startup costs and financial risks associated with vaccine production by providing financial incentives to local manufacturers. This support is crucial in light of Africa’s existing challenges, including overburdened health systems, rising national debt, and limited fiscal space.

AVMA aims to accelerate vaccine production on the continent by providing technical support, facilitating technology transfers, and fostering public-private partnerships. This initiative aligns with Gavi’s new strategic plan, unveiled in Paris, which emphasizes building sustainable vaccine manufacturing capacity in LMICs.

These efforts create a robust framework for not only enhancing Africa’s self-reliance in health product manufacturing but also an active member and contributor to the global vaccine ecosystem. Africa has made tremendous progress and manufacturers are already producing antigens.

Challenges remain, but leaders must act

African Union leaders signed an agreement with Rwanda’s Ministry of Health to establish the African Medicines Agency’s first headquarters in the capital, Kigali, in June 2023.

Despite these advancements, several challenges remain.

Technology transfer, capacity building, and supply chain strengthening require sustained effort and investment. The regulatory landscape needs continual enhancement to support local manufacturing and ensure compliance with quality standards. Additionally, there is a need for greater demand for locally manufactured products, achievable through multi-stakeholder partnerships and supportive government policies.

African leaders must therefore step up their efforts to reach the bold goal of producing 60% of vaccines on the continent by 2040. This vision must include end-to-end capabilities, from research and development to fill-and-finish. Policymakers must now commit to several key actions to realize this goal.

First, major government projects must prioritize investments in infrastructure and capacity building to support local vaccine manufacturing. This includes funding for state-of-the-art manufacturing facilities, training programmes for skilled workers, and research and development initiatives to foster innovation in vaccine production.

African leaders must also ensure there is sufficient and predictable demand from African countries for these vaccines. While we appeal to Gavi and other partners to commit to procuring at least 30% of all vaccines produced by the continent for global consumption, it’s imperative to further strengthen national regulatory authorities to ensure ensure vaccines and health products manufactured in Africa meet the global standards of WHO Maturity Level 3 and above.

mRNA hub
Lab technicians work in laboratories in Afrigen, a company in Cape Town that has been selected as the WHO Vaccine Hub, in South Africa, on 11 February 2022.

That’s where regulatory harmonization is crucial. African countries must fully support the African Medicines Agency (AMA) and its full operationalization to help streamline regulatory processes and ensure that locally manufactured vaccines meet global quality standards. This will build trust in Africa-made vaccines and facilitate their distribution across the continent and beyond.

Public-private partnerships are also essential. African governments should incentivize collaborations between local manufacturers, international pharmaceutical companies, and non-governmental organizations. These partnerships can provide the technical expertise, financial investment, and market access necessary to scale up vaccine production.

African leaders must advocate for and implement policies that support local manufacturing, such as reviewing prohibitive tax laws and introducing tax incentives like tax holidays, reduced corporate tax rates, and subsidies for local manufacturers. These incentives would enhance the competitiveness of local producers and attract investment in vaccine manufacturing.

The path to vaccine self-sufficiency in Africa is challenging but attainable. By leveraging recent developments like the AVMA and fostering a supportive environment for local manufacturing, Africa can build a resilient health system capable of meeting its population’s needs. This transformation will not only enhance health security on the continent but also contribute significantly to global health resilience.

Now is the time for African leaders to act decisively and make vaccine manufacturing a reality for the continent.

About the authors

Maureen Awuor Okoth is the Program Manager of Global Health Research, Development and Innovation at Amref Health Africa. 

Caroline Mbindyo is the Program Director of Global Health Research, Development and Innovation at Amref Health Africa. 

Image Credits: Kerry Cullinan, Rwanda Ministry of Health, WHO.

Officials from the WHO and India at the signing ceremony in Geneva, Switzerland.

India will contribute $85 million over a decade to the World Health Organization’s Global Traditional Medicine Center, the WHO announced.

The center, located in the Indian western city of Jamnagar, aims to strengthen the evidence base for traditional medicine and provide data on related policies, practices and public use.

The donation is part of a larger $250 million investment from India to support the center’s work, including funding for its operations, interim premises, and a new building.

“Traditional medicine supported within national health systems can allow us to reach those most often left behind,” WHO Assistant Director-General Dr Bruce Aylward said of the importance of the donation. “Integration of traditional practice and knowledge is critical to achieving health for all.”

The Jamnagar center’s work will focus on traditional medicine research, primary care integration, indigenous knowledge preservation, digital health applications and a biennial global summit.

“India remains committed to supporting WHO in its work to strengthen traditional medicine systems globally for achieving universal health coverage,” said India’s UN ambassador Arindam Bagchi. “Especially through this Global Centre in Jamnagar.”

Traditional Medicine: Ancient Practices Meet Modern Scrutiny

Billions worldwide rely on traditional medicine, with India at the forefront of integrating these practices into its national health system. In 2014, Prime Minister Narendra Modi established the Ministry of Ayush to revitalize the country’s ancient medical wisdom.

Vaidya Rajesh Kotecha, Secretary of the Ayush Ministry, hailed the WHO agreement as “a major milestone” aligned with Modi and WHO Director-General Tedros Adhanom Ghebreyesus’ vision for the traditional medicine centre’s development.

However, this embrace of traditional medicine has ignited fierce pushback from India’s modern medical community. The Indian Medical Association (IMA) led strikes protesting government policy allowing Ayush doctors – practitioners of disciplines like Ayurveda and homeopathy – to perform surgeries, citing fears for the lives of patients. The IMA has also taken legal action against traditional medicine companies for misleading health claims.

The WHO finds itself walking a tightrope, pledging to promote only evidence-based practices while seeking to integrate traditional medicine where scientifically supported. Yet controversy erupted at the first traditional medicine summit in India in 2023, when WHO social media posts appeared to endorse unproven treatments, contradicting its official stance.

Health Policy Watch reported experts questioning WHO’s apparent support for naturopathy, homoeopathy, and osteopathy as “traditional” medicine, warning against “legitimizing harmful pseudoscience.”

The next traditional medicine summit is scheduled for November 2025.

Image Credits: WHO/Lindsay Mackenzie.

Children are vulnerable to climate change due to a range of underlying vulnerabilities, says the UNICEF in its latest report.

Climate change is endangering children’s health at every stage of development, threatening to reverse decades of progress in reducing child mortality worldwide, according to a new UNICEF report.

The U.N. children’s agency’s “Threat to Progress” report released last week consolidates growing evidence of climate change’s effects on children’s health, identifying six major hazards: extreme heat, droughts, wildfires, floods, air pollution and ecosystem changes.

“Climate change is changing children,” UNICEF said. “It is impacting almost every aspect of child health and well-being from pregnancy to adolescence.”

Children are uniquely vulnerable to climate change due to physiological, psychosocial and behavioral factors, as well as their dependence on caregivers, the report found. Their frequent outdoor activities expose them to environmental risks differently than adults.

Extreme weather events are becoming more common, disrupting food supplies and increasing child malnutrition. Children are also susceptible to injuries from climate hazards and mental health issues, including developmental delays and depression.

UNICEF’s Children’s Climate Risk Index reported in 2021 that one billion children are at extremely high risk from climate impacts, threatening their survival and deepening existing inequities.

“We suffer the most,” said Francisco, a 14-year-old UNICEF child advocate in Somalia. “Children have dreams about the future, but they are losing hope because of climate change. It’s absolutely important to consider children’s health when tackling these issues because the climate crisis is also a health crisis.”

Climate change threatens to reverse gains in maternal and new-born health made over decades, according to UNICEF.

Deadly consequences 

This vulnerability has deadly consequences.

Child mortality has fallen sharply in recent decades, from 93 deaths per 1,000 live births in 1990 to 37 in 2022 for children under 5. Despite this progress, UNICEF calls the current rate “unacceptably high,” with an estimated 4.9 million children dying annually.

Now, climate change threatens to reverse these gains.

The report found that 559 million children currently face frequent heat waves, a number expected to surpass 2 billion globally by 2050. Between 2000–2019 approximately 489,000 heat-related deaths occurred every year, according to the World Health Organization (WHO). U.N. Secretary-General Antonio Guterres warns that nearly 25% of children today endure frequent heat waves.

In low-income countries, a 1 C temperature rise causes 16.6 additional infant deaths per 1,000 live births in the first year of life. With global temperatures on track to rise 2.7 C by the century’s end, this could result in millions of additional infant deaths.

Water stress affects 953 million children, impacting health and food availability. In 2019, air pollution contributed to 476,000 infant deaths in their first month of life.

Climate-related displacement is a major concern. Over the past six years, weather-related disasters caused 43.1 million internal displacements of children, averaging about 20,000 daily.

“These issues are not just future threats; they are current realities impacting our children today,” said Dr Helena Clements, child health officer for climate change at the Royal College of Paediatrics. “We can no longer talk about improving child health without also addressing the urgent need to tackle climate change.”

A warming world is intensifying infectious diseases like malaria and dengue. Heat-related illnesses, asthma, and chronic metabolic and cardiovascular diseases are also worsening. Heatwaves and other climate hazards are linked to pregnancy complications, including preterm births, low birth weight and stillbirths.

Without swift action to mitigate climate change and scale up adaptation measures, children will continue to bear the brunt of the crisis, the U.N. children’s agency said.

Children’s vulnerability to climate change varies widely based on circumstances they didn’t choose: wealth, gender, nationality, and health status. Yet all face a crisis they didn’t create, the U.N. children’s agency said.

Children in countries with poor socio-economic conditions are more vulnerable to the impacts of climate change.

“The world is at a crossroads,” UNICEF said. “The true measure of success or failure in addressing climate change lies not solely in temperature metrics, but rather in the tangible reduction of child mortality and morbidity attributable to its impacts.”

The report urges governments to take decisive action on three fronts to stem the crisis. It calls for drastic emissions cuts to meet the Paris Agreement’s 1.5°C target, a goal that’s slipping away as global temperatures climb.

The agency also pushes for robust measures to shield children from climate impacts, including bolstering climate-resilient healthcare and securing access to food and clean water. Above all, UNICEF stresses that child welfare must be at the heart of climate policy.

“It is our responsibility to call for action on areas such as high greenhouse gas emissions and air pollution, food and water supplies, climate-resilient health services, and overall preparedness for our changing climate,” said Clements. “We cannot allow our children to inherit a damaged and unsafe planet.”

Image Credits: UNICEF report ‘A Threat to Progress: Confronting the Effects of Climate Change on Child Health and Wellbeing’ .

Smoke rises over Northern California amid the ongoing Park Fire, set to become the fourth-largest in state history as firefighters brace for a weekend heat wave expected to bring hotter, drier conditions.

New research suggests long-term exposure to wildfire smoke may significantly increase dementia risk, posing a greater threat to brain health than other forms of air pollution.

The study, presented this week at the Alzheimer’s Association International Conference, examined a decade of electronic medical records for 1.2 million older adults in Southern California from 2009 to 2019. Researchers found a 21% higher risk of dementia diagnosis for every microgram per cubic meter increase in fine particulate matter (PM2.5) from wildfire smoke in the air, measured over three years.

By contrast, a three-microgram increase in PM2.5 from other sources like vehicle emissions or industrial pollution raised dementia risk by only 3%. The results, currently under peer review, account for variables including age, sex, race, ethnicity, smoking status, and income.

“There is quite a bit of prior literature that demonstrates an association between exposure to ambient air pollution and dementia, but there’s very limited research on how wildfire PM2.5, specifically, might be associated with dementia,” said Dr Holly Elser, lead author of the study and neurology resident at the University of Pennsylvania.

California’s ongoing Park mega-fire, which has burned 392,480 acres and become the state’s fifth-largest wildfire on record, underscores the study’s urgency. Smoke from this blaze now blankets regions where the study’s subjects live.

A separate study published in the Proceedings of the National Academy of Sciences (PNAS) in February highlighted the growing threat, revealing some parts of California endured nearly 18 months of high wildfire smoke levels over 15 years. Rural and tribal areas suffered the worst exposure, with some regions facing 10 times the average smoke particle levels.

These findings indicate that many Californians may face a 5% to 50% higher dementia risk, with economically disadvantaged communities experiencing the greatest danger.

“As wildfire events become more intense, more frequent, and occur in places outside of the Western US, we felt this was an important, specific source of air pollution to consider as a potential risk factor for dementia,” Elser said. “This is a real problem.”

Why wildfire smoke may be more dangerous

Firefighters respond to the Park mega-fire in Northern California.

PM2.5, the main pollutant in wildfire smoke, consists of airborne liquid and solid droplets smaller than 2.5 micrometres – about 30 times finer than a human hair. These tiny particles can penetrate deep into the lungs, enter the bloodstream, and potentially reach the brain.

Sources of PM2.5 range from coal- and natural gas-fired plants to cars, agriculture, unpaved roads, construction sites, and wildfires. It can take the form of dirt, dust, soot, or smoke.

While researchers are still investigating why wildfire smoke appears more harmful to brain health than other forms of air pollution, several theories have emerged.

Despite sharing the PM2.5 label, particles from wildfires may be more toxic than urban pollution. Their chemical makeup varies widely based on burned materials, unlike the more predictable composition of vehicle or factory emissions.

“There’s a greater concentration of toxic chemicals in wildfire smoke,” said Niki Rubarth, regional director of the Alzheimer’s Association of Northern California. “Wildfires burn everything in their path so that can be anything.”

A 2022 US study of more than 18 million people linked black carbon, a major component of wildfire smoke, to higher dementia risk. Researchers found that each microgram per cubic meter increase in black carbon raised dementia risk by 12%. That same year, a separate study published in Environmental Health Perspectives revealed that even brief exposure to wildfire smoke could impair cognitive functions, including attention.

Another factor is particle size. PM2.5 particles from wildfires are typically smaller than those from urban pollution, potentially allowing for easier penetration into organs and the bloodstream.

The study’s authors emphasize the need for further research to pinpoint which specific components of wildfire smoke might be driving the increased dementia risk.

“I’m really curious to see whether or not we see a similar association with other neurodegenerative processes like Parkinson’s disease or ALS,” Elser added. The link between air pollution and Parkinson’s – a known cause of dementia – is well-established.  

Experts suggest wildfire smoke’s toxicity isn’t the only factor boosting dementia risk; stress and trauma from these events may also significantly impact cognitive decline.

“Exposure to environmental shocks like wildfires can also uncover cognitive changes already underway,” Elser explained. “The stress and depression associated with these events could potentially unmask neurodegenerative processes that were already present.”

Repeated trauma from losing homes and fleeing wildfires has well-documented links to post-traumatic stress disorder, depression and anxiety across California – all conditions that increase a patient’s risk of dementia.

Similar mental health impacts have been observed globally in relation to extreme weather events. Following devastating floods in the Philippine capital of Manila last year, researchers found evidence of worsened anxiety and distress.

“Repeated chronic stress can cause all sorts of physiological changes,” said Vaibhav Narayan, executive vice president at the Davos Alzheimer’s Collaborative. “Stress is a well-known activator of brain health decline and cognitive issues.” 

“It’s not just the physical impact of these stressors,” Narayan added. “It’s also the psychological impact that is detrimental to brain health.”

Growing evidence links air pollution to dementia risk

Map of active global wildfires. / Source: IQAir

The new findings bolster a mounting body of evidence connecting air pollution, particularly high PM2.5 concentrations, to brain health issues.

In its 2024 update released Wednesday, the Lancet Commission on dementia prevention reported that at least nine systematic reviews and meta-analyses since 2019 have established a strong link between air pollution and increased dementia risk.

Studies worldwide demonstrate air quality’s impact on cognitive health. In China, stricter clean air policies slowed cognitive decline in older adults, while another study found 42.4% higher dementia risk in the country’s more polluted northern regions compared to the south.

In 2022, French researchers linked a 12 microgram per cubic meter reduction in PM2.5 levels over 10 years to a 15% lower dementia risk. In the US, meanwhile, older women experiencing larger improvements in air quality over a decade showed lower dementia risk.

High levels of fine particulate matter correlate with increased rates of dementia, mild cognitive impairment, and Alzheimer’s disease in both wealthy and developing nations, the Lancet Commission found. 

Indoor pollution poses additional threats, particularly in developing countries where solid fuels for cooking and heating are associated with higher dementia risk and faster cognitive decline in adults over 45.

While most studies focus on older adults, experts warn that air pollution could affect brain health earlier in life.

“People entering older age now have been exposed to wildfires quite extensively – potentially through their 40s, 50s and 60s,” said Dr Joan Casey, co-author of the wildfire study and a neurologist at the University of Washington. “That might be really important.” 

The Lancet Commission reported growing support for World Health Organization global air quality guidelines, noting, “It is unclear whether any safe concentration of air pollution exists.”

The commission now estimates that addressing “modifiable” risk factors could prevent up to 45% of dementia cases, up from 40% in its 2020 report. These factors include air pollution, less education, hearing loss, hypertension, physical inactivity, diabetes, social isolation, excessive alcohol consumption, smoking, obesity, traumatic brain injury and depression.

“The world can’t afford to ignore the 45%,” said Narayan. “That’s the most scalable way to address this issue.”

Wildfires spread globally 

Smoke from wildfires in North Africa in 2023 crossed the Atlantic, affecting air quality in Latin America.

The study’s findings come amid increasing global wildfire activity. Human-caused climate change has increased atmospheric aridity and fuel dryness, leading to longer, more active fire seasons.

The European Union’s Copernicus Climate Change Service identified significant fire seasons across the world in 2023, from Australia to Bolivia, Algeria, Thailand, North America, Russia, and Chile. 

Canada experienced record-breaking wildfire carbon emissions as climate change more than doubled the likelihood of extreme fire weather in Eastern Canada, while Greece battled the largest wildfire in European Union history. Between 1984 and 2020, the annual area burned by wildfires in the western United States surged by over 300%, with some regions seeing a staggering 1,000% increase. 

Globally, the length of the fire season has lengthened by nearly 20% between 1979 and 2013. 

“The biggest thing will be to slow climate change, stop burning fossil fuels and figure out how we’re going to better manage wetlands so we have reduced wildfire exposures,” said Casey. “Of course, that’s quite complicated.”

Wildfire smoke can impact air quality thousands of miles away. In 2023, Canadian wildfire smoke reached Europe and turned New York City skies orange. Smoke from Algerian wildfires made the reverse journey across the Atlantic, reaching Latin America. 

Experts recommend several strategies to reduce exposure to wildfire smoke, including staying indoors on poor air quality days, using high-efficiency air filters, and wearing N95 or KN95 masks when outdoors during smoke events. However, these measures may not be equally accessible to all populations.

“This is a global problem. Wildfire smoke can travel across oceans and impact everybody,” said Narayan. “But like in everything in life, poor people are always disproportionately impacted.”

Women and children wait outside the MSF clinic in Zamzam camp in January 2024, where a malnutrition crisis was causing one child to die every two hours, according to Médicins sans Frontières.

More than half a million people in Sudan’s North Darfur region are now suffering from famine conditions, the Famine Review Committee (FRC) of the UN’s Integrated Food Security Phase Classification (IPC) announced Thursday. 

The escalating violence in Sudan between government troops and the paramilitary Rapid Support Forces, which broke away from the Sudanese Armed Forces in 2023, is at the root of the food crisis. 

Meanwhile, armed conflicts in the Democratic Republic of the Congo (DRC) and in Gaza continue to perpetuate two more of the world’s other most acute hunger and food crises.

In Sudan, the FRC assessed the conditions in the Zamzam refugee camp near El Fasher town, where some 600,000 people have taken refuge, as experiencing famine risks, the worst of the IPC classification levels. 

Famine is declared when at least 20% of an area’s population suffers from extreme lack of food and hunger (IPC level 5), facing actual starvation. Though the IPC analyzed only the Zanzam camp, the food crisis is likely of a similar scope in other regions of North Darfur, said the IPC.

The camp, set in the southwest of the country, has been besieged by the RSF for months, and famine risks will likely remain severe through the end of October 2024, the IPC assessment concluded. 

In Sudan, 26.6 million people, more than half of the population, are food insecure, according to the World Food Programme (WFP) data. Fighting between the country’s army and RSF, said to be backed by Russia’s Wagner Group, continues to impede the operations of aid organisations. Over 10 million Sudanese are internally displaced and 2 million abroad – the largest number in the world, according to a WHO update July 17.

In Khartoum, free kitchens operating there were forced to shut down in mid-July, due to a lack of funding and food supplies.

The RSF, a rebranded name for the Sudanese Janjaweed militia, has been accused of war crimes over the past decade in Darfur, as well as South Kordofan, and Khartoum, according to groups like Human Rights Watch. The violations include burning villages, raping women, unlawful detentions, and repurposing hospitals and churches as military shields. 

In the Darfur region, many people face hunger (IPC 5), the Famine Review Committee assessed after analysing the situation in the refugee camp next to El Fasher (al-Faschir).

DRC has the largest number of people in need of humanitarian aid in the world 

In the neighbouring Democratic Republic of Congo, meanwhile, more than one million children are at risk from acute malnutrition as rising violence perpetrated by armed militias drives up needs among millions of displaced people, the World Health Organization said on July 12.

The DRC currently has the highest number of people in need of humanitarian aid in the entire world, with 25.4 million people affected, Dr Adelheid Marschang, WHO Senior Emergency Officer, said at a UN press briefing in mid-July. 

Despite this, in the DRC “underfunding is indeed severe,” said Dr Adelheid Marschang, WHO Senior Emergency Officer, in a press briefing July 12.

The WHO is aiming for a $30 mln budget “to address the situation till the end of the year,” she said, but could only access about $6 mln on the day of the briefing.

In the eastern DRC provinces of Ituri, North Kivu and South Kivu, where the rebel M-23 militia, reportedly backed by Rwanda, has made significant inroads, 5.4 million people are food insecure, while almost three million children across the country are severely malnourished, according to the World Food Programme. 

With floods having destroyed this season’s crops, the prospects for next year are even more grim. Unless immediate action is taken, over one million children will suffer from acute malnutrition, the WHO warned.

In Gaza, 96% of the population still faces crisis levels of hunger

Gazans struggle to obtain basic supplies of food and water amidst mounting piles of garbage and debris.

In Gaza, where Israel continues its nine-month military campaign to crush the Islamic Hamas organization following Hamas’ deadly 7 October 2023 raids on Israel, WHO officials have warned that one in four people remain at risk of starvation – even if previous forecasts of widespread famine by July did not yet materialize.  

Some 96% of the enclave’s 2 million residents are facing crisis levels of hunger (IPC 5) – according to the World Food Programme. 

Israel’s closure of the Rafah crossing into Gaza in mid-May has paralyzed the flow of health supplies and humanitarian aid from Egypt – forcing exclusive reliance on Israeli aid crossing points.  

Meanwhile, the World Food Programme (WFP) was forced to reduce food rations in Gaza City in May to ensure broader coverage for people who have been newly displaced after new Israeli incursions in the north and south.  

In June, WFP provided more than a million people in Gaza with food assistance, and more than 153,845 individuals in the West Bank received cash-based transfers.

Image Credits: MSF.org, Domenico-de-ga, UNRWA .

Exposure to infected poultry is among the main sources of avian flu infections

As more avian flu cases are detected across the Asia-Pacific region, the Food and Agriculture Organization (FAO) is calling for “regional efforts to combat a rise” of the disease. Over the past year, highly pathogenic avian influenza clades, especially H5N1, have gained ground globally, infecting an increasing number of species, including poultry, dairy cows, and domestic animals.

As of July 31, one single avian flu variant of H5N1 had infected 172 dairy herds and 13 farm workers in the United States  and continues to spread further, raising questions about the country’s ability to curb the transmissions. 

In the Asia-Pacific region, there have been 13 human H5N1 avian flu cases since late 2023, six of which were reported in Cambodia this year. The newly-reported cases point to a trend of more human infections from the virus.  And in the Asian-Pacific, at least one other avian flu variant is circulating along with the H5N1 type, clade 2.3.4.4b, prevalent in the US.  

“All these cases involved direct contact with poultry or wild birds, and so far, no human-to-human transmission has been observed,” confirmed Filip Claes, FAO’s Asia-Pacific Regional Laboratory Coordinator in an email response to Health Policy Watch.

“The primary threat is that HPAI continues to circulate in poultry causing economic losses. Additionally, it provides an opportunity [for the virus] to continuously adapt, and spill over to additional species, including humans,” he added.

He called for building diagnostics capacity and more data sharing, along with strengthening farming biosecurity and biosafety measures.

Avian influenza has even reached the arctic and Antarctic regions, infecting scavenger species, marine mammals, carnivorous domestic pets, and mammals farmed for fur, and dairy cattle. Since last year, there have been human cases in Australia, India, the US, Mexico, Vietnam, China, and Cambodia. 

Of the 886 human infections reported from 2003 to May 2024, more than half were fatal.

Alhough the World Health Organization continues to assess H5N1-related risks to the public as low (and low-to-moderate for farm workers), the emergence of new, more easily transmissible strains “increases the pandemic threat,” warned Kachen Wongsathapornchai, Regional Manager of FAO Emergency Centre for Transboundary Animal Diseases earlier this week. Calling the recent bird flu surge “deeply concerning” the FAO official appealed for “immediate action.”

Insufficient outbreak response

Avian flu H5N1 situation update as of 31 July 2024 – all reports since outbreak began in March.

“Strengthening and integrating surveillance systems is crucial,” Claes said, enumerating measures South-East Asian countries should implement to fight the outbreaks. “Countries should invest in advanced diagnostic infrastructure and training for laboratory personnel,” as well as enhance international and inter-agency collaboration, prepare biosecurity protocols for farms and consider vaccination campaigns.

In the US, where the virus has infected an expanding circle of dairy cattle herds since first reports emerged in March, the country response is insufficient, US experts have long maintained.

There is, for instance, too little data and research that would ensure better understanding of the virus and the ways in which it transmits – not only through the mammary glands during milking, as was previously thought, new research seems to suggest.

Farmers reluctant to have herds and workers tested

Modes of infection with avian flu from poultry – a likely transmission path for some of the human cases

There is not enough testing infrastructure either. And farmers and their employees are reluctant to get themselves or their cattle tested, posing yet another problem in the US where there is no legal framework for mandatory animal tests.  

Similarly, for farm workers, testing and even wearing personal protective equipment is neither compulsory nor popular due to a general mistrust towards the official agencies, fear of lost revenue or, in the case of the workers, lack of a healthcare insurance.

Meanwhile, lax sanitation procedures in large dairy operations are big enablers of virus transmission, allowing cow-to-cow transmission when milking machines are not cleaned between every individual animal.

“Much more extensive follow up, serology studies and close monitoring of ‘mixing vessel animal species’, for instance pigs,” which can more easily incubate and transmit viruses to humans is needed, said Michael Osterholm, director of the University of Minnesota-based Centre for Infectious Disease Research and Policy (CIDRAP), in earlier comments to Health Policy Watch.

Overall, a more coherent plan of response is urgently needed in the Americas as well as Asia, Claes emphasized. In creating a plan, communication about the risk “with all stakeholders, from national governments to grassroots levels, is crucial to develop awareness and community engagement in tackling and controlling avian influenza.” 

Image Credits: Pickpik, USDA, CDC.