A child splashes water during a heatwave in Sudan
A girl cools off in the Bieh camp for internally displaced people in South Sudan. The region has seen an increasing number of extreme heat days.

One in five children now live in parts of the world that are experiencing double the number of extremely heat days per year, as compared to six decades ago, according to a new analysis by the United Nations Children’s Fund (UNICEF). 

The analysis comparing average temperatures during the 1960s to the period 2020-2024, highlights a dramatic increase in the frequency of extreme heat days, where temperatures exceeded 35° Celsius (95° Fahrenheit), as well as in the frequency of heat waves. UNICEF defines a heatwave as a period of three days or more of above-average heat.

Heatwave duration, severity, and frequency all intensified since 1960, with more than half of the world’s children 18 and under now experiencing twice as many heatwaves as 60 years ago. 

In the worst affected regions, two-thirds of children in West and Central Africa and 28% of children in the Middle East and North Africa now experience three times as many heatwaves, in comparison to children growing up in the 1960s. In Latin America and the Caribbean, nearly 57 million children – 60% – are now exposed to twice the number of heatwaves. And in the United States, 36 million children – more than half of that population – are exposed to double the number of heatwaves in comparison to their counterparts in the 1960s. 

Frequency of heatwave events by region in the 1960s, when most of the world was seeing 0-3 (beige) or 3-6 (very light brown)events a year.
Frequency of heatwave events in the 2020s, where most of the world is seeing 6-9 events (medium brown), or 9-15 or more events (darker brown) a year.

Hottest summer days now seem normal

“The hottest summer days now seem normal,” remarked UNICEF Executive Director Catherine Russell in a press statement. “Extreme heat is on the rise, disrupting children’s health, well-being, and daily routines.”

The report’s findings are particularly alarming for children in 16 countries, which now see over a month more of  extremely hot days compared to the 1960s. Among those are children in war-stricken Sudan.

“[The analysis] has a real relevance to Sudan, where 80% of children now face double the number of heat waves that their grandparents did,” said UNICEF spokesperson James Elder at a Tuesday press conference at the UN in Geneva.

Most of the 16 flagged countries are in Africa: Senegal, Burkina Faso, Mali, and Senegal all struggle with rising levels of heat, while Tunisia and Paraguay also made the list. For example, children in South Sudan face an average of 165 extremely hot days annually this decade, up from 110 days in the 1960s. In Paraguay, the number of such days has doubled from 36 to 71.

Extreme heat in Cambodia
A typical summer day in rural Cambodia, where temperatures reach as high as high as 40 degree Celsius.

Health effects of  extreme heat on children

With climate change upending global temperature norms, the burden of extreme heat on children, as well as pregnant women, can often be as severe as the impacts on other adults. That’s despite the fact that adults often get most of the attention insofar as they suffer from more chronic respiratory and cardiovascular diseases, which are exacerbated by heat. 

“Children are not little adults. Their bodies are far more vulnerable to extreme heat. Young bodies heat up faster, and cool down more slowly. Extreme heat is especially risky for babies due to their faster heart rate, so rising temperatures are even more alarming for children,” Russell said.

The analysis links heat exposure to a range of adverse health outcomes, including pregnancy complications, low birth weight, preterm birth, child malnutrition, heat-related illnesses, and increased vulnerability to infectious diseases such as malaria and dengue. Additionally, extreme heat has been shown to negatively impact neurodevelopment, mental health, and overall well-being.

Compounded by other climate related hazards

The impact of extreme heat on child health is compounded by the broader effects of climate-related hazards on food and water security, infrastructure, education, and displacement. These challenges are further exacerbated by existing vulnerabilities such as socioeconomic status, gender, location, and underlying health conditions. 

Heat interventions are often out of reach financially – heat relief like air conditioning is costly. Many experts point to urban planning and building design to alleviate extreme heat. Narrow streets, green rooftops, and cul-de-sacs are all design techniques aimed at keeping buildings cool.

With the upcoming submission of new Nationally Defined Contributions (NDC 3.0) under the Paris Agreement, UNICEF is urging governments and the private sector to take bold climate action.

West and Central Africa heats up

Heatwave in Chad
Children gathering water in Moussoro, in the East of Chad. Chad is one of 16 countries that has seen more than 30 days of extreme heat per year compared to 1960.

Most notably, children in West Africa and Central Africa are facing the highest exposure to extremely hot days and the most significant increases in the past 60 years, warned UNICEF in a statement. 123 million children—39% of the region’s youth—experience extreme heat for at least a third of the year, equating to 95 days or more. In countries like Mali, Niger, Senegal, and Sudan, children are living through 195 to 212 days of extreme heat annually.

“Almost 40 per cent of children in the region live through extreme heat for more than one third of the year, the equivalent of at least four months in temperatures above 35 degrees [Celsius]. In many countries where infrastructure often isn’t available to manage this level of heat, there is a huge impact on children especially at school. The heat means many children in schools with overcrowded classrooms and inadequate ventilation or other means to manage extreme heat, get sick, are unable to study, play, or thrive,” says UNICEF Regional Climate Specialist in West and Central Africa David Knaute. 

“Just earlier this year the region suffered an extended heatwave, affecting several countries in the Sahel, where we saw the risks posed to vulnerable populations, especially children. Young people in Casamance, Senegal, told me how they had suffered or witnessed dehydration, dizziness, and exhaustion as a result of the extreme heat.”

 

Image Credits: © UNICEF/UN0836989/Naftalin, UNICEF, © UNICEF Cambodia/2019/Fani Llaurado, © UNICEF/UN0794414/Dejongh.

Sharing experiences across continents: A group of community health workers in a remote Guyana community describe their training to a visiting HeDPAC delegation.

The recent CARICOM summit of Caribbean leaders has endorsed a new Afro-Caribbean Health and Development  (HeDPAC) initiative aimed at stimulating South-South collaboration on resilient health systems, health worker capacity building, and local medicines and vaccines manufacture. 

The formal CARICOM Communiqué at the close of the Summit in Grenada invited its 15 member states and five associated states to join the voluntary partnership: 

“The HeDPAC initiative has three main priorities: to mitigate the difficulties faced by the health workforce of the Africa and Caribbean regions, including education, employment, deployment, retention, and performance; to build resilient health systems capable of withstanding emerging threats; and to promote the local manufacturing of medical products, including vaccines,” stated the Communiqué, noting that the overarching aim is “to manage the gaps identified during the COVID-19 pandemic. 

CARICOM leaders at the close of the recent summit, which endorsed a new initiative on Afro-Caribbean health and development cooperation.

“The Partnership could also be leveraged to improve knowledge exchanges between Africa and the Caribbean, to enhance regulatory capacity for medicines, medical supplies and equipment, and to facilitate the free movement of CARICOM nationals within the Community through advancing the digitalization of health information systems,” the Communiqué added. 

“All Member States are invited to partner with HeDPAC to leverage sustainable health development and capacity building through political, technical, and scientific collaboration between the Regions.” 

The communiqué was issued in early August, shortly after the conclusion of the summit in Grenada, which was postponed to the end July, due to Hurricane Beryl.   

It also referred to “health-related issues of the climate crisis” as another potential area of collaboration – in the wake of the devastating effects of Hurricane Beryl on the region’s small island states.  

Next stop, Africa

Following the CARICOM summit, HeDPAC’s advocates are now making a swing through Africa to build support among member states on the continent for stepped-up collaboration.  

In Addis Ababa last week, the African Union’s Technical Committee on Health, Nutrition, Population, and Drug Control (STC-HNPDC-5) heard a presentation on the initiative. 

Member States were invited to engage, beginning with stepped up participation in cross-regional events such as the upcoming Africa CARICOM day, observed on 7 September.

The initiative also may be a topic of discussion on the sidelines of the upcoming WHO African Committee meeting in Brazzaville, set for 26-30 August, sources say.

The media highlight of the AFRO Committee meeting is sure to be the election of a new Regional Director to replace the outgoing Matshidiso Moeti, the AFRO region’s first female RD, elected in 2015. [In this round, all four candidates are men].  

But some two-dozen WHO-led global and regional action plans are also on the agenda, covering critical topics ranging from local manufacturing to vector borne and infectious diseases, as well as health emergencies. 

A declaration Tuesday by Africa CDC of a continental health emergency on a new, and rapidly-expanding strain of mpox, first identified in DR Congo, along with a possible WHO declaration of a global mpox health emergency, will undoubtedly be another focus for discussions. 

Promoting salaried and certified community health workers

A community health worker who has graduated from her training describes her role in managing vaccine cold storage at a Guyana health facility in Lethem, a primarily indigenous community on the border with Brazil.

Most experts agree that a cross cutting requirement to address all of these challenges involves more robust primary health care systems, built around more and better trained health workers.

And one of the first concrete aims of the HeDPAC initiative is precisely that, says Dr Haileysus Getahun, CEO. It aims to harness lessons learned in the Caribbean to foster stronger cadres of African community health workers (CHW), serving on PHC frontlines.   

Caribbean countries can offer some African countries examples of a way forward, in terms of the standardized training of community health workers and their integration into the health workforce as certified and salaried civil servants, he points out. 

In contrast, many African CHW’s may serve primarily as volunteers, or for small stipends.

“We want to promote certified and salaried health workers to be part of the system in Africa. Not only that, but with career development schemes,” Getahun said in an interview with Health Policy Watch.

Conversely, some African countries, like Rwanda, have useful experiences to share with Caribbean partners related to strengthening regulatory and clinical trial capacity, Getahun noted.   

Building a community health care workforce 

A pharmacist assistant in Lethem, who first began her career as a community health worker, takes HeDPAC CEO Haileysus Getahun on a tour of products available in the clinic pharmacy.

On a recent visit to Guyana, Getahun said he had the opportunity to observe the country’s community health workers in action, in both remote indigenous communities such as Lethem, which sits aside the border with Brazil, as well as busy urban settings near the capital of Georgetown. 

“I found Guyana and the region very much developed and mature in terms of its  primary health care systems – and particularly community health care integration into primary health care.” 

 Community health worker (CHW) training is carried out in a hybrid mix of online-and in-person sessions – with a national curriculum and accreditation system ensuring a standard level of competencies.  

“In addition to being trained and salaried, Guyanan CHWs are offered paths for career advancement;  nursing assistant and pharmaceutical training courses keep them motivated and retained,” Getahun noted.   

A Guyana Online Academy of Learning (GOAL), offers a portal for virtual training in healthcare provisions – supported by a government scholarship programme for those that apply and qualify. There is also a programme for high school students to test out various work options in the health care sector. 

As a next step in building the partnership, HeDPAC is working with African and Caribbean  health leaders to organize experience-sharing visits. 

‘Health leaders in both regions are eager to learn from each other, and we are organizing those platforms to do so starting from field and exchange visits,” he said.

Finance remains a challenge

Barbados Prime Minister Mia Mottley laying out her Bridgetown agenda at the UN Climate Conference in Sharm el-Sheikh (COP 27) in 2022.

Along with awareness and political will, a key challenge for many African states remains finance for new community healthworker and primary health care initiatives. 

Much of Guyana’s innovation in the health sector has been financed by government budgets flush with funds from newfound oil and gas reserves. Surging revenues from oil and gas helped catapult the tiny nation from the status of a middle income country to an upper income one in World Bank classifications last year.  

But some other Caribbean countries, as well as many more of their African counterparts, remain hobbled with debt, which impedes their ability to develop their health systems – an issue Barbados Prime Minister Mia Mottley has called out repeatedly, as part of her “Bridgetown” Initiative calling for creative forms of debt relief that would also free up funds for development in health and climate projects in low- and middle-income nations.    

Along with Guyana, Mottley has also been one of the leading champions of the HeDPAC initiative in the CARICOM community. 

Regulatory standardization 

International political leaders at the launch of BioNTech’s new facility in Kigali in 2023.

Incubated by WHO, HeDPAC  was launched as an independent non-profit in December 2023. It aims to leverage lessons learned from the COVID-19 pandemic to promote health development across the Global South, beginning with more African-Caribbean collaboration. It works directly with government leaders and heads of state – minimizing the bureaucracy that intergovernmental organizations often involve. 

And while Africa may have a lot to learn from the Caribbean, Getahun argues that the collaboration is not a one way street. 

In Africa, Rwanda has been a leading African country championing the cross-continental partnership – and it also has lessons to share across the ocean. Rwanda recently became the host to the COVID pharma giant BioNTech’s first modular mRNA manufacturing facility, thanks partly to its conducive regulatory environment.   

“On the regulatory side, Guyana is just now establishing their own food and drug administration, whereas Rwanda has almost reached a WHO Maturity Level 3 in terms of its regulatory system and standards,” he remarked.

“So Guyana may be able to take some of the regulatory experiences from Rwanda,” he observed. 

  • Linda Straker in Grenada also contributed to reporting on this story.

_______________________________________________

Note: HeDPAC is also supporting expanded Health Policy Watch reporting on the healthcare workforce, resilient health systems and local manufacturing in Africa as well as the Caribbean.  

Image Credits: Sophie Mautle/HeDPAC , CARICOM/X, Sophie Mautle/HeDPAC, @DPA.

In Sudan, one of the most neglected humanitarian crises globally could mean tens of thousands avoidable deaths, James Elder, UNICEF Spokesperson said during a press briefing Tuesday

Without urgent humanitarian assistance, tens of thousands of people in Sudan may die of famine in coming weeks, UN officials warned during a Geneva press briefing Tuesday. 

Their calls for a ceasefire to enable humanitarian assistance to flow more freely came on the eve of peace talks scheduled to take place in Geneva with the Rapid Support Forces (RSF) that  mounted a 15 month insurgency against the Sudanese government – leading to the world’s largest humanitarian crisis. 

At the beginning of August, a UN Committee declared that at least 100,00 households in Sudan’s  Zamzam refugee camp near the town of Al Fasher, in the Darfur region west of Khartoum, were facing famine conditions (Integrated Food Security Phase Classification (IPC) – an extreme and rare claim, Health Policy Watch reported.

Map of Sudan food insecurity
IPC mapping of levels of food insecurity concentrated in the western portion of the country.

But that could be only the beginning, warned UNICEF Spokesperson, James Elder, in the briefing.

If nothing changes, “tens of thousands of Sudanese children may die over the coming months and that is by no means a worst-case scenario,” Elder said. “Any disease outbreak and we will see mortality skyrocket.”

”Beyond Zamzam, there are another 13 areas in Sudan that are on the brink of famine, and they are home to the staggering 143,000 children already suffering the most lethal type of malnutrition,” stressed Elder.

“Famine in Zamzam camp is the first determination of famine by the Famine Review Committee in more than seven years, and it’s only the third famine determination since that monitoring system was created 20 years ago,” he added, underling the gravity of the situation. 

Despite its large scope, the crisis in Sudan has received surprisingly little international attention. 

It’s “a crisis of neglect,” Elder said, noting the lukewarm international response. As of mid-year, UNICEF had recruited only 21% of the estimated $317 million budgeted for humanitarian aid in Sudan and neighbouring countries where displaced Sudanese have fled.

Mohammed Refaat, Chief of Mission for Sudan at the International Organization for Migration (IOM) during a press briefing Tuesday

“We must confront painful truths. The international community is not doing enough. The crisis in Sudan demands more than our sympathy, and it demands our action,” said Mohammed Refaat, Chief of Mission for Sudan at the International Organization for Migration (IOM). “We must go beyond words and pledges,” he stressed.

Famine conditions

Famine is the most severe phase of the IPC. Dubbed IPC Stage 5, it means at least one in five households faces extreme deprivation of food. To declare an area to be in a famine, the IPC committee also has to confirm that over 30% of the children there are acutely malnourished and that in a population of 10,000, more than two people die every day.

As access and data collection for humanitarian organizations in Sudan is limited, the easier-quantifiable assessment for the Zamzam camp, home of over 500,000 internationally displaced persons, is considered a bellwether for many other areas in North Darfur, a vast region of Sudan stretching along its western border.

The area where the camp is located has been besieged for months by the Rapid Support Forces (RSF), a paramilitary group that broke away from the Sudanese Armed Forces which enjoys backing from Russia’s Wagner Group, has been fighting government forces since April 2023.

One in five Sudanese have been displaced since the crisis began. And one-half of Sudanese, some 26.6 million people, are food insecure, World Food Programme (WFP) data shows. Fighting between the RSF and the Sudanese armed forces is at the root of the food crisis.

Rampant sexual violence

People denied access to humanitarian areas due to fighting, travel or logistic restrictions in Sudan in June

Rampant sexual violence is also an issue, Elder noted. 

“Yesterday in Khartoum, I spoke to a senior medical worker who…has had direct contact with hundreds of women and girls, some as young as eight years old, who have been raped,” Elder said. Sexual violence is increasing, he stated, especially in places where UNICEF and other organisations are denied a humanitarian presence.

Due to travel and logistic constraints as well as in conflict zones, about 1.78 million people were denied crucial humanitarian assistance in June, according to the UN’s Office for the Coordination of Humanitarian Assistance (OCHA).

An “immediate ceasefire” and unimpeded and safe humanitarian access is needed to ensure aid can reach those who need it, Elder highlighted at the press briefing.

On Wednesday, ceasefire talks in Geneva, initiated a month ago by the United States, are set to convene with only the RSF representatives, despite the absence of the Sudanese Army.

The US has decided to go ahead with the talks as planned despite that – and the failure of previous attempts at negotiations. The first round, planned as a separate engagement of each party with the US envoy, is expected to last up to ten days – even though only the RSF is currently present.

“We will move forward with our international partners to reach […] a concrete action plan about how we can advance to a cessation of violence and have full humanitarian access, and a monitoring enforcement mechanism. These are long past due,” Tom Perriello, the US special envoy for Sudan told Voice of America.

Image Credits: UNICEF/UNI530171/Mohamdeen, IPC , UNOCHA.

Bottom: Africa CDC Director Jean Kaseya; Above Margaret Edwin and Prof. Salim Abdool Karim, at the press briefing announcing the continental health emergency.

“Words must now be matched with deeds,” Africa CDC Director General Jean Kaseya said after the official declaration.

The Africa Centers for Disease Control and Prevention (Africa CDC) has officially declared the surging mpox outbreak a “public health emergency of continental security” – the first time it has made such a declaration on its own.

Jean Kaseya, Africa CDC’s Director-General said the centre’s historic move represents a pivotal moment in Africa’s fight against the long-simmering and now rapidly spreading disease.

“Today, Tuesday, 13 August 2024, I declare with a heavy heart, but with an unwavering commitment to our people, to our African citizens, we declare mpox as a public health emergency of continental security in Africa,” Kaseya stated at a Tuesday afternoon press briefing.

In just the past week,  more than 2500 new mpox cases and 56 deaths were reported in some five African Union member states, Africa CDC officials noted at the briefing.  Those included Burundi, the Central African Republic, Congo, the Democratic Republic of Congo (DRC), and South Africa.  Since the beginning of the year, 17,541 mpox cases have been reported across 13 AU states, according to the latest Africa CDC epidemic intelligence report, published 9 August.

In the days leading up to the declaration, Health Policy Watch reported that a new variant of the mpox virus, known as Clade 1b, is fueling an outbreak in eastern Democratic Republic of Congo (DRC) that has now spread to neighboring countries. 

In other areas of DRC, Clade 1a of mpox is also spreading, according to WHO reports. Historically Clade 1a variants of mpox have seen high mortality rates of up to 10%. A mix of Clade I and II cases also continue to be reported in multiple other countries of West, Central and East Africa, affecting children and adults and spread through multiple modes of transmission. 

The case fatality rate (CFR) from this mix of mpox clades and variants is a startling high 2.95%, according to Africa CDC.

In Africa and throughout the world, the milder Clade IIa variant, spread mainly through men having sex with men, also continues to spread.  

Since the beginning of the year, a total of 17,541 mpox cases have been reported, including 2,822 laboratory confirmed, with 517 deaths – Africa CDC.

A consultation process involving more than 600 people

Describing the journey to the declaration, Kaseya said it was not made lightly. He noted it was the culmination of an extensive consultative process involving a diverse array of stakeholders at various levels, as mandated by the Africa CDC statutes. 

“Africa CDC didn’t sit in its office and make a decision. No, it was a constructive, consultative process led at various levels by capable people…at least 600 people were reached in various capacities to discuss data and evidence and to provide a way to move forward for this outbreak,” the DG said at the press briefing.

The Emergency Consultative Group (ECG), comprising African and international experts, reviewed epidemiological data and unanimously recommended declaring a public health emergency. 

“We resolved to make a recommendation to the Director-General of the Africa CDC to declare mpox a public health emergency of continental security,” Professor Salim Abdool Karim, the ECG chair, said at the briefing.

Karim expressed concerns, in particular, that the virus variants are now spreading almost entirely between humans – well beyond traditional animal reservoirs. 

“The evidence we have does not seem to be that it’s zoonotic transmission, in other words, from an animal reservoir. It seems to be almost all, mostly from human to human transmission,” he said. 

“We are seeing new cases in countries that didn’t have cases before,” Karim added, saying  saying the declaration should help “ensure that the disconnected attempts that are being made are brought together in a large plan with some coordination to improve the efficacy of our intervention measures.”

Africa CDC aims to leverage the emergency announcement to coordinate a stronger international response, mobilise resources, enhance surveillance, accelerate research and development, and foster global solidarity, Kaseya said. 

All of those have been sorely lacking in previous months. 

“Words must now be matched with deeds, and today, I commit to you that Africa CDC will lead this fight with every resource at our disposal, together with our partners,” Kaseya added.

Africa’s growing mpox disease burden – 60% children

Mpox research as part of a Nigerian -UK collaboration. Much more is neeeded.

According to the DG, the decision to declare a public health emergency was driven by the new modes of transmission, including sexual transmission; a growing proportion of cases involving children; late detection of cases; and limited access to countermeasures like vaccines and diagnostics. “This is one of the aspects that is alarming us…you will see it’s mostly driven by cross-border transmission linked also to sexual transmission,” Kaseya added.

A staggering 60% of cases in the DRC involve children under 15 years old, according to Africa CDC. Kaseya said this alarming statistic underscores the urgency of the situation and the need for swift action to protect the most vulnerable populations.

Furthermore, the outbreak has spread to non-endemic countries, such as Burundi, Kenya, Rwanda, and Uganda, which have reported their first-ever cases of mpox this year. This unprecedented spread, Kaseya noted, has necessitated a coordinated, continental approach to curbing the disease’s transmission.

Addressing the challenges posed by the outbreak, Kaseya acknowledged the complexity of the situation, citing insecurity in certain regions, limited understanding of the epidemiological and transmission dynamics, inadequate global attention, and the unavailability of countermeasures as significant hurdles. 

Support at the highest levels 

However, Kaseya expressed optimism in light of the fact that the decision to declare the public health emergency had garnered political support at the highest levels in Africa, especially the leadership of the African Union. 

This he said is important to ensure engagement now in a more coordinated, multi-sectoral response.

Already, the African Union has approved the emergency release of $10.4 million to support the continental response to the outbreak, he said. He announced that the funding will aid in securing necessary vaccines, strengthening surveillance systems, and bolstering overall preparedness and response efforts.

“We are advocating strongly and we are going to be creating subcommittees on surveillance and diagnostics, on communication, on vaccines and therapeutics to ensure that we have a holistic view on the way we address this issue,” he added.

Africa needs 10 million vaccine doses – only 200,000 available

One of the critical challenges facing the response efforts is the limited availability of mpox vaccines, as well as multiple hurdles to their rollout. Existing vaccines have been produced by only two manufacturers, Bavarian Nordic, whose production has been constrained, and the Japanese LC16 KMB, produced by KM Biologics. The latter has the advantage of being just one, rather than two jabs, but it requires intradermal administration – a procedure requiring training for the health workers unfamiliar with the technique.  

Currently, Africa requires at least 10 million doses of mpox vaccines. But only 200,000 doses are right now available, said Kaseya.  He said that underlines the urgency of more local vacccine manufacturing. “Local manufacturing of vaccines [and] medicines is the second independence of Africa,” he said.

In a bid to address the vaccine shortage, Africa CDC said it is actively engaging with various partners, including the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) and the German-based BioNTech which partnered with Pfizer to produce the mRNA COVID vaccine, as well as others to finalise contracts and scale up production for millions of doses in 2025. 

In light of the current shortages, however, Karim emphasised the importance of strategic vaccine distribution. 

“We have to be very strategic in who we use the limited number of vaccines on…for example, healthcare workers have been one of the groups that have to be addressed,” he said.

All eyes on WHO

Mpox is an orthopoxvirus, a disease in the same family as smallpox., which was eradicated in 1980. Previously called monkeypox, it was renamed by WHO  in 2022, due to the racist stigma associated with the historic name. In July 2022, WHO declared a public health emergency over the first worldwide outbreak of mpox, involving a milder Clade II variant spreading internationally, parimarily between men who have sex with men; it was declared to be over in 2023. 

In the wake of the Africa CDC announcement regarding this latest outbreak, all eyes are on now WHO – where an emergency expert committee is holding further consultations on Wednesday over the possible declaration of a global mpox public health emergency as well. 

That meeting is convening in Geneva under the auspices of the circa 2005 WHO International Health Regulations (2005) – the framework under which global health emergencies, known as Public Health Emergencies of International Concern (PHEIC), are declared.  

There has been simmering criticism, however, that WHO criteria for issuing global health emergency declarations are always not fit for purpose in the case of many of the outbreaks that Africa has faced first on the continent, alone.  In the wake of the worldwide COVID pandemic, the World Health Assembly in May finally approved amendments to the IHR that now allow  for the declaration of a pandemic emergency. However, in the two years of negotiations leading up to the revisions, member states ultimately rejected proposals to revise the  “binary” system of emergency declarations to a tiered system dubbed a “traffic light”, allowing for a WHO declaration of regional emergencies, or emergencies with global potential. 

In the case of the current outbreak, those long-simmering issues all contributed to the decision of Africa CDC to act on its own first, on Tuesday. 

Image Credits: US Centres for Disease Control , Paul Adepoju, Africa CDC, CDC.

Anna Maria Żukowska, a PM from the New Left, displays a t-shirt with the symbol of the Women’s Strike, just after the Parliament decides to postpone a vote on liberalising Poland’s restrictive abortion laws.

Nearly a year after new Polish Prime Minister Donald Tusk promised a fresh start for abortion rights, following his election victory in October 2023, reform efforts have stalled as campaign promises collide with the realities of coalition politics in a divided Poland. 

Poland is amongst only four countries worldwide to have restricted abortion rights in the past three decades, joining El Salvador, Nicaragua, and the United States. In 2020, Poland’s Constitutional Tribunal, stacked with judges appointed by the right-wing Law and Justice (PiS) party, further tightened the country’s already strict 1993 abortion law.

The Tribunal has even banned abortions due to fetal defects, which had accounted for about 90% of legal terminations. Current law permits abortions only in cases of rape, incest, or when the pregnancy endangers the mother’s life or health. At least six women have died after being denied abortions since the 2020 ruling.

The ruling sparked nationwide protests, mobilising millions of women across the country. Then, in the 2023 election that brought Tusk to power, 74% of eligible women voted, up from 61.5% in 2019. Exit polls indicated abortion policy as a key motivator. 

Tusk, capitalizing on the women’s rights movement, made the promise to liberalize abortion laws central to his campaign, which led to his centrist Civic Platform party taking power in a coalition with the New Left and centrist Third Way party – the latter a coalition of Poland 2050 and the rural-based Polish People’s Party (PSL). Even so, since his victory, hopes that the reform promises would be realized have turned to anger and frustration. 

First major legislative test fails

In its first major legislative test, the government coalition faced defeat on July 12 when a bill to decriminalize assistance for women seeking abortions was narrowly rejected by the Parliament’s lower chamber (Sejm), including by members of Tusk’s own Civic Platform, who abstained, as well as the Third Way and most notably the PSL, who voted outright against the reform.

Votes on the draft law decriminalising abortion help in the Polish Sejm (Parliament)

“Among us activists, we’re furious,” said Agata Adamczuk of the feminist NGO Dziewuchy Dziewuchom, or Gals Help Gals. “Decriminalising help in getting an abortion directly affects activists because criminalisation has immediate consequences for us.”

The defeated bill would have removed potential three-year prison sentences for those helping women obtain abortions by providing tools, such as abortion pills, or persuading them to terminate a pregnancy. While assisting in abortions is criminalised, ending one’s own pregnancy remains legal in Poland, regardless of circumstances.

Estimates suggest 80,000 to 93,000 abortions occur annually in Poland, with only a few hundred performed legally. Most women rely on NGOs for information about accessing abortion pills online or through procedures abroad.

“Punishing abortion help is absurd and inhumane,” Adamczuk told Health Policy Watch. “People are sentenced for helping their loved ones.”

Coalition joins opposition

The bill’s defeat has exposed deep fissures within Tusk’s coalition and ignited public outrage. Tusk swiftly disciplined his own party members who were absent during the vote, suspending their party membership and stripping them of government and party functions.

“I feel very bad that I haven’t found arguments that would convince all those who voted differently than I did,” Tusk said following the vote. “I have a clear conscience because I’m doing everything so that this women’s hell will disappear.”

Even more notably, the Polish People’s Party’s (PSL) added its 24 votes to those of opposition forces: 175 from the right-wing Law and Justice party, 17 from the far-right Confederates, and two other right wing parliamentarians associated with a party known as Kukiz’15 (Law and Justice aligned). This coalition of 218 lawmakers narrowly blocked the legislation.

Advocating for a national referendum

Instead of a parliamentary vote on a new law, the PSL has advocated for a national referendum. This proposal is opposed by coalition allies and women’s rights organisations, who fear it could be weaponised by right-wing forces against women’s interests.

“PSL is a separate party, we have our own policy,” said Władysław Kosiniak-Kamysz, the PSL leader. “In matters of personal belief, members always vote individually.”

The bill’s defeat was met with thunderous applause from its far-right opponents. Lawmaker Bartłomiej Wróblewski hailed the outcome as a triumph for “life and the constitution.”

“The Sejm has rejected the most blatant attempt to violate the Constitution since 1989 and strip unborn children of legal protection,” Wróblewski said.

The vote’s outcome sparked nationwide protests. On July 23, women’s rights activists demonstrated in front of parliament and in several cities, continuing pro-choice rallies against Tusk’s that began in January. Protesters repurposed slogans from 2020 demonstrations against PiS, now directing them at PSL.

Women’s Strike protests in Warsaw, 2020, against the constitutional tribunal sentence dramatically limiting access to abortions. July demonstrations reused slogans from previous protests, directing them against the PSL.

According to pre-election polls last October, PSL was at risk of falling just below the electoral threshold – an outcome that may have provided a path for Law and Justice to retain power. As a a pro-democratic NGO said in a pre-electoral public statement, voters of the anty-Law and Justice coalition should consider “a strategic vote for the Third Way, regardless of their support for the Civic Platform or the New Left.”

The electoral score for the alliance reached 13% instead of the expected 8%: a sudden boost mostly credited to strategic voting. PSL now owes many of its parliamentary seats – and role in government – to voters who support more abortion liberalization than the party is willing to offer. 

Almost half of the coalition voters (44%) are disappointed with the lack of abortion law liberalisation, concluded a poll conducted in June. The number rises to 57% among women aged 18-39, an especially numerous group in the last elections.

First of four competing proposals

The July 12 vote, however, is only the first of four competing proposals aimed at easing Poland’s strict abortion laws. Three more bills await consideration by a special parliamentary committee but face an uncertain future due to ideological rifts within the coalition.

Two bills from the Civic Platform and the New Left would legalise abortion on demand up to 12 weeks, while a third bill, proposed by PSL and Poland 2050, seeks to reinstate exemptions only for fetal defects, returning the law of the land to its pre-2021 state.  

Even if future bills pass parliament, they face another hurdle: Polish President Andrzej Duda, of the conservative opposition Law and Justice party, has vowed to veto any decriminalization bill, citing abortions as “depriving people of life”. 

Duda’s term extends until mid-2025, giving him veto power over any legislative changes for more than a year. Overriding a presidential veto requires a three-fifths majority in parliament, a threshold that seems unattainable given the coalition’s struggle to secure even simple majorities on abortion-related legislation.

The Constitutional Tribunal, still dominated by rightist Law and Justice-appointed judges, could also overturn new laws enacted by Parliament.

Exploring ways to circumvent a presidential veto

The government is exploring alternatives to circumvent presidential vetoes on abortion-related legislation. After President Andrzej Duda vetoed a bill on March 29 that would have made a morning-after contraceptive pill available without prescription, Health Minister Izabela Leszczyna quickly countered with a workaround.

Leszczyna introduced new regulations allowing pharmacists to write prescriptions for the pills, making them available by May. While effective in this case, officials acknowledge such administrative measures are generally less potent than laws passed by parliament.

In July, Attorney General and Justice Minister Adam Bodnar issued new guidelines for prosecutors, offering another temporary solution in the absence of a bill decrmininalising abortion assistance. The directive aims to clarity which cases should be pursued and which should not. 

Under these guidelines, prosecutors are instructed to target organised groups profiting from the sale of abortion pills, but NGOs simply writing about abortion assistance are to be left alone. The guidelines suggest that doctors who refuse to terminate pregnancies that endanger a patient’s health could face criminal charges.

Abortion debate unfolds in era of rapid social change

Abortion rights by country. In comparison to its neighbours, Poland stands out with its restrictive laws on abortion.

Poland’s abortion debate is unfolding against a backdrop of rapid social change. Support for liberalising abortion laws has risen from 29% in 2016 to nearly 60% in December 2023, although support for abortion on demand up to 12 weeks – endorsed by Tusk and the Left – remains below 40%, according to a poll conducted by market research firm Ipsos.

The struggle has deep historical roots. Before 1993, Poland had one of Europe’s most liberal abortion laws. However, post-communism, the Catholic Church’s growing influence led to restrictions, against strong public opposition.

As Poland upheld its 1993 abortion restrictions, 60 countries worldwide have expanded access to the procedure. Polish women, facing hurdles to legal abortions, have taken their fight to the European Court of Human Rights. The court has ruled against Poland in several cases, citing violations of women’s rights.

Civic Platform’s growing political clout may still carry the bills forward

Despite setbacks, the New Left party plans to reintroduce the decriminalisation bill in late autumn, hoping to pick up at least three of the votes that it lost via the absence of Civic Platform and other coalition members in July.

Civic Platform’s recent victory in European Parliament elections may also signal shifting tides. In that contest, Tusk’s party secured 37.1% of the Polish vote, outperforming all other major mainstream parties in the EU. 

The victory was seen as a signal that Warsaw’s Mayor Rafal Trzaskowski, also a member of Civic Platform, has a real chance of winning next year’s Polish presidential election, potentially aligning the presidency and its veto power with Tusk’s government. 

For now, activists like Adamczuk continue their work. “It’s always worth it to have hope,” she said. “We’re really wearing ourselves out, using a lot of our time and resources for this.” 

The only thing that the failure of the bill changes in the work to advance abortion rights, Adamczuk said, is “that we’re more and more angry.”

Stefan Anderson edited and contributed reporting to this story. 

Image Credits: Klub Lewicy, Greenpeace Polska, Council on Foreign Relations.

Microplastics on a plate
Global human consumption of microplastics has now grown to six times the rate in 1990.

Humans are ingesting and inhaling more microplastics than at any time in recorded history, a Cornell University study revealed.

The research shows microplastic consumption has risen sixfold globally since 1990, with Asian, African, and American countries all experiencing increases. People in China and the United States are among those consuming record levels of tiny plastic particles through food, water, and air.

These pervasive particles have been detected in human blood, lungs, and breast milk. Scientists warn that microplastics are altering cell behavior in internal organs, leading to a condition they’ve dubbed “plasticosis.”

Analyzing data from 109 countries, researchers found an uneven global distribution of microplastic intake. Southeast Asian countries suffer the highest rates, with some areas exceeding 50 times 1990 levels. Parts of the Middle East, North Africa, and Scandinavia also emerged as hotspots for high microplastic consumption.

Contaminated seafood, packaging, water drive global disparities

chart of global microplastic consumption
Southeast Asia suffers from the highest rates of microplastic consumption.

Indonesia tops global microplastic dietary intake at 15 grams per month – over a tablespoon of plastic ingested per capita. Malaysia, at 12 grams per month, ranks second, while Vietnam and the Philippines saw 11 grams of MP consumption per person per month. 

Researchers attribute high microplastic intake in Southeast Asian countries to seafood-rich diets. Marine life often mistakes plastic for food, which then accumulates in their bodies. As a result, fish and other sea creatures account for 70% of human exposure to microplastic particles, the study found.

In these countries, plastic particles often contaminate refined grains during milling, drying and packaging processes, contributing to over 20% of microplastic dietary uptake.

Disparities persist beyond seafood and grain exposure, with industrializing countries bearing a greater burden. The researchers note that the microplastic concentration in table salt in industrializing countries like Indonesia was around 100 times higher than that in the U.S.

Other sources include imported packaging, litter, poor waste collection, and a lack of lined landfills. 

In the air

Map of airborne microplastic consumption
China and Mongolia face the highest daily microplastic inhalation per capita.

While microplastics are most often associated with the marine environment and seafood consumption, the particles can also be inhaled. Airborne microplastics typically originate from urban activity and industrial manufacturing.

People in East and Southeast Asian countries can inhale up to 2.8 million particles a day, with China and Mongolia having the highest amounts of inhaled microplastics. In the US and Canada, that number is 10,000 particles a day – several orders of magnitude smaller. 

“Ubiquitous” in the environment

Since plastic production began en masse in the 1950s, humanity has churned out enough plastics to wrap the earth in clingfilm. Millions of tons of plastics are dumped into the environment each year, much of which degrades into smaller pieces that infiltrate our food, water, and air. Known as microplastics, these particles have been detected in our bodies as well. 

The risks of microplastics on human health remains an understudied topic. 

A 2022 World Health Organization report concluded there was no clear risk to human health, based on limited available evidence. 

Most research has focused on ways the particles cause inflammation. A 2022 study reported a correlation in higher levels of microplastics in patients with inflammatory bowel disease. 

A newer study, published earlier this year in the New England Journal of Medicine, found a link between microplastics and heart attacks and strokes. 

“Even though there’s a lot we still don’t know about microplastic particles and the harm they cause to humans, the information that is available today is in my mind very concerning,” Boston College researcher Dr Philip Landrigan told the Associated Press recently.  

Studies have also found that microplastics act as effective carriers of other toxic pollutants. These pollutants “cling” to microplastics, making them more toxic and allowing them to travel longer distances. 

Hopes for plastics treaty at INC-5 

microplastics
Southeast Asia and Egypt have measurably high levels of microplastics in their populations’ blood.

The fifth Intergovernmental Negotiating Committee on Plastic Pollution (INC-5) is set to meet in November. Its goal is to develop an international legally binding instrument on plastic pollution, including in the marine environment.

Plastic production mitigation must be a priority, the Cornell researchers said, especially through incentivizing the removal of preexisting plastic from waterways. The study projects that the removal of 90% of plastic debris from the oceans and rivers would halve microplastic consumption in Southeast Asia.

Torn single-use plastics abandoned, and buried into fields worldwide are leading to the accumulation of microplastics in soils.

The authors argue that food, water, and industrial policy can shift the microplastic landscape, halting future sources and managing current plastic debris. Stopping microplastic entry into the food system would mean less exposure from seafood and produce.

Image Credits: Xiang Zhao/Fengqi You, Xiang Zhao/Fengqi You, FAO – Assessment of Agricultural Plastics and their Sustainability – A Call to Action .

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

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

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

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

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

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

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

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

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

This is a developing story. 

Image Credits: Africa CDC .

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

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

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

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

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

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

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

Conflict leaves Gazan children lacking routine immunizations

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

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

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

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

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

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

Conflict causes polio to “thrive”

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

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

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

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

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

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

Lack of ceasefire threatens vaccine delivery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Interim government takes power

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

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

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

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

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

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

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

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

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

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

WHO’s integrity in the dock

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

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

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

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

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

Calls for electoral reform

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

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

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

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

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

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

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

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

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

mpox virus

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

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

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

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

Mpox is back

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

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

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

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

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

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

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

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

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

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

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

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

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

Vaccines sitting in stockpiles

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

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

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

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

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

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

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

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

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

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

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

Image Credits: National Institute of Allergy and Infectious Diseases.