Dr Jean Kaseya

The US should lift its Marburg-related entry restrictions on people travelling from Rwanda as they are “killing” that country’s economy, according to Dr Jean Kaseya.

The US requires people who have visited Rwanda in the past 21 days to fly to one of only three airports for health screening.

“Now that we are out of the [US] election, let us start to talk science and let us lift this entry status,” said Kaseya, Director-General of the Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya added that not a single Marburg case had been transmitted out of Rwanda. Rwanda has had no new Marburg cases in the past week, and its 66 cases are all linked to the index case and health workers who treated him.

Kaseya also called on the US to deliver on the pledge made by President Joe Biden to contribute $500 million to assist Africa with the current mpox outbreak. He added that less than 20% of partners’ mpox pledges had been delivered to the continent.

Mpox outbreak continues 

Meanwhile, Mpox cases continue to rise, particularly in Central Africa, with 2,532 new cases in the past week – including 20 in Rwanda, which hadn’t recorded any cases in the past few weeks, and a new district of the Central Africa Republic bordering Chad.

While vaccinations were generally progressing well in the DRC and Rwanda, Burundi has not yet received any doses as the Africa CDC was still discussing some issues with the country, Kaseya noted.

However, despite a high case load, Burundi had not yet reported a single death.

Africa CDC’s mpox lead, Dr Ngashi Ngongo, attributed this to dedicated inpatient treatment centres for mpox patients that offered treatment as well as nutritional and psycho-social support.

While the overall case fatality rate is 9,3%, the death rate for younger children is four or five times that of adults, said Ngongo, adding that a forthcoming paper would offer more analysis about the contributing factors to the high mortality in children.

“The context is important. In some of these countries, especially in Central Africa, there’s a high malnutrition rate in those children. In Burundi, about 53% of children below five are chronically malnourished. In DRC, it’s about 42%,” said Ngongo.

“The second element that might be contributing to the DRC figure is that in the case of malnourished children who are so fragile, the more time you take to seek care, I think the more advanced the disease and the poorer the outcome.”

Kaseya added that children’s co-infection with measles was also contributing to the higher deaths.

However, he added that, as Burundi had not recorded any deaths despite high malnutrition,  “there are many things we don’t yet understand”.

The continent is still struggling to protect young children from mpox, as the MVA-BN vaccines at hand can only be used on children from 12 years of age. The Japanese LC16 vaccines that can be used on children are not yet available.

The World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization has advised that, although MVA-BN is currently not licensed for persons under 18 years of age, it may be used “off-label” in infants, children and adolescents, and in pregnant and immunocompromised people in outbreak settings where the benefits of vaccination outweigh the potential risks.

So far, the mpox cases in Africa this year are 545% higher than in 2023 and cases are increasing at a steady pace of between 2000 and 3000 cases every week, Kaseya noted.

Climate data could help countries respond to extreme weather events better but many countries lack data, according to WMO’s latest report.

There are big gaps in the data that governments rely on to make decisions to mitigate the effects of climate change, according to the latest report by the UN body World Meteorological Organization (WMO), released on Thursday.

Climate data includes information about rainfall, drought, sea level rise, storm surges, and cyclones, as well as the impacts of these on vulnerable communities.

This data can help policymakers issue advance warnings to limit deaths and economic damage, as well as effectively distribute their resources to those most in need.

Around a third of countries’ National Meteorological and Hydrological Services (NMHSs) provide climate services at an ‘essential’ level, and nearly one-third at an ‘advanced’ or ‘full’ level, according to the report. But there are still many countries that only provide basic level of climate services or none. This is a long way off from the UN’s target of all countries to have access to a full range of climate services by 2027.

The report added that while countries in Asia and Africa in particular have made strides in boosting their capacity, gaps persist.

Big gaps in Asia, Africa 

The WMO reports say there have been improvements in capacity in regions like Asia and Africa but more needs to be done. Latin America and the Caribbean, for instance, face a growing need for early warning services to deal with hazards such as forest fires and droughts.

“We need to make the necessary investments for a sustainable future. The cost of no action is several times higher than the cost of action,” said WMO Secretary-General Celeste Saulo.

Too few nations are creating tailored climate services for their citizens, and there are still significant gaps, especially in Least Developed Countries (LDCs) and Small Island Developing States (SIDS), the report found.

The availability of climate services has improved in Asia and Africa at the back of increased investments.

Deaths from extreme weather events like storms and floods have also surged, as have the economic losses. Some deaths are not even recorded due to low levels of death registrations, especially in low- and middle-income countries making the toll a likely underestimate.

And so the UN has reiterated that a portion of this impact can be mitigated with timely warnings well in time.

Rising need for climate services

There is a growing awareness of the importance of climate services from countries as well as the funding these services.

Over 80% of the 58 countries that have submitted national adaptation plans to UNFCCC, the UN process for negotiating an agreement to limit dangerous climate change, recognized the importance of climate services as part of their national adaptation strategies.

The WMO analysis shows that the services being provided to national governments, agriculture and emergency planning and response are in highest demand.

The European Union’s Earth observation programme, Copernicus, released a report on Wednesday noting that 2024 is “virtually certain” to be the warmest year on record – with the average global temperature rise being 1.55°C above the pre-industrial era.

The 2015 Paris Agreement commits global leaders to contain the increase in the global average temperature to 1.5°C above pre-industrial levels. A warmer world means more frequent and more intense extreme weather events as well as their intensity.

Investments in climate services

Of the $63 billion being spent on climate adaptation, nearly a third goes towards climate-informed investments. Of this, only about $4 to $5 billion goes to explicitly supporting climate services and early warning activities, according to the report.

UN Secretary-General António Guterres has been pushing countries to invest in early warning systems to respond better to extreme weather events. The UN has also launched an initiative called ‘Early Warning Systems for All’ that has set a target to provide the full range of life-saving early warning systems by the end of 2027 for everyone.

Other stakeholders have already begun taking a lead from the UN. The Asian Development Bank (ADB) released its report in August this year that looked at the state of climate data in Asia. Of the 29 countries in the Asia and the Pacific region that were assessed, only 17 covered climate data in some form.

Experts from the ADB reiterated the need to go a step further and combine climate data with other socio-economic parameters like poverty and unemployment levels to identify the most vulnerable populations so they can be helped in the aftermath of the extreme weather events.

WMO has flagged regional cooperation as a key enabler for the successful development and delivery of climate services

“In the face of unprecedented environmental challenges, the development, delivery, and use of climate information to enable climate action has never been more crucial,” Saulo of WMO said.

“On our journey towards sustainable development, we need to do more to turn climate science and climate information into actionable services, to make climate services more accessible and to use them more effectively,” she added.

Image Credits: WMO 2024 Calendar Competition – Winner – Muhammad Amdad Hossain, WMO.

Smog envelops a South Delhi building – two images from the same spot but a month apart. 

For some years, the Indian government has monitored farm fires, a major source of Delhi’s air pollutions. Officials say the fire count is drastically down as a result, but researchers say their satellite surveillance is missing fires.

DELHI – Peak pollution season has been building up for the last few weeks, and a major government hospital says that cases are rising at its pollution clinic.

On 1 November, the city was the world’s most polluted city thanks largely to Diwali celebration firecrackers the day before – despite a firecracker ban passed in 2018. 

But the worst ranking came a couple of days later when there were few firecrackers but farm fires in two states, Punjab and Haryana, north-west of the Indian capital. 

At a hearing on air pollution a week before Diwali, the Supreme Court criticised both state governments and the government of India for failing to act against polluters, thus making the Environment Protection Act “toothless”. 

Advocate Aparajita Singh, acting as amicus curiae at the hearing, pointed out that neither the 2018 ban on fireworks nor regulations on stubble burning were being implemented. 

“Farm fires and stubble fires are a deadly combination,” Singh told the hearing.

Underscoring that citizens have the right to live in a pollution-free environment according to Article 21 of the Indian Constitution, the court directed the governments to initiate penal action against those setting fires.

These are usually farmers trying to clear the paddy stubble in time to sow the next crop. The court pointed out that despite some 1,000 fires in Punjab reported by the time of the hearing, fewer than 500 people had been fined. 

By 23 October, when the court directed the government to take action, it was reported that the pollution was so bad that the Chief Justice of India, D Y Chandrachud told reporters that he had stopped his early morning walks.

However, the states and central government all asserted at the hearing that they are taking measures that are having an effect.

The crux of their three-fold defence at the hearing is, first, that they are providing funds and subsidised machinery to help farmers clear the paddy stubble without burning,  second, that they are penalising farmers and charging them and third, as a result, the number of fires has reduced over the years.

A few days after the court directive, India’s agriculture minister Shivraj Singh Chouhan, said that the number of fires has halved in the last seven years, and by 35% in Punjab and 21% in Haryana, which impacts Delhi’s air quality. 

Scientists question drastic decline in farm fires 

But researchers told Health Policy Watch (HPW) that they doubted that there had been a decline in the fire count has happened. They base this on satellite observations of fires, burnt areas, and pollutants (aerosols) as well as ground measurements. 

The official fire count in Punjab has fallen from almost 79,000 in 2021 to roughly 32,000 in 2023, whereas in Haryana it’s gone from about 11,000 to about 3,300. 

These numbers are based on images from two satellites that pass over the region at around 10:30am and 1:30pm daily.  But researchers say that these satellites miss many fires as they are usually started later in the afternoon. 

Dr Hiren Jethva, a senior research scientist at NASA Goddard Space Flight Center and affiliated with Morgan State University., tweeted that while the downward fire trend has been drastic in 2022, 2023, and 2024, the aerosol loading, or pollutants, in the atmosphere has increased or remained near stable compared to previous years. 

This, he says, “raises suspicion” that farm fires are ignited after the satellite overpass time, which means the satellite cannot ‘see’, and therefore, detect the active fires.

“The total aerosol loading over the Indo-Gangetic Plain, in which carbonaceous smoke aerosols emitted from the farm fires are a major component around this time of the year, retrieved from the space doesn’t corroborate such decline,” Jethva told HPW.

“This raises a serious doubt that farm fires may not have gone done in previous years,” said Jethva. “Since the timing of igniting farm fires has been shifted to late afternoon, the fire counts show a downward trend.”

Jethva corroborates this assertion with another source: a South Korean satellite GEO-KOMSAT 2A. He points to two images from this satellite taken on 1 November 2024 (see below). The first is taken at 1:30 pm (India time) when the satellite on which the fire counts are based, makes an overpass. The second is taken at 4:20 pm. Unlike the polar-orbiting satellite making once or twice a day overpass, the geostationary satellite continuously monitors the same region at high frequency.

 The second image shows fires just a few hours later.

Pic Left: few or no fires at 1:30 pm IST on 1 Nov., and (right) several fires at 4:20 pm.

Jethva also investigated the shortwave-infrared signal, which is sensitive and useful to detect active fires, from the same satellite, and found a statewide eruption of fires in Punjab during later afternoon hours. 

 Dr Piyush Bharadwaj, an air quality scientist at Bengaluru-based Center for Study of Science, Technology and Policy (CSTEP), told HPW, that “many farmers in Punjab set the fires overnight which generally are not detected” in the morning and afternoon satellite overpass. 

Bharadwaj says another reason for the lower fire count could be that the overpass satellite uses instrumentation (MODIS) with a 1 sq km pixel resolution. 

“Many of the farm fires are much smaller than this,” says Bharadwaj who is Group Head of Atmospheric Composition Modeling group at CSTEP.

His group’s analysis of the fires during the last three years has shown a reduction of daytime fires from ~2500 to ~1000 fire counts, which is a 60% reduction. Even if there has been a decline in fire counts, as claimed by the government, this does not seem to have led to a decline in pollution over Delhi, Bharadwaj adds. 

“Delhi air quality on a year-to-year basis is determined by changing burning activity, meteorology and other emission sources. To our knowledge, the air quality has not improved over Delhi, and/or hard to say with the last five years of data.” 

A recent report by Dr Palak Balyan, of Climate Trends in Delhi, echoes this. Tracking the data in the stubble burning months of September to December from 2019 to 2023, Balyan found that while the fire count dipped by about 23% in Punjab and 44% in Haryana, the air quality index (AQI) in Delhi dipped only by about 5%. 

Fires fall 23 and 44% but Delhi’s AQI dipped only 5%

State 2019 2023 %change (’19-’23)
Punjab fire count 68550 52722 -23.09
Haryana fire count 14122 7959 -43.64
Delhi’s AQI 214.62 203.63 -5.12

Source: Climate Trends

Balyan further explains how much Punjab and Haryana’s fires impact air pollution in Delhi during September and December. Without the fires, the AQI in Delhi averages about 175, which is ‘moderate’ air quality as per the Indian air quality standards.

When the fire count goes up to about 600, the AQI worsens to 233 which is ‘poor.’ Beyond a fire count of 600, the AQI deteriorates to approximately 337 which is ‘very poor,’ when the official health warning reads respiratory illness on prolonged exposure. 

Fire activity AQI Category % Days
No Fire (Fire counts =0) 175 Moderate 5%
Climatological Fire activity

(Fire counts=500-600)

233 Poor 2%
Above Climatological Fire

(Fire counts> 600)

337 Very Poor 21%
Below Climatological Fire (0<Fire counts< 500) 229 Poor 72%

Source: Climate Trends

“Our analysis reveals a notable impact of fire incidents in Punjab and Haryana on air quality in Delhi,” says Balyan. “Specifically, it was found that fire incidents (September to December, 2019 to 2023) in these neighbouring states contribute to an increase in Delhi’s Air Quality Index (AQI) by approximately 103 units.”

A recent study submitted to the Delhi state pollution control committee shows just how much burning biomass contributes to Delhi’s pollution in November and December, which tend to be peak pollution months. 

Biomass burning, of which stubble fires are only one component, contributes 36% to air pollution in November but this dips to 21% in December. November is the time when farm fires peak and are largely stopped in Punjab and Haryana.

Biomass burning: November and December.

Researchers say there needs to be a ground-truthing exercise to accurately gauge the totality of farm fires. Additionally, a geostationary satellite with high-resolution and very frequent imagery over north India is needed.

HPW reached out to a spokesperson for the ruling party in Punjab but there has been no response for over three days till filing this report. 

Image Credits: Hiren Jethva.

Brazilian Health Minister Nísia Trindade (centre) addresses the meeting between G20 health and finance ministers in Rio.

Health Ministers from the powerful G20 nations have resolved to set up a “Global Coalition” to strengthen local and regional production to promote more equitable access to “safe, affordable, quality and effective health products and technologies”.

The primary focus of the coalition will be to strengthen the manufacturing capacities of countries to deal with “neglected diseases and persons in vulnerable situations”, according to a declaration adopted by the health ministers of the powerful group at their meeting in Rio de Janeiro last week.

It will start by identifying two or three projects to test approaches that could include “technical cooperation, advanced market commitments, voluntary technology transfer on mutually agreed terms, existing funding sources, regulatory cooperation and strengthening, and developing, regional environments that stimulate investments”. 

Two criteria will guide the selection of projects: the diseases they target and the technological platforms and capabilities they will use to promote more equitable access .

Brazil, the current head of the G20, is the key driver of the coalition and will serve as its the executive secretariat and presidency for the first two years. 

Membership will be voluntary and financed through projects by the involved participants and with no mandatory or fixed contribution from members or other institutions involved. 

It is “intended to promote synergies with existing and potential future initiatives, funding channels and philanthropic organisations,” according to the declaration.

The G20 stretches from the US to China, and also counts the African Union and the European Union as members. But non-G20 countries and international organisations that contribute to its objectives can join the coalition if approved by G20 members.

The World Health Organization (WHO) has already been invited to support the coalition by providing scientific and technical support, and help map existing projects to avoid duplication.

Praise for ‘visionary’ coalition 

The Global Council on Inequality, AIDS, and Pandemics, which is convened by UNAIDS  welcomed the establishment of the coalition to stimulate local production.

UNAIDS Executive Director Winnie Byanyima described the coalition as a “visionary, politically feasible solution [that] could transform global health for as long as it remains bold in vision and wide in scope.” 

Nobel Prize-winning economist Joseph Stiglitz, co-chair of the Global Council, said: “Reforms in both the developed and developing countries and in international agreements and institutions, and investments which help broaden the production of medical products and reduce prices are vital to address market failures and accelerate access to medicines for the people in greatest need.”

Brazilian Health Minister Nísia Trindade, who is also a member of the Global Council, said: “By building production capacity in every region, we can learn from past mistakes by ensuring that medicines for neglected and socially determined diseases are made around the world and that capacity is available to respond swiftly to future outbreaks.”

Brazil’s representative at the pandemic agreement talks.

The health ministers also discussed the pandemic agreement negotiations, which re-convened in Geneva on Monday.

Brazil’s representative at the negotiations described the G20’s decision to establish the coalition as “particularly timely” for occurring shortly before the 12th meeting of the intergovernmental negotiating body (INB).

The G20 health ministers’ declaration also expressed their support for the conclusion of the INB process, reiterating their “commitment to an instrument that is ambitious, balanced, effective and fit-for-purpose, including equitable access to medical countermeasures during pandemics”.

Finance and health ministers

Health has been a central concern of Brazil’s G20 Presidency, and the country also hosted the joint meeting of G20 Finance and Health Ministers last week, which focused on addressing the social determinants of health, debt-for-health measures to bolster countries’ investment in health and pandemic prevention, preparedness, and response (PPR)

“Ministers underscored the need to enhance investments in health systems to bolster resilience, safeguard the global economy, and mitigate disruptions, particularly in anticipation of future pandemics,” according to a statement from the meeting.

“Health equity is one of our priorities and a transversal principle in all the discussions we are promoting,” Brazilian Health Minister Trindade told the meeting.

 “From climate change and its impacts on health to the health workforce and the One Health approach, we need to tackle inequalities and protect our most vulnerable populations,” she said.

Trindade also stressed the importance of the “debt-to-health swap” instrument, which allows part of the debts to be converted into investments for the sector, but warned that such instruments should complement rather than replace the efforts to restructure debt.

 “There is consensus on the importance of maintaining a voluntary basis for participation in debt-for-health swaps and aligning them with larger international health and development financing structures to maximise their impact,” she explained.

The UN biodiversity summit in Cali yielded welcome decisions on health, Indigenous representation and benefit sharing from genetic sequences but fell short of major questions of finance and implementation.

Nearly 200 nations have backed a groundbreaking global action plan linking health and the natural world at the close of UN biodiversity negotiations in Cali, Colombia, marking a rare victory in a summit otherwise characterised by disappointment.

The final agreement on a “health and biodiversity action plan” was approved as a voluntary rather than mandatory measure, serving as a best-practice guide for nations to integrate health considerations into their nature protection plans. But it still stands as an achievement, capping four years of negotiations and reflecting health’s growing prominence in environmental diplomacy.

“Parties approved a global action plan on biodiversity and health designed to help curb the emergence of zoonotic diseases, prevent non-communicable diseases, and promote sustainable ecosystems,” the COP16 secretariat announced as the Cali meeting closed early on Saturday morning after a frantic overnight session.

“The strategy embraces a holistic ‘one health’ approach that recognises the health of ecosystems, animals and humans as interconnected,” the secreteriat added.

Other key developments from the 16th conference of parties to the Convention on Biodiversity (COP16) included a new voluntary framework whereby a small percentage of corporate profits derived from genetic resources harvested in countries should be allocated to a new global fund for biodiversity protection – dubbed the Cali fund.

Nations also agreed to establish a permanent body for Indigenous peoples within the UN treaty framework following three decades of advocacy on the issue.

Yet the likely legacy of COP16 came in its complete failure to mobilise funds anywhere near the $200bn annual target for nature protection by 2030 set out in the landmark Convention on Biodiversity (CBD) agreement reached in Montreal in 2022. It raised just $163 million in new funds to combat the biodiversity crisis – 500 times short of the 2030 goal.

In a final blow to the summit’s ambitions, nations failed to agree on mechanisms to monitor compliance with the treaty and its targets – this after the world has missed every single UN biodiversity goal since the CBD framework’s establishment in 1992.

Global action plan links health and nature protection

The new UN biodiversity and health action plan urges governments to put health at the heart of their nature protection strategies. While voluntary, the agreement marks a turning point in environmental policy by formally recognising for the first time that “biodiversity loss and its direct drivers are a threat to animal, human and plant health”.

The decision comes as scientists increasingly warn that the destruction of natural habitats is driving disease outbreaks and raising pandemic risks. The loss of biodiversity also undermines Earth’s basic life support systems – from food security and clean water to medicinal plants and vital ecosystem services. These impacts are amplified by the climate crisis, creating a feedback loop that further threatens public health.

Drawing on “lessons” from Covid-19, the plan emphasises the “urgent need to conserve, restore and sustainably use biodiversity” to prevent future zoonotic diseases – those that jump from animals to humans.

‘Embracing the interconnectedness of biodiversity and health’

The decision document places particular emphasis on how vulnerable groups, including women, children, the elderly and people with disabilities face outsized health impacts, while Indigenous communities are especially hard hit,  given their “unique interdependent relationship” with local ecosystems. 

Key rehabilitation strategies outlined in the 21-page health and biodiversity blueprint call on countries to set health-relevant targets that would also help reach the overall targets of the Convention on Biodiversity. These include, for example, the promotion of more healthier and sustainable agriculture, fisheries and forestry; addressing wildlife fragmentation and species management; land and sea use; and reducing pollution in multiple forms, from air pollutants to microplastics.

The text also calls for countries to address the unsafe disposal of antimicrobials and pharmaceuticals – which fuel drug resistance already claiming 1.27 million lives every year and threatening the efficacy of medicines used by billions globally.

“This is a breakthrough moment affecting humans, wildlife and other animals, and ecosystems,” the Wildlife Conservation Society, which provided technical input to the negotiations said in a statement

“Millions died and suffered due to the COVID-19 pandemic, and this Convention is charting an excellent path to fully embrace the integration and interconnectedness of biodiversity and health,” WCS vice-president Susan Lieberman added.

“There can be no prevention of future pandemics of zoonotic origin without the protection and ecological integrity of nature,” Lieberman said. “We have no future without nature.”

No binding measures adopted

However, as one of few documents achieving consensus in Cali, the final text emerged somewhat diluted. 

The plan repeatedly emphasizes its voluntary nature, stating that “nothing” in the document “should be interpreted as modifying the rights and obligations” of any nation that is party to the legally binding CBD agreement reached in Montreal in 2022. 

Specific references to industry’s impacts on biodiversity and health were softened. For instance, explicit mention of “unsustainable agricultural intensification” was removed from the final text. Ditto for a blunt reference to the “increasing human demand for animal protein” as a factor driving zoonotic diseases. Instead, the final text notes that  infectious diseases “can be exacerbated by human activities, such as unsustainable land-use change practices and habitat fragmentation.” 

Even so, advocates of a stronger linkage between health and biodiversity said the decision was a step in the right direction. 

“At the end of the day, this plan is only going to be voluntary, but it’s still good guidance,” Dr Colman O’Criodain, head of biodiversity policy at WWF, told Carbon Brief. “Even if countries that don’t commit formally to implement it use the guidance and take the parts of it that are relevant to them, that’s still a good thing.” 

Landmark ‘Cali Fund’ created for companies to share profits from the use of genetic resources 

Another key agreement came in the early hours of Saturday morning, when nations agreed to create a new global biodiversity fund, financed by corporate profits derived from the creation of new products using genetic resources. 

The agreement, which first appeared uncertain amid hundreds of early textual disputes, stood out as a rare note of final consensus in an otherwise divided summit.

At the heart of the new arrangement is the sharing of Digital Sequence Information (DSI) – which can map the unique genetic blueprint of virtually any plant species or micro-organism, including pathogens, at the digital level, making sharing faster and more efficient than through biological tissue samples. 

Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. But developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. 

The agreement targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits to the new “Cali Fund” to support developing country biodiversity preservation and restoration. Although the rates remain “indicative”. 

Further underlying that voluntary nature, a last-minute revision stripped out a requirement for companies to “demonstrate” they hadn’t used DSI in their products. 

“The deal reached means businesses have the option of voluntarily contributing to a new fund – known as the Cali Fund – if they use this genetic information from nature, said the UK Government’s Department for Environment, Food and Rural Affairs, calling it a “new deal for biodiversity from using nature’s genetic information”

Global patterns of gene sequence data sharing, June-November 2022. The bigger the dot/higher the number, the more DSI data generated by the country was used by researchers elsewhere.

The CBD will manage the funds collected for nature conservation, with at least half flowing to indigenous communities. In that way, the new Cali Fund also aims to avoid the pitfalls of closely attributing the profits from genetic resources culled by industry to one particular country or community. 

“Parties and non-Parties are invited to take administrative, policy or legislative measures, consistent with national legislation, to incentivise contributions from users in their jurisdiction to the global fund in line with the modalities of the multilateral mechanism,” the text urges.   

UN Environment chief Inger Andersen also hailed the mechanism as a “big win” – even if further refinements to the profit-sharing mechanism will have to rely on national interpretation – or next year’s next COP 17.   

“The new ‘Cali Fund,’ although imperfect and with many details still to be ironed out, is an important step forward,” said Kirsten Schuijt, Director General of WWF International. “It ensures that companies profiting from nature contribute fairly to biodiversity conservation and directs critical funding to the people and places that need it most.”

Notably, the United States, home to many leading agro, pharma and cosmetics giants is  not a signatory to the CBD – leaving Washington outside the scope of compliance altogether. 

Pharma voices concerns over impacts on medicines and vaccines R&D 

Inudstry groups from all sectors showed up in full force to the Cali negotiations. / Graph by DeSmog.

Despite its voluntary nature, the new arrangement quickly came under fire from pharma industry voices who expressed fears that the arrangement could hinder the rapid sharing of genetic data on pathogens, critical for new medicines development during health emergencies. 

Pharma has argued that pathogens, unlike genetic resources used to develop new plant products or cosmetics, need to be shared with researchers with no strings attached so as to expedite the development of new vaccines and medicines. Pathogens also  mutate, rapidly crossing borders and making their genetic origins all the more difficult to trace. 

During COVID-19, for instance,  mRNA vaccines by Moderna, Pfizer and BioNTech relied on hundreds of digital genetic sequences to roll out vaccines in record time – generating billions in profits but also saving millions of lives.

“The decision adopted today does not get the balance right between the intended benefits and potential costs to society and science,” warned David Reddy, Director General of IFPMA in a press statement. 

“The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” Reddy said. 

Even so, “The ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he added. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. 

Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.”

Issue is also being debate in WHO-led negotiations on a Pandemic accord  

WHO member states discuss new pandemic convention or treaty, 18 July 2022.

Another complication lies in the fact that a mechanism for linking pharma pathogen access and benefit sharing (PABS) is also being debated in WHO-led member state negotiations over a Pandemic Accord, which resumed on Monday in Geneva

Any decision ultimately reached in a Pandemic Accord could potentially supersede the arrangements in the CBD, particularly since the Accord is supposed to be a legally binding agreement.  

Meanwhile, independent experts are still divided over if and how a profit-sharing mechanism could  be designed that did not also hamper rapid vaccine development and outbreak monitoring and reporting by countries. 

The DSI Scientific Network, a global alliance of experts from over 20 countries, has, on the one hand, suggested sales-tax like levies on end products– could balance seamless genetic sequence access for research with profit-sharing. It has also proposed “in-kind” contributions like vaccine doses to ensure equitable access.

Yet charging companies for using particular genetic sequences in their end products – may in fact be much harder than it sounds, the same expert network observes.

“Research that uses DSI routinely compares and selects among millions of sequences, often merging or editing them, making it impossible to attribute products to any single sequence,” DSI Network researchers explained in one brief, which explored Moderna’s COVID-19 vaccine patent application as an example.

“With many nearly identical sequences from different countries, proving which ones were used to develop commercial products becomes unfeasible,” the researchers said. 

Funding shortfalls for biodiversity preservation 

The majority of nations have yet to submit their national biodiversity protection required by the Montreal-Kunming Agreement, but officials say the less than two year deadline – and the incredible complexity of ecosystems like the Amazon, means these plans take time to develop.

While observers say that the new ‘Cali Fund’ for DSI profit sharing could eventually generate up to $1 billion annually for biodiversity protection, reaping those funds is years away. 

And that still falls far short of the target in the legally binding UN biodiversity of 2022.  That  treaty called for $200 billion annually for nature protection by 2030, including $20 billion from rich countries on a voluntary basis. The needs, meanwhile, rise as high as $700 billion annually required to sustainably protect and restore global ecosystems, independent experts have maintained.

Over the two-week run of COP 16, just $163 million from eight countries – including Germany, Austria, France, Norway and the UK – was pledged to the CBD’s ‘Global Biodiversity Framework Fund’ (GBFF), hosted by the World Bank. That brings currently available funding to $400 million – 500 times short of the 2030 target.

After COP 16 stretched into overtime, lasting all night Friday until 9am Saturday morning, the summit was abruptly suspended when too few countries remained in the room for decisions to be made. Many smaller delegations, unable to afford costs to rebook flights, had to leave – an unceremonious end that encapsulates the core frustration expressed by developing nations, scientists and civil society observers alike: where is the money?

Where is the money? 

Originally, funds were expected to come from slashing $500 billion in environmentally harmful subsidies, which the 2022 Montreal CBD agreement had pledged to eliminate. Governments, however, allocated a record-breaking $1.4 trillion to fossil fuel subsidies in 2023. And the World Bank estimates countries spent $1.25 trillion subsidizing agriculture, fossil fuels, chemical production and other industries that destroy biodiversity.

While the EU announced it will double its biodiversity funding to $7 billion for 2021-2027 and committed hundreds of millions to other projects to deliver –”on global financing commitments to protect nature” – a strong push led by the African Group and Brazil to establish a new biodiversity fund was rejected. 

Developing nations had argued that the World Bank-hosted GBFF is too complicated to access and controlled by wealthy countries – an argument rejected by the European Union and other major donors.

Ultimately, the meeting even failed to agree on a budget for the Convention on Biological Diversity itself, the instrument under which the biodiversity COPs are organized. 

Debt crisis sidelined

As developing countries face unprecedented debt burdens, nations argue finance in the issued in the form of debt should not be counted towards nature spending targets.

Host nation Colombia’s also pushed to have the burgeoning debt crisis recognized in financing arrangements – but that too failed to receive support. 

Donor nations in Europe and elsewhere provide the majority of their biodiversity funding as loans – and that trend is accelerating, with about 80% or more of new funding in 2021-2022 coming as loans rather than grants. China – which holds trillions in developing country loans – also opposed recognizing debt as part of the biodiversity crisis.

Last month, the World Bank revealed the world’s 26 poorest countries are in their worst financial shape since 2006, as natural disasters and COVID-19’s reverberating shocks continue to hit their economies. Over 3 billion people now live in nations spending more on debt financing than education and health budgets, according to UN figures. Developing countries trapped under major debt burdens argue loans should not count as finance.

An expert report on debt, nature and climate released just ahead of COP16 meanwhile found that countries most exposed to biodiversity loss and climate-driven extreme weather now rely increasingly on expensive loans to rebuild and cope with changes.

“Emerging markets and developing economies have seen both the levels and cost of debt soar,” the Independent Expert Group reported. “This means that EMDCs can borrow less, at greater cost, at a moment when they need more and cheaper finance to limit the extent of future shocks.”

“It is essential today to change debt for climate action,” Colombia’s President Gustavo Petro said at the opening of COP16. “Those who emit the most CO2 into the atmosphere are the fossil, oil and coal economies, they are the powerful economies of the United States, China and Europe,” and they are the ones who “charge interest rate surcharges to countries that can still absorb CO2.”

“That is a true moral and deadly contradiction,” he said. “It is the richest, predatory countries that must be taxed to eliminate carbon from production and consumption,” he added.

Historic victory for indigenous peoples 

Yet amid the summit’s setbacks, one significant victory emerged: the agreement by nations to establish a permanent body for Indigenous Peoples within the CBD  framework.

The new subsidiary body recognizes “Indigenous Peoples and people of African descent as key protagonists in biodiversity conservation,” providing them with a seat at the table to protect traditional knowledge systems, strengthen representation in decision-making, and promote Indigenous territorial biodiversity management.

It is the first formal mechanism for indigenous communities’ representation within UN environmental negotiating frameworks. 

“This is an unprecedented occasion in the history of multilateral environmental agreements,” said Camila Paz Romero, Indigenous Peoples’ spokesperson at the summit. “Indigenous peoples and local communities of the world – connected from our knowledge systems in the care of life and biodiversity – remember the long road we have travelled towards this agreement.”

Image Credits: COP16, CIFOR-ICRAF, UNCTAD.

INB co-chairs Anne-Claire Amprou and Precious Matsoso, alongside WHO Director-General Dr Tedros Adhanom Ghebreyusus.

The pandemic agreement talks resumed on Monday for two weeks, but parties only have a week to decide whether they have sufficient common ground to call a special World Health Assembly (WHA) in December to adopt the document.

Procedurally, 12 November is the last day by which a December WHA can be called. Negotiators will “stocktake” progress on Friday and decide by next Monday whether to call a December WHA or wait until next year’s regular assembly in May.

Several countries are pushing for a December agreement amid growing geopolitical uncertainties including the imminent US election, and outbreaks of mpox, H5N1 and Marburg.

A Donald Trump victory could mean the US withdrawal from the negotiations and withholding their dues from the World Health Organization (WHO), which Trump did during the COVID-19 pandemic.

US and African negotiators pushed for the December WHA during the opening of the 12th meeting of the intergovernmental negotiating body (INB), while others including stakeholders, cautioned against sacrificing content for speed.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus warned negotiators not to make “the perfect the enemy of the good”, stressing that no party will get all their demands.

“With the proposals on the table, I believe you have the ingredients in place to meet your objective,” Tedros told the INB, which has been negotiating for almost three years.

He also said that reaching agreement would provide hope that, “despite political and ideological differences between countries, we can still come together to find common solutions to common problems”.

Africa, US push for December adoption

Tanzania, speaking for the Africa Group, wants the agreement adopted in December.

“The Africa group is resolute in its ambition to finalise the agreement process by December 2024. This timeline is not arbitrary, but a moral imperative,”  said Tanzania, speaking on behalf of the Africa Group of 48 countries.

For Ethiopia’s Ambassador Tsegab Kebebew Daka, “the outstanding issues are not that many, but are those that require political decisions to ensure whether the language in the current text addresses the shared threat of the next pandemic and the challenges that our countries are facing on the ground”.

US Ambassador Pamela Hamamoto told the INB: “There’s no question that this pandemic agreement will have real-world consequences. The recent declaration of mpox as a public health emergency of international concern (PHEIC) demonstrates just how relevant our work remains. 

“Concluding these negotiations is a priority for the United States, and we seek to facilitate an effective agreement by year-end, if at all possible.”

Hamamoto said that the Friday stock-take was crucial to “carefully assess progress made and accurately identify areas of convergence, as well as issues that will require further discussion before consensus can be reached”. To assist, she appealed to the INB bureau to develop a framework of clear  criteria for member states to consider to make the December call.

US Amabassador Pamela Hamamoto.

At a stakeholder briefing last week, the INB Bureau stressed that they are aiming for a document that can grow in the future – in other words, what commentators have described as a pandemic agreement “lite” that can provide the framework for more detailed plans about contentious issues such as the proposed pathogen access and benefit-sharing (PABS) system.

‘Consensus is the silver bullet’

But many countries advocated caution, including the European Union (EU). EU Ambassador Lotte Knudsen called for “pragmatic solutions that work for all of us” given that “a number of key issues are still outstanding”

“To proceed with calling a special session, we all need to be fully convinced that the agreement will be ready for adoption. This is too important an objective to make any leap of faith that is not properly grounded in tangible progress in the negotiations,” Lotte stressed.

The agreement’s test is whether it will make a substantial difference to improving prevention, preparedness and response on the ground, she added.

“The content will be far more important than the timing of its adoption. Consequently, our top priority remains to achieve a meaningful and impactful agreement that can command large, ideally universal, participation.”

Comparing the agreement to food, Germany’s Bjorn Kummel stressed that negotiators had to ensure that the “dish needs to be tasteful to all of us” for it to be adopted by all 194 member states.

“Consensus is the magic bullet here,” Kummel stressed.

Germany’s Bjorn Kummel.

Equity challenges

Malaysia, on behalf of the 35 countries making up the Equity Group, spelt out the mountain that still needs to be climbed to change the status quo in favour of low and middle-income countries.

The Equity Group’s key concern is how the proposed PABS system ensures that countries sharing information about pathogens with pandemic potential can benefit from vaccines, therapeutics and diagnostics (VTDs) developed as a result.

“We cannot leave all the critical details for the PABS system for the future,” Malaysia noted.

Malaysia, speaking for the Equity Group, outlined some of the shortcomings of the current draft.

The Equity Group’s demands to ensure fair and equitable benefit sharing include a clear link between access and benefit sharing, making 20% of real-time production of VTDs available to LMICs during a pandemic and annual payments for access to PABS by entities that may profit, such as pharmaceutical companies.

Appeal from the coalface

Meanwhile, Rwanda’s Minister of State for Health Dr Yvan Butera said that his country’s outbreak of the deadly Marburg virus shows that the world is “prone to shocks at any time and anywhere”.

When asked by Health Policy Watch whether he had a message for INB negotiators, Butera said “being able to work together collaboratively to handle these situations efficiently” is essential.

“The capacity to be able to prevent, rapidly detect, respond, and deploy innovative tools in terms of prevention, therapeutics and  diagnostics, is extremely important,” said Butera.

“And then sharing the knowledge so that it can shape better policies or better tools to contain and control future diseases that have potential to become outbreaks, epidemics or pandemics.”

Meanwhile, Africa CDC’s lead on mpox, Dr Ngashi Ngongo, stressed that “benefit-sharing really resonates”.

“If you have used the viruses and pathogens from an African country to develop vaccines, it is really common sense that, in the distribution of the medical countermeasures, those that also contributed with the pathogens also get a share,” said Ngongo.

“Perhaps the lines were a bit hard at the first time, but we are hoping, with everything that has gone behind the scenes, that both sides will be able to come to to a compromise.”

WHO EURO Region Committee leadership
WHO European Region leaders and member states met to discuss policies and priorities for the coming years, including a focus on health security and health systems strengthening.

WHO Member States gathered in Doha, Washington, D.C, Copenhagen, Manila, and Brazzaville for their respective World Health Organization (WHO) Regional Committee sessions in the past months to set policies, strategies, and frameworks for the coming years. 

The WHO Regional Committees – the WHO’s governing bodies in each of six regions – meet yearly to formulate regional policies, supervise WHO activities, comment on the regional components of WHO’s budget, and every five years, nominate a regional director. 

On Wednesday, in the final edition of the regional series, the WHO European Regional Committee nominated Dr Hans Henri Kluge as WHO Regional Director for Europe for a second 5-year term, which will begin in February 2025 after his formal re-election by the WHO Executive Board at their January 2025 meeting. 

That followed the nomination of a new Regional Director for WHO’s African Region in late August, where Dr Faustine Engelbert Ndugulile of Tanzania was nominated to take over the helm from Matshidiso Moeti, Africa’s first female RD, who served ten years in the position. The AFRO Regional Committee featured WHO director general Dr Tedros Adhanom Ghebreyesus pledging support for Africa CDC and the African Medicines Agency, in an attempt to sooth purpoted tensions between the two agencies.

The Pan American Health Organization Directing Council, which met in early October, unveiled a roadmap for a new strategic plan, after member states adopted policies ranging from health system strengthening to climate and health adaptation and mitigation.

Kluge’s tenure began at the beginning of the COVID-19 pandemic, and along with the pandemic response, he has made a name for himself leading the Region through a broad range of other health emergencies. Those range from extreme weather events, to Europe’s mpox outbreak, the war in Ukraine and the Region’s response to crises in Africa and the Eastern Mediterranean regions. 

“By identifying and acting on priorities of importance to the almost one billion people across Europe and Central Asia, our Member States display welcome solidarity and multilateralism at a time of deepening distrust and division,” said Dr Kluge at the close of the Regional Committee session, where he was nominated for a second term. “Health can and does bring countries and communities together. We at WHO/Europe are grateful for the opportunity to work with our Member States and partners to help shape the future of health for the benefit of all.”

At the European Regional meeting, member states also discussed plans and strategies for: healthcare system resiliency and primary healthcare investment, health emergency preparedness – known as “Preparedness 2.0”, emergency medical teams capacity, and health innovations and emerging technologies. Member states also discussed five year plans and strategies around national health security, mental health, the climate crisis, and gender-based violence. 

Western Pacific focuses on improving health financing, digital health

The Western Pacific Region (WPRO) member states, home to more than 1.9 billion people across 37 countries and areas, including the Philippines, Malaysia, Australia, Korea, China, and Japan, met 21 to 25 October, adopting strategies that aim to increase national public health funding, and implement digital health solutions. 

Despite recent reforms in health financing, public health spending in the Western Pacific Region remains “inadequate” to meet growing needs, the WRPO said in a press release. The lack of healthcare service access and the financial burden of care costs presents a growing burden in the Region, where in 2019 more than 300 million people faced “catastrophic” health costs. 

To curb costs, the Regional Committee endorsed a regional action framework for health financing. The Framework aims to improve health financing through five action domains: 1) greater reliance on public funding for health; 2) more equitable and efficient health spending; 3) financing primary health care (PHC) now and into the future; 4) strengthening governance for health financing; and 5) promoting health for all in economic and social policy, according to a statement

The Committee also endorsed measures to accelerate digital healthcare technologies, which calls on countries to prioritize “governance, socio-technical infrastructure, financing and economics, digital health solutions, and data in strengthening health systems in the era of digital transformation.” 

Regional conflicts take center stage at Eastern Mediterranean regional committee

Dr Hanan Balkhy, EMRO director, at the Regional Committee meeting in Doha.

On 14 October, meanwhile, Eastern Mediterranean Region member states met in Doha, Qatar, for its 71st regional committee. The conflicts in Gaza, Sudan, Yemen, and Lebanon occupied much of the discussion. The devastation of health infrastructure and the outbreaks of vaccine-preventable diseases – “an unprecedented series of emergencies” – were the backdrop to the Committee’s “Health Beyond Borders” theme. 

“In several countries in the Eastern Mediterranean Region, conflicts, epidemics and political unrest have weakened health services, requiring responsibility, solidarity and equity to improve the lives of all people. We have learned from pandemics and epidemics the importance of solidarity, and that protecting health requires global efforts that transcend national borders,” observed Dr Hanan Al-Kuwari, Qatar Minister of Health in her opening remarks. 

WHO director general Dr Tedros Adhanom Ghebreyesus echoed the intensity of threats facing the region in his opening address, noting : “The eruption of conflict in Lebanon has put the health of millions more people at risk. The number of internally displaced people is growing rapidly, and so is the threat of disease outbreaks, compounded by overcrowding in shelters and the closure of hospitals.”

The Director General urged EMRO Member States to engage in Pandemic Agreement negotiations, “and if possible, to complete it by the end of this year” as well as to participate in the ‘WHO Investment Round’ that aims to raise some $7 billion in supplementary funds to fill a gaping hole in WHO’s $11 billion budget for the next four years. 

The EMRO four-year strategic plan focuses on three flagship initiatives: expanding equitable access to essential medicines, vaccines and medical products, investing in a more resilient health workforce and scaling up public health action on substance abuse. Member states formally adopted the plan at the end of the four day conference; approved a strategic frameworks for implementation of Immunization Agenda 2030, strengthening health laboratory services in the Region 2024–2029. The Committee also endorsed a new regional strategy to strengthen local vaccine production.

South Asia regional meeting under cloud of Regional Director’s controversy

Saima Wazed (in black), along with her mother Bangladesh Prime Minister Sheikh Hasina, during an official visit to the United States to meet US President Joe Biden and First Lady Jill Biden in 2023. A few months later, Wazed’s nomination as the next SEARO Regional Director was confirmed by the WHO Executive Board.

In New Delhi, meanwhile, South-East Asian (SEARO) Member States converged  in the first week of October to adopt resolutions on adolescent health and set measles and rubella elimination targets.  The meeting took place despite late summer unrest in neighbouring Bangladesh that saw Prime Minister Sheikh Hasina resign and flee the country. That followed the controversial election in February 2024 of Sheikh Hasina’s daughter, Dr Saima Wazed, as the new SEARO regional director – in a vote that critics said was laced with politics.

There were fears that the subsequent resignation of Sheikh Hasina could further complicate Wazed’s job as the new SEARO RD.  However, despite the political upheaval, the Regional Committee session took place on schedule.

The SEARO event also featured a number of regional health achievements by member states. Those included six countries’ attainment of SDG targets for reducing  under five mortality and still  birth rates; India’s elimination of trachoma; Timor-Leste’s elimination of lymphatic filariasis; Bhutan’s achievement of interim WHO targets for cervical cancer elimination; and Maldives and Sri Lanka’s progress on Hepatitis B control in children.

“The progress being made is the Region is heartening. I congratulate countries for their achievements which demonstrates their commitment to health and wellbeing of people. I look forward to together building on this momentum to further accelerate efforts for equitable access to health services for all in our Region in the coming years,” said Dr Wazed in a press release at the close of the meeting.

WHO ‘investment rounds’ now a feature of Regional Committee meetings

In a new twist on the decades’ old formula, WHO has also now been making use of the Regional Committee events to stage awareness-raising events about the agency’s new ‘Investment Round’ strategy – which aims to streamline and amplify member states’ voluntary contributions so as to raise roughly $7.4 million more to fund WHO’s 2025-28 budget of $11.1 billion.

In the case of the African, WPRO and SEARO regions, fund raising events even took place directly at the regional meetings. In the first-ever SEARO WHO Investment Round,countries pledged some $345 million, beyond their assessed annual contributions. That followed pledges from the African region for $45 million at their annual meeting in August. At the Western Pacific Regional meeting, in late October, meanwhile, countries pledged a total of $20 million.

As for other (richer) regions, such as the European Region, the Americas and the Eastern Mediterranean, those all-important pledges are being recruited and announced separately.  A gala European Region event was featured at the mid-October World Health Summit in Berlin, which garnered nearly a$1 billion for the organization – although major donors such as France, Spain and the United Kingdom did not announce commitments there.  As for the conflict-wracked EMRO region, which also includes wealthy Gulf countries, and the Americas, where a US election win by former President Donald Trump could lead to another US disengagement from WHO, as per the moves made during his last term, the Regional Committee meetings were used for briefings and awareness-raising. But it remains to be seen when and how concrete pledges will actually be finalized and announced.

WHO Secures $1 Billion at First European Investment Round

See the following links for Health Policy Watch coverage of outcomes from two other WHO regional committees – the Pan American Health Organization (PAHO) and the African Region (AFRO).

Image Credits: WHO/EURO, WHO/EMRO, X.

First stage of the polio vaccine campaign gets underway in northern Gaza on 10 September: WHO has doubts whether the second dose will reach as many children.

WHO Director General Dr Tedros Adhanom Ghebreyesus appealed to Israel to reverse this week’s decision by the country’s Knesset, or parliament, to close the Jerusalem-based operations of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), saying that “there is simply no other alternative to UNRWA.” 

Tedros also said that the third phase of a polio booster campaign in northern Gaza would get underway Tuesday, after Israel had agreed to a ‘humanitarian’ pause in the Gaza City metropolitan area.  But he also expressed fears that the significantly smaller in which health workers would be allowed to move about freely without fear of attack could mean that the campaign would not hit its target of 90% of children, under the age of 10 living in the northern region of the 365 square meter enclave. 

“The final phase of the campaign had aimed to reach an estimated 119,000 children under 10 years old,” Tedros said. “But achieving that target is now unlikely as conditions in northern Gaza get worse every day in the past two weeks.”

The WHO Director General was speaking at a WHO press conference in Geneva on Friday. 

‘Communications directly with Israel to reconsider’

WHO Director General Dr Tedros Adhanom Ghebreyesus appeals directly to Israel to reverse the decision to close UNRWA’s Jerusalem headquarters.

Asked if he had tried to speak directly with Prime Minister Benjamin Netanyahu about the UNRWA closure, scheduled in 90 days time, Tedros sidestepped the question, saying: 

“There are communications directly to Israel to reconsider; and not implement the decision by the Knessset. And I hope that will be the case…we encourage Israel actually to reconsider.” 

Israel’s decision stems from allegations that UNRWA  employees participated in the bloody 7 October 2023 assault on Israeli communities along the border with Gaza, while it’s schools and health facilities have provided a base for Hamas weapons stores and operations.  Testimony by several former Israeli hostages in Gaza described their captors as being affiliated with UNRWA. But there also has been a longstanding Israeli grudge regarding UNRWA,  a sprawling institution with schools, clinics and welfare activities serving 6 million Palestinians in the Occupied West Bank and Gaza, as well as Jordan, Lebanon and Syria, and institutionally separate from the mandate of the UN High Commissioner for Refugees (UNHCR), which serves the rest of the world’s 32 million UN-registered refugees.

Tedros acknowledged that nine employees are being investigated for operating on behalf of Hamas, including during the 7 October 2023 rampage in Israeli communities and a music festival near the Gaza border. 

“But even if we said these people have relationships with Hamas, they cannot represent the whole of UNRWA,” he asserted.  “This ban will not make Israel safer. It will only deepen the suffering of the people of Gaza, and increase the risk of outbreaks.” 

“They (UNRWA) are the engine block of humanitarian support, education, (water and sanitation) WASH, shelter, logistical support,” added Dr Rick Peeperkorn, WHO’s representative to the Occupied Palestinian Territories, speaking from Gaza. “The UN will not replace UNRWA.”

Mass dislocation and siege in north limits effectiveness of second polio campaign phase

Dr Rik Peeperkorn, WHO Representive to the Occupied Palestinian Territories

In terms of the polio campaign, where a second dose is set to be delivered in northern Gaza on Tuesday, vaccine workers won’t be able to reach the enclave’s northernmost areas, including Jabalia refugee camp, Beit Lahia and Beit Hanoun, WHO warned.

While mass Israeli evacuation orders have sent tens of thousands of Palestinians streaming south, and into safer areas close to Gaza City, tens of thousands of people still remain in those areas, where fierce fighting has been underway for weeks. 

“We currently have a humanitarian pause, necessary to conduct a campaign,” said Peeperkorn. “However, the area which this pause is covering has substantially been reduced compared to the first round of vaccination [in September]. 

“It’s mainly limited to the broader Gaza area, and while unfortunately, 100,000 people have been forced to evacuate from the northern Gaza, fleeing North Gaza to Gaza City, we still estimate…that approximately 15,000 children under 10 years in the towns of north Gaza, Jabalia, Beit Lahia and Beit Hanoun, still remain inaccessible and will be missed during the campaign. 

“So this is not an ideal campaign,” Peeperkorn said. “I want to stress that it’s a compromise campaign. And to interrupt poliovirus transmission, you want to get at least 90% of the children in every community, which will be challenging.”

Dysfunctional hospitals 

WHO teams arrive at Kamal Adwan hospital in embattled Beit Lahia, Gaza, on 28 October to evacuate critically ill patients and bring fresh medical supplies.

Along with the limitations of the polio campaign, WHO has been barred by Israel from operating  numerous relief and supply missions to northern Gaza’s hospitals, and particularly Kamal Adwan hospital, in Beit Lahia, which has been at the epicenter of fierce fighting over the past week. 

In the ensuing battles, the hospital’s pharmacy and an oxygen center were both destroyed, while two children in the intensive care unit died, according to Palestinian sources. Some 44 hospital staff were also detained in a two-day siege by Israel, which said it was trying to root out a Hamas command center on the hospital grounds.

The net result, however, is that the three main hospitals in northern Gaza, Kamal Adwan, Al Awda and the Indonesian hospital are barely functioning now, WHO officials said. 

On the brighter side, Shifa Hospital in Gaza City, which had been the site of a major Israeli siege and gun battles in mid-November, and again in the spring, has however, resumed partial operations, performing about ten surgeries a day, along with the reopening of its intensive care and dialysis services, as well as emergency trauma case, Peeperkorn said.

Over the past few weeks, WHO managed to operate six missions to the besieged hospitals of northern Gaza in October, including the evacuation of 60 critically ill patients from Kamal Adwan to other hospitals further south, added Peeperkorn. 

“But I want to stress that many of the missions in October were denied, delayed or, indeed on one of the missions, we were not allowed to bring in a fuel supply,” he added. Many of the WHO supplies that had been brought to Kamal Adwan also were destroyed or damaged during the destruction of the pharmacy. 

“Just to summarize, there were three partly functional hospitals in north Gaza: Kamal Adwan, Al Awda and the Indonesian Hospital.  The Indonesian is currently not functional anymore. It’s damaged. Kamal Adwan and Al Awda are minimally functional. WHO plans another support mission to Al Awda and to Kamal Adwan, this coming Sunday, bringing supplies and also, probably again, transferring critical patients to Shifa. I want to stress again, it is critically important that these hospitals remain functional.”

MPOX – new mechanism began allocating almost 900,000 vaccines this week

Vaccines as part of a multi-pronged strategy. Here, the International Organization for Migration conducts mpox screenings along the DRC-Uganda border.

In other news, Tedros said that a new mpox Access and Allocation Mechanism (AAM) this week began allocating almost 900,000 doses of donated mpox vaccines to nine African countries, based on their public health need – “and especially those with significant transmission of Clade 1B virus.

“Countries are being informed of allocations today, and WHO and our partners will announce the details soon. This is the first allocation of almost 6 million vaccine doses that we expect to be available by the end of 2024,” he declared. 

The AAM mechanism was created by WHO last month, together with Africa CDC, the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) Gavi, the Vaccine Alliance, and UNICEF, with donations secured so far from the European Union, Canada, the United States and others.

More than 50,000 people in the Democratic Republic of Congo (DRC) and Rwanda had now been vaccinated against the mpox virus – since a campaign in those countries began in earnest at the beginning of October, he added.

While vaccination is an important step towards bringing the mpox outbreak under control, he stressed that, “it’s important to underscore that vaccination is only one part of that plan, alongside case finding, contact tracing, infection prevention and control, clinical care, risk communication and testing.

“Although testing rates have risen significantly this year, only 40 to 50% of suspected cases were tested in DRC in the two past weeks.”

Image Credits: WHO, @WHOoPt, @daniels_ugochi.

Abandoned cars and campers debris litter the entrance to theNova Music Festival in Israel, following the surprise attack by Hamas on festival goers in the early morning hours of 7 October 2023.

Israeli researchers were surprised to find that alcohol use, as compared to psychedelics, contributed more significantly to psychological challenges amongst survivors of the October 7, 2023, Nova music festival attack, following a study, conducted by researchers from Sheba Medical Centre and Ben-Gurion University of the Negev. The study was published in October in World Psychiatry.

On October 7, about 4,000 people were attending the Nova music festival in southern Israel when Hamas militants entered early in the morning and began attacking their encampment. The massacre claimed the lives of nearly 400 people at the festival, as well as another 800 people living in surrounding rural communities and military outposts. Some 250 people, including about 40 festival goers, were also abducted by Hamas and taken to Gaza.

Many attendees had consumed various recreational drugs and alcohol, including LSD, MDMA, MMC, cannabis, and combinations of these. They had to react quickly, fleeing and hiding to save their lives.

The research team wanted to examine how the use of these drugs and alcohol impacted the way attendees responded to the attack, explained Prof Mark Weiser, chairperson of the Division of Psychiatry at Sheba and a professor at Tel Aviv University. The team hypothesised that survivors who were on drugs at the time would have been more hyper-aware of the event and their surroundings, thereby experiencing more post/trauma from the attack overall. However, they were wrong.

‘It was the alcohol’

“It was the alcohol,” he told Health Policy Watch. “These people were the ones who had more severe post-traumatic symptoms.”

After the attack, a total of 232 people sought treatment at Sheba Medical Center, located near Tel Aviv, which was treating post-trauma victims. Of these, 123 survivors qualified for the study, after excluding those with severe physical injuries or histories of mental disorders, including prior PTSD, as well as two participants who had used hallucinogenic mushrooms and ketamine before the event. The latter two were excluded due to the small sample size for these substances.

The average age of participants was 28. Most (61%) were male, 69% were single, and 68% had at least a high school diploma or equivalent. Amongst participants, 71 reported using psychoactive drugs, 12 only alcohol, nine only LSD, seven only MDMA, six only cannabis, three only MMC, 15 a combination including alcohol, and 19 a combination excluding alcohol.

The researchers administered a series of questionnaires to assess how these substances impacted participants’ cognitive and stress responses during the attack. They found that all participants experienced high levels of anxiety and hyperarousal-related symptoms, regardless of drug use. Amongst those who had taken drugs, such responses were significantly elevated during the crisis, which lasted for hours.

Alcohol consumption and brain function

A installation in Tel Aviv’s Hostage Square to the victims of the Nova Music Festival attack; some 400 people died and 40 were taken hostage by Hamas on 7 October 2023.

Even so, those who consumed alcohol—either alone or with drugs—had a much greater likelihood of experiencing post-traumatic symptoms such as depression, anxiety, arousal and hyperactivity, as well as emotional numbness.

“Alcohol consumption exerts various effects on brain function and behaviour, ranging from anxiolytic and mild disinhibitory effects to sedation, motor incoordination, altered memory, and emotional processing,” the researchers wrote. “Therefore, pre-trauma alcohol consumption may have interfered with the cognitive, emotional, and psychological processes necessary to cope with the traumatic event.”

They researchers did not differentiate between the different types of drugs used as there was not a large enough sample size.

Weiser noted that this study only looked at participants up to two months after the event. To determine any potential long-term effects, or whether drugs and alcohol might impact cognitive responses differently over time, further research would be needed. Weiser said he hoped that he and his research team might follow up with these 123 participants to assess their status over a year after the attack.

He also emphasised the small sample size, which primarily includes “people who were treatment seekers,” meaning those who recognised their need for help.

“There were a lot of people at Nova who were frightened, saw horrible things, but they went home, and life went on,” Weiser said. “It is important to realise we are talking about treatment seekers and not a random sampling from the party.”

Weiser added that, statistically, 15% to 20% of people who experience trauma will develop longer-term post traumatic stress disorder (PTSD). He noted that PTSD has a very broad diagnostic range, including those who have recurring bad dreams or troubling memories as well as those whose trauma disrupts their daily lives and ability to function.

Suicide after trauma

Beyond this study, however, a comprehensive tracking of the health and mental health outcomes of the festival goers, has not been undertaken.

Just last week, one Nova festival survivor, 22-year-old Shirel Golan, took her own life after a year-long struggle with PTSD, according to her parents. Her death has sparked concerns about whether the country is providing enough support for survivors of the October 7 events.

Hundreds of survivors continue to face serious mental health challenges, including PTSD, survivor’s guilt, depression, and anxiety.

In April, festival survivor Guy Ben Shimon told a State Audit Commission that “there have been almost 50 suicides amongst the Nova survivors.” However, the Health Ministry quickly countered, stating it has no data confirming this claim, and Weiser agrees.

In response to October 7, the Israeli government established a public mental health support program offering free therapy. Survivors with PTSD qualify for up to 36 sessions, while others can receive up to 12. As of July, nearly 1,900 survivors had been referred for treatment. The government has committed about $5 million to this and related programs.

“Every suicide is a tragedy, but it is very premature and inappropriate to say [Golan] suicided because of her experience at Nova,” Weiser said.

“This does not mean it is not true, but suicide is a multifactorial event, and we don’t fully understand why one person may end their life while another does not.”

Both in Israel and the United States, studies have shown elevated suicide rates amongst those with PTSD, and especially those who served in the military.

As of 2021, 30,177 US active-duty soldiers and veterans who had served in Afghanistan, Iraq and other conflict zones over the past two decades, had died by suicide, as compared to 7,057 combat-related deaths over the same period, according to the United Service Organisations. In Israel, suicide also was the leading cause of death amongst soldiers in 2021, two years before the Gaza war broke out, with 11 soldiers taking their lives that year.

Image Credits: Kobi Gideon / GPO/Wikipedia, Chuttersnap/ Unsplash, Wikimedia.

Dr Yvan Butera, Minister of State in Rwanda’s health ministry, is vaccinated with Sabin’s experimental vaccine.

The spread of mpox in Uganda is “of great concern”, with some 830 recorded cases in 19 states, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Uganda’s first recorded case was in Nakasongola Prison in Central Uganda, but new cases have been reported close to the border with the Democratic Republic of Congo (DRC) while “new clusters” in fishing communities are a cause for concern, Dr Ngashi Ngongo, Africa CDC’s mpox lead, told a media briefing on Thursday.

In the past week, 61 new cases were confirmed and one death, he added.

Unlike the DRC where children make up half the mpox cases, only 12,5% of Uganda’s mpox cases are children. The majority, 63%, are adult men and clade 1b, which can be sexually transmitted, is the dominant strain. 

Meanwhile, Mauritius has recorded its first mpox case – and the UK recorded its first case of Clade 1b case in someone who recently travelled to a country with mpox, said Ngongo.

The continent’s weekly case tally increased by 2,766 cases – a similar increase to previous weeks. The vast majority of cases are in the DRC and Burundi.

Almost 900,000 mpox vaccines have been distributed to nine countries, with vaccination campaigns going well in the DRC and Rwanda. However, Nigeria postponed its planned vaccination campaign this week.

Four more Marburg cases

Meanwhile, Rwanda recorded four new Marburg cases in the past two weeks – a health worker (reported on last week) and three contacts of other cases, according to Dr Yvan Butera, Minister of State in the health ministry. Two people have also died in the past week.

Rwanda has confirmed 66 Marburg cases and 15 deaths reported, a case-fatality rate of around 23%. Close to 6,000 people have now been tested while close to 1,600 frontline workers have been vaccinated, said Butera.

The source of the outbreak has been traced to fruit bats in a mine near Kigali, which infected the index case who had visited the mine.

The Sabine Vaccine Institute has sent a further 1,000 of its investigational vaccines to Rwanda, the company reported on Thursday. These will be used for a randomized clinical trial arm within the ongoing open-label study.

Previously, Rwanda had rejected the World Health Organization (WHO) protocol, which would have involved a control group that got vaccinated three weeks after the trial group, according to the journal, Science.

Instead, Rwanda opted to vaccinate all trial participants  “as part of a Phase 2 rapid response open-label trial, sponsored by the Rwanda Biomedical Centre”, according to Sabin

“Under the updated protocol, sponsored by the Rwanda Biomedical Center, approximately 1,000 at-risk individuals, including mine workers, will receive Sabin’s single-dose investigational vaccine in a one-to-one randomization. Half will receive the vaccine immediately, and the other half 21 days later to align with the end of the disease incubation period,” according to Sabin.

Designed to prevent illness before exposure to the virus, Sabin’s Marburg vaccine has not yet been proven to have clinical benefit for recipients of the vaccine.

Image Credits: Sabin Vaccine Institute.