Israeli air strike at Yemen’s Sana’a International Airport, Thursday narrowly missed WHO Director General waiting to board a flight.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus was back in Geneva this week, after surviving a near miss from an Israeli Air Force strike on Sana’a International Airport, Thursday.

Airport TV footage aired Monday by the DG on X showed his entourage fleeing the VIP departures hall, where they had been waiting to board a UN flight, as the attack began.  A missile aimed at the airport’s air traffic control tower then sent shrapnel flying in the direction of the passenger terminal.

At least three people were killed while a crew member of the waiting UN plane was injured in the Israeli air strike, the largest to date. It came in response to months of Houthi missile fire into Israel, some 2200 kilometers away, including two strikes on Tel Aviv in the past ten days, which injured over a dozen people and destroyed a school.

Israel – ‘UN assets and staff not a target’

In a first-ever response to the incident on Monday, Israel’s UN Mission in Geneva declared in an X post that “UN assets and UN staff are not a target”. But Israel defended the strike saying it was aimed at “military infrastructure used by the Houthis for their terror activities, including in the Sana’a International Airport….

“Terrorist organizations must stop using civilian infrastructure to cover their terror activities,” the Israeli Mission continued. “The UN and the WHO should recognise terrorist organizations as such, stop justifying their activities, and address the regional situation in a fair and unbiased way. One-state-to-blame policy has never worked out, and never will.”

UN Security Council debate on escalating conflict

In a UN Security Council debate Monday, Khaled Khiari, UN Assistant Secretary-General for Middle East, Asia and the Pacific, warned about the new escalation of regional tensions, saying that attacks “originating from Houthi-controlled areas in Yemen must stop.”  But he also appealed to all sides “to respect and protect civilians and civilian infrastructure. Humanitarian workers must be protected at all times.

“The risks of disruption to vital humanitarian operations at a time when millions of people in Yemen are in need of life-saving assistance are of grave concern,” said Khiari.

But there was no sign that either the UN statements or the Israeli military reprisals would halt the strikes by the ad hoc regime, which is funded by Iran and has pledged to continue its attacks until the declared goal of an  Israeli ceasefire with Gaza is reached.

Late Monday evening, a Houthi missile aimed at Israel’s Tel Aviv and central region sent millions of people scurrying to shelters before it was intercepted, with some fragments showering down on a busy highway. That followed another ballistic missle strike early Saturday morning, aimed at the Negev and Jerusalem regions, and also intercepted.  Unlike the Islamic Hizbullah militia in Lebanon, which operated at close range to Israel’s border, the Houthi forces command vast swathes of distant desert from which they can launch projectiles, and remain unhindered by any other countervailing government force, observers said.

Tedros describes his ordeal

Thursday’s Israeli attack on Yemen targeted Houthi positions in and around the capital, including Hodeidah Port, power and fuel stations, and the airport’s runway and air traffic control tower – rendering the later inoperable.

Sana’a Airport control tower after the Israeli strike Thursday evening.

In his first X post that evening, the WHO Director General described the ordeal tersely, saying only, “As we were about to board our flight from Sana’a, about two hours ago, the airport came under aerial bombardment. One of our plane’s crew members was injured. At least two people were reported killed at the airport. The air traffic control tower, the departure lounge — just a few meters from where we were — and the runway were damaged. We will need to wait for the damage to the airport to be repaired before we can leave.

“My UN and @WHO colleagues and I are safe.”

Evacuated safely to Jordan on Friday

On Friday evening, after the WHO DG was evacuated to Amman, Jordan, accompanying the wounded crew member, a member of the UN Humanitarian Air Service (UNHAS), he spoke about the experience in more emotional terms, telling BBC Radio:

“It’s a matter of luck, if the missile deviated just slightly it could have been on our head.”

In Sana’a to negotiate with Houthi’s over release of UN workers being held hostage

The WHO DG had been in Sana’a with a United Nations team to negotiate with the Houthis over the release of more than a dozen UN workers who are being held as hostages by the rebel force.

Six staff of the Office of the High Commission of Human Rights (OHCHR) – one woman and five men – were arbitrarily arrested by the de facto Houthi authorities in June together with seven other UN personnel. A further two OHCHR staffers and two colleagues from other UN agencies have been detained and held “incommunicado” since 2021 and 2023 respectively.

The Houthis, a Shia movement aligned with Iran, took over the Yemenite capital of Sana’a in 2015, deposing the president who fled with Yemen’s UN-recognized government to Aden.

Since 7 October 2023, Houthi forces have been firing missiles intermittently at Israel, in support of the Palestinian Hamas fighting Israel in Gaza, as well as interrupting international shipping lines. On December 21, a Houthi ballistic missile fell in a Tel Aviv city park injuring some 16 people after Israel’s much-vaunted Iron Dome anti-missile system failed to intercept the projectile.  Two days earlier, another missile destroyed a school in the Tel Aviv suburb of Ramat Gan, although there were no injuries because structure was empty at the time.

Israeli media said the attack Thursday evening was the largest ever and included some 100 Air Force aircraft.

Speaking in a video statement, Prime Minister Benjamin Netanyahu of Israel said: “A short while ago, the Air Force attacked targets of the Houthi terrorist organization in Yemen, both along the coast and in Sana. We are determined to cut off this terrorist arm of Iran’s axis of evil. We will persist until we get the job done.”

Updated Monday 30.12.24

Image Credits: YNet/Yemenite TV , Al-Estiklal .

Filling up with water at a displaced persons’ camp in the war-torn Darfur region, where famine is prevalent.

More than 24.6 million people – one half of Sudan’s population – are experiencing high levels of acute food insecurity, according to the latest report of the Integrated Food Security Phase Classification (IPC), which tracks hunger risks and extreme hunger spots globally.

And famine (IPC phase 5) is present in at least five Sudanese areas in North Darfur and parts of the Western Nuba Mountains, according to the IPC’s Famine Review Committee, in its latest analysis, released on Tuesday, 24 December.

Without further access to aid in the conflict-wracked country, even more North Darfur areas will also face famine over the coming five months, the IPC predicted. And 17 other areas in North and South Darfur, Khartoum, and Al Jazirah states are at risk of famine, particularly in areas with high rates of internally displaced persons (IDPs), the review stated.

‘Famine is the most extreme manifestation of human suffering’

Large parts of Sudan face extreme food insecurity, with risk of famine in some places.

“Twenty months into the conflict, Sudan continues to slide into a widening Famine crisis characterized by widespread starvation and a significant surge in acute malnutrition,” the IPC Famine Review Committee (FRC) analysis stated. “This marks an unprecedented deepening and widening of the food and nutrition crisis, driven by the devastating conflict, which has triggered unprecedented mass displacement, a collapsing economy, the breakdown of essential social services, and severe societal disruptions, and poor humanitarian access.”

“Famine is the most extreme manifestation of human suffering, representing a catastrophic collapse of the systems and resources essential for survival,” the IPC  added. “It is not merely a lack of food but a profound breakdown of health, livelihoods, and social structures, leaving entire communities in a state of desperation.”

Famine (IPC Phase 5) first detected in August 2024 in Zamzam camp, North Darfur state, has not only persisted but also expanded to Al Salam and Abu Shouk camps and the Western Nuba Mountains for the period October to November 2024, the IPC committee found.

“Between December 2024 and May 2025, Famine is projected to expand in North Darfur localities including Um Kadadah, Melit, El Fasher, At Tawisha, and Al Lait,” they stated.  “There is a risk of famine in the Central Nuba Mountains (including in Delami, Western Kadugli, Um Durein, and Al Buram localities), and in areas likely to experience high influxes of IDPs in North and South Darfur,” as well as in Khartoum and Al Jazirah states.

Above-average rainfall during the May-October rainy season did provide relief in some areas of Sudan, allowing for more food production in areas where security conditions allowed, the report found. But the ongoing conflict has severely disrupted farming activities across vast swathes of the most affected regions.

Farmers were forced to abandon fields, and crops were looted or destroyed. Displaced families, particularly those in settlements and public buildings, are unable to access harvested foods.

UN Secretary General calls for warring parties to grant aid groups humanitarian access

UN agencies and partners are scaling up food assistance and other essential support programmes, said UN Secretary-General António Guterres.

However, ongoing fighting and restrictions on the movement of relief supplies and personnel continue to jeopardize aid operations.

“The Secretary-General reiterates his call for the parties to facilitate rapid, safe, unhindered and sustained access so that humanitarian assistance and staff can reach people in need wherever they are,” a statement by the SG’s spokesman warned.

RSF enjoys support from the UAE and Wagner group

The brutal civil war first erupted in April 2023 between the Sudanese Armed Forces, and the Rapid Support Forces, a paramilitary group previously operating under the auspices of the government of Sudan.

Built upon an association of tribal militias, the RSF has long wielded control over Sudanese gold mines in the Darfur area, with the precious metal exported to the United Arab Emirates where it was used to fund the RSF leader Mohamed Hamdan Dagalo (Hemedti) and the militia’s activities. The UAE is reportedly a key backer of the military force, with western countries as well as the UN largely turning a blind eye to the relationship, which has been condemned by Human Rights Watch and other humanitarian groups.  The RSF and its leadership also reportedly has connections with the Russian paramilitary Wagner group, which allegedly provided training and equipment to the fighters.

The conflict has claimed more than 20,000 lives and driven over 12 million people – nearly a quarter of Sudan’s population – from their homes. Fighting continues to rage, including in densely populated areas, with widespread reports of humanitarian law violations, as well as sexual violence, on the part of both the RSF and the Sudanese Armed Forces (SAF). On 19 December, three World Food Programme field officers were killed in an aerial bombardment of the WFP Field Office Compound in Yabus, Blue Nile State. The SAF denounced the attack, saying that it had no military activities in the area, while the RSF did not comment.


Health and education infrastructure lies in ruins while deadly diseases such as cholera are spreading, due to the lack of access to clean water and sanitation.

“Only a ceasefire can reduce the risk of famine spreading further and contain the already high levels of acute food insecurity,” the IPC report concluded.

Image Credits: IPC, UNICEF , IPC .

They reached out for a dialogue at the height of the COVID pandemic: Michelle Williams, then dean of Harvard’s School of Public Health, and Margaret Chan, dean of China’s Vanke’s School – face to face in  Geneva in May 2024.

In April 2022, amidst the continuing uproar of the COVID pandemic, four deans of schools of public health from the USA, China, Switzerland and Singapore, first got on a call with each other to see how they could ramp up cooperation – remotely.

Barred by lockdowns from the usual academic meetings and conferences, the urge to link up was stronger than ever.

Co-founders of the high-powered group were Michelle Williams, then dean of Harvard’s School of Public Health, and former WHO Director General  Margaret Chan, now dean of Beijing’s brand-new Vanke School of Public Health.

“At the height of the pandemic, my good friend here, Margaret and several others amongst us, decided that we needed to come together with deans of schools of public health, to promote solidarity, and to continue to be assertive about what global health diplomacy means for all of us,” said Williams at the first face-to-face Coalition meeting in May 2024.

“We were surprised at the lack of dialogue, the lack of cooperation and collaboration worldwide,” said Chan, of that difficult pandemic period. So, she was delighted when Williams reached out about a conferring virtually. “We felt that change is necessary, and we can make a contribution as universities – which represent the creation and translation of knowledge, through science, to policymaking.”

Other founding members included Antoine Flahault, director of the Zurich-based Swiss School of Public Health and long-time actor in Geneva, the world’s “global health hub”. And the deans of public health schools at the University of Cape Town; Mahidol University, Thailand. Heads of public health institutes in Huazhong, China, Mexico, Sydney, Chile and Singapore.

Online hosted by China

Vanke School of Public Health, Tsinghua University, China.

 That first encounter, organized online by Chan at the Vanke School, was naturally focused on health issues related to the COVID crisis – but with an eye beyond the immediate issues of vaccines, travel restrictions and lockdowns to the long-term challenges that everyone knew lay ahead.

Challenges like the need for countries to come together on the all-important task of building more resilient health systems, better prepared for the next pandemic.

“Working with Dr. Margaret Chan to co-create the Coalition was one of the few bright spots during the early part of the pandemic,” Williams, who recently stepped down as dean, told Health Policy Watch by email from California, where she is currently on sabbatical.

“I was delighted that Margaret, and I joined forces and then had other deans join us. I felt it was important that we academic leaders needed to redouble our efforts to break down real and perceived barriers to global health collaboration, cooperation and diplomacy.

“All around us, in political and public health practice spaces, I observed decision makers looking inward and sometimes missing the important imperatives and values of global public health,” Williams said.

“Vaccine nationalism, unthoughtful border closings and some other policies ran counter to public health, global health diplomacy and practice.  This was disheartening especially as pandemic threats, threats from climate change and other threats like antimicrobial resistance are global threats that require global cooperation.”

Linking academia’s public health leadership

‘Our aim is not to duplicate’, Antoine Flahault, dean of the Swiss School of Public Health (on left), with Geneva University’s Alexandra Calmy at a meeting of the Coalition in May, 2024

Indeed, while there are other established coalitions of Public Health Schools, mostly US-based, such as the American Association of Schools of Public Health, the World Federation of Schools of Public Health, and the Consortium of Universities for Global Health, one unique aspect of the GHF-based Coalition of Deans has been the way it links public health leaders, and not only the institutions, says Flahault.

“Our aim is not to duplicate, but to be complementary to all of these groups, with which we coordinate,” he said.

The loosely-knit group now includes about a dozen institutions, as well as the leading European and American associations or federations of Public Health universities and schools.

“Our vision is that this Global Coalition will allow us to learn more from each other, sharing our experiences, facilitating exchanges of students and faculty among schools and fostering joint research programs,” Flahault observed.

Adds Michel Kazatchkine, a physician, academic and former French diplomat, who also spoke at the group’s last meeting on the margins of the World Health Assembly:

‘Increasing interest in health diplomacy’: Michel Kazatchkine, physician and former diplomat.

“We’re now seeing an increasing interest in health diplomacy. But in this context, academia is particularly important because science is essential in evaluating the impact of policies and providing feedback analysis to politicians so that they can correct trajectories if needed.

“And academia provides the freedom to do research on any topic, even the most sensitive – to collect, analyze and speak about the findings of your data. So, we should not underestimate the role of academia as a fundamental pillar of knowledge-based, democratic societies.”

Focusing on planetary health and other neglected topics

The Sydney School of Public Health’s Flagship planetary health initiative in Fiji was one example featured at the Geneva Health Forum. A study of watershed interventions, it aims to reduce incidence of typhoid, dengue and other deadly diseases in Pacific Island countries.

This year, after two years of remote meetings organized by the Vanke School and Harvard in succession, members of the coalition convened face-to-face, for the first time in Geneva, on the margins of the World Health Assembly, hosted by the Geneva Health Forum and the University of Geneva.

The group focused on planetary health as their principal topic.

“We shared experiences from Australia, China, and the USA about academic programmes dedicated to this issue – and asked the question: how do schools of public health integrate planetary health into their curriculum?” Flahault said. Doctoral and masters’ students from selected schools were also invited to speak along with faculty about lessons learned, he noted.

The discussions continued a thread from the 2023 remote meeting, which examined climate-driven food insecurity in the global health context – another cutting- edge issue that rarely gets much attention in classic public health school textbooks or classrooms.

“The Coalition of Deans have already been instrumental insofar as bringing attention to the importance of creating multi-national and interdisciplinary collaboration to bring multiple perspectives into designing curriculum,” reflected Williams.

“We’ve also provided a platform (as seen in the meeting hosted by Prof Flahault last spring) for showcasing junior faculty members and graduate students working in the fields of global planetary health and environmental justice,” Williams pointed out.

The effort is all the more topical insofar as Harvard’s Chan School of Public Health just launched a concentration in climate and planetary health in 2024.

In China, the Vanke School is also planning to pilot a planetary health course in 2025. That course will bring together students of public health with those in students from economics, urban design, environmental health sciences and engineering to examine multi-sectoral challenges and design solutions, said Chan, speaking with Health Policy Watch.

Chan: Vanke’s new planetary health course will bring together students of diverse disciplines.

“Everyone knows about how John Snow stopped the cholera epidemic [by breaking the pump on a contaminated water cistern], but what about the sanitary engineer who helps to renovate and overhaul the London sewage system,” Chan said.

Tsinghua University, where the Vanke School is located, is world famous for its engineering school, she observes.  “So. this will train future decision-makers to bridge between disciplines such as engineering and health.”

Indoor air pollution and wastewater epidemiology

Along with partners in the WHO, the GHF and European Universities, Coalition members have also supported the development of a series of events on other interdisciplinary health topics over the past year.

These included a conference on Indoor Air Pollution, in September 2023 in Berne, as well as a recent Conference in Paris on Wastewater-based Epidemiology. See related story:

Post Pandemic: Wastewater-based Surveillance of Diseases Comes of Age 

 

“Of course we have moved on from the pandemic to other topics,” noted Chan, speaking with Health Policy Watch recently in a phone interview. “The change in the conversation is a reflection of the changes in the current trends in Public Health. And it’s going to be more diverse as we move along.

One topic she’d like to see the Coalition tackle at some point would be the challenges of harnessing AI for good in the broad context of public health research and policymaking.

“There is a lot of talk about AI in clinical work, but what about AI in public health?” she asks. “Patient confidentiality is important. But we also need policies in place to enable the use of AI in research and outreach, but also to protect people’s privacy.”

Whatever the theme may be, the approach is the same, says Williams, who was instrumental in establishing a student exchange programme between Harvard and the Vanke School in 2021.

“Sharing of teaching materials and experiences related to launching new courses and concentrations are ways we can facilitate the spread of ideas across other universities.

“Developing and supporting annual workshops, and supporting student and faculty exchanges, are another. It is hoped that the Deans can secure resources to help operationalize these collaborative initiatives.”

Looking forward to 2025

Cabo Verde's Minister of Health, Filomena Mendes Gonçalves.
Geneva Health Forum 2024 session on malaria elimination with Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves.

Looking forward, Flahault says the group aims to maintain its informal modus operandi, to facilitate exchange across borders – and keep the focus on meaningful meetings and liaisons.

“We are a lean organization without any budget and staff and not competing with any other organizations,” Flahault said.

At the same time, he envisions the Coalition playing an advisory role in a soon-to-be-formed Think Tank that aims to continue dialogue and problem-solving around the themes of the Geneva Health Forum throughout the year. “One major fruit or byproduct of this will be the GHF Think Tank, which we are launching this spring, and will tap the academic network the Global Coalition assembles,” he said.

That, in addition to their annual meetings, on the margins of the Geneva Health Forum’s annual conference during the World Health Assembly – with the next event organized by Teo Yik-Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Now that face-to-face meetings are once more feasible, working from the Geneva axis offers a unique vantage point that can transcend some of the sharp geopolitical divides that academic leaders face in dialogues at other venues, Flahault also points out.

Says Chan, who served as WHO Director General from 2006-2017, “I’m very biased – to me, Geneva is the capital of public health. And all countries come to the World Health Assembly. So, it’s natural that all of us in the Coalition would meet here, to make our voices heard.”

Returning to basics of infectious disease elimination

A child paralyzed by polio breathes in an iron lung – the best available intervention before the polio vaccine’s discovery in 1955.

Along with emerging global health issues around climate and planetary health – Flahault sees a future role for the group in reviving interest around some of the world’s longstanding, and unsolved public health challenges – such as elimination of polio, cholera and other preventable infectious diseases.

“Personally, I would love to see a WHA resolution against the three major diseases, polio malaria and cholera – with the same sense of determination we displaced against smallpox in the 1950s and 60s, with the same sharp formulation, we want to eradicate these diseases as soon as possible,” he said in a recent interview.

 “All of the major actors would push and row together to make this successful. For polio it’s already done but we have to say we have to end the job.

“We need to be modest and realistic,” Flahault admitted. “Surely, eradicating cholera from the planet, which has already been the subject of one WHA resolution, needs a huge political commitment. This is not in the portfolio of the Global Coalition or schools of public health.

“But we could still play a role. With players in the media ..we could try to mobilize political leadership which is lacking today. We don’t have many political leaders embracing global health issues, as happened during the pandemic, but today global health issues remain a source of power for promoting multilateral commitments.

“And in the coalition, we have a great opportunity for liaison between China, the USA and Europe and all of the other constituencies that are in the room, which give us an opportunity to push public health as a form of ‘soft power’ to move forward agendas.

After all, we succeeded in the 20th century to eliminate smallpox at the height of the cold war between the USSR and the USA.  It was not easy, but we succeeded thanks to a shared commitment to health.”

–Written as part of a Health Policy Watch collaboration with the Geneva Health Forum.

Image Credits: Vanke School of Public Health , Aaron Jenkins, Sydney School of Public Health, Geneva Health Forum, Paul Palmer/ WHO.

A healthworker administers polio vaccination in Pakistan’s sensitive northwestern region.

ISLAMABAD – Pakistan’s last countrywide anti-polio drive of 2024 is set to conclude on 22 December but eradicating polio remains a challenge for the government, and this year’s surge in cases has resulted in calls for an independent audit of the program.

Pakistan and Afghanistan are the last two countries in the world battling to eliminate polio. In Pakistan, 63 polio cases have emerged this year in comparison to six in 2023, raising eyebrows about the strategies adopted by the government and international organizations working on polio eradication.

Shahzaib Khan, a health worker from the northern district of Mansehra in Pakistan’s Khyber Pakhtunkhwa province, is one of those grappling with these concerns.

Shahzaib, who works as a vaccinator in the health department, participated in the countrywide anti-polio drive with the target of vaccinating 44 million children five and under. Around 260,000 frontline workers are involved in the campaign.

As a frontline polio worker, he believes that the check-and-balance system at the district level has weakened, resulting in rising polio cases.

According to Khan, while the number of polio vaccination teams in each district has increased, there has been a reduction in those monitoring their performance at the district level. 

“Previously, these teams numbered up to 80 per district, but now the minimum has reduced to around eight, which has affected the standard of monitoring field teams,” Khan said.

Moreover, the long gaps between national polio campaigns allows the crippling disease to strengthen its roots, he added. For instance, in Naran, Khyber Pakhtunkhwa, the recent campaign was conducted after a seven-month hiatus.

Increase in cases

Aside from the, 63 cases have been reported this year, positive polio samples from 27 districts indicate a potential increase in cases in the coming days.

The highest number of cases has been reported in Balochistan, Pakistan’s southwestern province, with 26 cases, followed by Khyber Pakhtunkhwa with 18, Sindh with 17 and one case each from Punjab and the federal capital, Islamabad.

The polio elimination program faces major challenges from population migration, cross-border movement with Afghanistan and the refusal from some tribal communities and ultra-conservative groups in remote areas to allow vaccinations.

These communities, where the government also struggles to establish its writ, consider anti-polio drives as a ‘Western conspiracy’ against their children, allegedly believing it will harm the children’s fertility.

Polio teams in these areas are sometimes subject to armed attacks. During the recent seven-day national anti-polio campaign, two security personnel and five children were killed in such attacks in Balochistan and Khyber Pakhtunkhwa.

Conspiracy theories

Abdul Basit, a health department official from southern province of Sindh, noted that mistrust about the polio program exists among some communities and parents who either see the polio vaccine as a conspiracy or believe it is harmful to their children’s health.

In areas where security threats hinder polio teams, incidents of fake vaccination marking and data are common, he added. There is no national or provincial law to deal with parents who refuse polio drops for their children or those involved in falsifying data. 

Basit believes paediatricians can play a crucial role in educating parents about the positive effects of the vaccine, as they are often the first to be consulted when children fall ill. He would like to see a comprehensive strategy involving pediatricians at primary health centers to educate parents about the importance of the polio vaccine for their child’s future.

Prime Minister’s intervention 

Prime Minister Shahbaz Sharif, during a high-level meeting on polio, expressed confidence that the country would soon be free of polio, but he has also ordered a third-party audit of the polio campaign.

He has also directed top health officials to form a comprehensive strategy to reduce the immunity gap.

The Prime Minister’s Office in its statement reiterated its commitment to eradicating polio from the country through concerted efforts.

Meanwhile, former federal minister and public health expert Dr Nadeem Jan believes that the current immunity gap can be reduced within two years if there are changes in the polio program.

Jan said that while the high number of polio cases in a single year is concerning, the virus’s spread can be contained with a new approach. He proposes that Pakistan integrate the polio program with the routine immunization program.

“Routine immunization is already accepted within communities and does not face the same level of resistance as the polio program, therefore, the polio program should also be managed under the Expanded Program on Immunization (EPI),” said Jan.

Jan also stressed the need for a third-party audit of the program to ensure its effectiveness.

‘Significant failure’

However, Dr Abdul Ghafoor Shoro, general secretary of the Pakistan Medical Association (PMA), the country’s largest body representing physicians, has described the rise in cases as a failure of the program.

“This alarming trend indicates a significant failure in the polio eradication efforts, and PMA calls on the government to take immediate and decisive action to address this critical situation,” said Shoro.

He claims that the current approach, which appears reliant on a bureaucratic and foreign-funded system, has failed to contain the virus.

The PMA has demanded a comprehensive and transparent investigation into the reasons behind the resurgence of polio, including a thorough assessment of the existing polio eradication program, the role of the government, and the effectiveness of the current strategies.

The PMA also urged the government to immediately implement a robust and effective polio eradication strategy, increase public awareness campaigns and strengthen the surveillance system to ensure timely detection and response to new cases.

It also emphasized that adequate resources and support need to be provided to the polio eradication program, and those responsible for the failure to control the spread of the virus need to be held accountable.

Militancy and insecurity

Door-to-door campaigns, a critical part of the polio eradication strategy, are difficult in districts with high insecurity.

The World Health Organization’s (WHO) regional polio eradication director Dr Hamid Jafari, told a webinar hosted by Global Polio Eradication Program that the current polio resurgence in Pakistan and Afghanistan is not comparable to the catastrophic levels witnessed decades ago, when over 20,000 children were paralyzed annually in Pakistan alone.

“By 2021 to 2022, Pakistan reported just one case of wild poliovirus, while Afghanistan recorded two. This is a dramatic improvement compared to the 176 cases reported in 2019 across both countries,” Jafari noted.

However, he explained that resurgence in polio is a predictable pattern in eradication efforts. “Until you completely eliminate the virus, it will resurge and come back,” he remarked.

Jafari highlighted several immediate causes for the recent rise in polio cases. These include the large-scale repatriation of Afghan nationals which triggered unpredictable population movements within Pakistan and across Afghanistan. 

Challenges such as militant insurgencies and insecurity have hindered vaccination campaigns in certain regions as “children in these insecure areas cannot be consistently vaccinated,” he explained.

Jafari also pointed to vaccine hesitancy and community boycotts driven by unmet expectations for broader services as significant obstacles.

Despite these setbacks, both Pakistan and Afghanistan are actively working to counter the polio resurgence using measures such as remapping and identifying children who missed vaccinations, particularly among migrant and mobile populations, he added. 

Strategies also address vaccine fatigue and hesitancy by rebuilding community trust and confidence. Pakistan and Afghanistan are collaborating with their respective security forces to access children in insecure regions, he added.

“In Afghanistan, where door-to-door vaccination campaigns are not feasible, WHO is working closely with local authorities and communities to ensure children are mobilized for vaccination,” he said.

 Jafari expressed optimism about the future, stating that the current resurgence does not signify a return to high case levels: “Next year, we are confident we will come very close to elimination.”

He emphasized the importance of overcoming challenges in the virus’s remaining safe havens – insecure areas, mobile populations, and vaccine-hesitant communities.

National priority

The Prime Minister’s health coordinator,  Dr Mukhtar Ahmed Bharath said polio eradication is our first national priority under the leadership of the Prime Minister of Pakistan.

He said necessary measures are being taken on an emergency basis for the complete eradication of polio and an effective road map has been laid out for the success of the upcoming polio campaigns.

“All resources and capabilities will be utilized to stop the spread of polio virus and for high-risk areas, the federation and the provinces have jointly formulated an integrated strategy,” said Bharath.

“Complete eradication of polio is our national goal, and the cooperation of parents is very important to achieve this goal.”

The health ministry’s spokesperson Sajid Shah, told Health Policy Watch that that a high-level review meeting,  chaired by the Federal Secretary of Health and the Chief Secretary of Khyber Pakhtunkhwa, was held to discuss the current situation of polio and its related challenges.

The meeting resolved to take strict disciplinary action against those who make fake finger markings in anti-polio drives while special integrated strategy attention is being formulated for the high-risk areas.

“With all efforts from the government parents are requested to cooperate fully with the polio teams for the healthy future of their children,” said Shah.

 

Image Credits: Pakistan Polio Eradication Program .

Sugary drinks now face additional taxes in Brazil.

Brazil’s National Congress approved a selective tax on tobacco, soft drinks, and alcohol this week as part of wide-ranging fiscal reform that also saw a reduction in taxes on healthy foods.

The trio of unhealthy consumables is now located in the same tax category as harmful goods and products including coal, vehicles and betting.

The specific tax rates for tobacco, alcohol, and soft drinks will be determined in 2025, but they will need to be high enough to deter consumers from buying these products to have an impact on health. 

The Congressional vote is a victory for advocacy groups as the Brazilian Senate had removed sugary drinks from the selective tax a week earlier, causing a public outcry.

The tax reform also establishes a National Basic Food Basket (CBNA) that will be tax-exempt. Meat, poultry and fish are included in this basket.

In addition, taxes have been slashed by 60% on horticultural and minimally processed goods including crustaceans, dairy products, honey, flour, cereals, pasta, juices, bread, nuts and fruit.

Lowering the price of healthy food

Brazilian legislators and civil society advocates aim to ensure that the prices of healthy foods are not higher than those of ultra-processed and unhealthy products.

 “This is a landmark moment for Brazil and a historic victory for global public health,” said Pedro de Paula, regional country director for the global public health organisation Vital Strategies in Brazil.

“By implementing a tax on these products, Brazil is not only saving lives by curbing the consumption of harmful products but also championing equitable access to healthier, more sustainable alternatives.  We commend Brazil’s National Congress for their leadership in this critical effort.”

De Paul said fiscal reform was necessary as Brazil had a “very complex, clunky system for production and consumer taxes”.

The new selective tax is an excise tax “for a handful of products which had clear negative externalities in terms of health and environment’, he added.

“This is landmark change, since it establishes a system that has clear taxes on top of the general VAT-like taxing structure with a clear narrative and purpose of reducing consumption and internalising the costs of the mentioned negative externalities,” he added.

While the tax will not be ring-fenced for health, De Paulo said that as the health system in Brazil is based on universal and free access, “any additional revenue implies additional minimum investments on health.”

However, Vital Strategies raised concerns about some of the provisions, such as “the inclusion of infant formula in the basic food basket and reduced tax rates for small alcohol producers.”

It will “collaborate closely with partners to advocate for tax rates that prioritise public health”, as “setting these rates at levels that significantly reduce consumption of harmful products will protect communities from preventable diseases.”

Sweetened beverages including soft drinks, artificial juices, and teas are “among the most consumed food groups in Brazil, with an average consumption of 65 litres per year per individual,” according to a recent article in the journal, Nature.

“Excess sugar is considered one of the main causes of excess weight and, consequently, its associated diseases (type 2 diabetes, hypertension). Therefore, the consumption of sugar-sweetened beverages is associated with an increased risk of developing obesity.”

Image Credits: Heala_SA/Twitter.

Africa CDC Director General Dr Jean Kaseya (centre) visiting DRC to assist with its mpox outbreak

Although malaria, compounded by malnutrition, seems the most likely cause of the mysterious illness in the Democratic Republic of Congo (DRC), haemorrhagic fever syndrome has not been ruled out.

Dr Ngashi Ngongo, mpox lead for Africa Centres for Disease Control and Prevention (Africa CDC), told a media briefing on Thursday that there were two “working hypotheses” currently being verified: either severe malaria against a background of malnutrition and viral infection, or a viral infection against a background of malaria and malnutrition.

The DRC had reported to Africa CDC earlier that day about the death of a man from the Panzi district suffering from the haemorrhagic fever syndrome, a term used for a group of viral diseases that can cause bleeding and damage to the body’s organs.

“His sample has been taken and sent to Kinshasa for laboratory testing,” said Ngongo.

However, with malaria confirmed via PCR in 86% of patients tested, “the diagnosis is leaning more toward malaria”, he said.

But the high case fatality rate of 6.2% (37 deaths out of 592 cases) triggered further investigation as this is way higher than usual for malaria.

The 37 deaths happened in health facilities but a further 44 community-based deaths are still being investigated, he added.

Of the 88 patients given rapid malaria tests, 55% were positive, while 25 of the 29 samples subjected to PCR tests were positive for malaria (86%). 

It is hard to confirm when an accurate diagnosis will be possible given the complications, including getting samples to laboratories, he added.

Mpox vaccinations too slow

Africa CDC is “not at all satisfied” with the fact that only 56,000 people have been vaccinated against mpox in DRC, said Ngongo.

The country has received over one million doses (people need two doses), so the DRC is “very far from reaching the target that they had set for themselves”.

Meanwhile, the arrival of 50,000 doses of the long awaited Japanese LC16 vaccines that are suitable for children is imminent. Japanese experts have been in the DRC training health workers on how to administer the vaccines.

Africa CDC convened a three-day mpox meeting in Ethiopia this week to review the continent’s response. This was attended by Burundi, Central Africa Republic, Cote d’Ivoire, DRC, Kenya, Liberia, Uganda, Nigeria and South Africa and seven partners including Africa CDC and Gavi.

One of the reasons the DRC gave for its slow vaccination rate at the review was “the demotivation of the response teams”, said Ngongo. While partners “have made allocations to provide some financial motivation, that will be conditional on performance”, he added.

The meeting identified eight priorities, the first being to “intensify resource mobilisation, including a funders conference”, as only 20% of pledges have materialised.

Other priorities include intensified country support for the hardest-hit countries, better data management systems and the acceleration and expansion of vaccinations. Countries also want to tackle co-infections like measles.

The mpox outbreak is now active in 15 countries, and continues to spread steadily. In the past week, 3,095 new cases were reported in comparison to 3,545 the previous week, said Ngongo.

Children below the age of 15 now represent about 34% of cases, while females now represent 54%. There has been a 789% increase in cases over 2023.

The DRC has the highest burden of cases, with 2,632 new cases and 29 deaths in the past week. Children under the age of 15 make up almost half its cases.

While Burundi, which has the second highest mpox burden, has not yet committed to vaccinating its citizens, its representatives at the review were “very interested to learn from the experience of DRC”, said Ngongo. 

The DRC shared their initial experiences at the review, and Burundi intends to integrate lessons from this into their country interaction review and make a recommendation on vaccinations.

Africa CDC will be part of Burundi’s action review in early 2025 “to be able to guide them in setting up priorities, including the decision on mpox vaccination”, Ngongo added.

Rwanda celebrates end of Marburg outbreak

Meanwhile, Rwanda has planned a celebration in its capital, Kigali, on Friday (20 December) to mark the end of its Marburg outbreak.

“This success is the result of the swift and coordinated effort that was laid by the [Rwandan] Ministry of Health, in collaboration with Africa CDC, WHO and all the key partners,” said Ngongo.

“Some measures that have contributed to this success include the leadership commitment with a prompt and transparent communication from the Minister of Health,” he added.

“We’ve also seen the enhancement of the national surveillance systems that allowed for early case detection, the intensified contact tracing and the early case isolation. 

“We also saw very high level of laboratory testing with a very short result to turnaround. We saw also the expansion and the upgrading of treatment facilities that were really of a global standard. 

“And finally, there was really an intensification of the awareness campaign to ensure that the public I got the necessary information on how to prevent the infection.”

Rwanda had one of the lowest case fatality rates in a Marburg outbreak, estimated at 22.7%, in comparison to previous outbreaks where the case fatality rate was around 50%.”

Image Credits: Africa CDC.

An Afghan woman amongst ruins caused by ongoing conflict in the country.

Medical institutions were the last hope for Afghan girls and women seeking higher education since the Taliban banned schools and universities for women

“Why do you torture us every day? Just give us poison and end it all,” a heartbroken Afghan medical student told Taliban forces, expressing the despair of thousands of girls whose dreams of becoming healthcare professionals were shattered by the Taliban’s latest decree.

The hardline group has banned all female medical students from pursuing education, marking the closure of nursing and midwifery programs across Afghanistan, the last lifeline for girls seeking higher education in a country where women’s rights have been systematically eroded since the Taliban’s return to power in 2021.

The Taliban’s recent decree, issued directly by the group’s supreme leader, Hebatullah Akhundzada, has caused immediate devastation. 

For the past three years, nursing and midwifery were the only remaining fields of study open to women after the Taliban banned girls from attending secondary schools and universities. The abrupt closure of these institutions has ignited widespread despair across Afghan society.

The ban comes a few months after the Taliban banned women’s voices and faces in public under so-called new vice and virtue laws. 

‘Are we not human?’

The abrupt ban came just days before completion of the last 2024 semester for many aspiring students like Zohra*, a nursing and midwifery student at the Abu Ali Sina Institute in the country’s northern Balkh province.

She told the Health Policy Watch: “These institutes were our last chance to continue our education after schools and universities were closed. I had set a new goal and worked hard, receiving good grades. I was on my way to becoming a midwifery graduate, to help my family, my country, and other women. Now, I’ve truly lost all hope for life.”

Kabul-based Maryam* echoed the despair. “We are Muslims, we observe Islamic hijab, and we just want access to education. Why do they not open the doors of the medical institutes for us? Since the closure of the institutes, I’ve lost track of day and night. I can’t sleep. My parents took me to a psychologist a few times, but nothing is helping. Are we not human?”

‘I have turned homeless’

“I have turned homeless, wandering aimlessly,” one student said in a viral video. Her words, along with others like it, have echoed through Kabul and beyond as girls wearing full-body black veils, many in tears, left their classrooms for the final time, uncertain if they would ever return.

Fariba*, a mother from Kabul, received devastating news when her daughter, Parwana, called early one morning, sobbing uncontrollably. 

“She never calls at this time,” Fariba, who once taught elementary education to girls, told Health Policy Watch. “It’s when she’s in class.” 

Her daughter Sara* had been studying nursing after her dream of attending university to study computer science was dashed by the Taliban’s closure of higher education for girls.

“Now, we are left without hope,” Sara, 20, lamented. “Our dreams are shattered. We are being pushed into the darkness.”

Conservative estimates suggest that around 35,000 girls were enrolled in over 150 private and 10 public medical institutions offering diplomas in fields such as nursing, midwifery, dentistry, and laboratory sciences before the Taliban’s ban. 

These programs were the last available option for young Afghan women who sought to contribute to their communities, particularly in healthcare.

The abrupt suspension has left students in shock. The administrator of one of the nursing institutes sent a message to all female students: “With a heavy heart, I must inform you that until further notice from the Islamic Emirate, you must not come to the institute for studies.”

Deepening health crisis

Training to be a nurse or midwife was the sole remaining career option for Afghan women after the Taliban takeover in 2021.

This move not only marks the end of the academic ambitions of girls and women, but also deepens the country’s already precarious healthcare crisis.

Afghanistan’s healthcare system was already under strain before the Taliban’s return to power, with one of the highest maternal mortality rates in the world. 

In 2020, the country saw 620 women die for every 100,000 live births – a stark contrast to just 10 deaths in the UK, according to the World Health Organization (WHO). 

Less than 60% of births were overseen by trained health personnel in 2019, according to the  United Nations Population Fund (UNFPA), which estimates that Afghanistan requires an additional 18,000 skilled midwives to meet the needs of its women.

Despite the overwhelming need for female healthcare workers, the Taliban’s decision to block access to medical education for women will exacerbate the crisis. 

Médecins Sans Frontières (MSF) warned that the country’s lack of female healthcare professionals would directly impact the provision of essential health services, especially maternal care.

“There is no healthcare system without educated female health practitioners,” said Mickael Le Paih, MSF’s Country Representative in Afghanistan. 

“In MSF, more than 41% of our medical staff are women. The decision to bar women from studying at medical institutes will further exclude them from both education and healthcare.”

The healthcare sector’s reliance on female professionals is especially critical in Afghanistan, where cultural norms often prevent women from being treated by male doctors. 

Dr Ahmed Rashed, a Kabul-based health policy expert, warned that the Taliban’s latest decree would create numerous social challenges, especially for Afghan women who prefer to be treated by female healthcare workers.

“If girls cannot attend secondary school, and women cannot study at universities or medical institutes, where will the future generation of female doctors come from?” Rashed asked. “Who will provide healthcare to Afghan women when they need it most? For essential services to be available to all genders, they must be delivered by all genders.”

International outcry

Last week, the United Nations (UN) Security Council criticized the medical education ban and the “vice and virtue” law issued in August in a unanimous resolution voicing concern about “the increasing erosion” of human rights in the country.

“If implemented, the reported new ban will be yet another inexplicable, totally unjustifiable blow to the health, dignity, and futures of Afghan women and girls. It will constitute yet another direct assault on the rights of women and girls in Afghanistan,” according to UN Special Rapporteurs working on women’s rights, human rights and health. 

“It will undoubtedly lead to unnecessary suffering, illness, and possibly deaths of Afghan women and children, now and in future generations, which could amount to femicide.”

The Norwegian Afghanistan Committee (NAC), which trains female healthcare workers in collaboration with the Ministry of Health, reported that it had been verbally informed that classes for women would be “temporarily suspended.” 

As the Taliban’s gender-based restrictions continue to devastate the lives of millions of Afghan women and girls, the question remains: What is the future of Afghanistan’s healthcare system? Without access to education, Afghan women will be barred from becoming the doctors, nurses, and midwives their country so desperately needs.

This decision, experts warn, will not only create immediate social and healthcare challenges but will have long-term consequences for generations to come.

* Names changed to protect their identities. Updated 22.12.2024.

Manija Mirzaie is an Afghan journalist now based abroad.

 

Image Credits: WHO EMRO, Ifrah Akhter/ Unsplash.

Particles of air pollution settle on the leaves in a south Delhi neighbourhood where the PM 2.5 is  approximately 400 micrograms/cubic metre.

New evidence shows that one in four deaths between 2009 and 2019 is linked to PM 2.5, one of the most dangerous pollutants commonly monitored. 

NEW DELHI – In November Delhi recorded its worst day of air pollution since 2019. As concerned citizens expressed outrage, authorities scrambled for answers – and it seems that the dirty air crisis may be worse than previously reported.

A new study published in The Lancet this week analyses the link between air pollution and deaths in districts (an administrative jurisdiction of a state or province) in India over 11 years from 2009. 

It shows pollution is not just a Delhi problem nor is it a recent problem, estimating that during the time period, 16.6 million deaths are attributable to PM 2.5 pollution. This is the particulate matter pollutant that is much finer than human hair that penetrates deep into the human body. 

The report is timely as the Supreme Court is now expanding the scope of its air pollution hearing from Delhi to cover all of India. 

A south Delhi neighbourhood with PM 2.5 at approximately 400 micrograms/cubic metre.

The study calls for a fundamental rethink of India’s battle against air pollution. Firstly, it shows 24.9% of deaths – almost one in four – are attributable to air pollution, more specifically PM 2.5. 

Secondly, it calls for India’s regulatory standards for air quality to be tightened. The Indian National Ambient Air Quality Standards for annual mean PM2.5 is 40 micrograms per cubic metre (µg/m³) whereas WHO’s guideline is 5 (µg/m³). 

Thirdly, the authors say this report is more relevant to policymakers than previous reports as it is based on data from India. In the past senior Indian government officials have questioned or rejected data linking deaths to air pollution, particularly from global agencies. 

More deaths than previously estimated

The Lancet report found an average of 1.5 million deaths from air pollution between 2009 and 2019, almost a quarter of all deaths.

This is a higher estimate of mortality than earlier studies. For instance, a WHO study reported an average of 830,000 deaths annually in the decade ending 2019, a conservative estimate based on secondary data sources. 

A study for 2019 by the Indian Council of Medical Reseach (ICMA), a government agency, and others estimated 1.7 million deaths. The new study tops that with 1.8 million attributable deaths for that year.

Applying the more relaxed guideline of 40 µg/m³ for PM 2.5 set by the Indian government, the number of deaths is estimated by the Lancet report to be 3.8 million over 11 years, or 300,000 every year. 

The entire population of India breathes air of a quality worse than the WHO’s guideline for an annual average.

New data is ‘more credible’ 

While there have been several large-scale studies globally on the link between PM 2.5 air pollution and deaths, this is the first such one in India which in recent years has the most polluted places. 

One of the authors, Dr Siddhartha Mandal, told Health Policy Watch that studies usually make associations between exposure to PM 2.5 and mortality. However, this report “lends more credibility” to the numbers because it uses a difference-in-difference approach to reach causal estimates. This methodology compares the changes in outcomes over time between a treatment group and a control group.

(A) Annual mean concentrations of PM2·5 in 2009. (B) Differences in annual concentrations in 2014 compared with 2009. (C) Differences in annual concentrations in 2019 compared with 2009.

“We believe that our study provides the most accurate exposure-response function and health impact assessment in India to date based on causal estimations from a state-of-the-art comprehensive exposure assessment and nationwide mortality data collected in India,” according to the authors.

It covers air pollution across 655 districts of India. The authors collected and analysed national counts of annual mortality for the 11 years, and also factored in the population and GDP per capita for each district. 

The authors say they observed stronger associations between annual PM2.5 averages and mortality in poorer districts (in terms of GDP).

Risk of death rises with pollution

In a country racked by an air pollution health crisis, there is one pressing figure for policymakers. Every 10 microgram/cubic meter increase in PM 2.5 leads to an increase in all-cause mortality rates by 8.6%, the study estimated. 

PM2·5 concentration is shown up to the 99th percentile.

While the AQI at 500 or 1,000 grab headlines, what the research points out in terms of health risks at lower levels is an eye-opener. 

“As the exposure levels increase, a plateauing effect is seen where, if you keep increasing the levels, additional increments in health are likely to be small,” says Mandal, who is affiliated with the Centre for Chronic Disease Control, New Delhi, and the Centre for Health Analytics and Trends, Ashoka University.

Simply put, that means that the risks rise from much lower levels of PM 2.5, when many thought the air quality was fine, but as the levels become extremely high, the risk may plateau or taper. 

How PM 2.5 harms humans

“Due to its size, PM 2.5 can enter the bloodstream and hence gets transported to multiple organs,” Mandal explains.

“Thereafter several common mechanisms such as inflammation and oxidative stress are triggered or exacerbated in the tissues.

“One of the major ways by which PM2.5 affects cardiovascular health is by inducing an imbalance in the autonomic nervous system, which controls several involuntary functions in humans such as cardiac rhythm. So PM2.5 contributes in multiple ways leading to exacerbation or acceleration of these conditions and subsequently death.”

A few days before this report was published, the Indian government reiterated in Parliament that “there are no conclusive data available in the country to establish direct correlation of death/disease exclusively due to air pollution.

“Health effects of air pollution are synergistic manifestation of factors which include food habits, occupational habits, socioeconomic status, medical history, immunity and heredity etc. of the individuals.” 

However, the authors say that policymakers could first take stock of all the recent work done relating air pollution and health (including mortality) using Indian data.

Experts from multiple domains, including public health, clinicians and engineering disciplines can deliberate on how to incorporate health-related evidence into designing interventions, mitigation strategies as well as revision of air quality standards. 

In parallel, there should be targeted actions backed by scientific evidence in the short and long-term, rather than reactive actions. For example, one could design and test out a public transport based intervention in certain areas within Delhi to assess how it affects pollutant levels across time. 

But they say, “most importantly, we should not wait for a perfect study to emerge and rather utilise available national as well as international evidence to take steps to improve the quality of air in the context of health.”

Image Credits: Chetan Bhattacharji, The Lancet.

Robert F Kennedy Jnr, Trump’s pick for US Health Secretary

Robert Kennedy Jr, President-elect Donald Trump’s nominee to lead the United States health system, arrived in Washington, D. C. on Monday to rally support from lawmakers for his candidacy amid fears from health experts that the anti-vaccine activist and lawyer could roll back hard-won public health gains credited with saving millions of lives and protecting more from deadly disease.

Kennedy’s campaign on Capitol Hill kicks off following revelations last week by the New York Times that Aaron Siri, his lawyer on the campaign trail who is helping him vet picks for federal health officials at the Florida white house in Mar-a-Lago, petitioned the Food and Drug Administration (FDA) to revoke its approval of the polio vaccine.

The polio vaccine, first approved over 70 years ago, has protected hundreds of millions of people in the US and around the world from the deadly disease, which primarily affects children under five, attacking the nervous system and causing paralysis and death.

“RFK Jr has spent virtually his entire career casting doubt about vaccines. This is all part of a pattern that has gone on for a decade or more,” Lawrence Gostin, a public health expert at Georgetown University, told Health Policy Watch. 

“Vaccines are among the most studied medical interventions, far safer than many medicines in people’s homes that they take regularly, such as ibuprofen.

“We need widespread vaccination coverage to protect everyone,” Gostin added.

Before the first poliovirus vaccine in 1955, children affected by polio depended on a mechanical respirator known as an “iron lung” for their survival as they had respiratory paralysis.

Prior to routine vaccinations in the 1960s, childhood illnesses like polio, measles, diphtheria, tetanus, mumps, and rubella killed and hospitalized hundreds of thousands of children annually in the US. The overwhelming success of vaccines has largely erased these memories, shifting public debate towards vaccine safety rather than the diseases they prevent. 

A reminder of how recent the dangers of polio are came from Senator Mitch McConnell, 82, who is a survivor of childhood polio, which he contracted at age two. As Kennedy hit Capitol Hill, the Republican Senate leader issued a sharp warning against any suggestion the polio vaccine’s approval should be questioned.

“Efforts to undermine public confidence in proven cures are not just uninformed – they’re dangerous,” McConnell said in a statement. “Anyone seeking the Senate’s consent to serve in the incoming administration would do well to steer clear of even the appearance of association with such efforts.”

Extensive testing of vaccines

The first polio vaccine, invented by Dr Jonas Salk in 1955, underwent extensive testing against placebos in nearly two million American children before its rollout. The modern-day vaccine, manufactured by French pharmaceutical firm Sanofi, did not undergo placebo trials but is very similar to the original Salk vaccine.

 Siri, Kennedy’s lawyer who has been involved in extensive efforts to fight vaccines of all kinds nationwide, pointed in his legal filings to this lack of a placebo control trial, arguing the vaccine should be suspended until this happens. 

That would mean depriving children of a vaccine that will protect them against a potential death, however, which the overwhelming majority of health experts consider unethical. Salk himself opposed the placebo trial conducted on his original vaccine for this same reason.

“Randomized control trials are unethical in the context of vaccines because vaccines are so effective – we can’t give a person a placebo knowing that he or she is susceptible to potentially serious or deadly infectious diseases,” Gostin said. “Since we know vaccines are highly protective, we can’t withhold the treatment.”

Sanofi notes that the vaccine has been used by nearly 300 million people worldwide. More than 300 studies, including trials with follow-up periods of up to six months, have been conducted since the vaccine’s development began in 1977.

“From the age of two, normal life without paralysis was only possible for me because of the miraculous combination of modern medicine and a mother’s love,” McConnell said. “But for millions who came after me, the real miracle was the saving power of the polio vaccine.”

Today, wild polio remains endemic in just two countries: Afghanistan and Pakistan. Forty-six nations across Africa and the Asia Pacific are listed as outbreak countries by the Polio Eradication Initiative.

Global efforts led by the Rotary Club, the global vaccine platform Gavi, the Global Fund, the Gates Foundation and the Polio Eradication Initiative aim to eradicate polio. This would make it only the second disease ever to be fully eradicated after smallpox, considered the largest global health victory in history.

A health worker administers a polio vaccination in Pakistan’s northwestern region.

US childhood vaccination rates are falling

In statements to legacy media outlets, congress and cable networks, Kennedy has been careful to craft a moderate image on vaccines. Katie Miller, a spokeswoman for his office, said in response to the New York Times report on Siri’s efforts to revoke polio vaccine approval that Kennedy “has long said that he wants transparency in vaccines and to give people choice.”

Yet Kennedy and Siri are key players in a profitable industry of anti-vaccine activism that flourished during the COVID-19 pandemic, which killed over 1.2 million Americans. Their ascent coincides with reports from the Centers for Disease Control and Prevention (CDC) of falling childhood vaccination rates for all available vaccines.

Earlier this year, measles outbreaks were reported in 15 US states, coinciding with the lowest child immunisation rates the country has seen in 10 years, according to the CDC.

Kennedy has repeatedly stated he believes vaccines cause autism and “neurodevelopmental disorders.” Asked whether he would support a move to end childhood vaccination programs if Kennedy passes the Senate, Donald Trump told Time magazine: “We’re going to have a big discussion. The autism rate is at a level that nobody ever believed possible. If you look at the things that are happening, there’s something causing it.”

Long anti-vax history

Kennedy was a key figure in the anti-vaccine world long before the COVID-19 pandemic shut down the world in 2019. 

He took over the flailing World Mercury Project in 2015, a non-profit named after the belief that mercury in vaccines causes autism in children. He rebranded the organisation as Children’s Health Defense (CHD) in 2018 and has shepherded it into a global anti-vaccine juggernaut.

CHD,  which Kennedy led until stepping down for his presidential run, is one of the top medical disinformation sites on the internet. This week, the most-read story on the Defender, CHD’s news arm, covers a study led by Peter McCollough, another leader in the anti-vaccine movement, who argues that COVID-19 vaccines should be suspended by the FDA. The study appears to be based on a misuse of VAERS, a federal database that records unverified reports of adverse events.

The “peer-reviewed study” is published in the misleadingly titled Journal of American Physicians and Surgeons, the publication of a conservative non-profit that has also published studies on the “health benefits of firearms,” which calls gun research sponsored by the CDC “junk science.”

It has also published articles claiming that tobacco taxes and indoor smoking bans harm public health and that there are links between abortion and breast cancer. It is not listed in academic literature databases such as MEDLINE, PubMed or Web of Science.

CHD, whose revenue skyrocketed from $1.1 million in 2018 to $23.5 million in 2022, the last year for which tax disclosures are available, is part of a constellation of “medical freedom” groups that include the Informed Consent Action Network (ICAN), led by Kennedy’s presidential campaign’s director of communications, Del Bigtree. 

In 2022, ICAN paid Siri’s law firm $5.3 million for its legal efforts to fight vaccine approvals and mandates across the US, including polio and hepatitis B.

Kennedy made $510,000 in executive compensation for his role as director of CHD in 2022; ICAN paid out $880,000 in executive compensation from its $13.4 million in revenue that same year, public filings show.

“It’s difficult to understand the motivations behind RFK Jr and his organization and staff,” Dr Peter Hotez, a vaccine expert, told Health Policy Watch.

“I could only speculate, and that wouldn’t be helpful, but I can say his anti-vaccine [stance] is very damaging for global public health,” added Hotez, who has an autistic child, has been introduced to Kennedy by colleagues at the National Institutes of Health in an attempt to persuade him that vaccines do not cause autism.

Kennedy has other fringe views including that AIDS is not caused by HIV, that antidepressants are responsible for mass school shootings, and that atrazine, a widely used herbicide, triggers gender dysphoria and has led to increases in young people identifying as transgender. 

https://x.com/PeterHotez/status/1868848477054419408

“Vaccines [are] our most impactful public health/scientific successes for the last 50 years, saving 154 million pediatric lives,” Hotez argues. “We also have overwhelming evidence for vaccine safety and knowledge vaccines don’t/cannot cause autism. I hope to say this every chance I get.”

Image Credits: Paul Palmer/ WHO, Pakistan Polio Eradication Program .

Lenacapavir, packaged as Sunlenca in the US, where is sellas for $42,250 for two injections.

Some two million people may get access to lenacapavir, the twice-yearly antiretroviral injection that prevents HIV injection, within the next three years, thanks to the Global Fund and United States President’s Emergency Plan for AIDS Relief (PEPFAR).

The initiative is contingent upon regulatory approval from the US Food and Drug Administration (FDA), national pharmaceutical regulators, and a recommendation from the World Health Organization (WHO).

It is being supported by the Children’s Investment Fund Foundation (CIFF) and the Bill & Melinda Gates Foundation (BMGF) 

At present, lenacapavir is licensed in the US and other countries as a treatment for adults with drug-resistant HIV. 

However, in two clinical trials it has shown to almost completely block HIV when used as pre-exposure prophylaxis (PrEP).

Not a single one of the 2,138 women in PURPOSE 1 trial who received lenacapavir contracted HIV. In the PURPOSE 2 trial involving men and gender-diverse people, only two of the 2,179 participants became infected during the trial – a success rate of over 99%.

In both trials, lenacapavir was tested alongside oral PrEP and found to be superior as the twice-a-year injection is much easier to adher to than taking daily pills.

“We cannot reach a sustainable HIV response without rapidly reducing the 1.3 million new HIV infections that occur worldwide every year,” said Ambassador Dr John Nkengasong, US Global AIDS Coordinator head of PEPFAR in a statement on Tuesday.

“Lenacapavir offers a potentially tremendous opportunity to transform the impact of HIV programs to ensure adolescent girls and young women, key populations, and others who could benefit have access to highly effective HIV prevention, testing and treatment services and to end HIV/AIDS as a public health threat by 2030.”

In October the medicine’s manufacturer, Gilead, announced that it had signed non-exclusive, voluntary licensing agreements with six pharmaceutical companies to manufacture and supply generic versions of lenacapavir for 120 primarily low- and lower-middle-income countries.

Global regulatory filings

“Data from both PURPOSE 1 and PURPOSE 2 will support a series of global regulatory filings for lenacapavir for PrEP that will begin by the end of 2024,” Gilead announced.

The FDA has granted lenacapavir for PrEP “breakthrough therapy designation”, which is intended to expedite the development and review of new drugs that may demonstrate substantial improvement over available therapy.

The FDA has also granted a “rolling review” for lenacapavir for PrEP, which allows the FDA to fast-track the review of a drug application by allowing a company to submit sections of the application for review as they are completed.

In September, WHO announced that it is “working rapidly to convene a guideline development group with experts, ministries, partners and communities”.

This group will develop and issue guidelines based on a “rigorous assessment of the potential of lenacapavir for HIV prevention, evaluating key aspects such as efficacy, safety, cost-effectiveness, values and preferences from stakeholders and communities, and global scalability, among others”.

A WHO spokesperson told Health Policy Watch on Tuesday that the Guideline Group meeting will be held from 28-30 January and would have a recommendation by July 2025, at the latest.

“WHO has already listed lenacapavir on the Expression of Interest list (EOI) and has provided guidance on bioequivalence,” the spokesperson added.

It is also working to ensure rapid regulatory approval via the FDA and European Medicines Agency EMA Medicines4All pathways.

Once a Stringent Regulatory Authority (SRA) approval is obtained, the manufacturer can apply for pre-qualification using the abridged pathway.

“WHO is working with potential early adopter countries to anticipate and prepare for guidelines and country regulatory approvals,” the spokersperon said.

Excited by the promise

“At the Global Fund, we are incredibly excited by the promise of lenacapavir and its potential to help us achieve a further significant reduction in new infections among individuals at high risk of acquiring HIV,” said Peter Sands, Executive Director of the Global Fund. 

“As part of this coordinated effort, the Global Fund, PEPFAR, CIFF, and BMGF will work with Gilead and the voluntary licensing manufacturers to accelerate affordable and equitable access, so that more people can benefit from this powerful innovation from day one.”

CIFF founder and chair Sir Chris Hohn, said that innovations like lenacapavir can profoundly impact the lives of millions.

“It will be a travesty if the communities who need it most don’t have access. That is why this collaboration is so essential to ensure that lenacapavir is available as soon as possible for those who need it the most,” said Hohn.

Image Credits: Gilead.