Ted Herbosa, Health Secretary for the Philippines

A tax on tobacco and alcohol in the Philippines resulted in a sixfold increase in the country’s health budget as well as a drop in consumption of the harmful products, Ted Herbosa, the country’s health secretary, told a meeting on non-communicable diseases (NCD) and financing on Thursday.

“It increased the health budget by six times from 1.8% to 5.8% of GDP, so we were able to infuse money into the healthcare system to be able to care for the poorest populations,” Herbosa told an international financing dialogue for NCDs and mental health, hosted by the World Health Organization (WHO) and the World Bank in Washington DC. 

The two-day meeting aims to generate consensus about how best to finance effective strategies to tackle NCDs and mental health. It is part of the build-up to the United Nations High-level Meeting on these issues in 2025.

Excise taxes on harmful products is one of the WHO’s package of 88 “best buys” to tackle NCDs – but countries should prioritise which of these will work best for the NCDs they face, said Bente Mikkelsen, WHO director for NCDs.

However, Mikkelsen appealed to countries to focus on diagnosing hypertension, a major cause of cardiovascular disease (CVD), which causes around a third of global deaths. Less than half of those living with hypertension have been diagnosed, yet testing is cheap and easy to do, she added.

Despite three prior high-level meetings on NCDs, only a handful of countries are on track to meet global targets to reduce these. A mere six countries are on track to reduce NCD mortality, for example.

In some countries, death rates due to NCDs have increased and millions of people, especially in lower-income settings, lack access to interventions that could prevent or delay NCDs, mental health conditions, and their consequences. 

Phased approach

Countries at the meeting shared some of their insights and experiences, stressing political will, multi-sectoral collaboration and the importance of sustainable domestic financing for NCD prevention and care services. 

In 2018, Egypt started to phase in universal health care (UHC) starting with a pilot of one million people in a single city with all citizens contributing to a special health insurance fund based on their income.

Some six million Egyptians are covered out of the total population of 100 million, and the country expects to cover all citizens by 2030.

“My advice is not approaching everything at once,” said Radwa Iman from Egypt’s health promotion department.

Egypt’s Radwa Iman

“Actually 85% of our mortality rate was due to NCDs in 2018. Now all our chronically ill patients [covered by UHC] get monthly medications from the primary healthcare facilities. They have medical files. They have regular checkups, and we have annual checkups for the citizens to screen earlier for any medical problems so we can find them in the early stage instead of getting complications.”

Ala Nemerenco, Moldova’s health minister, said that her ministry was largely funded by health insurance contributions, which enabled flexibility as money could be redirected fairly easily.

“Moldova was coming from a post-Soviet system, where for mental health, everything was about hospitalisation,” said Nemerenco. Over several years, the country has  integrated mental health care into primary health care, where family doctors work with nurses and social workers to address mental health.

However, Moldova’s health facilities are being strained by Ukrainian refugees who are in need of mental health support as they flee Russian aggression.

“One year ago, we approved one year ago a national programme on mental health care services. We approved by the government programme on NCDs, including cardiovascular, cancer and diabetes. We now are working on a cancer registry and early detection, screenings and programmes,” she added.

Fiji, with a high burden of NCDs in its population of about one million scattered over 300 islands, has invested in health promotion in schools to prevent NCDs.

Mental health out in the cold

Devora Kestel, WHO Director of Mental Health and Substance Use, appealed for the mental health focus to cover the full spectrum of life – from child and adolescent mental health to dementia in old age.

Devora Kestel, WHO director of mental health.

Kestel described investment in mental health as “totally inadequate”, usually comprising 1-2% of the health budgets in low and middle-income countries, with “70% of that budget in many countries going to old fashioned [mental] institutions”. 

“Even in high-income countries, 50% of the people affected by depression will not have access to care. In low-income countries this is 90%,” she said.

“We need health system financing reforms that are part of a universal health coverage approach and that need to be adequately targeted to answer to the mental health and NCD agenda. 

“We have evidence, we have good ideas, we know what works and what doesn’t. We need to make sure that they become a common practice everywhere.”

The meeting continues on Friday.

Sania Nishtar, Gavi’s CEO, during the Global Forum for Vaccine Sovereignty and Innovation in Paris

Gavi has already raised $ 2.4 billion of the $9 billion it needs to finance its operations between 2026 and 2030, the global vaccine alliance announced at Global Forum for Vaccine Sovereignty and Innovation in Paris on Thursday.

The Forum, co-hosted by France and the Africa Centres for Disease Control and Prevention (Africa CDC), also marks the launch of the African Vaccine Manufacturing Accelerator (AVMA) to promote regional vaccine production.

AVMA already has financing pledges of “at least $1.2 billion”, already exceeding the initial benchmark of $1 billion, said Gavi CEO Sania Nishtar.

 

When talking about AVMA, “we are not just talking about money. We are talking about people, who […] start to dream, to see Africa manufacturing our own vaccines,” highlighted Africa CDC Director General Dr Jean Kaseya.

Reaching zero-dose children and expanding vaccine portfolio

In the coming strategic period, Gavi plans to add new vaccines to its portfolio, prioritise “zero-dose” children who have not received any vaccines and speed up its operations to double the recent achievement of a billion vaccinated children from 2000 to 2020 in half the time.

The bulk of its pledges – $1.58 billion – have been promised by the US. However, Gavi has about 18 months to finalise its current financing period and fine-tune the details of its plan for the years ahead. 

In the 20 years of its existence, Gavi has saved 17 million lives, said Nishtar, all while maintaining a $54 return on every dollar invested. 

Panelists during Gavi’s replenishment launch: Sania Nishtar, Gavi’s CEO, Christophe Guihou, representing the French government, Jean Kaseya, Director General of Africa CDC

The organisation asserts that it is on track with its 2025 targets despite the pandemic disruptions.  

Its aims for the next period are more ambitious, such as extending the availability of  new Ebola, meningitis, rabies and hepatitis B vaccines, put on hold because of the COVID-19 pandemic, regulation, or supply issues.

Decentralising vaccine production

With AVMA, Gavi is turning to regional vaccine manufacturing instead of working with the biggest producers to get low prices per dose.

This will initially cost more, but the imperative for regional production to safeguard all parts of the world became evident during COVID-19, as vaccine-producing countries prioritised jabs for their own populations, leaving Africa behind.

Many European countries, for instance, accumulated more vaccines than they would use – on average, 0.7 dose wasted per resident – at the time when some regions in Africa did not have enough jabs for health workers, Health Policy Watch reported.

Per capita COVID-19 vaccine doses wasted by European countries: 0.7 on average

In response, the African Union announced a target of producing and supplying more than 60% of the continent’s vaccine requirements by 2040.

Africa is home to 20% of the world’s population and yet, it constitutes only 0.1% of the global vaccine production. Though vaccine hoarding was not addressed openly during the launch, the pandemic has shown that local vaccine manufacturing is key for obtaining the doses in time.

AVMA is meant as a catalyser for more investments in vaccines and drugs in the region. “I saw in so many people announcing now additional support around AVMA,” highlighted Kaseya. “For me, is a success story.”

AVMA is an innovative investment tool that will offer incentive payments to offset some of the initial high costs of production, with specific caps and categories designed to ensure priority vaccines receive adequate funding and that no vaccine type or manufacturer is overrepresented. 

The minimum goal is to support at least four African vaccine manufacturers and produce over 800 million vaccine doses over 10 years.

“The launch of the AVMA represents a groundbreaking financing instrument, to help both catalyze vaccine production within Africa and bolster global health resilience and equitable access to vaccines,” said Greg Perry, Assistant Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

“The pharmaceutical industry is committed to playing our part in the collective efforts to […] equitable access to innovative vaccines.”

Image Credits: Politico.

The Solomon Islands are facing severe climate threats.

On June 20, 2024, over 21,000 health workers from more than 80 countries will attend the tenth edition of Teach to Reach, a two-day peer learning conference organized by the Geneva Learning Foundation. This event is not just another conference—it’s part of a growing movement that recognizes the power of local knowledge and action to solve global health challenges.

This 10th edition will focus on two pressing issues: the intersection of climate change and health and the future of immunization.

On climate and health, participants will share firsthand observations of how changing environmental conditions impact the health of the communities they serve. Health professionals from the hardest-hit communities will respond to thought-provoking questions, shedding light on the challenges, successes, and opportunities in addressing the climate-health nexus. Global health leaders like Dr. Maria Neira from the World Health Organization are participating as Guides on the side, to listen and engage – not as Sage on the stage.

The conference will mark the 50th anniversary of the WHO’s Expanded Programme on Immunization (EPI). Immunization leaders from over 80 countries will share their greatest successes and toughest challenges over the past 50 years. Teach to Reach 10 will celebrate this milestone by launching the Nigeria Immunization Collaborative, a partnership of The Geneva Learning Foundation with UNICEF and NPHCDA, to galvanize routine immunization by supporting locally-led action.

Conference Lineup

HPV vaccine
The WHO has recommended a single-dose regimen for HPV vaccines.

The Women Who Deliver Vaccines collective, comprising women working at various levels of the immunization system, will open the conference.

Immunization staff will introduce an HPV vaccination handbook developed from insights gained during previous Teach to Reach sessions.

This handbook exemplifies how Teach to Reach’s peer learning model can foster effective change by developing new, practical knowledge. Drawing on the collective experiences of health workers from diverse backgrounds, it is designed to support successful HPV vaccination campaigns.

It is based on practical insights and strategies shared by health workers at earlier Teach to Reach events.

For example, Penina Oketch from Kenya underscored the importance of keeping a school HPV register and involving teachers and youth in vaccination.

Dr. Portia Manangazira from Zimbabwe highlighted the necessity of thorough preparatory work, which includes identifying and educating key professionals and promoting cross-sectoral collaboration.

Mbuh noted that health workers share specific actions they took and what made those actions successful, bridging the gap between global health guidance and practical application.

Uniting to Combat NTDs

Another highlight will be a plenary session in partnership with Uniting to Combat NTDs on neglected tropical diseases (NTDs), where health workers from NTD-endemic regions will share their experiences fighting these diseases that affect the world’s most marginalized communities. We will discuss the devastating impact of NTDs, innovative prevention strategies, the power of community engagement, and the emerging threat of climate change on NTD transmission.

In the fight against malaria, health workers from affected communities will share insights on the challenges, successes, and opportunities in rolling back this deadly disease. There, we will explore lessons learned from community engagement and behavior change strategies, the need for equitable access to interventions, and the path toward the ambitious goal of malaria eradication.

Leaders Forum

Teach to Reach 10 will also feature—for the first time—a forum for leaders of over 2,000 local organizations to share their stories, challenges, and innovations. This forum will highlight the vital role of community-driven solutions in sustainable development. It embodies a commitment to partnerships grounded in mutual respect and a shared vision of a thriving future for every community.

Teach to Reach is part of reshaping global health dialogue that centers on the voices and experiences of those on the frontlines. It’s about going beyond the rhetoric and polemics of “decolonization” – and providing a new mechanism to take on the transformation that many stakeholders recognize is needed but are missing the “how” to make it happen.

It’s a powerful reminder that the most effective solutions often come from those closest to the challenges. By listening to and learning from health workers, we can ensure that global health efforts are aligned with local realities and have the most significant impact.

Since its inception in 2021, Teach to Reach has repeatedly shown that health workers can be genuine agents of change for the communities they serve. When the COVID-19 pandemic hit, thousands of immunization staff joined through Teach to Reach to rapidly share emerging lessons on introducing COVID-19 vaccines. This collaborative spirit was instrumental in navigating an unprecedented challenge.

As we look to the future, Teach to Reach 10 promises to galvanize the growing movement of health worker collaboration and leadership. By amplifying frontline voices, promoting local action, and fostering partnerships, Teach to Reach is reshaping the global health dialogue. It’s an invitation for all of us to listen, learn, and join forces with those on the leading edge of change.

Reda Sadki is the founder and executive director of The Geneva Learning Foundation, a Swiss non-profit that researches, develops, and implements new ways to learn and lead in the face of critical threats to our societies.

Image Credits: National Cancer Institute on Unsplash, UNEP.

Long queues for passports make it more difficult for healthcare workers to emigrate.

HARARE, Zimbabwe – After a decade of service as a nurse in the public sector and very little to show for her years of toil, Letina Chiwongotore has thrown in the towel.

The 35-year-old is packing her bags for the UK, no longer able to bear mounting economic hardships.

Nurses, doctors, pharmacists and other healthcare staff have been fleeing for several years to escape low salaries and poor working conditions in a country that seems unable to overcome its economic problems. 

Earlier this year, the Zimbabwean government converted the $300 COVID allowance it had been paying to nurses to a permanent salary. Nurses now take home an average of $255 every month after tax. 

The payment in US dollars, although small, has been welcomed by the Zimbabwe Nurses Association (ZINA) as nurses had previously been paid in local currency. With hyperinflation, the local currency had almost completely lost its value, rendering the nurses’ salaries and pensions of retired nurses virtually worthless.

People queue to draw money as the cash crisis in Zimbabwe shows no signs of improving.

However, this salary is substantially lower than that paid back in 2018 when nurses received $540. Meanwhile, civil servants’ organisations estimate that the minimum wage should be $840.

Years of brain drain

Zimbabwe’s health care system has been crumbling under the strain of decades of brain drain, fuelled by economic and political instability since the late 1990s, which has caused high inflation and the collapse of the local currency.

Health workers’ salaries have not been spared the inflation amid currency woes, forcing many professionals to migrate in search of better opportunities abroad.

By 2000, 51% of Zimbabwe’s doctors and 25% of its nurses were already practising abroad. By 2019, the UK’s National Health Service employed 4,049 Zimbabwean healthcare professionals including doctors, nurses and clinical support staff.

As if that was not enough, more than 4,000 health workers, including more than 2,600 nurses, left Zimbabwe in 2021 and 2022 alone, according to official statistics. 

Aside from the UK, health workers have sought employment in Canada and Australia.

Between September 2022 and September 2023, some 21,130 Zimbabweans were given visas to work in the UK, many of those being nurses and care workers, according to that country’s Home Office data.

Late last year, the World Health Organization (WHO) went on record, saying that 4,600 Zimbabwean health workers had left the country since 2019.

Crippling effect on health

The brain drain of health professionals from Zimbabwe has had a crippling effect on the country’s public health system and on health outcomes.

For example, in 2021 life expectancy was 58.5 years, a two-year drop from the already low 60.7 years in 2019, according to WHO figures. This is also lower than the average life expectancy for Africa, which was 63.6 years in 2021.

WHO data (2021)

The growing shortage of healthcare workers is endangering the lives of patients in hospitals that are already poorly equipped.

HIV, respiratory tract infections and neonatal conditions –  mostly preventable and treatable – are the three biggest killers. Tuberculosis infection has worsened since 2021. Infectious diseases, maternal, perinatal and “nutritional conditions” including malnutrition are responsible for 47% of deaths. However, non-communicable diseases are on the rise, accounting for almost 40% of deaths.

The few Zimbabwean nurses that remain in the country’s crumbling healthcare facilities are having to attend to ballooning numbers of patients. 

This has caused a domino effect, accelerating the exodus of health workers who cannot manage the work load and face daily demoralisation in under-resourced facilities.

Melina Chiwara, a 28-year-old nurse, says that she is struggling to cope with the growing workload and deteriorating working conditions.

Chiwara, like thousands of others who have left the southern African nation, says that she too will soon join the quest for a better life abroad as she can no longer manage.

Government withholds proof of qualification 

Desperate to stem the brain drain, the government has resorted to withholding the verification letters that thousands of nurses and doctors need to secure jobs abroad. These letters confirm health workers’ qualifications.

In addition, it is time-consuming and costly to get a passport.

Incensed by the ongoing recruitment of health workers by wealthy countries, Vice President Constantino Chiwenga threatened legal action last year against the recruiting countries.

“If one deliberately recruits and makes the country suffer, that’s a crime against humanity. People are dying in hospitals because there are no nurses and doctors. That must be taken seriously,” said Chiwenga.

However, despite the challenges, many qualified health workers are still opting to leave, taking lower-paying jobs as care workers in the UK in particular, as these jobs will enable them to support families back home.

“I will be going to the UK because I can’t keep on offering my nursing services for peanuts. I am tired. If I don’t get all my relocation papers in order, I will settle for any dirty job in the UK and at least earn something [more] meaningful than remaining in this jungle,” Chiwongotore told Health Policy Watch.

‘The heart belongs at home’

Nurse Setfree Mafukidze relocated to the UK three years ago with his wife and four children. For years, Mafukidze had toiled at a clinic in Chivhu, a town located approximately 140 kilometres south of the Zimbabwean capital, Harare.

Now living in Somerset in the UK, Mafukidze asserts that “most nurses are better off outside Zimbabwe than they were in Zimbabwe.” The starting salary is around $34,000 per month.

“Nurses earn enough to survive within the UK because most of the nurses are not required to pay school fees for their children if they have any,” said Mafukidze.

“They don’t need to pay for healthcare services either unless one chooses to go private.  The normal healthcare services here are always free for nurses, while in Zimbabwe if a nurse falls sick, you need to do crowdfunding to help them – yet they are the people that sustain the healthcare,” said Mafukidze.

Since Zimbabwe was placed on the WHO ‘red list’ of countries with critical health worker shortages, the UK has stopped recruiting its health workers.

News of not-so-rosy conditions have also started to filter back to remaining health workers.

“It’s unfortunate that, with the UK now being flooded by migrant healthcare workers, shifts for care workers are now scarce. I have heard of inflation and increased cost of living there as well. I no longer see myself leaving any time soon,” said Warren George, a 30-year-old nurse who has opted to stay in the country.

For those nurses already abroad, even as they pride themselves after fleeing from Zimbabwe, they remain attached to their country despite the odds.

“The heart belongs home. Most nurses and doctors want to be home, but home doesn’t provide the tools for the trade. Home doesn’t provide good mental care to its workers,” said Mafukidze.

Image Credits: WHO.

WHO Regional Director for Africa Dr Matshidiso Moeti.

Five male candidates are contesting to be the next regional director for the World Health Organization’s (WHO) African Region.

One of them will replace Botswana’s Dr Matshidiso Moeti, who has served two terms in the position and is not eligible for re-election. Moeti, who was appointed in 2015, has overseen WHO’s operations through trying circumstances, including Ebola outbreaks and the COVID-19 pandemic.

Two of the candidates are currently employed at WHO headquarters, while a third is also based in Geneva.

Senegalese Dr Ibrahima Socé Fall, who has been proposed by his home country, is currently the WHO director of Global Neglected Tropical Diseases (NTD). Prior to this, he was WHO Assistant Director General for Emergency Response, appointed a year before the COVID-19 pandemic (in March 2019), where he led WHO’s global response to all emergencies, heading the incidence teams.

Dr N’da Konan Michel Yao, proposed by his home country Côte d’Ivoire, has been WHO Director of Strategic Health Operations since August 2020, where he coordinates the body’s response to health, natural and humanitarian disasters.

Dr Richard Mihigo, proposed by Rwanda, is also based in Geneva where he has worked for Gavi, the vaccine alliance, since 2022. He is currently senior director of programmatic and strategic engagement with the African Union and Africa CDC. Prior to this, he was Gavi’s  global lead and senior director for COVID-19 Vaccine Delivery, Coordination and Integration.

Dr Boureima Hama Sambo, proposed by Niger, is WHO’s Representative to the Democratic Republic of the Congo as Head of Mission. He has previously worked at the WHO headquarters on climate change.

Dr Faustine Engelbert Ndugulile, proposed by Tanzania, was that country’s Minister for Communication and Information Technology between December 2020 and September 2021 and has also served as a deputy minister of health.

The Regional Committee of WHO African Region will vote for the next regional director in a closed meeting from 26 – 30 August in Brazzaville in the Republic of Congo.

Their nomination will be submitted to the WHO Executive Board meeting in January 2025. The newly appointed director will take office in February 2025 for a five-year term and be eligible for reappointment once.

Image Credits: WHO.

Air pollution in Shanghai, China

The fifth State of Global Air report shows air pollution is now the second-leading risk factor for death globally, after high blood pressure. Most of the deaths are from non-communicable diseases (NCD). The report has a silver lining about lives saved which shows how there’s been a large drop in the death rate of children

Almost 2,000 children under the age of five die every day because of air pollution, according to the latest State of Global Air (SoGA). Yet, the annual total of 700,000 deaths is a fraction of the 8.1 million lives lost because of air pollution. While there is a silver lining that some progress has been made, SoGA has several messages of concern for governments and citizens, especially parents. 

The report looks at deaths and health impacts caused by three pollutants: fine particulate matter (PM 2.5), household air pollution, and ozone (O3). It also looks at nitrogen dioxide (NO2), which causes childhood asthma, particularly for infants and toddlers. The study underscores how traffic exhaust, a major source of NO2, can make children acutely ill with long-term consequences. 

“Children are particularly susceptible to the health effects of air pollution, especially since their organ systems, including lungs, are still developing. To the extent possible, efforts should focus on reducing children’s exposure to air pollution.

A recent systematic review reported that exposure to traffic-related air pollution could result in asthma onset as well as acute lower-respiratory-tract infections in children,” Dr Pallavi Pant, head of Global Health at Boston’s Health Effects Institute (HEI), told Health Policy Watch. 

The SoGA report is a joint effort by HEI and UNICEF. It is a detailed analysis of recently released data from the Global Burden of Disease study from 2021.

Nine out of 10 deaths are caused by the tiny PM 2.5 particles. These enter the lungs and then the bloodstream, increasing the risks of NCDs in adults like heart disease, stroke, diabetes, lung cancer, and chronic obstructive pulmonary disease (COPD). 

The report exposes climate inequities as developing and low-income nations have the highest number of deaths. It also underscores how PM 2.5, the most-tracked air pollutant, is linked to greenhouse gases which are warming the world. The sources of both are largely the same – burning fossil fuels and biomass, particularly coal-fired power plants and transportation, and wild and farm fires. The most vulnerable populations are disproportionately affected by both climate hazards and polluted air.

India, Nigeria, and Pakistan top list of child air pollution deaths

Of the 700,000 child deaths are due to air pollution, and almost half a million are due to household pollution. The air pollution-linked death rate in children under the age of five in East, West, Central and southern Africa is over 100 times higher than their counterparts in high-income countries. There are two deaths per 100,000 of the population in rich countries, but the death rate in Africa’s children is 210/100,000. 

The highest number of children dying of air pollution is in India, Nigeria and Pakistan. The reason is largely pollution within households burning polluting fuels such as coal/charcoal, wood, animal dung, agricultural residue etc. 

In India over 169,000 children are estimated to have died in 2021 because of air pollution, that is more than one death every four minutes. Nigeria’s toll is over 114,00, and Pakistan’s over 68,000. 

“Despite progress in maternal and child health, every day almost 2,000 children under five years die because of health impacts linked to air pollution,” said UNICEF Deputy Executive Director Kitty van der Heijden.

“Our inaction is having profound effects on the next generation, with lifelong health and well-being impacts. The global urgency is undeniable. It is imperative governments and businesses consider these estimates and locally available data and use it to inform meaningful, child-focused action to reduce air pollution and protect children’s health.”

Globally, air pollution is only second to malnutrition in terms of risk factors for child deaths. The report points out that children are uniquely vulnerable to air pollution. The damage from air pollution can start in the womb with health effects that can last a lifetime. Children inhale more air per kilogramm of body weight and absorb more pollutants relative to adults while their lungs, bodies, and brains are still developing.

Countries with the highest air pollution deaths 

The total number of deaths linked to air pollution was 8.1 million in 2021, which is one out of every eight deaths globally. This is more than any previous year, which indicates that the disease burden of air pollution continues to rise.

The top 10 countries account for about 70% of all global deaths which includes two hundred countries and territories. 

The two countries with the most such deaths by far are China (2,349,332) and India (2,087,016), which is about 4 deaths a minute due to air pollution.

Air pollution is second only to high blood pressure as a global risk factor for death, except in South Asia where air pollution is the biggest cause of death. 

Most of the global deaths – 7.8 million, or nine out of every 10 – are because of PM 2.5 or ambient air pollution. As the report points out, nearly all of the world’s population lives in areas with unhealthy air. Among the key air pollutants that are currently measured, long-term exposure to PM 2.5 is the most consistent and accurate predictor of poor health outcomes across populations. 

Ozone and NO2: Traffic exhaust a threat to humans 

Apart from PM 2.5 and household pollution, the third cause of death the report examines is ozone (O3). Ground-level ozone is not emitted but it is a product of traffic exhaust, in particular nitrogen dioxide, and warmer temperatures in the presence of sunlight. That’s why, for example, during heatwaves, there is a higher level of ozone in place with heavy traffic from where it can travel long distances. It is also a greenhouse gas. 

For humans, O3 increases the risk of both acute and chronic respiratory illnesses such as COPD. The chances of fatalities are higher among those vulnerable, the sick, and the elderly. The report estimates that in 2021, long-term exposure to ozone contributed to an estimated 489,518 deaths globally, including 14,000 ozone-related COPD deaths in the United States, higher than in other high-income countries. 

However, now ozone is also a rising threat in developing nations as well. SoGA notes that countries including India, Nigeria, Pakistan, and Brazil have experienced increases of more than 10% in ambient ozone exposures in the last decade. 

As the table below shows, while the overall number of air pollution deaths has increased since 1990, this has mainly happened because of a rise in PM 2.5 and ozone (which in turn is produced by, among other factors, nitrogen dioxide from burning fossil fuels in vehicles, etc.) Deaths due to household air pollution declined largely thanks to the use of cleaner cooking fuels. 

Traffic triggers childhood asthma

While the current SoGA report has not looked at deaths attributable to nitrogen dioxide (NO2), exposure has been linked to a variety of health effects, including asthma and other respiratory diseases. As with ozone, the highest exposure to NO2 is in countries with high socio-development index, for example, Canada, Japan, and Singapore. But the exposures are declining because of policy actions like switching to more public transport and electric vehicles. 

Traffic is a major source of NO2 and its concentration is typically highest in urban areas, even though there are other sources of the gas such as power plants, industrial units, and agriculture. Pinpointing the traffic patterns and other factors that lead to spikes in NO2 pollution can help cities identify effective ways to control NO2 and reduce exposure.

Some ‘good news’

SoGA has emphasised that there is some “good news.” Since 2000, the death rate linked to children under five has dropped by 53%, due largely to efforts aimed at expanding access to clean energy for cooking, as well as improvements in access to healthcare, nutrition, and better awareness about the harms associated

with exposure to household air pollution. Although the report has not gone into the effects of specific schemes, India, which has the largest number of child deaths, launched the Ujjwala programme to provide cleaner cooking gas to low-income families. 

The reports authors are clear that air quality actions help. In under-served regions like Africa, Latin America, and Asia, steps can include installing air pollution monitoring networks or low-cost sensors, implementing stricter air quality policies, or switching to hybrid or electric vehicles. 

Arsenal of data 

Scientific studies over several decades have established that air pollution is associated with impacts on every major organ system in humans. While earlier ones looked at the more obvious connections with heart and respiratory issues, more recent ones are exploring the link with diseases such as Alzheimer’s and other neurodegenerative diseases. 

Breathing polluted air for months or years can lead to illness and early death from heart and lung diseases and diabetes, and increase the likelihood of adverse birth outcomes including preterm births, stillbirths and miscarriage. SoGA is the latest of several scientific studies that have conclusively demonstrated the vast health and economic benefits of slashing emissions from burning fossil fuels and biomass.

There’s enough in this arsenal of air pollution data for policymakers especially in the worst-hit countries to step up action quickly. Will they?

Image Credits: Unsplash.

Researcher explores evidence around the wildlife-trade- pandemic nexus

The world lacks the funds, political will and appropriate global platforms to tackle the next pandemic – and the World Health Organization (WHO) should possibly be split into two entities, with one focusing solely on health emergencies.

This is according to a new report by former New Zealand Prime Minister Helen Clark and former Liberian president Ellen Johnson Sirleaf, former co-chairs of the Independent Panel for Pandemic Preparedness and Response.

“If there were a new pandemic threat today, such as if H5N1 began to spread from person to person at scale, the world would likely be overwhelmed again. We just aren’t equipped enough to stop outbreaks before they spread further,” according to Clark speaking at an event to release the report hosted by Club de Madrid.

The report, No time to gamble: Leaders must unite to prevent pandemics, takes stock of progress made to implement recommendations made by the Independent Panel to the World Health Assembly in May 2021, following its eight-month review of the global response to COVID-19. 

“We were clear in 2021 at the height of COVID-19, that leaders needed to act urgently to make transformative changes to the international system so that there would be a new approach to funding, new ways of managing equitable access to products like vaccines, therapeutics and tests, and a new Framework Convention at WHO to complement the rules for outbreaks and pandemics,” said Clark 

“Instead of taking action to prepare for the next major outbreak, leaders have turned away from pandemic preparedness. This is a gamble with our futures,” write Clark and Sirleaf in the report. 

Clark decried the lack of funds to pandemic-proof the world, how “high-income countries are holding on too tightly to traditional charity-based approaches to equity”, and that there was still no pandemic agreement after two-and-a-half years of negotiations.

“A new agreement must be successfully concluded. But the world can’t wait for its adoption or for the ratification required from 60 countries – an effort that could take three or more years,” the report notes.

“There must be action now – to close the gaps that put eight billion people at risk of a new pandemic. The recent jump of the avian H5N1 virus to more mammals – including new human cases transmitted from cattle in the United States – portends an influenza pandemic the world is nowhere near ready to manage.”

However, Clark said there had been some “encouraging developments” such as the amendments to the International Health Regulations.

Sirleaf was not present as she was attending the funeral of her son, Charles.

Helen Clark. former co-chair of the Independent Panel.

Controversial proposal to split WHO

The report notes that 40% of the WHO’s operational spending goes on emergencies, including on the delivery of supplies, and this is “far outstripping” spending on important issues such as universal health coverage, non-communicable diseases and the social determinants of health. 

However, the WHO’s “focus should be on high-quality normative and technical work, not just during emergencies but also for preparedness purposes,” according to the report. 

“We pose an open question, and I stress it is an open question: Should WHO is split into two organisations, one that is focused on emergency operations, as that work has to be done, and one that’s focused on operational and technical excellence in health?” asked Clark.

WHO’s expenses in 2023, as captured by the report, “No time to gamble”.

She repeated the Independent Panel’s call for “a truly independent monitoring mechanism” to assess countries’ pandemic preparedness – such as a “Global Preparedness Monitoring Board which is completely independent of WHO” or “a new independent monitoring group”, perhaps along the lines of the Intergovernmental Panel on Climate Change (IPCC).

Inadequate financing

Around $10–15 billion is needed annually to fill the gaps in pandemic preparedness, particularly in low and middle-income countries.

“This does not include investments in One Health, which would require an added $10.3–11.5 billion annually to raise public veterinary standards, improve farm biosecurity and decrease deforestation in high-risk countries,” according to the report.

The Pandemic Fund, set up under the World Bank to assist, has raised almost $2 billion.

The report proposes that the fund be converted into a “preparedness and surge mechanism based on a global public investment model” rather than an ODA [overseas development aid] mechanism.

“All governments [should] contribute based on a formula according to their ability to pay, supporting both preparedness efforts and immediate response needs including to pay for the countermeasures countries will need to stop outbreaks and mitigate the impact of pandemics,” according to the report. It adds that countries should also have a say in the fund’s administration.

However, Mauricio Cardenas, former finance minister of Colombia, warned that public finances are “under a lot of stress in different countries, mainly because of the high levels of debt and very high interest rates”.

“Public finances play a very important role, because domestic resource mobilisation is crucial and should be the foundation of preparedness and response, but that’s not enough. We need international finance, but we don’t need charity,” he stressed.

Expanding access to medical countermeasures 

Budi Gunadi Sadikin, Indonesia’s health minister.

Indonesian Health Minister Budi Gunadi Sadikin called for different rules for the Pandemic Fund during a pandemic, which he compared to wartime, including “speedy decision-making and expedited fund disbursement”.

Sadikin, who addressed the launch, also called for all emergency medical countermeasures produced during pandemics to become “public”.

There needs to be an “upfront agreement” in the pandemic agreement that for-profit companies answering to shareholders will be reasonably compensated by a large public institution or country , for their products such as vaccines and therapeutics, added Sadikin.

The report describes medical countermeasures as a “global common good”, noting that inequities in access to these during COVID-19 “have left a lasting painful moral stain, and the resulting mistrust has affected negotiation of a pandemic agreement”.

Dr Petro Terblanche, CEO of Afrigen Biologics which hosts the WHO mRNA hub in South Africa, said that the world’s knowledge base around pandemic response had “tripled” in the past three years.

“Yet if we have a pandemic today, the Global North will move at speed and will be better prepared than three years ago because of the knowledge that we’ve been able to possess,” said Terblanche. But the position of the Global South would depend on “where these critical medical countermeasures are produced”.

The mRNA programme’s final outputs “are threatened now by lack of funding”, she said, urging investment in “end-to-end research and manufacturing capabilities in low and middle-income countries” to prepare for future pandemics.

“In 2023, the African continent had 155 outbreaks and for less than 10 of there, vaccines are available,” she noted.

“With Rift Valley Fever,  this is going to be an opportunity to develop a single vaccine using an antigen using mRNA to both for the vaccination of animals, livestock and humans,” said Terblanche, adding that such an approach should be prioritised  from a research and development and product development perspective.

 

Image Credits: Prachatai/Flickr, Wildlife Conservation Society .

Tilak Chandra Nath, TDR-supported fellow at the Indonesian Universitas Gadjah Mada

Growing up in Bangladesh where several infectious diseases transmitted by helminths (worms) take a large health toll, Tilak Chandra Nath has always been fascinated with the challenges of addressing diseases of poverty.

During his postgraduate training as a TDR-supported fellow at the Universitas Gadjah Mada (UGM) in Indonesia in 2016, he studied parasitic diseases, focusing on helminths, and he is currently using his knowledge to advance a One Health approach to eliminating those diseases in his home country.

After graduating as a biologist, Ezra Valido’s interest in infectious diseases took him to work in a rural, poor community in the eastern Philippines, where he headed public health programmes on tuberculosis, measles, dengue and chikungunya.

Valido’s community was devastated in 2013 by Typhoon Haiyan, one of the most powerful tropical cyclones ever recorded. From that, he gained experience working in the aftermath of a disaster, including how to prevent waterborne diseases and sanitation-related illnesses.

As a TDR-supported fellow, also at UGM in 2017, Valido’s research project focused on how willing people were to take doses of the dengue vaccine in poor communities in the Philippines’ Quezon City. His initial plan was to focus on how the vaccines were rolled out. But this had to be shelved after community and media outrage based on misinformation about the vaccine led the government to cancel its vaccination plans.

Focus on implementation research

Both Nath and Valido were part of a special postgraduate training programme focused on implementation research, based at UGM’s Faculty of Medicine, Public Health and Nursing, located in Yogyakarta.

The programme, involving students from both WHO’s South-East Asia and Western Pacific Regions, is supported by TDR, a global programme for research on diseases of poverty, hosted by the World Health Organization (WHO) in Geneva, and co-sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), WHO and the World Bank.

UGM is part of TDR’s global postgraduate training scheme network, developed over the past  eight years to boost the skills of future research leaders.  

The initiative focuses on building students’ skills in implementation research, a fast-growing field that supports the identification of system bottlenecks to delivering health services and approaches to addressing them. It is particularly useful in low- and middle–income countries where many health interventions do not reach those who need them the most.

One of the two partner institutions in Asia Pacific is UGM, where the initiative is co-ordinated by Professor Yodi Mahendradhata, Dean of Research and Development at the Faculty of Medicine, Public Health and Nursing. 

Involved from the start

Mahendradhata is proud of the fact that UGM was involved from the start – back in 2015 – in  TDR’s fellowship scheme as well as in the parallel development of course content for implementation research. So he feels considerable ownership over how it has evolved.

“It wasn’t just about receiving the tools and the toolkits, but being involved very early on in the development of the implementation research course, and that is what we particularly appreciate from TDR,” said Mahendradhata. “We learned a lot from participating in the development process, and that gives us a sense of ownership.”

His university has also developed and piloted lessons on implementation research as a part of a TDR-supported Massive Open Online Course (MOOC), enabling researchers in places like Nepal and Myanmar to participate in virtual training, with UGM as the hub.

Critical and relevant research

Valido is sanguine about how he had to shift the focus of his research on a new dengue vaccine from examining the standard parameters of mass rollout to focusing on the vaccine’s  acceptability in one city, Quezon, the biggest city in the Philippines.

Professor Yodi Mahendradhata

Sanofi Pasteur’s Dengvaxia vaccine was approved in the Philippines in December 2015, and the government started to roll it out to primary school children in 2016. However, in late 2017, Sanofi issued a statement reporting that, in rare cases, the vaccine could increase the risk of severe dengue illness in children who had never had the disease if they contracted the virus after being vaccinated. A public outcry followed, and the health department suspended the vaccine programme soon afterwards.

“While we were conducting the research, an update on the vaccine information caused a media frenzy which eventually led to its suspension and eventual cancellation,” he says. “We had to change the research and eventually looked at the change in the acceptability of the vaccine pre- and post-controversy.”

“The programme teaches you to be critical and relevant, and I had to change my research to remain relevant,” Valido says.“At the time, the Philippines was the only country implementing mass dengue vaccination in schools.”

Dengvaxia has since been approved in a number of countries, including the US – but only for people clinically proven to have had dengue in the past.

Valido enjoyed the opportunity to dissect the Filippino government’s plans for the vaccine’s implementation, focusing on “strategic actions, context and health system thinking.”

Meanwhile, Nath’s research into parasitic diseases gave him new insights into how they can be both managed and prevented.

“In developed countries, most parasitic diseases have been either eradicated or controlled, but the scenario is quite different in lower-income countries, where many diseases remain a serious constraint to public health safety,” says Nath.

“Through the TDR training programme,” he says, “I learned to investigate the problems in preventing these diseases in greater detail and pave the way to find an implementable solution for policy-makers to mitigate the burden.”

Preparing for the future

Following his studies at UGM, Nath continued his research training, completing a PhD in Medicine from the Chungbuk National University, in Korea, in the area of One Health.  He is now an Associate Professor in the Department of Parasitology at Sylhet Agricultural University in Bangladesh.

 In a sense he has come full-circle – bringing knowledge amassed through years of study abroad back to his home country to ponder issues that he wondered about since his youth.  

“I am now actively engaged with helminthiasis elimination and biobanking of parasites projects,” says Nath, who is currently also the director of Bangladesh’s Parasite Resource Bank, where he is investigating the interactions between human, animal, and environmental parasites, following the One Health approach. 

Meanwhile, Valido is working on the biomedical aspects of infectious diseases as a post-doctoral researcher at Swiss Paraplegic Research, where he is exploring the interaction of microbiomes and the spinal cord. He started this work while completing his PhD in Health Sciences at the University of Lucerne in Switzerland. 

Few scientists understand the biomedical aspects of infectious diseases and “the complexity of public health designs to improve health programmes, guide health policies and identify key health infrastructure,” Valido observes. The TDR training helped him to build that interdisciplinary skill set.

This is the first article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions.

Nurses| Cameroon
Student nurses prepare for the morning rounds at the Ndop District Hospital in Bamenda, Cameroon

When nursing graduates in low- and middle-income countries (LMICs) receive their hard-earned diplomas, they’re no longer cheered on only by proud family members and university faculty.

“The recruiters pitch up on the nurses’ graduation day in our country,” one delegate told me at the recent World Health Assembly (WHA).

It’s a striking image: nurses, newly educated by their home countries, swarmed by recruitment agencies hoping to attract them to wealthier nations experiencing staff shortages. Experienced and specialist nurses, including critical care nurses, are also being aggressively recruited, depriving their native countries of vital expertise.

Across a week of conversations with the world’s nurses, nurse leaders, and policymakers at this year’s WHA, a clear picture emerged of a worsening nursing migration crisis driven overwhelmingly by a small number of high-income nations, including the UK, USA, Canada, Australia, and certain Gulf states, poaching nurses from vulnerable countries in what some African healthcare leaders have called a “new form of colonialism”.

This is not only a workforce and staffing issue: it’s a public health and global equity issue that threatens the achievement of our shared UN sustainable development goals, including universal health coverage.

Tackling this requires immediate action on multiple fronts. We propose three key measures: a temporary ban on actively recruiting nurses from fragile health systems; a stronger WHO Global Code of Practice with robust monitoring and accountability mechanisms; and meaningful compensation for underresourced countries losing nurses to wealthier nations.

Our world’s most vulnerable health systems need us to develop, not deplete, their nursing workforce—and with crucial worldwide elections and the next G20 meeting fast approaching, now is the time to prioritise this issue on the global agenda.

To chart a path forward, we must first understand the current situation and how we got here. 

Deepening global inequalities

It’s important to protect individual nurses’ rights to migrate in search of better opportunities but the playing field is grossly unequal.

The distribution of the world’s nurses is strikingly uneven across regions — the State of the World’s Nursing report shows that just 3% (less than 1 million) of the world’s nurses are in Africa with over 80% in Europe, the Americas,  and the Western Pacific region. With up to a tenfold difference in nurses per capita between high- and low-income nations, this means affluent countries are recruiting from the most fragile health systems who can least afford to lose their workers.

At WHA, we heard repeated frustrations around high-income countries draining nurses from this scarce pool, offloading the costs of nursing workforce education and planning onto vulnerable nations. In Africa alone, one in ten nurses (and one in five doctors) now work outside the continent, stripping away desperately needed expertise.

Nursing density map
Nurse density maps show a stark divide between high and low-income countries.

We heard that small island states like Tonga and Fiji have suffered even more acute losses. At the Fiji National Economic Summit 2023, health leaders discussed losing 26.7% of their nurses the year previously — and at WHA, we heard that this trend has continued, with 20%–30% of Fiji’s nurses leaving year on year, mostly headed to countries like New Zealand and Australia. 

Stepping-stone migration 

We are seeing new patterns of “carousel migration”, where countries like New Zealand and the UK act as stepping stones for nurses who then go to other nations like Australia, evident in the number of overseas-trained nurses seeking Certificates of Current Professional Status (CCPS) which indicates they’re gearing up to work abroad. We also heard that Canada and Australia are actively recruiting from the UK, with advertisements plastered across public transport hubs urging UK-based nurses to make the move.

Graph of number of UK nurses trained overseas
More overseas-trained nurses are joining the UK workforce — but more of these nurses are then pursuing Certificates of Current Professional Status to practice elsewhere.

We know from historical data that migration left over 40% of nursing jobs in the English-speaking Caribbean unfilled, and the issue hasn’t improved — we heard from Jamaica that ~20% of Jamaica’s nurses were applying for credentials to leave.

Historically the Philippines has been a supplier of nurses for the world but we heard concerns from their representatives at losing a third of Filipino nurses overseas each year and the impact that has on meeting their own country health needs. This sounds a cautionary note on the  “educate-to-export” model that purposefully trains nurses as labour exports, which has been advocated for as a solution to the current global shortage. This is a risky policy that could widen health inequalities as the gap in numbers of nurses grows between source and destination countries — and it locks the sending countries into dependence on nursing exports rather than setting them on a path to sustainably grow their own healthcare workforce.

Crisis made worse by stopgap measures

Poor working conditions, limited opportunities, and economic strains in developing countries drive nurses to seek better salaries abroad. Even as vulnerable nations face nurse shortages, we are hearing that some lack employment for their nursing graduates due to underdeveloped health systems. They need high-income countries to support them in building robust health systems — rather than raiding their workforce. 

Over a year ago, ICN declared a global health emergency based on the global shortage of 6 million nurses and deep-seated health inequalities, exacerbated by the brain drain of skilled nurses from vulnerable nations. We are already off track on our global ambitions to achieve universal health coverage by 2030 — and rising levels of often aggressive and ethically questionable nurse recruitment is a major contributor, widening healthcare gaps and jeopardising our progress.

Nurses in high-income countries are ageing and burning out — and we are consistently seeing governments make the unethical and unsustainable choice to plug their staffing gaps by looking abroad, rather than addressing the root causes and investing in both educating and retaining their nurses. 

This is a short-sighted, leaky-bucket approach. It’s also self-defeating to simply try to turn the tap of nursing education to fully open, without fixing the holes of poor employment and working conditions that cause so may to leave. The failure to create decent working conditions and retain the valuable nurses we already have has led to an alarming rise in strike action by healthcare workers worldwide. Increased pressures on the nurses left behind in countries like Fiji and Tonga has sparked labour unrest.

In high-income destination countries like Sweden, where nurses are currently on strike, health leaders at WHA side events said “migration is being used to short-cut the issues of decent work and investment in the education, recruitment and retention of our health and care workers.” An unsustainable dependence on nurse immigration also undermines healthcare resilience and pandemic preparedness in wealthier nations — we saw how temporary blocks on health worker mobility during Covid left wealthier countries massively short staffed.

Reshaping global policy and practice 

The WHO’s Global Code of Practice on the International Recruitment of Health Personnel calls for countries to prioritise self-sufficiency by training and retaining domestic health staff and identifies vulnerable states off-limits for hiring unless bilateral agreements are in place where hiring countries invest in the source nation’s health workforce or education.

So far, though, we have seen little evidence for meaningful, well-defined bilateral agreements with clear financial commitments. Often, these agreements give more of a whiff of creating an ethical veneer than ensuring truly proportional and mutual benefits.

To actually stem the tide of nurse migration from developing countries, the Code must be drastically strengthened and universally and consistently enforced.

We need at least a temporary freeze on active recruitment of nurses from the world’s most fragile health systems.

We need a better system for monitoring and reporting on international nurse mobility, national self-sufficiency, and compliance with the Code, and we need measures to ensure accountability. Only seventy-seven countries, representing 55% of the world’s population, are currently reporting their health worker migration information to WHO. At a time when we need nations to take this worsening issue more seriously than ever, European countries are actually reporting less than in previous years — fewer than half submitted data to WHO in the latest reporting round.

WHO code reporting graph
The last round of global WHO code reporting shows major gaps in the participating countries.

We need wealthier countries to compensate vulnerable countries when recruiting from them, by directly investing longer-term in their health infrastructure and education, perhaps through an “offsetting” program akin to carbon credits.

Above all, we need to act now — we cannot afford to wait until next year’s WHA to address this burning problem.

That is why the International Council of Nurses is calling on the G20 heads of state to make effective implementation of ethical health worker migration policies a central agenda item when they convene in November.

Building self-sufficient nursing workforces is the only way to achieve our global goals of health for all.

Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations representing the 29 million nurses worldwide. He has worked extensively on nursing and healthcare workforce issues, co-chaired the first State of the World’s Nursing Report, led ICN’s efforts to support nurses during the pandemic, and continually advocates for health in all policies and the essential contribution of the nursing profession to addressing the global health agenda.

Image Credits: © Dominic Chavez/The Global Financing Facility, State of the World’s Nursing Report, UK Health Foundation, WHO, Studioregard.ch.

Alzheimer's Disease and dementia can lead to loneliness in old age.
Alzheimer’s disease is the most common type of dementia found in elderly people.

Around 55 million people worldwide live with dementia, and an estimated 60% to 80% of those individuals suffer from Alzheimer’s Disease (AD), according to the World Health Organization (WHO). That number is expected to increase to around 139 million within 25 years.

Projections from the National Center for Health Workforce Analysis indicate that by 2025, the demand for neurologists will surpass the available supply across all regions of the United States. Access to specialist services is already restricted or nonexistent in some low- and middle-income countries. Consequently, many individuals with cognitive impairments do not and will not receive proper evaluations, and it is anticipated that access to dementia specialists will become increasingly constrained in the future.

Already, data suggests that 31- 74% of patients with symptomatic AD are not identified, which can lead to delays in care, administration of inappropriate therapies and incorrect prognostic guidance.

Last week, a peer-reviewed article was published in Nature Reviews Neurology by the Global CEO Initiative on Alzheimer’s Disease BBM (blood biomarker) Workgroup, highlighting why “blood tests for Alzheimer’s disease promise to provide an earlier and more accurate diagnosis for many patients with cognitive impairment.”

“Some currently available blood tests are extremely accurate while others are little better than flipping a coin,” explained Workgroup lead Suzanne Schindler. “We worked with many stakeholders to develop minimum standards for the accuracy of these blood tests because we know that a timely and accurate diagnosis of Alzheimer’s disease has a major impact on a patient’s life.”

Since 2021, new treatments for AD that modify the disease’s progression have started to be used in clinical practice. The FDA has approved two amyloid-β antibody treatments, aducanumab and lecanemab, and is currently reviewing a third, donanemab. These therapies are designed for early stages of AD, including mild cognitive impairment or mild dementia, and require confirmation of amyloid plaques in the brain before starting treatment.

Anti-amyloid treatments help by targeting and removing beta-amyloid, a protein that forms plaques in the brain. Each therapy works uniquely, targeting different stages of plaque formation.

The team wrote in its paper that because Amyloid PET and CSF tests have limitations and aren’t easy to scale up, BBM tests are likely to become the primary method for diagnosing Alzheimer’s. They said that BBM tests are more convenient and accessible and can quickly increase in number to meet the rising demand. They can also be used in primary care (like your regular doctor’s office) and secondary care (specialist clinics), making them a practical option for more widespread testing and treatment.

“The backdrop that’s important to understand here is that the current state of the Alzheimer’s disease diagnostic pathway has at least two primary bottlenecks, including long wait times to see brain health specialists, made worse by overwhelmed primary care providers who lack the practical tools, operational support and standardized assessment process to triage patients effectively,” Tim MacLeod, director of the Healthcare System Preparedness Program of the Davos Alzheimer’s Collaborative (DAC), told Health Policy Watch.

“Traditional diagnostic inputs to inform an Alzheimer’s diagnosis are typically expensive and not readily accessible. Current methods may include lumbar puncture to collect cerebral spinal fluid and imaging such as positron emission tomography or magnetic resonance imaging.

“Blood biomarkers are a promising tool that could help make the diagnostic pathway more time and resource-efficient,” he continued, commenting in general and not on the new Nature report specifically.

The BBM Workgroup recommended that a BBM test have a sensitivity of ≥90 percent, with a specificity of ≥85 percent in primary care and ≥75–85% in secondary care, depending on the availability of follow-up testing.

The CEOi BBM Workgroup, which includes 90 stakeholders from healthcare, academia, non-profit, government, venture capital, industry, and patient advocacy, said its performance standards can be used for any test and does not endorse any specific BBM test. Its standards reflect an expert consensus, marking the first time stakeholders have united to establish a common framework.

The group said that “by adhering to these performance standards, high-quality BBM tests have the potential to revolutionize Alzheimer’s diagnosis, enabling more patients to receive the timely and accurate assessment of whether they may wish to consider using newly approved disease-modifying treatments.”

“A delayed diagnosis to a later stage of the disease will effectively deny access to current and promising disease-modifying treatments,” commented George Vradenburg, founding chairman of the DAC. “Diagnosis delayed will mean treatment denied.”

Health care 'ecosystems'
George Vradenburg participates in a private Davos panel discussion on building better health “ecosystems”

‘Significant Challenges’

However, MacLeod said, “Unsurprisingly, as we watch health systems plan, we’re observing that while specialty sites of care may have a diagnostic pathway, there are significant challenges in making those pathways scalable through the addition of primary care.”

He said, for example, that figuring out how primary care teams can identify patients who need a blood test is a widespread challenge. This process demands significant operational changes and better cooperation across different practice areas. Additionally, there are practical issues like limited access to specialists and long referral wait times. In some cases, providers within their system are skeptical about the availability and effectiveness of treatment and support options, further complicating the efforts of primary care providers to address cognitive complaints.

To address these challenges, the DAC has launched a new initiative across health systems in five countries. This initiative uses BBMs and confirmatory diagnostic testing to improve the timely and accurate diagnosis of Alzheimer’s disease and related dementias (ADRD). Managed by the DAC Healthcare System Preparedness (DAC-SP) team, the Accurate Diagnosis project is the first global research program to explore the integration of blood biomarkers in the ADRD diagnostic process.

“This program – implemented in both primary and specialty care centers – will help us understand the barriers to implementing blood biomarkers and the ways in which blood may help drive efficiencies in the diagnostic process,” MacLeod told Health Policy Watch.

Healthcare systems in Germany, Japan, the Netherlands, the United Kingdom and the United States will implement, evaluate, and share insights on using BBMs and confirmatory Alzheimer’s pathology testing. This project aims to integrate these tests, typically used in research, into routine clinical practice, speeding up the adoption of validated tools for timely patient care.

Sites were chosen based on their scientific and clinical expertise and their ability to reach diverse patient populations in terms of age, race, ethnicity, education, socioeconomic status, and geographic location, DAC said. The initial sites include:

  • University of Kansas Alzheimer’s Disease Research Center
  • Icahn School of Medicine at Mount Sinai
  • Wake Forest University School of Medicine
  • Alzheimer Center Amsterdam at Amsterdam UMC
  • Imperial College London and Imperial College Healthcare NHS Trust
  • Ludwig-Maximilians University (LMU) Hospital Munich – Alzheimer’s Therapy and Research Center
  • Tokyo Metropolitan Institute for Geriatrics and Gerontology

“The project sites are just beginning … to get patients enrolled this summer and hope to have results to share in 2026,” MacLeod shared. “One of the primary aims of this program is to make implementation easier for other health systems that want to implement this type of program.

To that end, we will co-design a blueprint with site leaders informed by our research learning that will help translate lessons learned and effective implementation strategies into pragmatic, actionable tools that can be harnessed by health system leaders.

“Additionally, by using implementation science methods, we are uniquely positioned to learn as we go,” MacLeod continued. “We are already seeing learnings emerge in the start-up phase that we expect will be of great benefit to future health systems wanting to use blood biomarkers in their practice. And by bringing the site leaders together for a monthly community of practice, they have the unique benefit of being able to share their learnings with one another and get creative as they navigate common challenges in their project planning.”

MacLeod stressed that “the stakes are really important here” as an accurate diagnosis is a necessary first step toward receiving interventions such as lifestyle modifications, pharmacological treatments, education, support, practical care and legal planning.

“As new treatments become available, pinpointing the patients who can benefit most from them will be essential since current treatments and interventions are effective when administered at earlier stages of the disease,” MacLeod said. “This is the first time [an implementation study of BBMs] has been done. Our goal is to speed up research and get directly to the patient faster.

“This is a very optimistic time for the field.”

Image Credits: Photo by Steven HWG on Unsplash, John Heilprin.