David Laborde, Director of the Agrifood Economics Division of the Food and Agriculture Organization, presents the most recent report on nutrition and food security.

Food security and nutrition initiatives often fail due to fragmentation, a lack of consensus on priorities, and the prevalence of numerous actors delivering mostly small, short-term projects, according to this year’s State of Food Security and Nutrition in the World (SOFI) report, due to be released next week.

More targeted and less risk-averse finance, as well as better alignment and synergy amongst different funding sources, is critical to scaling up assistance more effectively in hunger-stricken areas of the world, said Qu Dongyu, Director-General of the UN Food and Agriculture Organisation. 

He was speaking this week during an event on Finance to End Hunger and Food Insecurity, held on the sidelines of the UN Economic and Social Council (ECOSOC) High-Level Political Forum in New York City.

“I call on funders and partners across agri-food systems to enhance coordination and consensus on what and where it is essential to finance and to better target financing for the ones most in need,” said the FAO Director-General in a video-taped address. 

The annual report, a collaboration of FAO, the World Health Organization (WHO) and other UN agencies, analyses the progress made in addressing SDG2, No Hunger. The full document is due to be launched July 24 at a G20 ministerial task force meeting.

“Every year we report on progress towards the SDG targets towards ending hunger, food insecurity, and malnutrition,” said WHO Director General, Dr Tedros Adhanom Ghebreyesus. “And every year we report that progress has been insufficient.”

There were between 691 and 783 million people facing hunger in 2022, according to the State of Food Security and Nutrition in the World report – an increase of 122 million people compared to 2019.

Blurry definitions impede action

Different financial estimates for fighting food insecurity vary greatly.

Counting people who lack reliable and sufficient nutrition is easier than estimating the costs to address their needs, raising funds and delivering aid that makes a difference long-term and not only in emergencies, according to FAO’s preview of key SOFI report findings. 

Depending on the definitions and scope of planned interventions, the sum needed to ‘feed the world’ could amount to anything between $77 and $15,400 billion, one of the report’s authors, David Laborde, noted at the side event.

No clear definition is “obviously […] a bad starting point,” Laborde pointed out, especially as it obscures accountability. “It’s not that we’re lacking progress, it’s that we’re moving in the wrong direction,” he added. As per the SOFI report, despite continuing efforts, countries that face the most acute malnutrition are also the ones that have the least access to funding.

Need to tackle root drivers of hunger

Funding is also aimed too narrowly, addressing core needs like emergency food supplies – but failing to tackle the roots of the problem and improve the situation in the long run. The current structure is also at fault. Fragmented and dispersed, mostly consisting of small, short-term projects of varying priorities, the funding remains ineffective, Maximo Torero Cullen, FAO Chief Economist assessed at the ECOSOC Forum event.

The report proposes a common definition for food support programmes and encourages agencies to work together and ensure they are communicating about mapping areas of progress.

Electricity or vaccines are also food interventions

A more holistic view on food security could be key to achieving the “no hunger” SDG goal, the Forum’s speakers also highlighted. “Nutrition is a smart investment with significant health and economic returns,” Tedros said, stressing also the economic benefits to resilient food systems. And building those requires diverse funding in various fields.

Dr Qu Dongyu, Director-General of the Food and Agriculture Organisation, during an event presenting this year’s nutrition report results.

Rather than a stand-alone problem, malnutrition is a result of several health factors caused by structural problems, Laborde reminded, and as such, needs a broader problem-solving vision.

Expanding energy access in a rural area can be a boost for the local farmers, now able to use electricity-powered irrigation equipment or access food cleaning and cooling technologies.

Investment in community-based animal health services and livestock vaccinations can also serve as a driver for a stronger food system, as demonstrated in areas of conflict in South Sudan and Sudan.

Overcoming uncertainty

The main improvements needed to achieve SDG2 are better coordination – also in terms of targeting and definitions – increased donor risk tolerance and more blended finance, FAO’s Director-General Dr Qu Dongyu said.

Interventions strengthening local food production, for instance enabling electricity-powered irrigation, can effectively combat food insecurity.

Agrifood systems operate under risk by definition, he highlighted, and the uncertainty is even rising with climate-change-induced extreme weather conditions and irregular rainfall. Donors need to understand the nature of the sector and invest despite the risks.

It’s still a bet worth taking, and “financing zero hunger today is investing in a better future tomorrow,” Qu said.

SOFI 2024 estimates that achieving SDG2 “could amount to several trillion USD,” though it is difficult to calculate the exact cost. The sum is beyond the scope achievable for the public sector, which then points to the need for blended, private-public financing.

Depending on the country’s access to financial flows, different instruments are most appropriate. The report recommends grants and concessional loans for those with limited access, domestic tax revenue, especially linked to food security and nutrition outcomes for those with moderate access. High-access countries can use bonds or similar instruments to embed specific food security and nutrition objectives.

Dr Tedros Adhanom Ghebreyesus during the forum in New York.

“It’s time to rethink financing food security and nutrition,” Tedros said. The change needs to be treated “as an investment in a healthier, safer, and fairer world.”

Food crises also aggravated by conflict 

Along with the longer-term solutions, conflicts in numerous regional hotspots continue to fuel hunger crises, the WHO has underlined over and again. 

More than one million children are at risk from acute malnutrition in Democratic Republic of Congo as rising violence drives up needs amongst millions of displaced people, WHO said on Friday.

The DRC now had 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 the press briefing. Despite this, the situation in DRC remains one of the world’s most underfunded and forgotten crises.

In the most affected provinces, Ituri, North Kivu and South Kivu, 5.4 million people are food insecure, while almost three million children across the country are severely malnourished, according to the WFP. With floods destroying crops, the prospect for next year is even more severe food insecurity. Unless immediate action is taken, over one million children will suffer from acute malnutrition, the WHO alarms.

Conflicts, climate change, economic crises and inequality are amongst the main drivers of food insecurity.

In Sudan, 26.6 million people, more than half of the population, are food insecure, according to the World Food Programme (WFP) data. Continued fighting between the country’s army and paramilitary Rapid Support Forces (RSF), going on since April 2023, continue to impede the operations of aid organisations. Over 10 million people are internally displaced and 2 million abroad – the largest number in the world, according to a WHO update this week.  

In Khartoum, free kitchens operating there announced July 13 they were forced to shut down due to a lack of funding and food supplies.

In Gaza, where Israel continues its nine-month military campaign to crush the Islamic Hamas organisation following Hamas’ deadly October 7 2023 raids on Israel, WHO officials have warned that one in four people faces starvation risks – even if previous forecasts of widespread famine by July did not yet materialise. Some 96% of the enclave’s 2 million residents are facing crisis levels of hunger – or worse – according to the World Food Programme. 

Israel’s closure of the Rafah crossing into Gaza in mid-May has paralysed the flow of health supplies and humanitarian aid from Egypt – forcing exclusive reliance on Israeli aid crossing points.  Meanwhile, the World Food Programme (WFP) said Wednesday that it had been forced to reduce food rations in Gaza City to ensure broader coverage for people who have been newly displaced after new Israeli incursions in the North and South. In July so far, WFP has provided more than 600,000 people in Gaza with food assistance, and more than 500,000 people with food parcels and wheat flour.

INB co-chairs Anne-Claire Amprou and Precious Matsoso

As delegates at this week’s Intergovernmental Negotiating Body (INB) worked to nail down a day-by-day agenda for negotiating a pandemic agreement for the next few months, it appears increasingly unlikely that the talks will be concluded by year-end. 

The detailed work plan – an indication that the Bureau has heard criticism that it has given member states too little notice in the past – underscores that there is so much to do in so little time.

As US Ambassador Pamela Hamamoto noted on the first day of the meeting, the work proposal for the next INB meeting in September “assumes we can reach consensus on at least one article per day, which may be overly ambitious”.

Delegates have also resolved to include consultation with experts as part of the process. This is high time, given that the structures and processes they agree on should be workable for frontline pandemic ‘responders’: scientists studying pathogens, pharmaceutical companies making medicines, health workers and government officials trying to contain outbreaks. But it will mean more time is needed.

New co-chair Anne-Claire Amprou also told delegates on Wednesday that they would need to decide by 11 November – not 15th, as assumed the previous day – if there was sufficient agreement to call a World Health Assembly (HWA) special session in December to adopt a pandemic agreement.

The US wants a “stocktake” by the end of the next INB meeting on 20 September to see how realistic this is, while the Bureau proposed such a stocktake at the INB meeting in early November.

Part of the proposed agenda for the next INB meeting from 9-20 September.

Debate over experts and stakeholders

Delegates were divided on which experts should be consulted. Several countries – including China, Russia and Nigeria – proposed including only those in official relations with the WHO in terms of its Framework of Engagement with Non-State Actors (FENSA)

Others, such as Colombia, wanted more diversity. Nonetheless, countries have until 26 July to submit their proposals on experts to the Bureau.

The INB circled around whether to allow groups with official stakeholders status to sit in on closed drafting sessions. Initially, it appeared stakeholders would be allowed into closed meetings as observers, but by the end of the meeting, delegates settled on closed talks and daily information sessions at the start of each day with stakeholders.

This prompted the European Union’s Americo Zampetti to comment that such sessions should not simply serve as information giving but also solicit the inputs and opinions of the stakeholders, which range from patient advocacy organisations to pharmacuetical companies.

WHO Assistant Director General Mike Ryan stressed at the close of the INB that political agreement was essential and appealed to delegates not to become mired in technical issues and lose the momentum they had gained by the end of the talks in May.

“I would just say to you as negotiators, to separate what is technical from what is ultimately political, and not to delve too far back into technical discussions,” said Ryan.

“A better understanding of the technical issue will not resolve political issues,” he stressed.

“Do not look for answers to what are essentially political trust and other issues in the land of technical explanation. You will find some answers and some reassurance there, but you will not find resolution of what are essentially political issues

Ryan warned that the world’s biome is becoming more volatile and unpredictable, making other pandemics more likely.

“The pandemic agreement will not itself stop the next pandemic. The pandemic agreement will not in itself directly save lives, but without a pandemic agreement, the chaos, the lack of coherence, the lack of equity, the lack of efficiency that we had in the last pandemic will continue and probably increase giving our given our geopolitical differences.

“So this is not an academic exercise. It’s not even a political exercise. This is an exercise in saving human lives. And I just hope that that energy you had when you finished the last time, the disappointment you put to the side, and the commitment to get this done as quickly as possible, is still there.”

The next INB meeting will be from 9-20 September, with further sessions set for November and December – as well as February and April if agreement is not reached in November.

Community healthcare worker checks the blood pressure of a patient with TB and NCD at a Nakshatra Centre in Chennai, serving as a “Center of Excellence for TB”

By 2035,  nearly three quarters of the  40 million people living with HIV worldwide will be living with one or more chronic disease, also referred to as noncommunicable diseases (NCDs). 

While there are encouraging examples of integrated HIV and NCD healthcare delivery,  this is yet to become the norm in low- and middle-income countries. 

As stakeholders convene for the 25th International AIDS Conference next week in Munich, more attention should be focused on this theme – and on scaling up the bright lights of success seen in parts of East Africa as well as India. People living with HIV face the same health challenges as everyone else

Revolutionary medicines and expanded access to screening and treatment around the world have transformed HIV from being a death sentence into a chronically manageable disease. People living with HIV now enjoy life spans equal to those who do not have the disease.

The cruel irony of that success is that many people living with HIV are thus faced with the same NCD challenges as all older adults: diabetes, hypertension, cardiovascular disease, and other chronic illnesses.  

NCDs account for seven of the 10 leading causes of death globally. But  the reality for people living with HIV is that they mainly live in countries whose health systems have not evolved enough to reflect and service what is essentially a new disease burden. 

Challenges in accessing NCD services

People living with HIV may visit a clinic for free antiretroviral therapy (ART), where they may also be screened for common NCD risk factors such as elevated blood pressure and blood glucose levels. But if an NCD risk is identified, it cannot be treated at the same clinic, and the patient faces immense challenges in seeking NCD care at another clinic, such as long wait times, costly transportation, a need to find childcare, or lost wages.   

Additionally, a hypertension or diabetes diagnosis can translate to expensive treatments that, unlike HIV medicines, are often paid for by the patients themselves.

A Zimbabwean health worker administers an HIV test.

Those who don’t have enough resources face difficult choices – placing medical necessities behind basic needs like feeding their household or educating their children. The time commitment can also be overwhelming, with many patients foregoing follow-up visits, thereby surviving HIV only to die prematurely of NCDs. 

We know a different reality is possible. As a company focused on pioneering life-changing medicines for many NCDs, Eli Lilly and Company is committed to improving NCD care for patients living in resource-limited settings around the world.

Lilly has a long history of investing in efforts to strengthen health systems and improve care delivery. Since 2016, it  has supported efforts to develop and scale integrated care solutions for patients with tuberculosis (TB). 

Linking to Care: A case study 

The Linking to Care project in Chennai, India— supported by Lilly and implemented by REACH with technical support from Advance Access and Delivery – has shown that TB can be used as an entry point to start screening patients for diabetes and hypertension and then linking them to care.

The project also screens patients’ close contacts for TB, diabetes and hypertension, and links them to care as well. By incorporating community healthcare workers (or TB Nanbans, as they are referred to in Chennai) to start delivering this integrated care to patients, the project makes care much more accessible in such resource-constrained settings.

This model, driven by a close partnership between public- and private-sector healthcare providers, has shown that comprehensive, holistic, patient-centered care not only improves public health efficiency but also delivers better health outcomes for people living with both communicable and noncommunicable diseases.

Progress in sub-Saharan Africa

There’s a long way to go before this kind of project becomes commonplace in low- and middle-income countries, but on the ground, the HIV and NCD communities have made some inroads into what is possible when it comes to integrated healthcare delivery.

There are some encouraging examples of this in Malawi, Zambia and Kenya, resulting in financing policy changes at PEPFAR and the Global Fund that were advocated for by civil society at the 2021 United Nations (UN) General Assembly High-Level Meeting on HIV/AIDS.

Member states committed to ensuring that 90% of people living with HIV would have access to NCD and mental health care by 2025.

This movement in policy is also increasingly being reflected in forums like the International AIDS Conference, and this year’s edition in Munich this month is expected to feature a number of sessions that address the crossover of NCDs and infectious diseases. This momentum needs to be built on so that soon all people living with an infectious disease, together with NCDs, can receive easily accessible and appropriate health care.

Katie Dain is the CEO of the NCD Alliance

Cynthia Cardona is the Head of Social Impact at Eli Lilly and Company

Image Credits: UNICEF Zimbabwe, NCD Alliance.

New INB co-chair Anne-Claire Amprou is welcomed by existing co-chair Precious Matsoso,
New INB co-chair Anne-Claire Amprou is welcomed by existing co-chair Precious Matsoso.

Anne-Claire Amprou, French Ambassador for Global Health, has replaced Roland Driece of the Netherlands as the co-chair of the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) that is hammering out the pandemic agreement.

However, Amprou, who coordinated the French response to COVID-19 and was a member of the international Ebola task force, is interim co-chair pending further discussion in the WHO European region.

New vice-chair Fleur Davis (Australia), joins existing vice-chairs Tovar da Silva Nunes (Brazil), Dr Viroj Tangcharoensathien (Thailand) and Amr Ramadan (Egypt).

The two new representatives bring more much-needed gender balance into the male-dominated leadership of the INB.

Australia’s Ambassador Fleur Davies is new INB vice-chair.

Welcoming the two new representatives, WHO Director General Dr Tedros Adhanom Ghebreyesus said that “consensus over the outstanding issues is possible within a relatively short time, if you prioritise public health over other considerations”.  

“We must always keep the urgency of this generational agreement at the forefront because, as the current outbreak of H5N1 reminds us, the next pandemic may be around the corner,” added Tedros.

He urged delegates to use the two-day meeting to “make the necessary adjustments that will allow you to move towards consensus and reach our shared goal of a pandemic agreement for a safer and more equitable world for all.”

‘Precarious moment’

Describing the global community as being in a “precarious moment” as it awaited the pandemic agreement, Eswatini appealed for equity to remain the focus of the talks to “address inequities that were experienced by most developing countries during the COVID-19 pandemic”.

The Africa Group supports the proposal that the next INB meeting in September focuses on  Article 12, the vexed issue of pathogen access and benefit sharing (PABS), added Eswatini, speaking on behalf of the Africa region and Egypt.

Africa wants any decision on PABS to be included in the main agreement, not as a “separate instrument”, said Eswatini, a small, landlocked country in southern Africa.

South Africa later added that PABS “has the potential of unlocking blockages in other areas” so “it is prudent to allocate sufficient time for the PABS system, followed by the other articles, which are all interrelated and crucial for a meaningful PABS system”.

Estwatini also called for shorter, less intense INB meetings, explaining that the marathon sessions of the past were extremely taxing on small delegations.

Ethiopia, South Africa and Indonesia also stressed their preference for the agreement to be sealed by the end of this year via a World Health Assembly (WHA) Special Session in December.

“Let’s work back from that date,” said Ethiopia’s Ambassador Tsegab Kebebew Daka during discussions on the work plan.

This plan proposes an 11th INB meeting from 9-20th September and a 12th meeting from 4-15 November. No negotiations are possible in October as various WHO regions hold their conferences. However, delegates proposed inter-sessional meeting during that month including sessions with experts to make progress.

The deadline for calling the WHA special session to discuss and adopt the pandemic agreement is 15 November.

More important to ‘get it right than do it fast’

US Ambassador Pamela Hamamoto

US Ambassador Pamela Hamamoto cautioned against haste, warning that there was “little time to reach a consensus agreement with many complex issues remaining”.

“It is more important to get it right than to do it fast. In order to be successful, this agreement has to be implementable,” said Hamamoto, who cast doubt on an agreement materialising from only two INB negotiations.

“We have concerns that two formal negotiating sessions will be sufficient to conclude a meaningful pandemic agreement by year end 2024. We are fully committed to trying, but we do not advise pushing critical issues in their entirety off to a future process. 

“To meet a December target, we need to find the right balance of what to include in the pandemic agreement and which details should be deferred to future working groups. The current INB 11 proposal assumes we can reach consensus on at least one article per day, which may be overly ambitious.”

The US proposed focusing on “core issues where additional understanding and alignment is needed regarding fundamental concepts, specifically Article 12, Articles 4 and 5, and the legal framework for proposed protocols or annexes”.

Hamamoto also proposed that talks be fast-tracked by informal working groups on key stumbling blocks, a robust intercessional work between the September and November INB meetings and consultation with experts, scientific institutions, the Quadripartite (the four UN agencies dealing with One Health), and the private sector.

“We need concrete ways to seek expert, technical and legal advice, perhaps through the use of expert advisory groups along the lines used in the ongoing plastics treaty negotiations,” said Hamamoto, adding that the US supports stakeholders being allowed to observe the drafting group. 

IHR overlap?

The European Union’s Americo Zampetti called for the WHO Secretariat to guide the INB on overlaps between the pandemic agreement and the recently agreed International Health Regulations (IHR) to help “cleaning up certain areas in the text”.

The EU, Mexico, Australia, Jamaica and several other countries also voiced support for greater involvement of non-state actors in the talks.

Mexico pointed out that their presence would help to counter disinformation about the pandemic agreement.

The meeting concludes on Wednesday and will have modified the proposed work plan and process.

At the interactive live mentorship session on the future of innovation and intellectual property

“Don’t be afraid to take risks. Think outside the box. Be agile. Adapt to change.”

This was some of the advice young innovators in the life sciences field received last week during an interactive live mentorship session on the sidelines of the World Intellectual Property Organization (WIPO) General Assembly.

Organized by WIPO and IFPMA (International Federation of Pharmaceutical Manufacturers and Associations), the panel discussion delved into the challenges and opportunities surrounding innovation and intellectual property in life sciences. The event brought together professionals from the private and public sectors, including academia and research, for a comprehensive discussion.

Josefa Cortés, founder and CEO of Palpa, offered the first piece of advice: get a mentor. 

Her company encourages women under 40 to perform regular breast self-exams using a sponge that simulates a palpable tumor. According to Cortés, a good mentor will believe in you and help you believe in yourself. Mentors can also “foster an entrepreneurial mindset and eliminate cultural barriers.”

Palpa CEO Josefa Cortés and Arthur Queval, CEO of Loop Medical.

Brighton Samatanga, founder and CEO of the Biotech Institute, discussed the importance of strategic partnerships. His company has benefited from various collaborations, including equipment sharing and joint research projects.

“We’ve also formed a partnership with the government, creating a public-private collaboration,” Samatanga said. “We now have access to their supercomputer and can use it for our bioinformatics work.”

Biggest innovation challenge: funding 

Panelist Syed Saader Ahmed, founding director and CEO of TechInvention Lifecare, highlighted the critical issue of funding. He noted that securing funding is the biggest challenge young innovators face. To survive, his company created an additional revenue stream.

“We work in the field of vaccines,” Saader explained. “Many of our scientists had experience in GMP manufacturing, quality assurance, and quality control. So, we set up a strategic and consulting advisory group and began taking on vaccine capacity and infrastructure advisory projects in low and middle-income countries.

“We started with one project,” he continued, “and thought that our indigenous research and vaccines would take off within two or three years [and we would stop these efforts]. But what began as an ancillary revenue stream has become a main revenue source. It’s now a standalone vertical.

“We are advisors to the World Bank and the Asian Development Bank, working on a large human vaccine project in Ethiopia and a veterinary vaccine project in Botswana. This has kept us bootstrapped and sustained our revenue flow.”

His advice to young entrepreneurs: identify an ancillary revenue stream that doesn’t require many resources but can generate early revenue. That will get things moving.

Inside one of the TechInvention laboratory sites

Saader also recommended staying asset-light. Instead of investing in expensive equipment, such as for a lab, he suggested that young innovators seek out accelerators or incubators where they can conduct their research.

“These facilities are affordable and do not infringe on your intellectual property,” Saader said.

Finally, he advised the event’s sponsors that there needs to be a balance between innovation and access in life sciences. He praised the collaboration between WIPO and IFPMA and suggested further partnerships with organizations like CEPII.

Saader also emphasized the importance of focusing on innovations with significant social impacts, such as life sciences, climate change, and sustainability. He proposed expedited procedures for patent filings in these areas to facilitate faster approvals.

The IP debate

Pharmaceutical companies and civil society continually clash over access to generic medicines in developing nations. As the central registry for patents worldwide, WIPO plays a pivotal role in shaping global health innovation policies.

This IFPMA-hosted event at WIPO’s assembly stressed that patent systems are crucial for safeguarding the rights of young entrepreneurs in sectors like pharmaceuticals, vaccines, and medical equipment.

Proponents assert that patents incentivize innovators by granting them exclusive rights over their inventions, enabling them to monetize their innovations and further drive progress.

Conversely, civil society organizations (CSOs) often contend that patents can create monopolies that keep prices high and restrict access to essential medications and technologies in critical moments.

The ongoing tensions between fostering innovation and ensuring equitable global access to life-saving medical products, means that debate over intellectual property (IP) will always be contentious in Geneva’s diplomatic circles.

‘Innovation cannot remain an idea’

The bottom line, however, is how Edward Kwakwa, assistant director general for the Global Challenges and Partnerships Sector at WIPO, put it: “Innovation cannot remain an idea.”

“We need to support grassroots innovation and consider commercialization, technology transfer, and more,” Kwakwa said. “Innovation requires resilience and the right support network. It takes mentorship and a willingness to collaborate across disciplines. Regulatory structures need to adapt to speak the language of innovation today.

“If we don’t provide the necessary support and frameworks, innovators will seek alternatives elsewhere.”

Image Credits: TechInvention.

Girls and women protest outside Gambia’s parliament this week in protest against attempts to reintroduce female genital mutilation.

The Gambia’s parliament voted by a substantial margin on Monday to uphold a ban on female genital mutilation (FGM), defeating a Bill by conservative lawmakers and religious leaders.

Thirty four of the 53 MPs voted against the Private Members’ Bill introduced by MP Almameh Gibba from the Alliance for the Patriotic Reorientation and Construction (APRC), which was supported by Imam Abdoulie Fatty, a long-time advocate for FGM.

In April, the parliament supported the decision for the Bill to be referred to its business committee for more discussion. Less than 9% of MPs are female in the conservative, majority Muslim country and there was fear that the country’s 2015 ban on FGM was in jeopardy.

The decision was commended by UNICEF Executive Director Catherine Russell, UNFPA Executive Director Natalia Kanem, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus, UN Women Executive Director Sima Bahous, and UN High Commissioner for Human Rights Volker Türk.

“FGM involves cutting or removing some or all of the external female genitalia. Mostly carried out on infants and young girls, it can inflict severe immediate and long-term physical and psychological damage, including infection, later childbearing complications, and post-traumatic stress disorder,” according to the leaders in a joint statement.

The Gambia banned FGM in 2015 but enforcement of the ban is weak. Almost three-quarters of Gambian women are estimated to have been subjected to the practice, and almost half were cut before their 15th birthday.

There has only been one FGM-related conviction in the past nine years, and that involved three women for cutting babies aged four to 12 months old, according to women’s rights activist Jama Jack. They received fines which were paid by Fatty via a public fundraising campaign, added Jack.The global leaders acknowledged “the fragility of progress to end FGM”.

“Assaults on women’s and girls’ rights in countries around the globe have meant that hard-won gains are in danger of being lost,” they added.

“In some countries, advancements have stalled or reversed due to pushback against girls’ and women’s rights, instability, and conflict, disrupting services and prevention programmes. 

Continued advocacy

“That is why legislative bans on FGM, while a crucial foundation for interventions, cannot alone end FGM.”

They called for “continued advocacy to advance gender equality, end violence against girls and women, and secure the gains made to accelerate progress to end FGM”.

To do so, they recommended more engagement with communities and grassroots organizations; working with traditional, political, and religious leaders; training health workers, and raising awareness effectively about the harms caused by the practice.  

“Supporting survivors of FGM remains as urgent as ever. Many suffer from long-term physical and psychological harm that can result from the procedure, and need comprehensive medical and psychological care to heal from the scars inflicted by this harmful practice.   

“We remain steadfast in our commitment to support the government, civil society, and communities in The Gambia in the fight against FGM. Together, we must not rest until we ensure that all girls and women can live free from violence and harmful practices and that their rights, bodily integrity, and dignity are upheld.”

Control over women’s sexuality

FGM is practised mainly to  “control” women’s sexuality. Around 90% of women in Somalia, Guinea and Djibouti are subjected to FGM.

Over 230 million girls and women alive today have undergone female genital mutilation (FGM), according to a report from the UN children’s agency, UNICEF. This is a 15% increase since eight years ago.

“The pace of progress to end FGM remains slow, lagging behind population growth, especially in places where FGM is most common, and far off-pace to meet the UN’s Sustainable Development Goal to eliminate the practice. The global pace of decline would need to be 27 times faster to end the practice by 2030,” UNICEF notes.

However, progress to prevent FGM is possible. In the past 30 years, FGM has declined in Kenya from moderate to low prevalence; Sierra Leone has dropped high to moderately high prevalence and Egypt is beginning to decline from a previously near-universal level.

HIV medicine dolutegravir has a significantly smaller carbon footprint than similar antiretroviral medication.

The lifesaving HIV treatment dolutegravir (DTG), used by 24 million people in low-and middle-income countries (LMICs), has unexpectedly contributed to a significant reduction in carbon emissions when compared to the previous standard of care, efavirenz, according to the latest report by global health initiative Unitaid.

The report estimates that the transition to DTG will have prevented over 26 million tons of CO2 from entering the atmosphere from 2017 to 2027. The emissions reduction is comparable to eliminating 10 years’ of carbon emissions from Geneva, Switzerland, according to the report released on Monday.

This is the first report to analyze the environmental impacts of a single widely used medicine compared to its alternative. It builds on Unitaid’s From milligrams to megatons report last year which analyzed the climate and nature assessment of 10 key public health products in its portfolio.

“One of the outcomes of this study of 10 products was that carbon emissions can be really significant and one product stood out as particularly important, it’s this one, dolutegravir,” Vincent Bretin, Director of Unitaid’s Results and Climate Team told Health Policy Watch.

“So, it’s [this report] really a deep dive on that comparison. And it’s showing that the previous generation of efavirenz was actually producing more emissions. So, all the steps required to manufacture it resulted in more carbon emissions worldwide compared to the current treatment,” he said.

Unitaid is hosted at the World Health Organization (WHO) and focuses mainly on supporting the treatment of tuberculosis, malaria, and HIV/AIDS along with its deadly co-infections in LMICs.

As global carbon emissions continue to rise and climate impacts worsen, different sectors are being called on to reduce their carbon footprint, while also meeting development agenda. It is in this context that Unitaid’s report provides a viable path forward for the reduction in the health sector’s carbon emissions.

Health sector’s carbon emissions

Health sector’s carbon emissions stand at roughly 5% of the global carbon emissions and is larger than the emissions of many big countries. While this has been discussed for a few years now, as Health Policy Watch has reported earlier, nothing concrete has been done to reduce these emissions.

Some 50-70% of the healthcare sector’s emissions comes from supply chains, according to various estimates, said Bretin. In the case of HIV treatment, 90% of the emissions come from the upstream part of the manufacturing process, he said.

DTG is the most effective and lowest-cost antiretroviral drug ever. It was rapidly scaled up across low- and middle-income countries starting in 2017, thanks to a concerted global effort by Unitaid, manufacturers, governments, global health organizations and affected communities. DTG is now the standard of care in over 110 low- and middle-income countries.

“This report demonstrates that we can achieve significant health improvements while also making strides in reducing carbon emissions. By adopting innovative practices and prioritizing sustainability, we can ensure that medicines like DTG are not only effective but also environmentally responsible,” Bretin said.

The reason for the reduction in emissions was found to be that DTG requires a smaller quantity of active pharmaceutical ingredients which naturally lowers emissions during the production process.

While DTG’s carbon footprint is significantly lower than its predecessor, it still remains very high, the report said, and there is a need for all stakeholders to work together to lower it further.

Need for innovation in the health sector

The sector will have to focus on technology upgrades and innovation to reduce carbon emissions of drugs and other pharmaceutical products.

The report outlines several measures that can be taken to reduce emissions from DTG even further, with the potential for application to other commonly used drugs.

Up to 40% of these emissions could be reduced through cost-saving measures such as process optimization to improve energy and material efficiency, and another 50% could be reduced by adopting green energy and materials, the report says.

Optimized supply chains, supported by coordinated efforts to improve distribution and production processes, will also be needed to further enhance environmental efficiency.

“While it (this report) demonstrates the potential for health interventions to contribute to our climate goals, it also highlights a missed opportunity: had climate considerations been mainstreamed into design of these efforts, its carbon footprint could have been reduced much further,” wrote Oyun Sanjaasuren, Director of External Affairs at the Green Climate Fund, the world’s largest climate fund, in the report’s foreword.

Unitaid hopes that the report encourages drug manufacturers, innovators, public health players and governments to look at the carbon emissions of the health sector.

“I think it’s the broader ecosystem that we need to look at that needs to shift from where we are right now to integrating climate considerations into our policies, ways of working approaches,” Bretin said.

No mechanism to prevent ‘greenwashing’

But promoting some products as greener than others opens the sector up to greenwashing – a form of marketing spin to persuade the public that the products are environmentally friendly.

End users have no way of knowing whether the drugs are green if more companies and entities use this claim while marketing their drugs.

“We don’t have yet the systems, the methods, the standards, as a global health community to do this in a standardized way, and to audit for instance, or to request information from manufacturers to ensure that what they do is really what they claim they’re doing,” Bretin acknowledged.

Unitaid’s report comes days before the International AIDS Society (IAS) Conference – the premier global event on HIV research and policy.

Image Credits: Unsplash, Unitaid report.

Prime Minister of Côte d’Ivoire, Robert Beugré Mambé; Minister of Health of Côte d’Ivoire, Pierre Dimba; Gavi CEO Dr Sania Nishtar; Kouyate Aïcha (mother); and Diomandé Aboulaye (son, 8 months).

Côte d’Ivoire became the first country to roll out the new R21/Matrix-M vaccine with the first child vaccinated in Abidjan on Monday.

The vaccine, co-developed by the University of Oxford and Serum Institute of India (SII), was granted prequalification status by the World Health Organization (WHO) in December last year.

This follows the approval of the malaria vaccine, RTS,S. Both vaccines are expected to have a high public health impact. 

Every year 600,000 people die of malaria in Africa, according to the WHO. Children under five years of age make up at least 80% of those deaths. 

Although the number of malaria-related deaths has fallen from 3,222 in 2017 to 1,316 in 2020 in Côte d’Ivoire, the mosquito-borne disease kills four people a day, mostly small children, and “remains the leading cause of medical consultations”, according to the Ministry of Health.

Wide implementation of the malaria vaccines, in conjunction with existing prevention methods like the use of bed nets, is expected to save tens of thousands of young lives each year.

 SII has manufactured 25 million doses of the vaccine and is committed to scaling up to 100 million doses annually, offering the vaccine at less than $4 per dose. 

“Reducing the malaria burden is finally within sight. Today’s start of the R21/Matrix-M™ vaccine roll-out marks a monumental milestone after years of incredible work with our partners at Oxford and Novavax,” said SII CEO Adar Poonwalla.

The vaccination “signifies the culmination of years of dedicated research and manufacturing efforts” by the two partners, they said in a joint media release.

 “The roll-out of the R21/Matrix-M™ malaria vaccine marks the start of a new era in malaria control interventions with the high efficacy vaccine now accessible at a modest price and very large scale to many countries in greatest need. We hope that very soon this vaccine can be provided to all countries in Africa who wish to use it,” said Professor Adrian Hill, Director of the Jenner Institute at Oxford University.

A total of 656,600 doses have been sent to the country, which will initially vaccinate 250,000 children aged up to 23 months across all 16 regions. 

The R21/Matrix-M vaccine has also been authorised by Ghana, Nigeria, Burkina Faso, and the Central African Republic. 

Gavi, WHO, UNICEF, the Global Fund and others are working with countries on their plans for vaccine roll out as part of holistic malaria control and prevention plans.

Fifteen African countries are expected to introduce malaria vaccines with Gavi support in 2024, and countries plan to reach around 6.6 million children with the malaria vaccine in 2024 and 2025. Gavi and partners are working with more than 30 African countries that have expressed interest in introducing the malaria vaccine.

 Gavi CEO Dr Sania Nishtar said: “Africa has borne the brunt of malaria for far too long, and Côte d’Ivoire has suffered more than most. With two safe and effective vaccines now available alongside other interventions, we have an opportunity to finally turn the tide against this killer disease.”

Image Credits: Miléquêm Diarassouba/ Gavi.

A health worker in Niger administers a vaccine to a baby

Childhood immunisation has stalled in the past year, mainly due to increased global conflict, with the number of children receiving no vaccines increasing to 14.5 million in 2023 – up from 13.9 million in 2022.

There has also been an almost threefold increase in measles cases in the past year – a sign of inadequate vaccinations – including in conflict-ridden Sudan, Yemen and Afghanistan.

This is according to the latest global immunisation estimates for 2023 based on data from 194 countries, that was released on Monday (15 July) by the World Health Organization (WHO) and UNICEF.

Around 55% of the “zero-dose” children “live in countries that have some aspect of the country that is fragile, conflict-affected or a vulnerable setting”, according to Dr Kate O’Brien, WHO Director of Immunization. These areas only contributed to 28% of global births.

Fragile and vulnerable settings usually refer to situations where humanitarian crises, armed conflicts and natural disasters prevail.

Sudan’s vaccination rate plunged from 75% in 2022 to 57% last year, with the result that about 700,000 children received no vaccines. This represents over 43% of all unvaccinated children in the region, noted Dr Ephrem Lemango, UNICEF’s global head of immunisation, at a media briefing to launch the data.

Palestine has been unable to document immunisation figures since September 2023 because of Israeli attacks in the region. However, Ukrainian immunisation has improved despite Russian attacks.

“Children who are living in [conflict-ridden and vulnerable] settings also lack security, lack nutrition, lack healthcare, and are most likely, as a result of those things, to die from a vaccine-preventable disease if they get it,” O’Brien told the briefing.

The needle also did not move for basic immunisation – the global marker for this being that children get three doses of the DTP combination vaccine for diphtheria, tetanus and pertussis (whooping cough).

While 84% of children – 108 million – got three DTP vaccinations in 2023, this was the same figure as the previous year. 

The WHO’s conflict-ridden Middle East and North Africa region recorded a 4% decline DTP vaccination.

Aside from the zero-dose children, 6.5 million children did not get all three doses of DTP. 

The zero-dose children and the under-immunized children amounted to 21 million kids in 2023 – 2.7 million more than before the pandemic, when there were 18.3 million of these un- or under-vaccinated children, O’Brien noted.

The COVID-19 pandemic significantly disrupted childhood vaccinations, one of the most powerful global weapons to protect babies and young children from serious illness and death.

UNICEF, the WHO and Gavi, the global vaccine alliance, united last year with “The Big Catch-up” campaign to regain lost ground. 

Twenty-five of the 35 low-income countries targeted have either recovered to pre-pandemic levels or have improved their coverage in the past year.

Bright spots: HPV vaccine expansion

In Freetown in Sierra Leone, students at St Augustine School receive the HPV vaccine.

There was a 3% reduction in zero-dose children in the Americas, largely thanks to an impressive recovery in Brazil.

Africa reduced its zero-dose children by 1% (to 6.7 million), with Chad, South Sudan,  Mauritania, Tanzania and Cameroon singled out for their improvements. Ethiopia also improved its immunisation following a reduction in conflict in Tigray.

Global coverage of the human papilloma virus (HPV) vaccine to prevent cervical cancer jumped by 7% last year, with 27% of girls receiving the first dose of HPV vaccine.

“This increase was largely driven by really strong introductions of HPV vaccine in large countries, including Bangladesh, Indonesia and Nigeria, which were supported by Gavi,” said O’Brien.

However, China, India and Russia have yet to introduce the HPV vaccine.

In addition, most countries are only vaccinating girls although males are both carriers of the virus that can be passed on to females during sex, and can be affected by penile and throat cancers caused by HPV.

O Brien explained that while the WHO recommends that both girls and boys get the HPV vaccine, “the priority, especially in the introduction phase of vaccine, is for provision of the vaccine to girls”, as the largest disease burden relates to cervical cancer.

“Once countries have well functioning programs, then an advancement in the program would be to consider moving including boys.”

Rising measles cases

“Immunization stands as one of humanity’s greatest achievements, and it has saved over 154 million lives over the past 50 years, with measles vaccination alone responsible for about 60% of this,” noted Dr Ephrem Lemango, UNICEF’s global head of immunisation.

“And yet, measles outbreaks continue to rise as measles vaccination coverage stalls. For example, the world saw over 300,000 confirmed measles cases in 2023 which is an almost threefold increase compared to what we had in 2022.”

Lemango noted that only 83% of children received their first measles vaccine dose, and 74% were fully protected by a second measles vaccine.

Afghanistan, Angola and Yemen had the lowest measles vaccination rates. However, countries without conflicts such as Indonesia and Pakistan also had low rates. Some of the setbacks related to countries’ weak economies following COVID, said O’Brien.

“Over the past five years, about 103 countries with inadequate vaccine coverage saw measles outbreaks,” said Lemango. “[This] contrasted sharply with the remaining 91 countries, where coverage exceeds 90% and no outbreaks occurred.”

“Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization and hitting the most vulnerable first,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places. WHO is committed to working with all our partners to support countries to close these gaps and protect the most at-risk children as quickly as possible.”

Vaccine hesitancy from COVID misinformation

A rising lack of confidence in vaccines – also a COVID-19 setback  – has affected uptake of routine childhood vaccinations.

“During the pandemic, we all experienced a huge amount of misinformation and disinformation, and this is continuing to reverberate in many countries, and is actually resulting in deaths,” said O’Brien. 

“It’s resulting in children and adults and adolescents not getting vaccinated when they are recommended to be vaccinated, and is causing harm. Misinformation and disinformation, are a health threat themselves, and they actually cost people their lives.”

“The latest trends demonstrate that many countries continue to miss far too many children,” said UNICEF Executive Director Catherine Russell.

“Closing the immunization gap requires a global effort, with governments, partners, and local leaders investing in primary healthcare and community workers to ensure every child gets vaccinated, and that overall healthcare is strengthened.”

Image Credits: Gavi, Gavi.

Debris after Hurricane Beryl on Barbados
Hurricane Beryl’s destruction in Barbados.

Caribbean leaders from “the frontlines of climate change” are appealing for international support in the wake of Hurricane Beryl, which has already caused widespread destruction – even before the usual start to the hurricane season.

Hurricane Beryl, the earliest recorded Category 4 storm in the region’s hurricane season, levelled 90% of the buildings on Grenada’s islands of Petite Martinique and Carriacou. 

“We have several hundred persons who are in shelters, mostly in schools, functioning as shelters,” Grenada’s Prime Minister Dickon Mitchell told a press conference this week. 

“The clearing of roads to allow relief to get to our citizens, who are in shelters and in the remnants of their homes, is ongoing….our priority over the last week has been mostly in ensuring that we get relief to our citizens who badly need them in Carriacou, and in Petite Martinique,” said Mitchell.

Mitchell joined Prime Minister Ralph Gonsalves of St Vincent’s and Grenadines in an appeal to international donors for hurricane relief. They cited the primary objectives for recovery as providing direct support like shelter, food, and medications; supporting the restoration of livelihoods, and protecting the most vulnerable. 

St Vincent and Grenadine’s Prime Minister Ralph Gonsalves (top) and Grenada’s Prime Minister Dickon Mitchell (bottom) address a media briefing this week in the hurricane’s aftermath.

Disasters linked to climate change

“Across St. Vincent and Grenadines, the faces of men, women and children are strained and anxious. They are apprehensive of the future. My country has had four significant disasters or emergencies since 2020,” remarked Gonsalves, referring to the COVID-19 pandemic, volcanic eruptions, Hurricane Elsa, and now Hurricane Beryl. 

“All of these are connected to deleterious climate change. And this matter has to be addressed by humanity. We are on the front lines.”

Their appeals underscore the vulnerability of their nations in the wake of an early-season storm and the disproportionate impact of climate change on small island nations

“We have four months left to go in the [hurricane] season. The prediction is not encouraging. We, in Grenada, Carriacou, Petite Martinique, St Vincent and the Grenadines, simply cannot afford another hurricane. Islands are simply too vulnerable at this point,” said Mitchell. 

“The major emitters are not listening as carefully as they should. And if they can, if they have been listening, they have not been summoned in the requisite will, political will. To address the existential question of climate change,” added Gonsalves. 

“When I use the word from the book of Revelations, Armageddon, in the southern Grenadines, it’s truthfully so.

“We are a resilient people and we have faith and we have fresh hope. But we require the solidarity of our friends and allies,” said Gonsalves.

Hurricane Beryl’s path of destruction through the Caribbean.

Managing chronic disease in a post-disaster setting

Mitchell noted that because his nation struggles with high levels of diabetes and hypertension – over 13% of the adult population has diabetes – the burden of these non-communicable diseases means that relief efforts must provide additional support. 

Hurricanes alter physical and social environments, exposing people to stressors and impeding healthcare delivery. While hurricanes are typically associated with health risks like water-borne diseases and pollution, the mental health burden of such a disaster requires additional psychosocial support. 

“Given the stresses that people are under, the challenges with the elements, and the extremely hot climate, there is a real risk that some of those [health] challenges will be exacerbated,” Mitchell said.

Grenada anticipated some of these challenges by evacuating its senior living homes on the island of Carriacou because “we simply could not deal with [the] potential catastrophe of the lack of medical supplies,” Mitchell explained. 

In need of international solidarity

Despite Grenada’s fiscal resilience and legislation that ensured some funds for “rainy days and disastrous days,” as Mitchell describes, its domestic funds are inadequate to help the more than 10,000 families rebuild their homes.

“Even a larger country with a larger economy would find this difficult,” Gonsalves added.  

In the wake of the destruction, the United Nations (UN) and its partners launched a $9 million response plan to provide urgent humanitarian aid to 43,000 people in Grenada and St Vincent and the Grenadines.

The UN’s Regional Overview and Response Plan seeks $5 million for Grenada and $4 million for St Vincent and the Grenadines.

Simon Edward Springett, UN Resident Coordinator in the Caribbean region, noted “what Grenada and the St Vincent and the Grenadines need right now is international financial support, and global solidarity.”

Image Credits: OCHA, IFRC.